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Monitoring haemodynamic response to fluid-challenge in ICU

comparison of pressure recording analytical method and oesophageal Doppler

A prospective observational study

Barthélémy, Romain; Neuschwander, Arthur; Dramé, Fatou; Redouté, Maximilien; Ditchi, David; Stern, Jules; Mebazaa, Alexandre; Pirracchio, Romain; Chousterman, Benjamin G.

European Journal of Anaesthesiology (EJA): February 2019 - Volume 36 - Issue 2 - p 135–143
doi: 10.1097/EJA.0000000000000924
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BACKGROUND The ability of the pressure recording analytical method (PRAM) in tracking change in cardiac output (ΔCO) after a fluid challenge in ICU needs to be evaluated with the most contemporary comparison methods recommended by experts.

OBJECTIVE Our objective was to report the trending ability of PRAM in tracking ΔCO after a fluid challenge in ICU and to compare this with oesophageal Doppler monitoring (ODM).

DESIGN Prospective, observational study.

SETTING Hôpital Lariboisière and Hôpital Européen George Pompidou, Paris, France, from April 2016 to December 2017.

PATIENTS Critically ill patients admitted to ICU with monitoring of CO monitored by ODM and invasive arterial pressure.

INTERVENTION ΔCO after fluid challenge was simultaneously registered with ODM and PRAM connected to the arterial line.

MAIN OUTCOME MEASURE Polar statistics (mean angular bias, radial limits of agreement and polar concordance rate) and clinical concordance evaluation (error grid and clinical concordance rate). Predictors of bias were determined.

RESULTS Sixty-eight fluid challenge were administered in 49 patients. At the time of fluid challenge, almost all were mechanically ventilated (99%), with 85% receiving norepinephrine. Admission diagnosis was septic shock in 70% of patients. Patients had a Sequential Organ Failure Assessment score of 10 [7 to 12] and a median Simplified Acute Physiology Score II of 61 [49 to 69]. Relative ΔCO bias was 7.8° (6.3°) with radial limits of agreement of ±41.7°, polar concordance rate 80% and clinical concordance rate 74%. ΔCO bias was associated with baseline bias (P = 0.007). Baseline bias was associated with radial location of the arterial line (P = 0.03).

CONCLUSION When compared with ODM, PRAM has insufficient performance to track ΔCO induced by fluid challenge in ICU patients. Baseline bias is an independent predictor of trending bias.

TRIAL REGISTRATION IRB 00010254-2016-033.

From the Department of Anaesthesia, Burn, and Critical Care, Saint-Louis Lariboisière University Hospital (RB, FD, MR, JS, AM, BGC), Department of Anaesthesia and Critical Care, European Hospital Georges-Pompidou, APHP (AN, DD, RP), Paris Diderot University, Sorbonne Paris Cité (AM, BGC), Inserm U942 (AM), Paris Descartes University, Sorbonne Paris Cité (RP), Inserm U1153 (RP) and Inserm U1160, Paris, France (BGC)

Correspondence to Romain Barthélémy, MD, Department of Anaesthesia, Burn, and Critical Care, Saint-Louis Lariboisière University Hospital, AP-HP, 2 Rue Ambroise Paré, 75475 Paris Cedex 10, France E-mail: romain.barthelemy@aphp.fr

Published online 11 December 2018

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© 2019 European Society of Anaesthesiology