TY - JOUR
T1 - Performance of Electrical Velocimetry for Noninvasive Cardiac Output Measurements in Perioperative Patients after Subarachnoid Hemorrhage
AU - Mutoh, Tatsushi
AU - Sasaki, Kazumasu
AU - Yamamoto, Shuzo
AU - Yasui, Nobuyuki
AU - Ishikawa, Tatsuya
AU - Taki, Yasuyuki
N1 - Funding Information:
Received for publication January 5, 2018; accepted May 16, 2018. From the *Institute of Development, Aging and Cancer, Tohoku University; ‡Department of Neurosurgery, Sendai East Neurosurgical Hospital, Sendai; and †Research Institute for Brain and Blood Vessels-AKITA, Akita, Japan. T.M. and K.S. contributed equally. Presented in part at the Anesthesiology 2015 American Society of Anesthesiologist’s Annual Meeting, October 25, 2015, San Diego, CA. Supported by the Grant-in-Aid for Scientific Research from the Japan Society for the Promotion of Science and Cooperative Research Project Program of Joint Usage/Research Center at the IDAC, Tohoku University. The authors have no conflicts of interest to disclose. Address correspondence to: Tatsushi Mutoh, MD, PhD, Department of Nuclear Medicine and Radiology, Institute of Development, Aging and Cancer, Tohoku University, Aoba-ku, Sendai 980-8575, Japan (e-mail: tmutoh@tiara.ocn.ne.jp). Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website, www.jnsa. com. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved. DOI: 10.1097/ANA.0000000000000519
Publisher Copyright:
© 2019 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2019/10/1
Y1 - 2019/10/1
N2 - Background:Fluid therapy guided by cardiac output measurements is of particular importance for adequate cerebral perfusion and oxygenation in neurosurgical patients. We examined the usefulness of a noninvasive electrical velocimetry (EV) device based on the thoracic bioimpedance method for perioperative hemodynamic monitoring in patients after aneurysmal subarachnoid hemorrhage.Patients and Methods:In total, 18 patients who underwent surgical clipping or endovascular coiling for ruptured aneurysms were examined prospectively. Simultaneous cardiac index (CI) measurements obtained with EV (CIEV) and reference transpulmonary thermodilution (CITPTD) were compared. A total of 223 pairs of data were collected.Results:A significant correlation was found between CIEV and CITPTD (r=0.86; P<0.001). Bland and Altman analysis revealed a bias between CIEV and CITPTD of-0.06 L/min/m2, with limits of agreement of ±1.14 L/min/m2 and a percentage error of 33%. Although the percentage error for overall data was higher than the acceptable limit of 30%, subgroup analysis during the postoperative phase showed better agreement (23% vs. 42% during the intraprocedure phase). Four-quadrant plot and polar plot analyses showed fair-To-poor trending abilities (concordance rate of 90% to 91%, angular bias of +17 degrees, radial limits of agreement between ±37 and ±40 degrees, and polar concordance rate of 72% to 75%), including the subgroup analysis.Conclusions:Absolute CI values obtained from EV and TPTD are not interchangeable with TPTD for perioperative use in subarachnoid hemorrhage patients. However, considering the moderate levels of agreement with marginal trending ability during the early postoperative phase, this user-friendly device can provide an attractive monitoring option during neurocritical care.
AB - Background:Fluid therapy guided by cardiac output measurements is of particular importance for adequate cerebral perfusion and oxygenation in neurosurgical patients. We examined the usefulness of a noninvasive electrical velocimetry (EV) device based on the thoracic bioimpedance method for perioperative hemodynamic monitoring in patients after aneurysmal subarachnoid hemorrhage.Patients and Methods:In total, 18 patients who underwent surgical clipping or endovascular coiling for ruptured aneurysms were examined prospectively. Simultaneous cardiac index (CI) measurements obtained with EV (CIEV) and reference transpulmonary thermodilution (CITPTD) were compared. A total of 223 pairs of data were collected.Results:A significant correlation was found between CIEV and CITPTD (r=0.86; P<0.001). Bland and Altman analysis revealed a bias between CIEV and CITPTD of-0.06 L/min/m2, with limits of agreement of ±1.14 L/min/m2 and a percentage error of 33%. Although the percentage error for overall data was higher than the acceptable limit of 30%, subgroup analysis during the postoperative phase showed better agreement (23% vs. 42% during the intraprocedure phase). Four-quadrant plot and polar plot analyses showed fair-To-poor trending abilities (concordance rate of 90% to 91%, angular bias of +17 degrees, radial limits of agreement between ±37 and ±40 degrees, and polar concordance rate of 72% to 75%), including the subgroup analysis.Conclusions:Absolute CI values obtained from EV and TPTD are not interchangeable with TPTD for perioperative use in subarachnoid hemorrhage patients. However, considering the moderate levels of agreement with marginal trending ability during the early postoperative phase, this user-friendly device can provide an attractive monitoring option during neurocritical care.
KW - cardiac output
KW - electrical velocimetry
KW - hemodynamic monitoring
KW - subarachnoid hemorrhage
KW - transpulmonary thermodilution
KW - validation study
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U2 - 10.1097/ANA.0000000000000519
DO - 10.1097/ANA.0000000000000519
M3 - Article
C2 - 29939977
AN - SCOPUS:85049183813
SN - 0898-4921
VL - 31
SP - 422
EP - 427
JO - Journal of Neurosurgical Anesthesiology
JF - Journal of Neurosurgical Anesthesiology
IS - 4
ER -