Noninvasive Assessment of Acute Dyspnea in the ED

García, X.; Simon, Peter; Guyette, Francis X.; Ramani, Rama; Alvarez, René; Quintero, Jorge; Pinsky, Michael R.

doi:10.1378/chest.12-1676

Cited by 15 publications

(7 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In agreement with previous data 1, 3,37,38 , the accuracy of the initial clinical work-up for ADHF diagnosis was only moderate. The LUS-implemented approach increased the sensitivity and specificity of clinical assessment by 11.7% and 7.4%, respectively, with a NRI of 19.1%, which shows a relevant diagnostic impact of LUS in this setting.…”

Section: Discussionsupporting

confidence: 91%

Lung Ultrasound-Implemented Diagnosis of Acute Decompensated Heart Failure in the ED

Pivetta¹,

Goffi²,

Lupia³

et al. 2015

Chest

326

238

View full text Add to dashboard Cite

Section: Discussionsupporting

confidence: 91%

Lung Ultrasound-Implemented Diagnosis of Acute Decompensated Heart Failure in the ED

Pivetta¹,

Goffi²,

Lupia³

et al. 2015

Chest

326

238

View full text Add to dashboard Cite

“…It was not the purpose of this study to validate this variable, which has recently demonstrated to diagnose acute decompensated heart failure in an emergency department. 24…”

Section: Discussionmentioning

confidence: 99%

Bioreactance is not reliable for estimating cardiac output and the effects of passive leg raising in critically ill patients

Kupersztych-Hagege

Teboul

Artigas

et al. 2013

British Journal of Anaesthesia

101

View full text Add to dashboard Cite

Editor's key points † Data are conflicting regarding the accuracy and validity of non-invasive cardiovascular monitoring devices in the critically ill. † This study compared changes in cardiac index in response to passive leg raising (PLR) and volume expansion using the NICOM w and PiCCO 2 TM devices. † There was poor correlation between the two monitors after volume expansion. † The NICOM w did not predict fluid responsiveness to PLR.Background. Bioreactance estimates cardiac output in a non-invasive way. We evaluated the ability of a bioreactance device (NICOM w ) to estimate cardiac index (CI) and to track relative changes induced by volume expansion.Methods. In 48 critically ill patients, we measured CI estimated by the NICOM w device (CI Nicom ) and by transpulmonary thermodilution (CI td , PiCCO 2 TM device) before and after a 500 ml saline infusion. Before volume expansion, we performed a passive leg raising (PLR) test and measured the changes it induced in CI Nicom and in pulse contour analysis-derived CI. Results.Considering the values recorded before PLR and before and after volume expansion (n¼144), the bias (lower and upper limits of agreement) between CI td and CI Nicom was 0.9 (22.2 to 4.1) litre min 21 m 22 . The percentage error was 82%. There was no significant correlation between the changes in CI td and CI Nicom induced by volume expansion (P¼0.24). An increase in CI estimated by pulse contour analysis .9% during the PLR test predicted fluid responsiveness with a sensitivity of 84% (95% confidence interval 60-97%) and a specificity of 97% (95% confidence interval 82-100%). The area under the receiver operating characteristic curve constructed to test the ability of the PLR-induced changes in CI Nicom in predicting fluid responsiveness did not differ significantly from 0.5 (P¼0.77).Conclusions. The NICOM w device cannot accurately estimate the cardiac output in critically ill patients. Moreover, it could not predict fluid responsiveness through the PLR test.

show abstract

“…StO 2 VOT-derived estimation of cardiovascular stress during a spontaneous breathing trials (increased DeO 2 ) also identified patients who subsequently failure that trial [37]. Furthermore, Guyette et al [38], measured both the VOT StO 2 as baseline serum lactate, known to define existing cardiovascular insufficiency in trauma, in a cohort of trauma patients during the air transport to the Trauma Center.…”

Section: Identification Of Cardiovascular Insufficiencymentioning

confidence: 99%

Functional haemodynamic monitoring

Pinsky

2014

Current Opinion in Critical Care

Self Cite

View full text Add to dashboard Cite

Purpose Functional hemodynamic monitoring is the assessment of the dynamic interactions of hemodynamic variables in response to a defined perturbation. Findings Fluid responsiveness can be predicted during positive pressure breathing by variations in venous return or left ventricular output using numerous surrogate markers, like arterial pulse pressure variation (PPV), left ventricular stroke volume variation (SVV), aortic velocity variation, inferior and superior vena cavae diameter changes and pulse oximeter pleth signal variability. Similarly, dynamic changes in cardiac output to a passive leg raising maneuver can be used in any patient and measured invasively or non-invasively. However, volume responsiveness, though important, reflects only part of the overall spectrum of functional physiological variables that can be measured to define physiologic state and monitor response to therapy. The ratio of PPV to SVV defines central arterial elastance and can be used to identify those hypotensive patients who will not increase their blood pressure in response to a fluid challenge despite increasing cardiac output. Dynamic tissue O2 saturation (StO2) responses to complete stop flow conditions as can be created by measuring hand StO2 and occluding flow with a blood pressure cuff, assesses cardiovascular sufficiency and micro-circulatory blood flow distribution. They can be used to identify those ventilator-dependent subjects who will failure a spontaneous berating trial or trauma patients in need of life saving interventions. Summary Functional hemodynamic monitoring approaches are increasing in numbers, conditions in which they are useful and resuscitation protocol applications. This is a rapidly evolving field whose pluripotential is just now being realized.

show abstract

Noninvasive Assessment of Acute Dyspnea in the ED

Cited by 15 publications

References 18 publications

Lung Ultrasound-Implemented Diagnosis of Acute Decompensated Heart Failure in the ED

Lung Ultrasound-Implemented Diagnosis of Acute Decompensated Heart Failure in the ED

Bioreactance is not reliable for estimating cardiac output and the effects of passive leg raising in critically ill patients

Functional haemodynamic monitoring

Contact Info

Product

Resources

About