Evaluation of the FloTrac Uncalibrated Continuous Cardiac Output System for Perioperative Hemodynamic Monitoring After Subarachnoid Hemorrhage
- 1 July 2009
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Journal of Neurosurgical Anesthesiology
- Vol. 21 (3), 218-225
- https://doi.org/10.1097/ana.0b013e3181a4cd8b
Abstract
Early hemodynamic assessment is of particular importance for adequate cerebral circulation in patients with aneurysmal subarachnoid hemorrhage (SAH), but is often precluded by the invasiveness and complexity of the established cardiac output determination techniques. We examined the utility of an uncalibrated arterial pressure-based cardiac output monitor (FloTrac) for intraoperative and postoperative hemodynamic management after SAH. In 16 SAH patients undergoing surgical clipping, arterial pulse contour cardiac index, and stroke volume variation (SVV) were analyzed via the radial FloTrac system. The hemodynamic values after induction of anesthesia until 12 hours after surgery were compared with reference transpulmonary thermodilution cardiac index (TPCI), calibrated pulse contour CI, and global end-diastolic volume index determined by the PiCCO system and central venous pressure. Arterial pulse contour cardiac index underestimated CI as overall bias+/-SD of 0.57+/-0.44 L/min/m2 and 0.54+/-0.46 L/min/m2 compared with TPCI and calibrated pulse contour CI, resulting in a percentage error of 24.8% and 26.6%, respectively. Subgroup analysis revealed a percentage error of 29.3% for values obtained intraoperatively and 20.4% for values measured under spontaneously breathing after tracheal extubation. Better prediction of cardiac responsiveness to defined volume loading for increasing stroke volume index >10% was observed for SVV under mechanical ventilation with greater area under the receiver operating characteristics curve than that for global end-diastolic volume index or central venous pressure. These data suggest that the FloTrac underestimates the reference CI, and is not as reliable as transpulmonary thermodilution for perioperative hemodynamic monitoring after SAH. SVV is considered to be an acceptable preload indicator under mechanical ventilation.Keywords
This publication has 42 references indexed in Scilit:
- Goal-Directed Fluid Management by Bedside Transpulmonary Hemodynamic Monitoring After Subarachnoid HemorrhageStroke, 2007
- Light activates the adrenal gland: Timing of gene expression and glucocorticoid releaseCell Metabolism, 2005
- Subarachnoid Hemorrhage: Neurointensive Care and Aneurysm RepairMayo Clinic Proceedings, 2005
- Management of severe subarachnoid hemorrhage; significance of assessment of both neurological and systemic insults at acute stagePublished by Springer Science and Business Media LLC ,2005
- Catecholamines mediate stress-induced increases in peripheral and central inflammatory cytokinesNeuroscience, 2005
- Triple-H therapy in the management of aneurysmal subarachnoid haemorrhageThe Lancet Neurology, 2003
- Adrenergic regulation of clock gene expression in mouse liverProceedings of the National Academy of Sciences of the United States of America, 2003
- Melatonin modulates the light-induced sympathoexcitation and vagal suppression with participation of the suprachiasmatic nucleus in miceThe Journal of Physiology, 2003
- Activation of Stress-Responsive Pathways by the Sympathetic Nervous System in Burn TraumaShock, 2002
- Complications of Swan-Ganz Catheterization for Hemodynamic Monitoring in Patients with Subarachnoid HemorrhageNeurosurgery, 1995