| Hand-carried echocardiography for assessment of left ventricular filling and ejection fraction in the surgical intensive care unit. | |
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MedLine Citation:
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PMID: 19327304 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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PURPOSE: To better define the reliability of left ventricular ejection fraction (LVEF) and left ventricular filling, as determined by either hand-carried ultrasound (HCU) or formal transthoracic echocardiography (TTE), in the critically ill surgical patient. MATERIALS AND METHODS: Prospective cross-sectional study of 80 surgical intensive care unit patients with concomitant (<30 minutes apart) formal TTE and clinician-performed cardiac HCU. Visual estimates of LVEF and left ventricular filling ("underfilled" vs "normally filled") were recorded, both by clinicians performing HCU and fellowship-trained echocardiographers. RESULTS: Bland-Altman plot analysis of LVEF estimates revealed good interobserver agreement between HCU and formal TTE (% LVEF mean bias, -2.2; with 95% limits of agreement, +/-22.1). This was similar to agreement between independent echocardiography observers (% LVEF mean bias, 1.3; with 95% limits of agreement, +/-21.0). However, assessments of left ventricular filling demonstrated only fair to moderate interobserver agreement (kappa = 0.22-0.40). Of note, a greater percentage of the 5 standard acoustic windows were obtainable using formal TTE (72% vs 56%). CONCLUSIONS: Formal TTE offers no advantage over HCU for determination of LVEF in critically ill surgical patients, even though the former allows for a more complete examination. However, estimations of left ventricular filling only demonstrate fair to moderate interrater agreement and thus should be interpreted with care when used as markers of volume responsiveness. |
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Authors:
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Dustin G Mark; Geoffrey E Hayden; Bonnie Ky; Anna Paszczuk; Monica Pugh; Shannon Matthews; Annamarie Horan; Vicente H Gracias; James N Kirkpatrick; Anthony J Dean |
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Publication Detail:
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Type: Journal Article Date: 2009-01-17 |
Journal Detail:
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Title: Journal of critical care Volume: 24 ISSN: 1557-8615 ISO Abbreviation: J Crit Care Publication Date: 2009 Sep |
Date Detail:
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Created Date: 2009-08-11 Completed Date: 2009-12-03 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8610642 Medline TA: J Crit Care Country: United States |
Other Details:
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Languages: eng Pagination: 470.e1-7 Citation Subset: IM |
Affiliation:
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Department of Emergency Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA. dustin.mark@uphs.upenn.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Critical Illness Cross-Sectional Studies Echocardiography / instrumentation, methods* Female Heart Ventricles / ultrasonography Humans Intensive Care Units Male Middle Aged Point-of-Care Systems Prospective Studies Stroke Volume* Ventricular Function, Left* |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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