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Accuracy and Trending Ability of Cardiac Index Measured by the CNAP System in Patients Undergoing Abdominal Aortic Aneurysm Surgery

Objectives: The CNAP system is a noninvasive monitor that provides a continuous arterial pressure waveform using an inflatable finger cuff. The authors hypothesized that dramatic changes in systemic vascular resistance index during abdominal aortic aneurysm (AAA) surgery might affect the accuracy of...

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Published in:Journal of cardiothoracic and vascular anesthesia 2021-05, Vol.35 (5), p.1439-1446
Main Authors: Miyazaki, Erika, Maeda, Takuma, Ito, Shinya, Oi, Ayako, Hotta, Naoshi, Tsukinaga, Akito, Kanazawa, Hiroko, Ohnishi, Yoshihiko
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cited_by cdi_FETCH-LOGICAL-c356t-414ae807817ffaab94b868fe9ea373ab7a3c41bd533f11d16d4131845360e2633
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container_end_page 1446
container_issue 5
container_start_page 1439
container_title Journal of cardiothoracic and vascular anesthesia
container_volume 35
creator Miyazaki, Erika
Maeda, Takuma
Ito, Shinya
Oi, Ayako
Hotta, Naoshi
Tsukinaga, Akito
Kanazawa, Hiroko
Ohnishi, Yoshihiko
description Objectives: The CNAP system is a noninvasive monitor that provides a continuous arterial pressure waveform using an inflatable finger cuff. The authors hypothesized that dramatic changes in systemic vascular resistance index during abdominal aortic aneurysm (AAA) surgery might affect the accuracy of noninvasive pulse contour monitors. The aim of this study was to evaluate the accuracy and trending ability of cardiac index derived by the CNAP system (CICN) in patients undergoing AAA surgery. Design: Prospective clinical study. Setting: Cardiac surgery operating room in a single cardiovascular center. Participants: Twenty patients who underwent elective AAA surgery. Interventions: CICN and cardiac index measured using 3-dimensional images (CI3D) were determined simultaneously at 8 points during the surgery. At aortic clamping and unclamping, the authors tested the trending ability of CICN using 4-quadrant plot analysis and polar plot analysis. Measurements and Main Results: The authors found a wide limit of agreement between CICN and CI3D (percentage error: 85.0%). The cubic splines, which show the relationship between systemic vascular resistance index and percentage CI discrepancy [(CICN−CI3D)/CI3D], were sloped positively. Four-quadrant plot analysis showed poor trending ability for CICN at both aortic clamping and unclamping (concordance rate: 29.4% and 57.9%, respectively). In the polar plot analysis, the concordance rates at aortic clamping and unclamping were 15.0% and 35.0%, respectively. Conclusions: CICN is not interchangeable with CI3D in patients undergoing AAA surgery. The trending ability for CICN at aortic clamping and unclamping was below the acceptable limit. These inaccuracies might be secondary to the high systemic vascular resistance index during AAA surgery.
doi_str_mv 10.1053/j.jvca.2020.08.012
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The authors hypothesized that dramatic changes in systemic vascular resistance index during abdominal aortic aneurysm (AAA) surgery might affect the accuracy of noninvasive pulse contour monitors. The aim of this study was to evaluate the accuracy and trending ability of cardiac index derived by the CNAP system (CICN) in patients undergoing AAA surgery. Design: Prospective clinical study. Setting: Cardiac surgery operating room in a single cardiovascular center. Participants: Twenty patients who underwent elective AAA surgery. Interventions: CICN and cardiac index measured using 3-dimensional images (CI3D) were determined simultaneously at 8 points during the surgery. At aortic clamping and unclamping, the authors tested the trending ability of CICN using 4-quadrant plot analysis and polar plot analysis. Measurements and Main Results: The authors found a wide limit of agreement between CICN and CI3D (percentage error: 85.0%). The cubic splines, which show the relationship between systemic vascular resistance index and percentage CI discrepancy [(CICN−CI3D)/CI3D], were sloped positively. Four-quadrant plot analysis showed poor trending ability for CICN at both aortic clamping and unclamping (concordance rate: 29.4% and 57.9%, respectively). In the polar plot analysis, the concordance rates at aortic clamping and unclamping were 15.0% and 35.0%, respectively. Conclusions: CICN is not interchangeable with CI3D in patients undergoing AAA surgery. The trending ability for CICN at aortic clamping and unclamping was below the acceptable limit. 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The authors hypothesized that dramatic changes in systemic vascular resistance index during abdominal aortic aneurysm (AAA) surgery might affect the accuracy of noninvasive pulse contour monitors. The aim of this study was to evaluate the accuracy and trending ability of cardiac index derived by the CNAP system (CICN) in patients undergoing AAA surgery. Design: Prospective clinical study. Setting: Cardiac surgery operating room in a single cardiovascular center. Participants: Twenty patients who underwent elective AAA surgery. Interventions: CICN and cardiac index measured using 3-dimensional images (CI3D) were determined simultaneously at 8 points during the surgery. At aortic clamping and unclamping, the authors tested the trending ability of CICN using 4-quadrant plot analysis and polar plot analysis. Measurements and Main Results: The authors found a wide limit of agreement between CICN and CI3D (percentage error: 85.0%). The cubic splines, which show the relationship between systemic vascular resistance index and percentage CI discrepancy [(CICN−CI3D)/CI3D], were sloped positively. Four-quadrant plot analysis showed poor trending ability for CICN at both aortic clamping and unclamping (concordance rate: 29.4% and 57.9%, respectively). In the polar plot analysis, the concordance rates at aortic clamping and unclamping were 15.0% and 35.0%, respectively. Conclusions: CICN is not interchangeable with CI3D in patients undergoing AAA surgery. The trending ability for CICN at aortic clamping and unclamping was below the acceptable limit. 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The cubic splines, which show the relationship between systemic vascular resistance index and percentage CI discrepancy [(CICN−CI3D)/CI3D], were sloped positively. Four-quadrant plot analysis showed poor trending ability for CICN at both aortic clamping and unclamping (concordance rate: 29.4% and 57.9%, respectively). In the polar plot analysis, the concordance rates at aortic clamping and unclamping were 15.0% and 35.0%, respectively. Conclusions: CICN is not interchangeable with CI3D in patients undergoing AAA surgery. The trending ability for CICN at aortic clamping and unclamping was below the acceptable limit. These inaccuracies might be secondary to the high systemic vascular resistance index during AAA surgery.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>32888805</pmid><doi>10.1053/j.jvca.2020.08.012</doi><tpages>8</tpages></addata></record>
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subjects Aortic Aneurysm, Abdominal - diagnostic imaging
Aortic Aneurysm, Abdominal - surgery
Arterial Pressure
Blood pressure monitor
Cardiac Output
echocardiography
Humans
Monitoring, Physiologic
Prospective Studies
Thermodilution
ultrasonography
title Accuracy and Trending Ability of Cardiac Index Measured by the CNAP System in Patients Undergoing Abdominal Aortic Aneurysm Surgery
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