Abstract
BackgroundAlthough pulmonary artery catheters (PACs) have been the reference standard for calculating cardiac output, echocardiographic estimation of cardiac output (CO) by cardiologists has shown high accuracy compared to PAC measurements. A few studies have assessed the accuracy of echocardiographic estimation of CO in critically ill patients by intensivists with basic training. The aim of this study was to evaluate the accuracy of CO measurements by intensivists with basic training using pulsed-wave Doppler ultrasound vs. PACs in critically ill patients.MethodsCritically ill patients who required hemodynamic monitoring with a PAC were eligible for the study. Three different intensivists with basic critical care echocardiography training obtained three measurements of CO on each patient. The maximum of three separate left-ventricular outflow tract diameter measurements and the mean of three LVOT velocity time integral measurements were used. The inter-observer reliability and correlation of CO measured by PACs vs. critical care echocardiography were assessed.ResultsA total of 20 patients were included. Data were analyzed comparing the measurements of CO by PAC vs. echocardiography. The inter-observer reliability for measuring CO by echocardiography was good based on a coefficient of intraclass correlation of 0.6 (95% CI 0.48–0.86, p < 0.001). Bias and limits of agreement between the two techniques were acceptable (0.64 ± 1.18 L/min, 95% limits of agreement of − 1.73 to 3.01 L/min). In patients with CO < 6.5 L/min, the agreement between CO measured by PAC vs. echocardiography improved (0.13 ± 0.89 L/min; 95% limits of agreement of − 1.64 to 2.22 L/min). The mean percentage of error between the two methods was 17%.ConclusionsCritical care echocardiography performed at the bedside by intensivists with basic critical care echocardiography training is an accurate and reproducible technique to measure cardiac output in critically ill patients.
Highlights
Pulmonary artery catheters (PACs) have been the reference standard for calculating cardiac output, echocardiographic estimation of cardiac output (CO) by cardiologists has shown high accuracy compared to pulmonary artery catheter (PAC) measurements
In this study, we found an acceptable agreement of CO measured by critical care echocardiography (CCE) vs. PAC with thermodilution, and the inter- and intra-observer reliability was high
These findings suggest that CO can be accurately measured in critically ill patients by intensivists with the basic CCE training
Summary
Pulmonary artery catheters (PACs) have been the reference standard for calculating cardiac output, echocardiographic estimation of cardiac output (CO) by cardiologists has shown high accuracy compared to PAC measurements. A few studies have assessed the accuracy of echocardiographic estimation of CO in critically ill patients by intensivists with basic training. The aim of this study was to evaluate the accuracy of CO measurements by intensivists with basic training using pulsed-wave Doppler ultrasound vs PACs in critically ill patients. Cardiac output (CO) is the reference standard measurement for assessing target organ perfusion and oxygen delivery in shock. Assessing CO in critically ill patients allows physicians to determine hemodynamic status, identify the most appropriate therapeutic strategy, and monitor the effects of therapy. Insertion of a pulmonary artery catheter (PAC) has been historically required to calculate CO by thermodilution [1]. Critical care echocardiography (CCE) has emerged as a promising technique that is commonly available, less expensive, and non-invasive
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