Abstract
Introduction: Central venous (CV) line is one of the most common methods of central venous pressure (CVP) measurement and hemodynamic monitoring among patients admitted to the intensive care unit (ICU). However, its complications are not rare and are life-threatening in some cases. Recently, transesophageal duplex is frequently used to monitor the cardiac output (CO) and intravascular fluid volume of patients admitted to ICU. The present study was conducted aiming to assess noninvasive hemodynamic monitoring and hypotension management with transesophageal doppler among mechanically-ventilated patients. Methods: In this descriptive cross-sectional study, 25 patients admitted to the ICU of Imam Reza Hospital, Tabriz, Iran, were studied. CV line had been inserted into the body of the patients prior to the study for various reasons. CO was measured using esophageal duplex and also transthoracic echocardiography (TTE), and CVP was determined via esophageal duplex and CV line findings. Results: Mean CO of the patients was 4.88 ± 0.61 and 4.86 ± 0.59 l/minute measured by esophageal duplex and TTE, respectively. Hence, the difference was not statistically significant between the two methods. The mean CVPs of the patients measured by esophageal duplex and CV line were 4.94 ± 1.15 and 4.54 ± 1.04 mmHg, respectively. In addition, the left ventricular (LV) filling pressure measured by Oesophageal Doppler Monitoring (ODM) and by TTE was 9.28 ± 2.66 and 9.28 ± 2.66 mmHg, respectively. The difference for both of the mentioned variables was statistically significant but clinically negligible. Conclusion: Based on the results of this study, esophageal duplex as a less invasive, safe and precise method can replace the use of CV line among patients undergoing mechanical ventilation. This will help clinicians to obtain accurate haemodynamic data from critically ill patients and avoid unexpected complications imposed by CV line insertion.
Highlights
Mean cardiac output (CO) of the patients was 4.88 ± 0.61 and 4.86 ± 0.59 l/minute measured by esophageal duplex and transthoracic echocardiography (TTE), respectively
Further analysis showed a significant difference between the central venous pressure (CVP) measured by oesophageal duplex and Central venous (CV) line (P = 0.012; 95% confidence interval (CI) = -0.161 to -0.022), since the observed difference was not clinically significant, Oesophageal Doppler Monitoring (ODM) can be used as an alternative to CV line to measure CVP of critically ill patients (Table 4)
The filling pressures of the left ventricle and CVP measured by ODM were statistically different from those evaluated by TTE and CV line, the differences were not clinically significant and ODM can be used as an alternative to TTE and CV line to determine these values among the critically ill and intubated patients admitted to the intensive care unit (ICU)
Summary
Basic demographic information of the patients including age, sex, height, and weight was recorded in the checklist designed for this purpose. The information required on the haemodynamic status of the patients was obtained using CV line and echocardiography. The CO and the CVP of these patients were measured using ODM device, and the values were compared with the those of CV line and echocardiography (LV filling pressure). SPSS software (version 20, IBM Corporation, Armonk, NY, USA) was applied for all statistical analyses of the study. The obtained data were expressed as mean ± standard deviation (SD), rate, and percentage. Student ttest was used to compare the quantitative variables of the study. The sample size was determined using the number of patients used in the previous studies, the test power of 80%, and the acceptable error rate (α) of 5%, which yielded the number of 25 patients.
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