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. 2012 Oct 29;16(5):R212.
doi: 10.1186/cc11846.

The estimation of cardiac output by the Nexfin device is of poor reliability for tracking the effects of a fluid challenge

Xavier Monnet, Fabien Picard, Elsa Lidzborski, Malcie Mesnil, Jacques Duranteau, Christian Richard, Jean-Louis Teboul

The estimation of cardiac output by the Nexfin device is of poor reliability for tracking the effects of a fluid challenge

Xavier Monnet et al. Crit Care. .

Abstract

Introduction: The Nexfin device estimates arterial pressure by the volume clamp method through a finger pneumatic cuff. It also allows to estimate cardiac index (CInoninv) by pulse contour analysis of the non-invasive arterial pressure curve. We evaluated the ability of the device to track changes in cardiac index induced by a fluid challenge.

Methods: We included 45 patients for whom a volume expansion (500 mL of saline infused over 30 min) was planned. The volume expansion-induced changes in cardiac index measured by transpulmonary thermodilution (CIinv, PiCCO device) and in CInoninv were recorded.

Results: In seven patients, the Nexfin could not record the arterial curve due to finger hypoperfusion. Considering both the values obtained before and after volume expansion (n = 76 pairs of measurements), the bias (lower and upper limits of agreement) between CIinv and CInoninv was 0.2 (-1.8 to 2.2) L/min/m2. The mean change in CInoninv was 10 ± 11%. The percentage error of CInoninv was 57%. The correlation between the changes in CIinv and CInoninv observed during volume expansion was significant (P = 0.0002) with an r2 = 0.31.

Conclusions: The estimation of CI by the Nexfin device in critically ill patients is not reliable, neither for estimating absolute values of CI nor for tracking its changes during volume expansion.

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Figures

Figure 1
Figure 1
Bland-Altman plot for the absolute values of mean arterial pressure obtained from the Nexfin device (MAPnoninv) and from the femoral arterial catheter (MAPinv) considering all the pairs of measurements performed during the study. N = 72; straight line, bias; dashed line, +2D/-2SD limits of agreement.
Figure 2
Figure 2
Bland-Altman plot for the absolute values of cardiac index obtained from the Nexfin device (CInoninv) and from transpulmonary thermodilution (CIinv) considering all the pairs of measurements performed during the study. N = 72; straight line, bias; dashed line, +2D/-2SD limits of agreement.
Figure 3
Figure 3
Trending ability of the cardiac index obtained from the Nexfin device (ΔCInoninv) against cardiac index measured by transpulmonary thermodilution (ΔCIinv) during volume expansion based on four-quadrant concordance analysis.
See this image and copyright information in PMC

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