Continuous non-invasive hemodynamic monitoring in early onset severe preeclampsia

Abstract

AbstractObjectivesContinuous hemodynamic monitoring offers the opportunity to individualize management in severe preeclampsia (PEC). We compared cardiac output (CO) and systemic vascular resistance (SVR) measured by bioreactance (NICOM), Clearsite™ Fingercuff [CS), and 3D-echocardiography (3DE).Study DesignThis prospective observational study included 12 pregnant patients with early PEC. CO and SVR were measured simultaneously by NICOM, CS, and 3DE antepartum and 1-2 days postpartum. Using 3DE as the standard, CS and NICOM interchangeability, precision, accuracy, and correlation were assessed.ResultsCompared to 3DE-CO, CS-CO was highly correlated (R2=0.70, p=<0.0001) with low percentage error (PE 29%) which met criteria for interchangeablity. CS-SVR had strong correlation (R2=0.81, p=<0.0001) and low PE (29%). While CS tended to slightly overestimate CO (bias +2.05 +/-1.18 L/min, limit of agreement (LOA) -0.20-4.31) and underestimate SVR (bias -279 +/-156 dyes/sec/cm5; LOA -580-18.4) these differences were unlikely to be clinically significant. Thus CS could be interchangeable with 3DE for CO and SVR. NICOM-CO had only moderate correlation with 3DE-CO (R2=0.29, p=0.01) with high PE (52%) above threshold for interchangeability. NICOM-CO had low mean bias (−1.2 +/-1.68 L/min) but wide 95% LOA (−4.41 - 2.14) suggesting adequate accuracy but low precision in relation to 3DE-CO. NICOM-SVR had poor correlation with 3DE-SVR (R2=0.32, p=0.001) with high PE (67%), relatively low mean bias (238 +/-256), and wide 95% LOA (– 655–1131). NICOM did not meet the criteria for interchangeable with 3DE for CO and SVR.ConclusionsClearsite Fingercuff, but not NICOM, has potential to be clinically useful for CO and SVR monitoring in severe preeclampsia.