Measuring cardiac index with a focused cardiac ultrasound examination in the ED

Dinh, Vi Am; Ko, Hideyoshi; Rao, Reena; Bansal, Ramesh; Smith, Dorothy B.; Kim, Tae Eung; Nguyen, H. Bryant

doi:10.1016/j.ajem.2012.03.025

Cited by 68 publications

(90 citation statements)

References 34 publications

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“…Furthermore, dynamic parameters have been extensively studied, leading to greater clinical use, including respiratory changes in aortic blood velocity, superior vena cava collapsibility, IVC collapsibility, and changes in SV and CO due to passive leg raising (PLR) [14,16-19]. In addition, many studies have demonstrated that echocardiography [2,16,18,20] offers a non-invasive, dynamic, and qualitative assessment of volume responsiveness in patients with hemodynamic failure, such as changes in the velocity time integral.…”

Section: Introductionmentioning

confidence: 99%

A 10-second fluid challenge guided by transthoracic echocardiography can predict fluid responsiveness

Zhou

et al. 2014

Crit Care

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IntroductionThe accurate assessment of intravascular volume status for the therapy of severe hypovolemia and shock is difficult and critical to critically ill patients. Non-invasive evaluation of fluid responsiveness by the rapid infusion of a very limited amount of volume is an important clinical goal. This study aimed to test whether echocardiographic parameters could predict fluid responsiveness in critically ill patients following a low-volume (50-ml crystalloid solution) infusion over 10 seconds.MethodsWe prospectively studied 55 mechanically ventilated patients. Echocardiography was performed during a 50-ml infusion of crystalloid solution over 10 seconds and a further 450 ml over 15 minutes. Cardiac output (CO), stroke volume (SV), aortic velocity time index (VTI), and left ventricular ejection fraction (LVEF) were recorded. Patients were classified as responders (Rs) if CO increased by at least 15% following the 500-ml volume expansion or were classified as non-responders (NRs) if CO increased by less than 15%. Area under the receiver operating characteristic curves (AUC) compared CO variations after 50 ml over 10 seconds (∆CO50) and 500 ml over 15 minutes (∆CO500) and the variation of VTI after infusion of 50 ml of fluid over 10 seconds (∆VTI50).ResultsIn total, 50 patients were enrolled, and 27 (54%) of them were Rs. General characteristics, LVEF, heart rate, and central venous pressure were similar between Rs and NRs. In the Rs group, the AUC for ∆CO50 was 0.95 ± 0.03 (P <0.01; best cutoff value, 6%; sensitivity, 93%; specificity, 91%). Moreover, ∆CO50 and ∆CO500 were strongly correlated (r = 0.87; P <0.01). The AUC for ∆VTI50 was 0.91 ± 0.04 (P <0.01; best cutoff value, 9%; sensitivity, 74%; specificity, 95%). ∆VTI50 and ∆CO500 were positively correlated (r = 0.72; P <0.01).ConclusionIn critically ill patients, the variation of CO and VTI after the administration of 50-ml crystalloid solution over 10 seconds (∆CO50 and ∆VTI50) can accurately predict fluid responsiveness.Trial registrationCurrent Controlled Trials ISRCTN10524328. Registered 12 December 2013.

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Section: Introductionmentioning

confidence: 99%

A 10-second fluid challenge guided by transthoracic echocardiography can predict fluid responsiveness

Zhou

et al. 2014

Crit Care

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Section: Discussionmentioning

confidence: 99%

“…To the best of our knowledge, this work was the first study in the emergency department looking at noninvasive bedside echocardiography for volume responsiveness. A study done by Dinh et al 22 in 2012 showed that emergency physicians can accurately measure the VTI and cardiac output. In contrast to the prior VTI studies, we did not challenge our patients with a fluid bolus, but, rather, we removed the fluid via hemodialysis, and we looked at the effect of the passive leg raise once these patients had this fluid taken off.…”

Section: Discussionmentioning

confidence: 99%

Bedside Echocardiography and Passive Leg Raise as a Measure of Volume Responsiveness in the Emergency Department

Chebl

Wuhantu

Kiblawi

et al. 2018

J of Ultrasound Medicine

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Objectives The aim of this study was to investigate the value of bedside echocardiography with a passive leg raise as a noninvasive marker of volume responsiveness. Methods This work was a prospective observational study of patients with end‐stage renal disease presenting to the emergency department. The left ventricular outflow tract (LVOT) velocity time integral (VTI) was obtained. Measurements before and after dialysis as well as before and after the passive leg raise were recorded. Results Fifty‐four patients were enrolled, in whom the mean volume of fluid removed ± SD was 3.89 ± 0.91 L. In the predialysis cohort, the mean LVOT VTI was 28.05 cm (95% confidence interval [CI], 26.55–29.55 cm). After the passive leg raise, the mean VTI was 28.52 cm (95% CI, 26.98–30.07 cm). In the postdialysis cohort, the mean VTI was 30.31 cm (95% CI, 28.92–31.69 cm), and it increased to 34.91 cm (95% CI, 33.11–36.72 cm) after the passive leg raise. The Δ VTI values were 1.83% (95% CI, 0.12%–3.55%) in the predialysis group and 15.05% (95% CI, 12.76%–17.34%) in the postdialysis cohort. When stratified by fluid removal, the mean Δ VTI values after hemodialysis were 12.64% (95% CI, 9.79%–15.49%) and 16.84% (95% CI, 13.47%–20.22%) for patients who had less than 4 L and 4 L or greater removed, respectively. In patients without congestive heart failure, the Δ VTI was 15.28% (95% CI, 12.25%–18.32%), whereas for those with congestive heart failure, the mean change was 14.63% (95% CI, 10.91%–18.35%). Conclusions The LVOT VTI in conjunction with a passive leg raise seems to correlate with the volume status and volume responsiveness.

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“…[105][106] In addition hemodynamic assessment with US for preload, cardiac function, and afterload has become an accepted diagnostic and monitoring tool. [107][108][109][110][111][112][113][114][115][116] Hepatobiliary System…”

Section: Emergent Echocardiography and Hemodynamic Assessmentmentioning

confidence: 99%

Ultrasound Guidelines: Emergency, Point-of-Care and Clinical Ultrasound Guidelines in Medicine

2017

Annals of Emergency Medicine

468

120

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Measuring cardiac index with a focused cardiac ultrasound examination in the ED

Cited by 68 publications

References 34 publications

A 10-second fluid challenge guided by transthoracic echocardiography can predict fluid responsiveness

A 10-second fluid challenge guided by transthoracic echocardiography can predict fluid responsiveness

Bedside Echocardiography and Passive Leg Raise as a Measure of Volume Responsiveness in the Emergency Department

Ultrasound Guidelines: Emergency, Point-of-Care and Clinical Ultrasound Guidelines in Medicine

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