Tracking changes in cardiac output: methodological considerations for the validation of monitoring devices

Background Until now, tools for continuous cardiac output (CO) monitoring have been validated as if they were tools for snapshot measurements. Most authors have compared variations in cardiac output between two time-points and used Bland–Altman representations to describe the agreement between these...

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Bibliographic Details
Published in:Intensive care medicine 2009-10, Vol.35 (10), p.1801-1808
Main Authors: Squara, Pierre, Cecconi, Maurizio, Rhodes, Andrew, Singer, Mervyn, Chiche, Jean-Daniel
Format: Article
Language:English
Subjects:
Accuracy
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Anesthesiology
Bias
Biological and medical sciences
Cardiac Output - physiology
Critical Care Medicine
Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care
Emergency Medicine
Heart Function Tests - instrumentation
Heart Function Tests - methods
Humans
Intensive
Intensive care
Intensive care medicine
Medical sciences
Medicine
Medicine & Public Health
Pain Medicine
Patients
Pediatrics
Pneumology/Respiratory System
Special Article
Validation Studies as Topic
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Summary:Background Until now, tools for continuous cardiac output (CO) monitoring have been validated as if they were tools for snapshot measurements. Most authors have compared variations in cardiac output between two time-points and used Bland–Altman representations to describe the agreement between these variations. The impacts of time and of repetitive measurements over time are not taken into consideration. Purpose This special article proposes a conceptual framework for the validation of CO monitoring devices. Four quality criteria are suggested and studied: (1) accuracy (small bias), (2) precision (small random error of measurements), (3) short response time and (4) accurate amplitude response. Because a tolerance is obviously admitted for each of these four criteria, we propose to add as a fifth criterion the ability to detect significant CO directional changes. Other important issues in designing studies to validate CO monitoring tools are reviewed: choice of patient population to be studied, choice of the reference method, data acquisition method, data acceptability checking, data segmentation and final evaluation of reliability. Conclusion Application of this framework underlines the importance of precision and time response for clinical acceptability of monitoring tools.
ISSN:0342-4642
1432-1238
DOI:10.1007/s00134-009-1570-9