Monitoring haemodynamic response to fluid-challenge in ICU: Comparison of pressure recording analytical method and oesophageal Doppler.

BACKGROUND: The ability of the pressure recording analytical method (PRAM) in tracking change in cardiac output (ΔCO) after a fluid challenge in ICU needs to be evaluated with the most contemporary comparison methods recommended by experts.

OBJECTIVE: Our objective was to report the trending ability of PRAM in tracking ΔCO after a fluid challenge in ICU and to compare this with oesophageal Doppler monitoring (ODM).

DESIGN: Prospective, observational study.

SETTING: Hôpital Lariboisière and Hôpital Européen George Pompidou, Paris, France, from April 2016 to December 2017.

PATIENTS: Critically ill patients admitted to ICU with monitoring of CO monitored by ODM and invasive arterial pressure.

INTERVENTION: ΔCO after fluid challenge was simultaneously registered with ODM and PRAM connected to the arterial line.

MAIN OUTCOME MEASURE: Polar statistics (mean angular bias, radial limits of agreement and polar concordance rate) and clinical concordance evaluation (error grid and clinical concordance rate). Predictors of bias were determined.

RESULTS: Sixty-eight fluid challenge were administered in 49 patients. At the time of fluid challenge, almost all were mechanically ventilated (99%), with 85% receiving norepinephrine. Admission diagnosis was septic shock in 70% of patients. Patients had a Sequential Organ Failure Assessment score of 10 [7 to 12] and a median Simplified Acute Physiology Score II of 61 [49 to 69]. Relative ΔCO bias was 7.8 (6.3°) with radial limits of agreement of ±41.7°, polar concordance rate 80% and clinical concordance rate 74%. ΔCO bias was associated with baseline bias (P = 0.007). Baseline bias was associated with radial location of the arterial line (P = 0.03).

CONCLUSION: When compared with ODM, PRAM has insufficient performance to track ΔCO induced by fluid challenge in ICU patients. Baseline bias is an independent predictor of trending bias.

TRIAL REGISTRATION: IRB 00010254-2016-033.