PORCENTAJE DE ERROR + 24.

6

Biais et al. Cardiac output measurement in patients
undergoing liver transplantion:
pulmonary artery catheter versus uncalibrated
arterial pressure waveform analysis.
Anesth Analg 2008 May; 106 (5): 1480-6.

PORCENTAJE DE ERROR + 43
Mayer et al. Anesth Analg 2008 Mar; 103(3): 867-72
PORCENTAJE DE ERROR + 58.8
Int Care Med. 1999 25:843-6.
Comparison of pulmonary artery and arterial thermodilution cardiac output
in critically ill patients.
Sakka SG, Reinhart K, Meier-Hellmann A.
Bias 0.7 L/min
Limits of
agreement 1.9 to -0.5 L/min
37 patients with sepsis /
septic shock (33) or SAH (4)
Crit Care Med. 2002 30;52-8.
Reliability of a new algorithm for continuous cardiac output determination
by pulse contour analysis during hemodynamic instability.
Godje O, Hoke K, Goetz A et al.
24 cardiac surgical patients with change in cardiac output
>20% during study period.
Bias -0.2 L/min
Limits of
agreement 2.1 to -2.5 L/min
In post surgical
patients
Pearse, Crit care
2005



In shocked patients
???
0 10 20 30 40 50 60
0.0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1.0
Control
EGDT
Number of patients alive and remaining in hospital
GDT 62 37 11 9 7 6 3
Control 60 48 23 15 12 11 8
Number of Days Following Surgery
P
r
o
p
o
r
t
i
o
n

r
e
m
a
i
n
i
n
g

i
n

h
o
s
p
i
t
a
l
Yes, (level of evidence, C)
but it depends.
Not all monitors are the same.
In stable patients they perform to a clinically
acceptable level and have other advantages.
Continuous data
Less invasive
Offer other variables.
In shocked patients the evidence is less clear.

Are the pulse analysis techniques as
accurate as the PAC for monitoring CO?
Dr Andrew Rhodes . St Georges Hospital. London
No.
But we should recommend more studies evaluating
the performance and efficacy of these monitors in
shocked patients.

Can we recommend this new
technology as an alternative to the PAC
in shock?
DETERMINAR LA
CAPACIDAD/HABILIDAD DE CIpc
(PiCCO) Y CIpw (VIGILEO), EN
REGISTRAR/ DETECTAR CAMBIOS EN
CItd INDUCIDOS POR EXPANSION DE
VOLUMEN O POR N.A EN SEPSIS
GRAVE.
El anlisis de la forma de la
onda de presin no calibrada
(vigileo), puede no reflejar los
cambios en el gasto cardiaco, en
condiciones de grandes
variaciones en el tono arterial,
especialmente en pacientes en
estado hiperdinmico.
80 PACIENTES
CON FALLA
CIRCULATORIA
Y SEPSIS
40 PCTES
FLUID
CHALLENGE
CVC Y LINEA
FEMORAL
PiCCO Y
VIGILEO
40 PCTES
INICIAR N.E
AUMENTAR
DOSIS
CVC Y LINEA
FEMORAL
PiCCO Y
VIGILEO
10 PCTES LAR
Y
LINEA FEMORAL
INTERVENCIONES Y TOMA DE DATOS:
1 SET DE MONITORIA.
INTERVENCION POR PROTOCOLO.
2 SET DE MONITORIA.

LOS DATOS REGISTRADOS FUERON:
PAS, Cipc, CIpw, Citd, SVR.



Distribucin normal: TEST DE KOLMOGOROV
SMIRNOV.
MEDIANAS: percentiles 25% - 75%: CItd, CIpc, CIpw,
dosis de NA.
Tets t student y Test pareado de Wilcoxon para
comparacin de valores antes y despus.
Test U de Mann Whitney para comparacin de los
grupos 1 y 2.
Analisis de Bland Altman para cambios absolutos.
Regresin lineal para cambios de porcentage.
CURVA ROC para testear la capacidad de CIpc y
CIpw de detectar un incremento >= del 15% in
CItd.
P < 0,05 estadsticamente significativo.

straight line, bias; dashed line: +2 SD/-2 SD limits of agreement); dashed line, correlation line.
straight line, bias; dashed line: +2 SD/-2 SD limits of agreement); dashed line, correlation line.
The precision of CIpw device was high (that is, the values of
repeated CIpw measurements were close), but its accuracy
compared with that of CItd was low.


The low accuracy of CIpw was related to the magnitude of SVR
changes.
The limitation of the system probably resides in an incorrect estimation of
the resistive component of the cardiovascular system.
By demonstrating that the CIpw was identical when measured
from the radial and femoral arteries.
Buena
precisin
Poca exactitud
Poca precisin
Buena
exactitud
Buena
precisin
Buena
exactitud
Poca precisin
Poca exactitud
PELIGROSAMENTE
PRECISO!!!!
INEXPERTO CON EL
ARCO Y LA FLECHA.
AZAR.
PRECISO
Y
EXACTO.
Precisin Exactitud
Definicin Grado en que tiene el
mismo valor cuando se
mide varias veces
Grado en que representa
realmente lo que se supone
que representa
Valoracin Comparacin entre
medidas repetidas
Comparacin con patrn de
referencia
Valor Incrementa la potencia
de deteccin de errores
Incrementa la validez de
conclusiones
Amenazado por Error aleatorio (varianza) Error sistemtico (sesgo)