Hemodynamics, fluids & transfusion
Trending Ability and Accuracy of Minimally Invasive Pulse Wave Analysis Devices: A Systematic Review and Meta-Analysis
Authors' conclusion
Minimally invasive pulse wave analysis devices do not achieve sufficient accuracy or trending ability to be interchangeable with reference techniques.
Study context
- Population
- Studies of perioperative and intensive care unit (ICU) hemodynamic monitoring comparing minimally invasive pulse wave analysis devices with reference techniques50 studies
- Comparison
- Pulse wave analysis devices vs Reference techniques
- Outcome
- Accuracy/precision (bias, percentage error) and trending ability (four-quadrant concordance, polar plot agreement) of CO measurement
Methodological detailsrandom-effects models, predefined fitness appraisal, subgroup analyses, sensitivity analyses, 49 studies provided accuracy/precision data (69 lines of analysis); all 50 provided trending ability data (70 lines)
- Random-effects models
- Predefined fitness appraisal
- Subgroup analyses
- Sensitivity analyses
- 49 studies provided accuracy/precision data (69 lines of analysis); all 50 provided trending ability data (70 lines)
Pooled result
As reported in the abstract
Accuracy and trending ability vs reference techniques (all devices and settings)
Pooled bias
0.09 L/min
95% CI −0.05 to 0.23
Pooled percentage error
48.3%
unweighted mean 49.0%, 95% CI, 45.8–52.2
Pooled four-quadrant concordance
72.6%
95% CI 67.9–77.4
Polar plot ±30° agreement
63.2%
95% CI 54.9–71.5
Further pooled results
Percentage error by clinical setting (subgroup)
- Lower percentage error in ICU than in noncardiac surgery
- ≈42% vs ≈55%
Results by declared conflict of interest (subgroup)
- More favorable results in studies with declared conflict of interest
- ≈44% vs 51%, P < .05
MostCare and Argos trending ability (subgroup)
- Four-quadrant concordance >90% and polar agreement close to accepted thresholds; based on few studies
High-quality datasets only (sensitivity analysis)
- Results very similar to the overall estimates
Original publication
Trending Ability and Accuracy of Minimally Invasive Pulse Wave Analysis Devices: A Systematic Review and Meta-Analysis. Anesth Analg. Published 7 April 2026. doi:10.
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