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The map and the territory: a critical appraisal of pulse contour cardiac output monitoring
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DOI：10.1016/j.bja.2026.07.014.png)
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Abstract
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Three recent meta-analyses published between 2025 and 2026 report pooled percentage errors of 44–49% for minimally invasive pulse contour analysis devices, exceeding the 30% interchangeability threshold. Percentage error alone cannot establish how much of this disagreement reflects each method's measurement noise rather than other sources of error, and the least significant change needed to distinguish a real haemodynamic change from device noise is rarely measured or reported. This uncertainty is compounded by arterial waveform artefacts, proprietary algorithms, and regulatory frameworks that, according to formal enquiries to regulatory agencies, do not mandate specific thresholds of accuracy, trending ability, or least significant change before market authorisation. The aim is not to abandon haemodynamic monitoring, but to make the clinical meaning of measurement error explicit before these devices are used to guide clinical decisions.
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