• A A Smetkin, A Hussain, V V Kuzkov, L J Bjertnæs, and M Y Kirov.
• Department of Anaesthesiology and Intensive Care Medicine, Northern State Medical University, Arkhangelsk, Russian Federation Department of Anaesthesiology and Intensive Care Medicine, City Hospital #1 of Arkhangelsk, Arkhangelsk, Russian Federation Department of Clinical Medicine (Anaesthesiology), Faculty of Health Sciences, University of Tromsø, Tromsø, Norway anesth_sm@mail.ru.
• Br J Anaesth. 2014 Jun 1;112(6):1024-31.

BackgroundCardiac output monitoring, as a part of a goal-directed haemodynamic management, has been shown to improve perioperative outcome in high-risk patients undergoing major surgical interventions. However, thorough validation of cardiac output monitoring devices in different clinical conditions is warranted. The aim of our study was to compare the reliability of a novel system for cardiac index (CI) monitoring based on uncalibrated pulse contour analysis (UPCA) with transpulmonary thermodilution (TPTD) during off-pump coronary artery bypass grafting (OPCAB).MethodsTwenty patients undergoing elective OPCAB were enrolled into the study. CI measured by means of UPCA (CIUPCA) was validated against CI determined with TPTD technique (CITPTD). Parallel measurements of CI were performed at nine stages during the surgery and after operation. We assessed the accuracy and the precision of individual values and the agreement of trends of changes in CI.ResultsTotally, 180 pairs of data were collected. There was a significant correlation between CIUPCA and CITPTD (ρ=0.836, P<0.01). According to a Bland-Altman analysis, the mean bias between the methods was -0.14 litre min(-1) m(-2) with limits of agreement of ±0.82 litre min(-1) m(-2) and a percentage error of 31%. A polar plot trend analysis revealed acceptable angular bias (-0.54°), increased radial limits of agreement (±52.7°), and decreased polar concordance rate (74%).ConclusionsIn OPCAB, UPCA provides accurate and precise CI measurements compared with TPTD. However, the ability of this method to follow trends in cardiac output is poor.Clinical Trial RegistrationNCT01773720 (ClinicalTrials.gov).© The Author [2014]. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

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