Document Detail

Thoracic electrical bioimpedance: a tool to determine cardiac versus non-cardiac causes of acute dyspnoea in the emergency department.
MedLine Citation:
PMID:  20442164     Owner:  NLM     Status:  In-Process    
OBJECTIVES: To determine whether cardiohaemodynamic parameters, using non-invasive thoracic electrical bioimpedance (TEB), can differentiate between cardiac and non-cardiac causes of acute breathlessness in adult emergency department (ED) patients.
METHODS: A prospective cohort study of adult patients who presented with acute breathlessness to the ED of a large urban teaching hospital. Study patients had their cardiohaemodynamic parameters measured, using a TEB device. The patient's hospital discharge diagnosis was used as the definitive diagnosis to determine whether the underlying cause of acute dyspnoea was cardiac or non-cardiac related. The definitive diagnosis was compared with the TEB data and the ED physician's diagnosis.
RESULTS: 52 patients were recruited into the study, of whom 51 had complete TEB data and were included in the analysis. There were statistically significant differences in cardiac output (6.2 vs 7.9, p<0.001), cardiac index (CI; 3.1 vs 4.4, p<0.001), systemic vascular resistance (1227 vs 933, p=0.002) and systemic vascular resistance index (2403 vs 1681, p<0.001) between the cardiac and non-cardiac cohort. CI was found to be an excellent discriminator (receiver operating characteristics area under the curve 0.906). The optimal diagnostic criterion for CI to distinguish between cardiac and non-cardiac dyspnoea was 3.2 l/min per square metre or less (positive likelihood ratio 7.9; negative likelihood ratio 0.14).
CONCLUSION: This study demonstrated that non-invasive TEB cardiohaemodynamic parameters can differentiate between cardiac and non-cardiac-related causes of dyspnoea in ED patients presenting with acute breathlessness. A large-scale trial is required to determine if TEB-derived cardiohaemodynamic information can aid ED clinicians in their early clinical decision-making and improve the care and outcome of patients with dyspnoea.
Christiane Vorwerk; Hanusha Jeyanithi; Timothy J Coats
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Emergency medicine journal : EMJ     Volume:  27     ISSN:  1472-0213     ISO Abbreviation:  Emerg Med J     Publication Date:  2010 May 
Date Detail:
Created Date:  2010-05-05     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100963089     Medline TA:  Emerg Med J     Country:  England    
Other Details:
Languages:  eng     Pagination:  359-63     Citation Subset:  IM    
Academic Unit of Emergency Medicine, University of Leicester, Leicester, UK.
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