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Parulekar P, Powys-Lybbe J, Bassett P, Roques S, Snazelle M, Millen G, Harris T. Comparison of cardiac index measurements in intensive care patients using continuous wave vs. pulsed wave echo-Doppler compared to pulse contour cardiac output. Intensive Care Med Exp 2023; 11:23. [PMID: 37106217 PMCID: PMC10140233 DOI: 10.1186/s40635-023-00499-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 02/10/2023] [Indexed: 04/29/2023] Open
Abstract
PURPOSE Cardiac index (CI) assessments are commonly used in critical care to define shock aetiology and guide resuscitation. Echocardiographic assessment is non-invasive and has high levels of agreement with thermodilution assessment of CI. CI assessment is derived from the velocity time integral (VTI) assessed using pulsed wave (PW) doppler at the level of the left ventricular outflow tract divided by body mass index. Continuous wave (CW) doppler through the aortic valve offers an alternative means to assess VTI and may offer better assessment at high velocities. METHODS We performed a single centre, prospective, observational study in a 15-bed intensive care unit in a busy district general hospital. Patients had simultaneous measurements of cardiac index by Pulse Contour Cardiac Output (PiCCO) (thermodilution), transthoracic echocardiographic PW-VTI and CW-VTI. Mean differences were measured with Bland-Altman limits of agreement and percentage error (PE) calculations. RESULTS Data were collected on 52 patients. 71% were supported with noradrenaline with or without additional inotropic or vasopressor agents. Mean CIs were: CW-VTI 2.7 L/min/m2 (range 0.78-5.11, SD 0.92). PW-VTI 2.33 L/min/m2 (range 0.77-5.40, SD 0.90) and PiCCO 2.86 L/min/m2 (range 1.50-5.56, SD 0.93). CW-VTI and PiCCO mean difference was - 0.16 L/min/m2 PE 43.5%. PW-VTI and PiCCO had a mean difference of - 0.54 L/min/m2 PE 38.6%. CW-VTI and PW-VTI had a mean difference of 0.38 L/min/m2 PE 46.0%. CONCLUSIONS CI derived from both CW-VTI and PW-VTI methods underestimate CI compared to PiCCO, with the CW-VTI method having closer values overall to PiCCO. CW-VTI may offer a more accurate assessment of CI. If using Critchley's PE cutoff of 30%, none of the doppler methods may accurately reflect the actual cardiac index.
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Affiliation(s)
- Prashant Parulekar
- Intensive Care and Acute Medicine, East Kent Hospitals University NHS Foundation Trust, William Harvey Hospital, London, UK.
| | | | | | - Seb Roques
- East Kent Hospitals University NHS Foundation Trust, William Harvey, London, UK
| | - Mark Snazelle
- East Kent Hospitals University NHS Foundation Trust, William Harvey, London, UK
| | - Gemma Millen
- East Kent Hospitals University NHS Foundation Trust, William Harvey, London, UK
| | - Tim Harris
- East Kent Hospitals University NHS Foundation Trust, William Harvey, London, UK
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Pellegrini JAS, Mendes CL, Gottardo PC, Feitosa K, John JF, de Oliveira ACT, Negri AJDA, Grumann AB, Barros DDS, Negri FEFDO, de Macedo GL, Neves JLB, Rodrigues MDS, Spagnól MF, Ferez MA, Chalhub RÁ, Cordioli RL. The use of bedside echocardiography in the care of critically ill patients - a joint consensus document of the Associação de Medicina Intensiva Brasileira, Associação Brasileira de Medicina de Emergência and Sociedade Brasileira de Medicina Hospitalar. Part 2 - Technical aspects. CRITICAL CARE SCIENCE 2023; 35:117-146. [PMID: 37712802 PMCID: PMC10406406 DOI: 10.5935/2965-2774.20230310-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 01/12/2023] [Indexed: 09/16/2023]
Abstract
Echocardiography in critically ill patients has become essential in the evaluation of patients in different settings, such as the hospital. However, unlike for other matters related to the care of these patients, there are still no recommendations from national medical societies on the subject. The objective of this document was to organize and make available expert consensus opinions that may help to better incorporate echocardiography in the evaluation of critically ill patients. Thus, the Associação de Medicina Intensiva Brasileira, the Associação Brasileira de Medicina de Emergência, and the Sociedade Brasileira de Medicina Hospitalar formed a group of 17 physicians to formulate questions relevant to the topic and discuss the possibility of consensus for each of them. All questions were prepared using a five-point Likert scale. Consensus was defined a priori as at least 80% of the responses between one and two or between four and five. The consideration of the issues involved two rounds of voting and debate among all participants. The 27 questions prepared make up the present document and are divided into 4 major assessment areas: left ventricular function, right ventricular function, diagnosis of shock, and hemodynamics. At the end of the process, there were 17 positive (agreement) and 3 negative (disagreement) consensuses; another 7 questions remained without consensus. Although areas of uncertainty persist, this document brings together consensus opinions on several issues related to echocardiography in critically ill patients and may enhance its development in the national scenario.
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Affiliation(s)
- José Augusto Santos Pellegrini
- Department of Intensive Care, Hospital de Clínicas de Porto
Alegre, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brazil
| | - Ciro Leite Mendes
- Department of Intensive Care, Hospital Universitário Lauro
Wanderley - João Pessoa (PB), Brazil
| | - Paulo César Gottardo
- Department of Intensive Care, Hospital Nossa Senhora das Neves -
João Pessoa (PB), Brazil
| | - Khalil Feitosa
- Department of Emergency Medicine, Hospital Geral de Fortaleza -
Fortaleza (CE), Brazil
| | - Josiane França John
- Department of Intensive Care, Hospital de Clínicas de Porto
Alegre, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brazil
| | | | | | - Ana Burigo Grumann
- Department of Intensive Care, Hospital Nereu Ramos -
Florianópolis (SC), Brazil
| | - Dalton de Souza Barros
- Cardiovascular Intensive Care Unit, Hospital Cardiopulmonar
Instituto D’Or - Salvador (BA), Brazil
| | | | | | | | - Márcio da Silveira Rodrigues
- Department of Emergency, Hospital de Clínicas de Porto
Alegre, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brazil
| | | | - Marcus Antonio Ferez
- Intensive Care Unit, Hospital Beneficência Portuguesa -
Ribeirão Preto (SP), Brazil
| | - Ricardo Ávila Chalhub
- Department of Echocardiogram, Hospital Santo Antônio, Obras
Sociais Irmã Dulce - Salvador (BA), Brazil
| | - Ricardo Luiz Cordioli
- Department of Intensive Care, Hospital Israelita Albert Einstein -
São Paulo (SP), Brazil
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Sullivan K, Metoyer CJ, Hornikel B, Holmes CJ, Nickerson BS, Esco MR, Fedewa MV. Agreement Between A 2-Dimensional Digital Image-Based 3-Compartment Body Composition Model and Dual Energy X-Ray Absorptiometry for The Estimation of Relative Adiposity. J Clin Densitom 2022; 25:244-251. [PMID: 34756706 PMCID: PMC8942865 DOI: 10.1016/j.jocd.2021.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 08/17/2021] [Accepted: 08/30/2021] [Indexed: 10/20/2022]
Abstract
The purpose of this study was to compare relative adiposity (%Fat) derived from a 2-dimensional image-based 3-component (3C) model (%Fat3C-IMAGE) and dual-energy X-ray absorptiometry (DXA) (%FatDXA) against a 5-component (5C) laboratory criterion (%Fat5C). 57 participants were included (63.2% male, 84.2% White/Caucasian, 22.5±4.7 yrs., 23.9±2.8 kg/m2). For each participant, body mass and standing height were measured to the nearest 0.1 kg and 0.1 cm, respectively. A digital image of each participant was taken using a 9.7 inch, 16g iPad Air 2 and analyzed using a commercially available application (version 1.1.2, made Health and Fitness, USA) for the estimation of body volume (BV) and inclusion in %Fat3C-IMAGE . %Fat3C-IMAGE and %Fat5C included measures of total body water derived from bioimpedance spectroscopy. The criterion %Fat5C included BV estimates derived from underwater weighing and bone mineral content measures via DXA. %FatDXA estimates were calculated from a whole-body DXA scan. A standardized mean effect size (ES) assessed the magnitude of differences between models with values of 0.2, 0.5, and 0.8 for small, moderate, and large differences, respectively. Data are presented as mean ± standard deviation. A strong correlation (r = 0.94, p <.001) and small mean difference (ES = 0.24, p <.001) was observed between %Fat3C-IMAGE (19.20±5.80) and %Fat5C (17.69±6.20) whereas a strong correlation (r = 0.87, p <.001) and moderate-large mean difference (ES = 0.70, p <.001) was observed between %FatDXA (22.01±6.81) and %Fat5C. Furthermore, %Fat3C-IMAGE (SEE = 2.20 %Fat, TE= 2.6) exhibited smaller SEE and TE than %FatDXA (SEE = 3.14 %Fat, TE = 5.5). The 3C image-based model performed slightly better in our sample of young adults than the DXA 3C model. Thus, the 2D image analysis program provides an accurate and non-invasive estimate of %Fat within a 3C model in young adults. Compared to DXA, the 3C image-based model allows for a more cost-effective and portable method of body composition assessment, potentially increasing accessibility to multi-component methods.
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Affiliation(s)
- Katherine Sullivan
- Department of Kinesiology, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Casey J Metoyer
- Department of Kinesiology, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Bjoern Hornikel
- Department of Kinesiology, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Clifton J Holmes
- Department of Kinesiology, The University of Alabama, Tuscaloosa, Alabama, USA; Program in Physical Therapy, School of Medicine, Washington University, Saint Louis, Missouri, USA
| | - Brett S Nickerson
- College of Nursing and Health Sciences, Texas A&M International University, Laredo, Texas, USA
| | - Michael R Esco
- Department of Kinesiology, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Michael V Fedewa
- Department of Kinesiology, The University of Alabama, Tuscaloosa, Alabama, USA.
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Genecand L, Adler D, Beghetti M, Lador F. Cardiac Output Determination in Precapillary Pulmonary Hypertension: A Systematic Review. Respiration 2021; 100:1243-1250. [PMID: 34256370 DOI: 10.1159/000517084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 05/06/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Cardiac output determination is essential in precapillary pulmonary hypertension. While direct Fick is the gold standard, thermodilution is commonly used as the reference method. Moving to noninvasive methods would be highly beneficial for patients, avoiding repetitive invasive assessments. This systematic review followed 3 objectives: (1) assessing the validity of indirect Fick and thermodilution in precapillary pulmonary hypertension, (2) assessing the interchangeability of noninvasive cardiac output measurement methods against reference methods in precapillary pulmonary hypertension, and (3) detecting methodological heterogeneity in the included studies. METHODS We systematically reviewed the literature using medical databases and following PRISMA guidelines. We included articles comparing an invasive or noninvasive cardiac output measurement method with thermodilution or direct Fick in precapillary pulmonary hypertension patients. Cutoffs of limits of agreement and percentage error derived from the Bland and Altman graph were used to accept interchangeability. To study methodological heterogeneity, we extracted 9 quality criteria from all studies. RESULTS Eleven studies were included. None reached the suggested interchangeability criteria. The median number of the 9 assessed quality criteria was 2 with interquartile range (0-4). CONCLUSIONS Further studies evaluating the reliability of thermodilution and the consequences of its use in precapillary pulmonary hypertension patients are necessary. No evidence supports the use of indirect Fick in precapillary pulmonary hypertension. The studied noninvasive methods could not be considered interchangeable with invasive methods. A robust methodology should be used to draw sensible conclusions.
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Affiliation(s)
- Léon Genecand
- Geneva Medical University, Geneva University Hospitals, Geneva, Switzerland, .,Internal Medicine Department, Riviera Chablais Hospital, Rennaz, Switzerland, .,Pulmonary Hypertension Program, Geneva University Hospitals, Geneva, Switzerland,
| | - Dan Adler
- Division of Pulmonary Diseases, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Maurice Beghetti
- Pulmonary Hypertension Program, Geneva University Hospitals, Geneva, Switzerland.,Paediatric Cardiology Unit, Geneva University Hospitals, Switzerland, Centre Universitaire Romand de Cardiologie et Chirurgie Cardiaque Pédiatrique, University of Geneva and Lausanne, Geneva, Switzerland
| | - Frédéric Lador
- Pulmonary Hypertension Program, Geneva University Hospitals, Geneva, Switzerland.,Division of Pulmonary Diseases, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
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The Accuracy of Acquiring Heart Rate Variability from Portable Devices: A Systematic Review and Meta-Analysis. Sports Med 2020; 49:417-435. [PMID: 30706234 DOI: 10.1007/s40279-019-01061-5] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Advancements in wearable technology have provided practitioners and researchers with the ability to conveniently measure various health and/or fitness indices. Specifically, portable devices have been devised for convenient recordings of heart rate variability (HRV). Yet, their accuracies remain questionable. OBJECTIVE The aim was to quantify the accuracy of portable devices compared to electrocardiography (ECG) for measuring a multitude of HRV metrics and to identify potential moderators of this effect. METHODS This meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Articles published before July 29, 2017 were located via four electronic databases using a combination of the terms related to HRV and validity. Separate effect sizes (ESs), defined as the absolute standardized difference between the HRV value recorded using the portable device compared to ECG, were generated for each HRV metric (ten metrics analyzed in total). A multivariate, multi-level model, incorporating random-effects assumptions, was utilized to quantify the mean ES and 95% confidence interval (CI) and explore potential moderators. RESULTS Twenty-three studies yielded 301 effects and revealed that HRV measurements acquired from portable devices differed from those obtained from ECG (ES = 0.23, 95% CI 0.05-0.42), although this effect was small and highly heterogeneous (I2 = 78.6%, 95% CI 76.2-80.7). Moderator analysis revealed that HRV metric (p <0.001), position (p = 0.033), and biological sex (β = 0.45, 95% CI 0.30-0.61; p <0.001), but not portable device, modulated the degree of absolute error. Within metric, absolute error was significantly higher when expressed as standard deviation of all normal-normal (R-R) intervals (SDNN) (ES = 0.44) compared to any other metric, but was no longer significantly different after a sensitivity analysis removed outliers. Likewise, the error associated with the tilt/recovery position was significantly higher than any other position and remained significantly different without outliers in the model. CONCLUSIONS Our results suggest that HRV measurements acquired using portable devices demonstrate a small amount of absolute error when compared to ECG. However, this small error is acceptable when considering the improved practicality and compliance of HRV measurements acquired through portable devices in the field setting. Practitioners and researchers should consider the cost-benefit along with the simplicity of the measurement when attempting to increase compliance in acquiring HRV measurements.
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Boisson M, Poignard ME, Pontier B, Mimoz O, Debaene B, Frasca D. Cardiac output monitoring with thermodilution pulse‐contour analysis vs. non‐invasive pulse‐contour analysis. Anaesthesia 2019; 74:735-740. [DOI: 10.1111/anae.14638] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2019] [Indexed: 11/28/2022]
Affiliation(s)
- M. Boisson
- Service d'anesthésie‐réanimation CHU de Poitiers France
| | | | - B. Pontier
- Service d'anesthésie‐réanimation CHU de Poitiers France
| | - O. Mimoz
- Service des Urgences CHU de Poitiers France
| | - B. Debaene
- Service d'anesthésie‐réanimation CHU de Poitiers France
| | - D. Frasca
- Service d'anesthésie‐réanimation CHU de Poitiers France
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Chen S, Leeton L, Castro J, Dennis A. Myocardial tissue characterisation and detection of myocardial oedema by cardiovascular magnetic resonance in women with pre-eclampsia: a pilot study. Int J Obstet Anesth 2018; 36:56-65. [DOI: 10.1016/j.ijoa.2018.07.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 07/23/2018] [Accepted: 07/30/2018] [Indexed: 01/19/2023]
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Abstract
PURPOSE OF REVIEW This article introduces the haemodynamic principles that underpin the pathophysiology of hypertension and introduces a rational physiological approach to appropriate pharmacologic treatment. RECENT FINDINGS Outdated understanding of haemodynamics based on previous measurement systems can no longer be applied to our understanding of the circulation. We question the current view of hypertension as defined by a predominantly systolic blood pressure and introduce the concept of vasogenic, cardiogenic and mixed-origin hypertension. We postulate that failure to identify the individual's haemodynamic pattern may lead to the use of inappropriate medication, which in turn may be a major factor in patient non-compliance with therapeutic strategies. A population-based approach to treatment of hypertension may lead to suboptimal functional dynamics in the individual patient. Finally, we question the validity of current guidelines and published evidence relating morbidity and mortality to the future treatment of hypertension. The importance of individual haemodynamic profiles may be pivotal in the understanding, diagnosis and treatment of hypertension if optimal control with minimal adverse effects is to be achieved. Research based on individual haemodynamic patterns is overdue.
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