Accuracy Of Noninvasive Cardiac Output Monitor In Hemodynamic Monitoring Of Critically Ill Patients

Objective: To evaluate the consistency of noninvasive cardiac output monitor(NICOM)by pulse index continuous cardiac output(Pi CCO)and ultrasound in hemodynamic monitoring of critically ill patients.To evaluate the predictive value of stroke volume index variation(?SVI)on fluid responsiveness in patients with circulatory shock(except cardiogenic shock)using the NICOM built-in passive leg raising(PLR)test program.Methods: We included critically ill patients requiring hemodynamic monitoring who were admitted to the department of intensive care unit(ICU)at the Fourth Hospital of Hebei Medical University from December 2018 to January 2020.All the patients used NICOM to obtain cardiac output(CO),meanwhile using Pi CCO or ultrasound to measure CO for consistency analysis.Fluid responsiveness was definded as ?SVI>10% determined by NICOM built-in PLR test program.Results: A total of ninety-eight patients were enrolled.Fifty-eight patients were consented to participate in the consistency of CO measured by NICOM and ultrasound.The two methods have a good consistency.Forty patients were consented to participate in the consistency of CO measured by NICOM and Pi CCO.The two methods also have a good consistency.Ninety-eight patients participated in the assessment of fluid responsiveness using ?SVI measured by NICOM built-in PLR test.Among these,thirty-eight patients had no fluid responsiveness(?SVI<10%)and did not perform fluid challenges.Sixty patients who had fluid responsiveness(?SVI>10%)were given fluid challenges,and forty-three of them had consistently fluid responsiveness which definded as,CO increased more than 15% after fluid infusion.The AUC of ?SVI predicting fluid responsiveness for patients with circulatory shock(except cardiogenic shock)was 0.754(95% CI,0.626-0.856),and the cut-off value was 18%(sensitivity 88.37%,specificity 52.94%).?SVI has a predictive value to determine fluid responsiveness in patients with circulatory shock(except cardiogenic shock).Conclusions:1.NICOM has a good consistency with Pi CCO and ultrasound in hemodynamic monitoring of critically ill patients,and can be used as an effective tool for hemodynamic monitoring and evaluation of critically ill patients.2.The predictive value of ?SVI determined by NICOM built-in PLR test program may have clinical implication if ?SVI>10% is the absolute cutoff to determine fluid responsiveness in patients with circulatory shock(except cardiogenic shock).