Prospective Randomized Study edside emergency cardiac sonography is ideally suited to rule in or rule out poor left ventricular (LV) systolic function. 1 Overall cardiac function is important in making more accurate diagnoses and clinical care decisions. [1][2][3][4][5][6] Visual estimates of LV systolic function can differentiate severely depressed from normal LV systolic function, but physicians often encounter disagreements in differentiating moderately depressed and normal LV systolic function. [7][8][9] Quantitative comprehensive echocardiographic measAnthony J. Weekes, MD, Abhiram Reddy, MD, Margaret R. Lewis, MD, H. James Norton, PhD Received April 19, 2012, ORIGINAL RESEARCHObjectives-Rapid bedside assessment of left ventricular (LV) function can aid in the evaluation of the critically ill patient and guide clinical management. Our primary hypothesis was that mitral valve E-point septal separation measurements would correlate with contemporaneous fractional shortening measurements of LV systolic function when performed by emergency physicians. Our secondary hypothesis was that E-point septal separation as a continuous variable would predict fractional shortening using a linear regression model.Methods-We studied a prospective convenience sample of patients undergoing a sequence of LV systolic function measurements during a 3-month period at a suburban academic emergency department with a census of 114,000 patients. The sample included adult emergency department patients who were determined by the treating emergency physician to have 1 or more clinical indications for bedside LV systolic function assessment. Investigators performed bedside M-mode cardiac sonographic measurements of fractional shortening and E-point septal separation using the parasternal long-axis window. The sequence of LV systolic function measurements was randomized.Results-A total of 103 patients were enrolled. The Pearson correlation coefficient for E-point septal separation and fractional shortening measurements was -0.59 (P < .0001). Linear regression analysis performed for E-point septal separation with fractional shortening as the dependent variable yielded an R 2 value of 0.35.Conclusions-E-point septal separation and fractional shortening measurements had a moderate negative correlation. E-point septal separation, when used as a continuous variable in a linear regression model, did not reliably predict fractional shortening.
Background: Ultrasonography, clinical methods and capnography are used to confirm the proper placement of endotracheal tube. Ultrasonography was thought to have high sensitivity and specificity and took less when compared with other two methods. Aims: To compare ultrasonography with the traditional clinical methods and the gold standard quantitative waveform capnography in confirming the proper placement of endotracheal tube. Materials and Methods: We carried out a prospective cohort study on 120 patients who were indicated for intubation in an emergency department of a tertiary care hospital, Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar, Telangana State, India. The study was carried out from June 2017 to December 2017. The confirmation of endotracheal tube placement was identified by three methods, ultrasonography, quantitative waveform capnography (end-tidal carbon dioxide) and traditional clinical method. The parameters recorded by three methods were confirmation of tube placement and time taken for tube placement. Results: Out of the 120 intubation attempts, six (5 %) had esophageal intubations. Ultrasonography produced a sensitivity and specificity of diagnosis of 98.63% and 100%, respectively, which was statistically comparable with the other two methods. When the time taken to confirm tube placement was compared, it was found that ultrasonography took significantly less time. The time taken by ultrasonography, waveform capnography and clinical methods was 8.13 ± 1.27, 17.86 ± 2.34 and 20.13 ± 2.72 seconds respectively. Conclusion: The endotracheal tube placement was confirmed by ultrasonography with comparable sensitivity and specificity to other two methods i.e. quantitative waveform capnography and clinical methods and it took less time.
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