Key result
Non-invasive cardiac output measurement using the T-Line system showed a mean difference of -0.8 l/minute (95% limits of agreement -4.0 to 2.3) compared to transpulmonary thermodilution.
Why the study?
Does continuous non-invasive cardiac output monitoring using radial artery applanation tonometry agree with invasive thermodilution and pulse contour analysis in ICU patients after major gastrointestinal surgery?
Observational (n=27)
Does continuous non-invasive cardiac output monitoring using radial artery applanation tonometry agree with invasive thermodilution and pulse contour analysis in ICU patients after major gastrointestinal surgery?
Mean Difference: -0.8 (95% CI -4–2.3)
Non-invasive cardiac output monitoring using the T-Line system showed high percentage errors compared to invasive methods, indicating further improvements are needed before clinical use in ICU patients.
TL-CO monitoring cannot replace invasive methods in post-surgical ICU patients; leaves open whether device refinements can achieve acceptable agreement.
The T-Line(®) system (Tensys(®) Medical Inc., San Diego, CA, USA) non-invasively estimates cardiac output (CO) using autocalibrating pulse contour analysis of the radial artery applanation tonometry-derived arterial waveform. We compared T-Line CO measurements (TL-CO) with invasively obtained CO measurements using transpulmonary thermodilution (TDCO) and calibrated pulse contour analysis (PC-CO) in patients after major gastrointestinal surgery. We compared 1) TL-CO versus TD-CO and 2) TL-CO versus PC-CO in 27 patients treated in the intensive care unit (ICU) after major gastrointestinal surgery. For the assessment of TD-CO and PC-CO we used the PiCCO(®) system (Pulsion Medical Systems SE, Feldkirchen, Germany). Per patient, we compared two sets of TD-CO and 30 minutes of PC-CO measurements with the simultaneously recorded TL-CO values using Bland-Altman analysis. The mean of differences (± standard deviation; 95% limits of agreement) between TL-CO and TD-CO was -0.8 (±1.6; -4.0 to +2.3) l/minute with a percentage error of 45%. For TL-CO versus PC-CO, we observed a mean of differences of -0.4 (±1.5; -3.4 to +2.5) l/minute with a percentage error of 43%. In ICU patients after major gastrointestinal surgery, continuous non-invasive CO measurement based on autocalibrating pulse contour analysis of the radial artery applanation tonometry-derived arterial waveform (TL-CO) is feasible in a clinical study setting. However, the agreement of TL-CO with TD-CO and PC-CO observed in our study indicates that further improvements are needed before the technology can be recommended for clinical use in these patients.
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Wagner et al. (2016) conducted an observational in ICU patients after major gastrointestinal surgery (n=27). T-Line system (TL-CO) vs. Transpulmonary thermodilution (TD-CO) and calibrated pulse contour analysis (PC-CO) was evaluated on Agreement between TL-CO and TD-CO (MD -0.8 l/minute, 95% CI -4.0 to 2.3). Non-invasive cardiac output measurement using the T-Line system showed a mean difference of -0.8 l/minute (95% limits of agreement -4.0 to 2.3) compared to transpulmonary thermodilution.
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