Comparative Evaluation of Minimally Invasive vs. Non-Invasive Hemodynamic Monitoring vs. Pulmonary Artery Pressures

24.00
Hdl Handle:
http://hdl.handle.net/10755/157030
Category:
Abstract
Type:
Presentation
Title:
Comparative Evaluation of Minimally Invasive vs. Non-Invasive Hemodynamic Monitoring vs. Pulmonary Artery Pressures
Author(s):
Pickett, Joya D.
Author Details:
Joya D. Pickett, RN,MSN,CCNS,ACNS-BC,CCRN, Swedish Medical Center, Seattle, Washington, USA, email: joya.pickett@swedish.org
Abstract:
POSTER PURPOSE: To evaluate the clinical usefulness of 2 hemodynamic monitoring devices: the minimally invasive FloTrac/Vigileo (Edwards Lifesciences, Irvine, California) device based on analysis of radial artery waveforms, and the noninvasive NICOM (Cheetah Medical Inc, Indianapolis, Indiana) based on chest bioreactance. Continuous thermodilution cardiac output (COtd) measured via a pulmonary artery catheter (PAC) was used as the reference. BACKGROUND/SIGNIFICANCE:The PAC is the clinical reference for measuring cardiac output. However, it is invasive, insertion carries inherent risk, and clinical outcomes have not been clearly demonstrated. Additionally, markers available in these less invasive devices (eg, stroke volume variation [SVV], and pulse pressure variation [PVV]) are reliable predictors of fluid responsiveness. Furthermore, noninvasive monitoring has the added benefit in that it may be used in clinical areas outside the intensive care unit. METHOD: A prospective 1-sample paired experimental design was used to study immediate postoperative open heart surgery patients with PACs as compared with the FloTrac (n = 2) or NICOM (n = 1) devices. Cardiac output (CO) and cardiac index (CI, calculated as cardiac output in liters per minute divided by body surface area in square meters) data sets (n = 57) were collected. All devices were calibrated at regular intervals and with changes in patient status before initiation of the readings. The various phases of the study were discussed at our staff nurse clinical practice committee meeting. RESULTS: A paired t test showed a significant difference between the minimally invasive device and the PAC and between the noninvasive device and the PAC (P < .01). Mean CO was 4.04 L/min for the PA catheter vs 4.53 L/min for the FloTrac; mean CI was 2.11 for the PAC vs 2.44 for the FloTrac for patients in sinus rhythm and sinus tachycardia (n = 11). Mean CO was 5.22 L/min for the PAC vs 5.11 L/min for the FloTrac; mean CI was 6.44 for the PAC vs 3.31 for the FloTrac for patients with atrial flutter (n = 18). Mean CO was 4.77 L/min for the PAC vs 5.13 L/min for the NICOM; mean CI was 2.10 for the PAC vs 2.25 for the NICOM for patients in sinus rhythm and sinus tachycardia (n = 28). CONCLUSIONS: The measurements obtained from the PAC differed significantly from measurements obtained with either the FloTrac or the NICOM. However, as all measurements were within the normal reference ranges, clinical significance remains to be determined. Limitations include the small sample size. Further research is needed with a larger sample size, device randomization, and expanded populations to measure if a significant difference exists between the devices as compared with the PAC.
Repository Posting Date:
26-Oct-2011
Date of Publication:
26-Oct-2011
Citation:
2010 National Teaching Institute Research Abstracts. American Journal of Critical Care, 19(3), e15-e28. doi:10.4037/ajcc2010866
Conference Date:
2010
Conference Name:
National Teaching Institute and Critical Care Exposition
Conference Host:
American Association of Critical-Care Nurses
Conference Location:
Washington, D.C., USA
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.type.categoryAbstracten_GB
dc.typePresentationen_GB
dc.titleComparative Evaluation of Minimally Invasive vs. Non-Invasive Hemodynamic Monitoring vs. Pulmonary Artery Pressuresen_GB
dc.contributor.authorPickett, Joya D.en_GB
dc.author.detailsJoya D. Pickett, RN,MSN,CCNS,ACNS-BC,CCRN, Swedish Medical Center, Seattle, Washington, USA, email: joya.pickett@swedish.orgen_GB
dc.identifier.urihttp://hdl.handle.net/10755/157030-
dc.description.abstractPOSTER PURPOSE: To evaluate the clinical usefulness of 2 hemodynamic monitoring devices: the minimally invasive FloTrac/Vigileo (Edwards Lifesciences, Irvine, California) device based on analysis of radial artery waveforms, and the noninvasive NICOM (Cheetah Medical Inc, Indianapolis, Indiana) based on chest bioreactance. Continuous thermodilution cardiac output (COtd) measured via a pulmonary artery catheter (PAC) was used as the reference. BACKGROUND/SIGNIFICANCE:The PAC is the clinical reference for measuring cardiac output. However, it is invasive, insertion carries inherent risk, and clinical outcomes have not been clearly demonstrated. Additionally, markers available in these less invasive devices (eg, stroke volume variation [SVV], and pulse pressure variation [PVV]) are reliable predictors of fluid responsiveness. Furthermore, noninvasive monitoring has the added benefit in that it may be used in clinical areas outside the intensive care unit. METHOD: A prospective 1-sample paired experimental design was used to study immediate postoperative open heart surgery patients with PACs as compared with the FloTrac (n = 2) or NICOM (n = 1) devices. Cardiac output (CO) and cardiac index (CI, calculated as cardiac output in liters per minute divided by body surface area in square meters) data sets (n = 57) were collected. All devices were calibrated at regular intervals and with changes in patient status before initiation of the readings. The various phases of the study were discussed at our staff nurse clinical practice committee meeting. RESULTS: A paired t test showed a significant difference between the minimally invasive device and the PAC and between the noninvasive device and the PAC (P < .01). Mean CO was 4.04 L/min for the PA catheter vs 4.53 L/min for the FloTrac; mean CI was 2.11 for the PAC vs 2.44 for the FloTrac for patients in sinus rhythm and sinus tachycardia (n = 11). Mean CO was 5.22 L/min for the PAC vs 5.11 L/min for the FloTrac; mean CI was 6.44 for the PAC vs 3.31 for the FloTrac for patients with atrial flutter (n = 18). Mean CO was 4.77 L/min for the PAC vs 5.13 L/min for the NICOM; mean CI was 2.10 for the PAC vs 2.25 for the NICOM for patients in sinus rhythm and sinus tachycardia (n = 28). CONCLUSIONS: The measurements obtained from the PAC differed significantly from measurements obtained with either the FloTrac or the NICOM. However, as all measurements were within the normal reference ranges, clinical significance remains to be determined. Limitations include the small sample size. Further research is needed with a larger sample size, device randomization, and expanded populations to measure if a significant difference exists between the devices as compared with the PAC.en_GB
dc.date.available2011-10-26T19:21:34Z-
dc.date.issued2011-10-26en_GB
dc.date.accessioned2011-10-26T19:21:34Z-
dc.identifier.citation2010 National Teaching Institute Research Abstracts. American Journal of Critical Care, 19(3), e15-e28. doi:10.4037/ajcc2010866en_GB
dc.conference.date2010en_GB
dc.conference.nameNational Teaching Institute and Critical Care Expositionen_GB
dc.conference.hostAmerican Association of Critical-Care Nursesen_GB
dc.conference.locationWashington, D.C., USAen_GB
dc.identifier.citation2010 National Teaching Institute Research Abstracts. American Journal of Critical Care, 19(3), e15-e28. doi:10.4037/ajcc2010866en_GB
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.-
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