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• W2003454421 abstract "Editor—Recently, a new cardiac output monitoring device (Vigileo™, Edwards Lifesciences, Irvine, CA, USA) has been introduced in clinical practice which is based on arterial pulse contour lacking the necessity of external calibration.1Manecke GR Edwards FloTrac sensor and Vigileo monitor: easy, accurate, reliable cardiac output assessment using the arterial pulse wave.Expert Rev Med Devices. 2005; 2: 523-527Crossref PubMed Scopus (138) Google Scholar This device offers the possibility of a nearly beat-to-beat measurement of cardiac output, stroke volume, and stroke volume variation (SVV). In patients undergoing coronary artery bypass grafting (CABG), this system has been demonstrated to measure cardiac output with clinically acceptable accuracy.2De Waal EEC Kalkman CJ Rex S Buhre WF Validation of a new arterial pulse contour-based cardiac output device.Crit Care Med. 2007; 35: 1904-1909Crossref PubMed Scopus (93) Google Scholar However, the reliability of SVV measured with this system in predicting fluid responsiveness is unknown. We therefore studied 18 CABG patients monitored with a FloTrac/Vigileo™-system (using software version 01.01) to analyse whether this new device is suited for functional preload monitoring. Fourteen male and four female patients [67 (7Reuter DA Felbinger TW Schmidt C et al.Stroke volume variations for assessment of cardiac responsiveness to volume loading in mechanically ventilated patients after cardiac surgery.Intensive Care Med. 2002; 28: 392-398Crossref PubMed Scopus (298) Google Scholar) yr, 79 (9) kg, 174 (9) cm, mean (sd), and BSA range 1.69–2.20 m2De Waal EEC Kalkman CJ Rex S Buhre WF Validation of a new arterial pulse contour-based cardiac output device.Crit Care Med. 2007; 35: 1904-1909Crossref PubMed Scopus (93) Google Scholar] undergoing CABG surgery were included in this study. The study was approved by the institutional review board. All patients had given written informed consent. Stroke volume index (SVI) was measured with transpulmonary thermodilution (PiCCO™, Pulsion Medical Systems, Munich, Germany) before and after a volume load (VL) of 10 ml·kg−1 hydroxyethyl starch 6% 1 h after arrival of the patients on the intensive care unit. In addition, central venous pressure (CVP) and SVV were recorded. Patients were mechanically ventilated (volume control) with a tidal volume of 8 ml·kg−1 (FiO2 0.4, PEEP 5 cm H2O) maintaining normocapnia. According to the available literature, fluid-responders were defined by an increase in SVI≥12% subsequent to the VL.3Michard F Changes in arterial pressure during mechanical ventilation.Anesthesiology. 2005; 103: 419-428Crossref PubMed Scopus (507) Google Scholar Statistical analysis was performed using SPSS version 15.0 (SPSS Inc, Chicago, IL, USA). Pearson's correlation analysis was used to describe the linear relation between preload parameters before a VL and the change in SVI (ΔSVI) induced by that VL. The ability to predict fluid responsiveness was quantified for each preload parameter by calculating the area under the receiver operating characteristic (ROC) curve.4Hanley JA McNeil BJ A method of comparing the areas under receiver operating characteristic curves derived from the same cases.Radiology. 1983; 148: 839-843Crossref PubMed Scopus (5990) Google Scholar A P-value of <0.05 was considered statistically significant. Nine patients did not respond to the fluid load. The correlation coefficient for the relationship between ΔSVI and CVP prior to the volume load was 0.244 (P=0.329), and between ΔSVI and SVV 0.452 (P=0.069). ROC analysis showed that both preload indicators failed to predict fluid responsiveness. The area under the ROC curve for CVP and for SVV were 0.685 (P=0.185) and 0.660 (P=0.268) respectively. The failure of CVP in predicting fluid responsiveness is in accordance with increasing evidence that static preload indicators are not suited for functional haemodynamic monitoring.5Osman D Ridel C Ray P et al.Cardiac filling pressures are not appropriate to predict hemodynamic response to volume challenge.Crit Care Med. 2007; 35: 1-5Crossref Scopus (506) Google Scholar In contrast, a growing number of clinical studies have clearly demonstrated the ability of dynamic preload indicators (including SVV) to accurately predict the response of an individual patient to a volume challenge.6Rex S Brose S Metzelder S et al.Prediction of fluid responsiveness in patients during cardiac surgery.Br J Anaesth. 2004; 93: 782-788Abstract Full Text Full Text PDF PubMed Scopus (155) Google Scholar 7Reuter DA Felbinger TW Schmidt C et al.Stroke volume variations for assessment of cardiac responsiveness to volume loading in mechanically ventilated patients after cardiac surgery.Intensive Care Med. 2002; 28: 392-398Crossref PubMed Scopus (298) Google Scholar In contrast to these reports, we found SVV (obtained with the FloTrac/Vigileo™ system) failed to predict fluid responsiveness. This finding might be attributed to the fact that in our system, the first software generation (version 01.01) was implemented. This version operates with a re-calibration interval of 10 min, which is probably too long to accurately measure changes in respiratory variations in the arterial pressure curve. In fact, by employing shorter re-calibration intervals in a newer software version, the accuracy of the FloTrac/Vigileo™ system in measuring cardiac output had been markedly improved.8Button D Weibel L Reuthebuch O Genoni M Zollinger A Hofer CK Clinical evaluation of the FloTrac/Vigileo system and two established continuous cardiac output monitoring devices in patients undergoing cardiac surgery.Br J Anaesth. 2007; 99: 329-336Abstract Full Text Full Text PDF PubMed Scopus (147) Google Scholar Therefore, our findings warrant further investigation whether the application of shorter re-calibration intervals will allow using the FloTrac/Vigileo™ system for functional haemodynamic monitoring." @default.
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• W2003454421 title "Stroke volume variation obtained with FloTrac/Vigileo TM fails to predict fluid responsiveness in coronary artery bypass graft patients" @default.
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