Trending Ability and Accuracy of Minimally Invasive Pulse Wave Analysis Devices: A Systematic Review and Meta-Analysis

Minimally invasive pulse wave analysis devices do not achieve sufficient accuracy or trending ability to be interchangeable with reference techniques. Extreme heterogeneity persists across devices, clinical settings, and methodological quality. Differences associated with conflicts of interest and between ICU and noncardiac surgery populations suggest that performance is context-dependent and influenced by study sponsorship. Taken together with recent evidence and new methodological standards for cardiac output validation, our findings underscore the need for more transparent algorithms, rigorous reporting of trending ability, and standardized validation frameworks before these technologies can be considered reliable for guiding hemodynamic management.