Nexfin® non-invasive continuous hemodynamic monitoring: validation against continuous pulse contour and intermittent transpulmonary thermodilution derived cardiac output in critically ill patients

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Koen Ameloot, Katrijn Van De Vijver, Ole Broch, Niels Van Regenmortel, Inneke De Laet, Karen Schoonheydt, Hilde Dits, Berthold Bein, Manu L. N. G. Malbrain



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

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