Arrêt de service programmé du vendredi 10 juin 16h jusqu’au lundi 13 juin 9h. Pour en savoir plus
Accéder directement au contenu Accéder directement à la navigation
Article dans une revue

Transthoracic echocardiography: an accurate and precise method for estimating cardiac output in the critically ill

Abstract : Background: Cardiac output (CO) monitoring is a valuable tool for the diagnosis and management of critically ill patients. In the critical care setting, few studies have evaluated the level of agreement between CO estimated by transthoracic echocardiography (CO-TTE) and that measured by the reference method, pulmonary artery catheter (CO-PAC). The objective of the present study was to evaluate the precision and accuracy of CO-TTE relative to CO-PAC and the ability of transthoracic echocardiography to track variations in CO, in critically ill mechanically ventilated patients. Methods: Thirty-eight mechanically ventilated patients fitted with a PAC were included in a prospective observational study performed in a 16-bed university hospital ICU. CO-PAC was measured via intermittent thermodilution. Simultaneously, a second investigator used standard-view TTE to estimate CO-TTE as the product of stroke volume and the heart rate obtained during the measurement of the subaortic velocity time integral. Results: Sixty-four pairs of CO-PAC and CO-TTE measurements were compared. The two measurements were significantly correlated (r = 0.95; p < 0.0001). The median bias was 0.2 L/min, the limits of agreement (LOAs) were -1.3 and 1.8 L/min, and the percentage error was 25%. The precision was 8% for CO-PAC and 9% for CO-TTE. Twenty-six pairs of Delta CO measurements were compared. There was a significant correlation between Delta CO-PAC and Delta CO-TTE (r = 0.92; p < 0.0001). The median bias was -0.1 L/min and the LOAs were -1.3 and + 1.2 L/min. With a 15% exclusion zone, the four-quadrant plot had a concordance rate of 94%. With a 0.5 L/min exclusion zone, the polar plot had a mean polar angle of 1.0 degrees and a percentage error LOAs of -26.8 to 28.8 degrees. The concordance rate was 100% between 30 and -30 degrees. When using CO-TTE to detect an increase in Delta CO-PAC of more than 10%, the area under the receiving operating characteristic curve (95% CI) was 0.82 (0.62-0.94) (p< 0.001). A Delta CO-TTE of more than 8% yielded a sensitivity of 88% and specificity of 66% for detecting a Delta CO-PAC of more than 10%. Conclusion: In critically ill mechanically ventilated patients, CO-TTE is an accurate and precise method for estimating CO. Furthermore, CO-TTE can accurately track variations in CO.
Type de document :
Article dans une revue
Liste complète des métadonnées

https://hal-u-picardie.archives-ouvertes.fr/hal-03577872
Contributeur : Louise Dessaivre Connectez-vous pour contacter le contributeur
Soumis le : mercredi 16 février 2022 - 18:57:56
Dernière modification le : vendredi 18 février 2022 - 03:22:48

Lien texte intégral

Identifiants

Citation

Pablo Mercado, Julien Maizel, Christophe Beyls, Dimitri Titeca-Beauport, Magalie Joris, et al.. Transthoracic echocardiography: an accurate and precise method for estimating cardiac output in the critically ill. Critical Care, 2017, 21, ⟨10.1186/s13054-017-1737-7⟩. ⟨hal-03577872⟩

Partager

Métriques

Consultations de la notice

7