Cardiac output monitors in septic shock: do they deliver what matters? A systematic review and meta-analysis
Authors' conclusion
Most CO monitors demonstrate poor agreement with reference methods in septic shock.
Study context
- Population
- Adult ICU patients with septic shock
- Participants
- 1,323 patients · 26 studies
- Comparison
- Cardiac output (CO) monitoring devices vs reference methods
- Pulmonary artery catheter (PAC)n = 18 datasetsreference
- Transpulmonary thermodilution (TPTD)n = 16reference
- Echocardiographyn = 3reference
- Outcome
- Agreement with reference methods (pooled bias, LoA, PE; agreement defined as PE < 30%)
Methodological detailsSidik-Jonkman random-effects model, Bland-Altman analysis
- Sidik-Jonkman random-effects model
- Bland-Altman analysis
Pooled result
As reported in the abstract
Agreement of CO monitors vs reference methods
Pooled bias
0.15 L min⁻¹
Limits of agreement (LoA)
± 3.45 L min⁻¹
Pooled percentage error (PE)
49%
Further pooled results
Agreement by device type (subgroup)
- Calibrated pulse contour analysis (PCA), PE (best agreement)
- 25%
- Uncalibrated PCA, thoracic electrical bioimpedance and bioreactance, PE (poor agreement)
- ≥ 52%
Trending ability (acceptable = concordance ≥ 90%)
- Datasets reporting trending
- 15
- Datasets achieving concordance ≥ 90%
- 3
Original publication
Cardiac output monitors in septic shock: do they deliver what matters? A systematic review and meta-analysis. Crit Care. Published 12 July 2025. doi:10.
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