Pulmonary artery catheter compared with less invasive hemodynamic assessment in cardiac surgical patients

In cardiac surgical patients, accurate hemodynamic monitoring and treatment is crucial, as these have been demonstrated to improve patient outcome. A pulmonary artery catheter (PAC) is utilized to monitor several hemodynamic variables valuable in evaluating cardiovascular function. Inserting a PAC is an invasive procedure and is associated with some potential risks. Therefore, less invasive devices and methods have been developed to replace the PAC.
In study I, we compared the noninvasive Starling SV and mini-invasive LiDCOrapid, which are continuous cardiac output monitors, to PAC in cardiac surgical patients with CPB. The trending ability of both devices was poor. LiDCOrapid showed sufficient accuracy, while the accuracy of the Starling SV was poor. Neither of the devices demonstrated sufficient measurement precision.
In study II, we compared central venous oxygen saturation (ScvO2) values to mixed venous oxygen saturation (SvO2) values drawn from a PAC. ScvO2 values showed acceptable accuracy. The precision of ScvO2 was inadequate, as was its trending ability.
Study III was performed to evaluate the association between transcranial near-infrared spectroscopy (NIRS) and cardiac index (CI) measured with PAC during cardiac surgery. The analysis of separate NIRS and CI pairs revealed a poor association. When the changes in NIRS from baseline or from the previous measurement were compared to those of CI, a significant association was discovered. This was particularly evident in patients undergoing off-pump coronary artery bypass (OPCAB).