Evaluation of an uncalibrated arterial pulse contour cardiac output monitoring system in cirrhotic patients undergoing liver surgery

Br J Anaesth. 2009 Jan;102(1):47-54. doi: 10.1093/bja/aen343.


Background: The pulmonary artery catheter is invasive and may cause serious complications. A safe method of cardiac output (CO) measurement is needed. We have assessed the accuracy and reliability of a recently marketed self-calibrating arterial pulse contour CO monitoring system (FloTrac/Vigileo) in end-stage liver failure patients undergoing liver transplant. The pattern of alterations known as cirrhotic cardiomyopathy, and the transplant procedure itself, provided an evaluation under varying clinical conditions.

Methods: The cardiac index was measured simultaneously by thermodilution (CI(TD): mean of four readings) using a pulmonary artery catheter and pulse contour analysis (CI(V): mean value computed by the FloTrac/Vigileo over the same time period). Readings were made at 10 time-points during liver transplant surgery (T1-T5) and on the intensive care unit (T6-T10). CI(V) was computed using the latest Vigileo software version 01.10.

Results: A total of 290 paired readings from 29 patients were collected. Mean (SD) CI(TD) was 5.2 (1.3) and CI(V) was 3.9 (0.9) litre min(-1) m(-2), with a corrected for repeated measures bias between readings of 1.3 (0.2) litre min(-1) m(-2) and 95% limits of agreement of -1.5 (0.2) to 4.1 (0.3) litre min(-1) m(-2). The percentage error (2SD(Bias)/meanCI(TD)) was 54%, which exceeded a 30% limit of acceptance. Low peripheral resistance and increasing bias were related (r=0.69; P<0.001). The Vigileo system failed to reliably trend CI data, with a concordance compared with thermodilution below an acceptable level (at best 68% of sequential readings).

Conclusions: In cirrhotic patients with hyperdynamic circulation, the Vigileo system showed a degree of error and unreliability higher than that considered acceptable for clinical purposes.

Publication types

  • Evaluation Study

MeSH terms

  • Adult
  • Blood Pressure
  • Cardiac Catheterization
  • Cardiac Output*
  • Critical Care / methods
  • Female
  • Humans
  • Liver Cirrhosis / physiopathology
  • Liver Cirrhosis / surgery*
  • Liver Failure, Acute / physiopathology
  • Liver Failure, Acute / surgery
  • Liver Transplantation*
  • Male
  • Middle Aged
  • Monitoring, Intraoperative / instrumentation
  • Monitoring, Intraoperative / methods*
  • Monitoring, Physiologic / methods
  • Postoperative Care / methods
  • Pulmonary Artery / physiopathology
  • Pulse
  • Reproducibility of Results
  • Thermodilution / methods
  • Vascular Resistance
  • Young Adult