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Master Thesis

Monitorage du débit cardiaque par une méthode d’analyse du contour de l’onde de pouls (ProAQT/Pulsioflex®) en post opératoire de chirurgie cardiaque

Abstract : Introduction: The ProAQT/Pulsioflex® (PF) is an arterial pressure derived continuous cardiac output monitoring technique. This study aimed to evaluate the new device after major cardiac surgery. Methods: We realized an ancillary study of SUCCES study, a prospective randomized study whose purpose was to compare the hemodynamic effect of a fluid challenge with hypertonic saline or lactated ringer®. Inclusion criteria were patients requiring a Swan Ganz catheter (SGc) for cardiac surgery and requiring fluid challenge during the post-operative period. Cardiac Index (CI) was monitored simultaneously in patients by PF or by a SGc continuous thermodilution. Data were compared during 18 hours. Statistical analysis was performed using linear regression and Bland and Altman analysis. Inter-method agreement during volume expansion was assessed using Kappa statistic. Results: The data of 22 patients were reviewed. We analyzed 12734 pairs of measurements. Values of CI were significantly different between SGc system (2.52 ± 0.52, 95% CI of the mean: 2.51-2.53 L/min/m²) and Pulsioflex® (2.58 ± 0.72, 95% CI of the mean: 2.57-2.59 L/min/m²), p< 0.001. Correlation coefficient between PF and SGc was R = 0.86 (95 % CI = 0.84 to 0.88, p <0.001); the bias was -0.06L / min, and limits of agreement were -1.18-1.05 L/min, with a percentage error of 44%. Response to volume expansion was considered as positive for 12 (75%) cases in SGc and for 2 (12%) cases in PF (Weighted Kappa -0.09; 95% CI= -0.35 to 0.17). Discussion: In our study, continuous CI measurement by PF was not satisfactory after cardiac surgery. PF didn't track correctly cardiac index changes compared to SGc during a fluid expansion.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-03018956
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Submitted on : Monday, November 23, 2020 - 10:42:07 AM
Last modification on : Wednesday, November 25, 2020 - 3:24:35 AM
Long-term archiving on: : Wednesday, February 24, 2021 - 6:44:15 PM

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  • HAL Id : dumas-03018956, version 1

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Cécile Estève. Monitorage du débit cardiaque par une méthode d’analyse du contour de l’onde de pouls (ProAQT/Pulsioflex®) en post opératoire de chirurgie cardiaque. Médecine humaine et pathologie. 2018. ⟨dumas-03018956⟩

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