Focused rapid echocardiographic evaluation versus vascular cather-based assessment of cardiac output and function in critically ill trauma patients

Murthi, Sarah B.; Hess, John R.; Hess, Aaron T.; Stansbury, Lynn G.; Scalea, Thomas M.

doi:10.1097/ta.0b013e31824d1112

Cited by 33 publications

(13 citation statements)

References 16 publications

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“…CUS performed by intensivists has played an important role in ICUs because it is a noninvasive test that provides useful hemodynamic information [1][2][3][4][5][6][7][8]. Furthermore, problem-focused US can help identify specific problems e.g., fluid collection, DVT, biliary tract diseases, and urinary tract obstruction, which are common in surgical patients as seen in the present study [13,14].…”

Section: Discussionmentioning

confidence: 87%

“…Ultrasonography (US) has become an essential tool in almost every subdivision of medical practice including critical care medicine. Various applications of US have been used in ICUs, for instance, monitoring of hemodynamic parameters such as intravascular volume (preload) and cardiac contractility [1][2][3][4][5][6][7][8]. Despite the fact that US has some inherent limitations and is largely operator dependent, it enables clinicians to rapidly assess unstable patients by the bedside and is relatively inexpensive.…”

mentioning

confidence: 99%

“…Furthermore, US also aids in performing various bedside procedures (e.g., central venous catheter placement, and percutaneous drainage), and in detecting fluid collection, pneumothorax, and venous thrombosis. Hence, US has a significant impact in managing ICU patients and is replacing invasive hemodynamic monitoring in ICU [1][2][3][4][5][6][7]. Recently, several studies evaluating the use of cardiac ultrasonography (CUS) in the surgical ICU (SICU) and critically-ill trauma patients have been reported [2][3][4][5][6][7].…”

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confidence: 99%

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Evaluation of the utility of cardiac ultrasonography of patients in a surgical intensive care unit

et al. 2016

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BackgroundUltrasonography is being more commonly used by intensivists to assess the hemodynamic status of patients in intensive care units (ICUs) and for other purposes.ObjectiveTo review the indications for and evaluate the impact of cardiac ultrasonography (CUS) on the management of patients in a surgical ICU (SICU).MethodWe conducted a retrospective observational cohort study of patients in the SICU who underwent CUS performed by intensivists at King Chulalongkorn Memorial Hospital from January 2011 to March 2013. CUS was used to determine (1) preload (using inferior vena cava (IVC) diameter and collapsibility index), (2) cardiac contractility (using subjective assessment and fractional shortening), and (3) other miscellaneous findings.ResultWe included data from 157 patients (96 male and 61 female) whose age ranged from 15 to 99 years (mean 63.5 years) in the study. CUS was performed 190 times in these 157 patients. The most common indication for CUS was hemodynamic status assessment (78), followed by shock (69), oliguria (35), and other (8). CUS results led to 71 changes in management (37% of cases) ; namely, fluid challenge (38), inotropic drug management (7), drainage of pleural/abdominal fluid (12), and other changes (14). A weakly-positive correlation between the IVC diameter and CVP (Pearson’s r = 0.45) was demonstrated. The overall mortality rate was 14.6%.ConclusionCUS performed by intensivists can be used to assess the hemodynamic status of patients in the SICU, especially those with shock or oliguria, and lead to changes in the management of these patients.

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Section: Discussionmentioning

confidence: 87%

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confidence: 99%

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confidence: 99%

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Evaluation of the utility of cardiac ultrasonography of patients in a surgical intensive care unit

et al. 2016

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“…Following approval by our institutional review board, this retrospective, single-center, observational study included data from all ICU patients who had received a focused rapid echocardiographic evaluation (FREE) [4] as part of their clinical care at our academic medical center between January 2015 and April 2018. Any patient less than 18 years of age was excluded.…”

Section: Study Populationmentioning

confidence: 99%

A novel method of calculating stroke volume using point-of-care echocardiography

Aligholizadeh¹,

Teeter²,

Patel³

et al. 2020

Cardiovasc Ultrasound

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Background: Point-of-care transthoracic echocardiography (POC-TTE) is essential in shock management, allowing for stroke volume (SV) and cardiac output (CO) estimation using left ventricular outflow tract diameter (LVOTD) and left ventricular velocity time integral (VTI). Since LVOTD is difficult to obtain and error-prone, the body surface area (BSA) or a modified BSA (mBSA) is sometimes used as a surrogate (LVOTD BSA , LVOTD mBSA). Currently, no models of LVOTD based on patient characteristics exist nor have BSA-based alternatives been validated. Methods: Focused rapid echocardiographic evaluations (FREEs) performed in intensive care unit patients over a 3year period were reviewed. The age, sex, height, and weight were recorded. Human expert measurement of LVOTD (LVOTD HEM) was performed. An epsilon-support vector regression was used to derive a computer model of the predicted LVOTD (LVOTD CM). Training, testing, and validation were completed. Pearson coefficient and Bland-Altman were used to assess correlation and agreement. Results: Two hundred eighty-seven TTEs with ideal images of the LVOT were identified. LVOTD CM was the best method of SV measurement, with a correlation of 0.87. LVOTD mBSA and LVOTD BSA had correlations of 0.71 and 0.49 respectively. Root mean square error for LVOTD CM , LVOTD mBSA , and LVOTD BSA respectively were 13.3, 37.0, and 26.4. Bland-Altman for LVOTD CM demonstrated a bias of 5.2. LVOTD CM model was used in a separate validation set of 116 ideal images yielding a linear correlation of 0.83 between SV HEM and SV CM. Bland Altman analysis for SV CM had a bias of 2.3 with limits of agreement (LOAs) of − 24 and 29, a percent error (PE) of 34% and a root mean square error (RMSE) of 13.9. Conclusions: A computer model may allow for SV and CO measurement when the LVOTD cannot be assessed. Further study is needed to assess the accuracy of the model in various patient populations and in comparison to the gold standard pulmonary artery catheter. The LVOTD CM is more accurate with less error compared to BSA-based methods, however there is still a percentage error of 33%. BSA should not be used as a surrogate measure of LVOTD. Once validated and improved this model may improve feasibility and allow hemodynamic monitoring via POC-TTE once it is validated.

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“…Therefore, there is a niche for noninvasive tools, such as cardiac ultrasound, that can provide the same information with no risk to the patient that can be utilized by an experienced general anesthesiologist. Moreover, diagnostic cardiac ultrasounds have been found to retrieve similar physiological findings as PACs [20]. A focused rapid cardiac ultrasound can be an intraoperative tool to assist in the management and care of patients undergoing noncardiac surgery [3,21] and can change care [2].…”

Section: Introductionmentioning

confidence: 99%

The use of ultrasound-guided cardiac assessment in the anesthetic management for emergent noncardiac surgical patients

Hong¹,

Galvagno²,

Murthi³

2015

J Anesthesiol Clin Sci

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Background: Hemodynamic monitoring is essential in emergent noncardiac surgery. The majority of reports investigate the use of transesophageal echocardiography with beneficial results. However, this requires expertise and is associated with complications. The use of an intraoperative diagnostic cardiac ultrasound is noninvasive and can provide real-time information, in the intraoperative period, and assist in decision-making by anesthesiologists especially during hemodynamic instability. Methods: This retrospective case series of six (6) patients describes the utility of a diagnostic intraoperative cardiac ultrasound, performed by anesthesiologists, in emergent noncardiac surgical patients. The ultrasound consisted of four standard windows: the parasternal long axis (PLA), parasternal short axis (PSA), apical (AP) and sub-xyphoid (SX) views. These views were used to assess basic findings including left ventricular function, right atrial function, right ventricular function, and overall volume status and volume responsiveness. Results: This case series included six emergent noncardiac surgical patients, including trauma, general, neurosurgical and orthopedic patients. The patients were between the ages of 29 to 87 years old with an equal distribution of males and females. Information from the cardiac ultrasound exams were used to assist in decisions for induction of anesthesia, level of resuscitation, inotropic or vasopressor initiation and etiology of cardiac arrest. Conclusion: A diagnostic cardiac ultrasound is a rapid non-invasive tool that, when used by experienced anesthesiologists, provide real-time information that help guide intraoperative patient care and may ultimately improve outcome.

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Focused rapid echocardiographic evaluation versus vascular cather-based assessment of cardiac output and function in critically ill trauma patients

Abstract: III, diagnostic study.

Cited by 33 publications

References 16 publications

Evaluation of the utility of cardiac ultrasonography of patients in a surgical intensive care unit

Evaluation of the utility of cardiac ultrasonography of patients in a surgical intensive care unit

A novel method of calculating stroke volume using point-of-care echocardiography

The use of ultrasound-guided cardiac assessment in the anesthetic management for emergent noncardiac surgical patients

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