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Open Access Research

The estimation of cardiac output by the Nexfin device is of poor reliability for tracking the effects of a fluid challenge

Xavier Monnet1*, Fabien Picard1, Elsa Lidzborski1, Malcie Mesnil2, Jacques Duranteau2, Christian Richard1 and Jean-Louis Teboul1

Author Affiliations

1 Service de réanimation médicale, Univ Paris-Sud, AP-HP, Hôpitaux universitaires Paris-Sud, Hôpital de Bicêtre, 78, rue du Général Leclerc, 94 270 Le Kremlin-Bicêtre, France

2 Service de réanimation chirurgicale, AP-HP, Hôpitaux universitaires Paris-Sud, Hôpital de Bicêtre, 78, rue du Général Leclerc, 94 270 Le Kremlin-Bicêtre, France

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Critical Care 2012, 16:R212  doi:10.1186/cc11846

Published: 29 October 2012

Abstract

Introduction

The Nexfin device estimates arterial pressure by the volume clamp method through a finger pneumatic cuff. It also allows to estimate cardiac index (CInoninv) by pulse contour analysis of the non-invasive arterial pressure curve. We evaluated the ability of the device to track changes in cardiac index induced by a fluid challenge.

Methods

We included 45 patients for whom a volume expansion (500 mL of saline infused over 30 min) was planned. The volume expansion-induced changes in cardiac index measured by transpulmonary thermodilution (CIinv, PiCCO device) and in CInoninv were recorded.

Results

In seven patients, the Nexfin could not record the arterial curve due to finger hypoperfusion. Considering both the values obtained before and after volume expansion (n = 76 pairs of measurements), the bias (lower and upper limits of agreement) between CIinv and CInoninv was 0.2 (-1.8 to 2.2) L/min/m2. The mean change in CInoninv was 10 ± 11%. The percentage error of CInoninv was 57%. The correlation between the changes in CIinv and CInoninv observed during volume expansion was significant (P = 0.0002) with an r2 = 0.31.

Conclusions

The estimation of CI by the Nexfin device in critically ill patients is not reliable, neither for estimating absolute values of CI nor for tracking its changes during volume expansion.