Nexfin® non-invasive continuous hemodynamic monitoring: validation against continuous pulse contour and intermittent transpulmonary thermodilution derived cardiac output in critically ill patients
Page hits: 1440, File downloaded: 185
Download fileDownload this file
Open in browserOpen this file in your browser
AuthorsKoen Ameloot, Katrijn Van De Vijver, Ole Broch, Niels Van Regenmortel, Inneke De Laet, Karen Schoonheydt, Hilde Dits, Berthold Bein, Manu L. N. G. Malbrain
- Tags: cardiac output, hemodynamic monitoring, minimal invasive, Nexfin, PiCCO, pulse contour analysis, thermodilution
Nexfin® (Bmeye, Amsterdam, The Netherlands) is a completely non-invasive blood pressure and cardiac output (CO) monitor based on finger arterial pulse contour analysis. The aim of this study was to validate this technique in a mixed population of critically ill patients.
Patients and methods
We performed a prospective open observational study in a mix of medicaL/surgical and burns critically ill patients (n=45) to validate Nexfin® against transpulmonary thermodilution and pulse contour CO (PiCCO, Pulsion Medical Systems, Munich, Germany). Nexfin® cardiac output (NexCO) and PiCCO pulse contour CO (CCO) were measured continuously and recorded at 2 hour intervals during the 8-hours study period. PiCCO thermodilution CO (TDCO) was measured at 0-4-8 hours. Statistical analysis was performed by Pearson regression, Bland and Altman, Concordance plot and Polar plot analysis.
N exCO showed a moderate to good (significant) correlation with TDCO (R2=0.68,p<0.001) and CCO (R2=0.71,p<0.001). Bland and Altman analysis comparing NexCO with TDCO revealed a bias (±limits of agreement, LA) of 0.4±2.32 L/min (with 36% error) while analysis comparing NexCO with CCO showed a bias (±LA) of 0.2±2.32 L/min (37% error). Subgroup analysis showed that NexCO keeps reasonable performance even in unstable septic patients with a high CO, low SVRI or on high dose of norepinephrine. NexCO is able to follow relative changes in TDCO and CCO during the same time interval (level of concordance 89.3% and 81 o/o respectively). The absolute amplitude correlation of these changes was clinically insufficient but statistically significant (R2=0.63,p