Assessment of changes in cardiac index and fluid responsiveness: a comparison of <scp>N</scp>exfin and transpulmonary thermodilution

Abstract

Background The N exfin device uses non‐invasive photoplethysmography to monitor cardiac output and respiratory variations in pulse pressure and stroke volume. The aim of this study was to compare rapid changes in cardiac index after fluid challenge between N exfin and bolus transpulmonary thermodilution and the ability to predict fluid responsiveness of dynamic indices given by N exfin. Methods Simultaneous comparative cardiac index were collected from transpulmonary thermodilution and N exfin before and after fluid challenge in 45 patients following conventional cardiac surgery. Correlations, B land– A ltman analyses and percentage errors were calculated. Pulse pressure variations and stroke volume variations before fluid challenge were collected to assess their discrimination in predicting fluid responsiveness. Results Eight (18%) patients were excluded. A weak positive relationship was found between rapid changes in cardiac index after fluid challenge given by both technologies ( n = 37, r = 0.39, P = 0.019). Bias, precision and limits of agreements were 0.20 l/min/m 2 (95% confidence interval ( CI ) 0.02–0.40), 0.57 l/min/m 2 and ± 1.12 l/min/m 2 before fluid challenge, and 0.01 l/min/m 2 (95% CI −0.24 to 0.26), 0.74 l/min/m 2 and ± 1.45 l/min/m 2 after fluid challenge. Percentage errors between N exfin and transpulmonary thermodilution were 55% and 58% before and after fluid challenge, respectively. Pulse pressure variations and stroke volume variations given by N exfin were not discriminant to predict fluid responsiveness: areas under receiver operating characteristics curves 0.57 (95% CI 0.40–0.73) and 0.50 (0.33–0.67), respectively. Conclusions The N exfin cannot be used to measure rapid changes in cardiac index following fluid challenge and to predict fluid responsiveness after cardiac surgery.