Bias, trending ability and diagnostic performance of a non-calibrated multi-beat analysis continuous cardiac output monitor to identify fluid responsiveness in critically ill patients.

OBJECTIVE

To evaluate the accuracy of non-calibrated multi-beat analysis continuous cardiac output (CCO), against calibrated pulse-contour analysis continuous cardiac output (CCO) during a passive leg raise (PLR) and/or a fluid challenge (FC).

DESIGN

Observational, single-centre, prospective study.

SETTING

Tertiary academic medical intensive care unit, Lyon, France.

PARTICIPANTS

Adult patients receiving norepinephrine, monitored by CCO, and in which a PLR and/or a FC was indicated.

MAIN OUTCOME MEASURES

CCO and CCO were recorded prior to and during the PLR/FC to evaluate bias and evaluate changes in CCO and CCO (∆%CCO and ∆%CCO). Fluid responsiveness was identified by an increase >15% in calibrated cardiac output after FC, to identify the optimal ∆%CCO threshold during PLR to predict fluid responsiveness.

RESULTS

29 patients (median age 68 [IQR: 57-74]) performed 28 PLR and 16 FC. The bias between methods increased with higher CCO values, with a percentage error of 64% (confidence interval: 52%-77%). ∆%CCO adequately tracked changes in ∆%CCO with an angular bias of 2 ± 29°. ∆%CCO during PLR had an AUROC of 0.92 ( < 0.05), with an optimal threshold >14% to predict fluid responsiveness (sensitivity: 0.99, specificity: 0.87).

CONCLUSIONS

CCO showed a non-constant bias and a percentage error >30% against calibrated CCO, but an adequate ability to track changes in CCO and to predict fluid responsiveness.