Document Detail


Focused rapid echocardiographic evaluation versus vascular cather-based assessment of cardiac output and function in critically ill trauma patients.
MedLine Citation:
PMID:  22673240     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Focused rapid echocardiographic evaluation (FREE) is a comprehensive transthoracic echocardiogram tailored for the intensive care unit. It assesses both the cardiac index (CI) and left ventricular ejection fraction (EF). FREE and vascular catheter-derived CI was compared, and the ability of CI to detect moderate to severe dysfunction (EF <40%) was determined.
METHODS: FREE quality assurance database was reviewed to identify patients who had a hemodynamic catheter.
RESULTS: Of 507 FREEs, 115 patients were identified, 25 pulmonary artery catheters (PACs) and 90 FloTrac Vigileo (FT/V) arterial catheters. There were 27 patients with an EF <40%. In 86%, the CI was determined by FREE, and it changed care in 59%. The CI correlation for FREE versus PAC was r = 0.88 and versus FT/V was r = 0.63 (p < 0.05). The PAC-FREE bias was -0.07 (95% confidence interval -0.89 to 0.74) and the FT/V-FREE bias was -0.13 (95% confidence interval -1.4 to 1.1). FREE-PAC categorized patients the same way 87% and FREE-FT/V 76%; in patients with EF <40%, this changed to 90% and 63%, respectively. Using a threshold value (CI ≤ 2.5), the PAC detected dysfunction in 62.5% and the F/VT in 6%, p < 0.05.
CONCLUSIONS: There was excellent agreement between FREE and PAC but less with FT/V, especially in patients with and EF <40%. FREE can be used to validate catheter-derived data and provide important additional information. Further studies are needed to determine its impact on patient outcome.
LEVEL OF EVIDENCE: III, diagnostic study.
Authors:
Sarah B Murthi; John R Hess; Aaron Hess; Lynn G Stansbury; Thomas M Scalea
Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The journal of trauma and acute care surgery     Volume:  72     ISSN:  2163-0763     ISO Abbreviation:  J Trauma Acute Care Surg     Publication Date:  2012 May 
Date Detail:
Created Date:  2012-06-07     Completed Date:  2012-08-21     Revised Date:  2013-09-25    
Medline Journal Info:
Nlm Unique ID:  101570622     Medline TA:  J Trauma Acute Care Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1158-64     Citation Subset:  AIM; IM    
Affiliation:
Division of Trauma and Surgical Critical Care, Department of Surgery, R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA. smurthi@umm.edu
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MeSH Terms
Descriptor/Qualifier:
Cardiac Catheterization / methods*
Cardiac Output / physiology*
Critical Illness*
Echocardiography / methods*
Female
Follow-Up Studies
Humans
Intensive Care Units
Male
Middle Aged
Pulmonary Artery
ROC Curve
Reproducibility of Results
Retrospective Studies
Ventricular Dysfunction / diagnosis*,  etiology,  physiopathology
Wounds and Injuries / complications*,  diagnosis,  physiopathology

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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