Radial Artery Applanation Tonometry for Continuous Noninvasive Cardiac Output Measurement: A Comparison With Intermittent Pulmonary Artery Thermodilution in Patients After Cardiothoracic Surgery

TY - JOUR

T1 - Radial Artery Applanation Tonometry for Continuous Noninvasive Cardiac Output Measurement: A Comparison With Intermittent Pulmonary Artery Thermodilution in Patients After Cardiothoracic Surgery

AU - Wagner, Julia Y

AU - Sarwari, Harun

AU - Schön, Gerhard

AU - Kubik, Mathias

AU - Kluge, Stefan

AU - Reichenspurner, Hermann

AU - Reuter, Daniel A

AU - Saugel, Bernd

PY - 2015/7

Y1 - 2015/7

N2 - OBJECTIVES: Radial artery applanation tonometry allows completely noninvasive continuous cardiac output estimation. The aim of the present study was to compare cardiac output measurements obtained with applanation tonometry (AT-CO) using the T-Line system (Tensys Medical, San Diego, CA) with cardiac output measured by intermittent pulmonary artery thermodilution using a pulmonary artery catheter (PAC-CO) with regard to accuracy, precision of agreement, and trending ability.DESIGN: A prospective method comparison study.SETTING: The study was conducted in a cardiosurgical ICU of a German university hospital.PATIENTS: We performed cardiac output measurements in 50 patients after cardiothoracic surgery.INTERVENTIONS: None.MEASUREMENTS AND MAIN RESULTS: Three independent sets of three consecutive thermodilution measurements (i.e., PAC-CO) each were performed per patient, and AT-CO was measured simultaneously. The average of the three thermodilution cardiac output measurements was compared with the average of the corresponding three AT-CO values resulting in 150 paired cardiac output measurements. In 13 patients, cardiac output-modifying maneuvers performed for clinical reasons additionally allowed to evaluate trending ability. For statistical analysis, we used Bland-Altman analysis, the percentage error, four-quadrant plot, and concordance analysis. Mean PAC-CO was 4.7 ± 1.2 L/min and mean AT-CO was 4.9 ± 1.1 L/min. The mean of differences was -0.2 L/min with 95% limits of agreement of -1.8 to + 1.4 L/min. The percentage error was 34%. The concordance rate was 95%.CONCLUSIONS: Continuous cardiac output measurement using the noninvasive applanation tonometry technology is basically feasible in ICU patients after cardiothoracic surgery. The applanation tonometry technology provides cardiac output values with reasonable accuracy and precision of agreement compared with intermittent pulmonary artery thermodilution measurements in a clinical study setting and is able to reliably track cardiac output changes induced by cardiac output-modifying maneuvers.

AB - OBJECTIVES: Radial artery applanation tonometry allows completely noninvasive continuous cardiac output estimation. The aim of the present study was to compare cardiac output measurements obtained with applanation tonometry (AT-CO) using the T-Line system (Tensys Medical, San Diego, CA) with cardiac output measured by intermittent pulmonary artery thermodilution using a pulmonary artery catheter (PAC-CO) with regard to accuracy, precision of agreement, and trending ability.DESIGN: A prospective method comparison study.SETTING: The study was conducted in a cardiosurgical ICU of a German university hospital.PATIENTS: We performed cardiac output measurements in 50 patients after cardiothoracic surgery.INTERVENTIONS: None.MEASUREMENTS AND MAIN RESULTS: Three independent sets of three consecutive thermodilution measurements (i.e., PAC-CO) each were performed per patient, and AT-CO was measured simultaneously. The average of the three thermodilution cardiac output measurements was compared with the average of the corresponding three AT-CO values resulting in 150 paired cardiac output measurements. In 13 patients, cardiac output-modifying maneuvers performed for clinical reasons additionally allowed to evaluate trending ability. For statistical analysis, we used Bland-Altman analysis, the percentage error, four-quadrant plot, and concordance analysis. Mean PAC-CO was 4.7 ± 1.2 L/min and mean AT-CO was 4.9 ± 1.1 L/min. The mean of differences was -0.2 L/min with 95% limits of agreement of -1.8 to + 1.4 L/min. The percentage error was 34%. The concordance rate was 95%.CONCLUSIONS: Continuous cardiac output measurement using the noninvasive applanation tonometry technology is basically feasible in ICU patients after cardiothoracic surgery. The applanation tonometry technology provides cardiac output values with reasonable accuracy and precision of agreement compared with intermittent pulmonary artery thermodilution measurements in a clinical study setting and is able to reliably track cardiac output changes induced by cardiac output-modifying maneuvers.

U2 - 10.1097/CCM.0000000000000979

DO - 10.1097/CCM.0000000000000979

M3 - SCORING: Journal article

C2 - 25844700

VL - 43

SP - 1423

EP - 1428

JO - CRIT CARE MED

JF - CRIT CARE MED

SN - 0090-3493

IS - 7

ER -