Clinical evaluation compared to pulmonary artery catheterization in the hemodynamic assessment of critically ill patients

Eisenberg, Paul R.; Jaffe, Allan S.; Schuster, Daniel P.

doi:10.1097/00003246-198407000-00001

Cited by 378 publications

(121 citation statements)

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“…Moreover, it should be underscored that in the recent ESCAPE trial (3), renal function was worsened in the group where treatment was guided only by expert clinical assessment, whereas it did not worsen when treatment was directed at lowering invasively measured right atrial pressure. Since clinical examination has been shown to be an unreliable tool to assess CVP (30), thus in our case record, 'inappropriate' administration, e.g. intravenous diuretics to patients with high IVCCI -low CVP, may occur and might worsen renal function.…”

Section: Discussionmentioning

confidence: 94%

Ultrasound evaluation of the inferior vena cava collapsibility index in congestive heart failure patients treated with intravenous diuretics: new insights about its relationship with renal function: An observational study

Vecchis¹,

Ariano²,

Fusco³

et al. 2012

Anadolu Kardiyol Derg

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Ultrasound evaluation of the inferior vena cava collapsibility index in congestive heart failure patients treated with intravenous diuretics: new insights about its relationship with renal function: An observational study ABSTRACTObjective: In chronic heart failure (CHF), collapsibility index of the inferior vena cava (IVCCI) is used for noninvasive ultrasonographic appraisal of central venous pressure, but it also may be related both to estimated glomerular filtration rate (eGFR) and renal outcome. Methods: On the basis of retrospective observational cohort study, we analyzed 49 patients with right or biventricular CHF in III NYHA class, who had undergone intravenous intensive treatment with furosemide. Aggravated renal dysfunction (ARD) was defined by serum creatinine (Cr) increase of ≥0.3 mg/dL from baseline. IVCCI was categorized in three layers (IVCCI ≤15%, IVCCI 16-40% and IVCCI >40%). The predictors of ARD were searched for as well as any relation between basal IVCCI and both eGFR at admission and occurrence of ARD. Results: Overall, 15 cases and 34 controls were compared. Multivariate predictors of ARD were a lower basal eGFR (HR: 0.82 CI: 0.72-0.94 p=0.0045) and intravenous furosemide daily mean dose >80 mg (HR: 48.62 CI: 1.62-3841.5 p=0.0430). A very significant positive correlation was found between IVCCI at admission ≤ 15% and basal eGFR (r=0.96 p<0.0001), while a negative correlation with eGFR was detected in the IVCCI highest (>40%) range (r=-0.696 p=0.0013). Furthermore, the category with basal IVCCI >40% showed a higher rate of ARD compared to that with basal IVCCI 16-40% (p<0.05). Conclusion:On the basis of the demonstrated u-shaped relationship between IVCCI and eGFR both the stratum with the highest (>40%) and the one with the lowest (≤15%) basal IVCCI may be associated with increased risk of ARD. (Anadolu Kardiyol Derg 2012; 12: 391-400) Key words: Heart failure, ultrasound monitoring, inferior vena cava, diuretics, acute kidney injury, regression analysis

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Section: Discussionmentioning

confidence: 94%

Ultrasound evaluation of the inferior vena cava collapsibility index in congestive heart failure patients treated with intravenous diuretics: new insights about its relationship with renal function: An observational study

Vecchis¹,

Ariano²,

Fusco³

et al. 2012

Anadolu Kardiyol Derg

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“…A quick-scan is suited to acute settings, including the acute medical unit, inpatients, 7,11-13 emergency department, 8 cardiac arrests, intensive care, 14,15 the perioperative period, 5 and special situations, such as mobile medical units, disaster zones and battle zones. 4,[15][16][17][18] In cardiac arrest, a quick-scan can identify or indicate the presence of reversible causes of pulseless electrical activity (PEA), and distinguish true PEA, which carries a worse prognosis, from pseudo-PEA. 19,20 A quick-scan can be used to triage those who need a standard echocardiogram and contributes to clinical risk stratifi cation.…”

Section: Clinical Applications Advantages and Limitations In Acute Mmentioning

confidence: 99%

Point-of-care cardiac ultrasound in acute medicine – the quick scan

2014

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Point-of-care cardiac ultrasound in acute medicine -the quick scanThe optimum management of acute medical patients requires prompt and accurate diagnosis, monitoring and treatment. The clinical history and physical examination remain central to diagnosis, but often need supplementation by laboratory testing or imaging. Echocardiographic assessment of cardiac structure and function provides valuable information that can aid diagnosis and assess clinical progress. It has many advantages as an imaging modality, and recent technological advances have resulted in hand-held, battery-powered ultrasound devices that provide high-quality images. Three broad applications of cardiac ultrasound now exist: conventional echocardiography, focussed echocardiography and the quick-scan. A quick-scan using a hand-held ultrasound device is readily integrated into the bedside clinical assessment, providing information that can be used immediately in diagnostic reasoning; it can also guide pericardiocentesis. Hand-held ultrasound devices can also be used in acute situations, as well as geographically remote areas or special situations (eg disaster zones) where other imaging is not available. However, the diagnostic yield of echocardiography is user dependent, and training is required for its benefi ts to be realised, adding to the hardware costs. More data are needed on the incremental value of hand-held ultrasonography and a quickscan over conventional methods of assessment, their impact on clinical outcomes, and cost effectiveness.

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“…However, the accuracy of clinical assessment of central hemodynamics is limited. 1 Consequently, a dynamic biomarker of heart failure status, and more specifically pulmonary edema, might aid in the management of this chronic, relapsing condition.…”

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confidence: 99%

Plasma Surfactant Protein-B

Pasquale

Arnolda²,

Doyle³

et al. 2004

Circulation

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Background-In chronic heart failure (CHF), elevated pulmonary microvascular pressure (P mv ) results in pulmonary edema. Because elevated P mv may alter the integrity of the alveolocapillary barrier, allowing leakage of surfactant protein-B (SP-B) from the alveoli into the circulation, we aimed to determine plasma levels of SP-B in CHF and their relation to clinical status. Methods and Results-Fifty-three outpatients with CHF had plasma SP-B and N-terminal proBNP (NT-proBNP) assayed, in addition to a formalized clinical assessment at each clinic review over a period of 18 months. The control group comprised 19 normal volunteers. Plasma SP-B was elevated in CHF (PϽ0.001), and levels increased with New York Heart Association classification (PϽ0.001). SP-B correlated with objective clinical status parameters and NT-proBNP. During follow-up, major cardiovascular events occurred in patients with higher plasma SP-B (PϽ0.01) and NT-proBNP (PϽ0.05). Furthermore, on conditional logistic regression analysis, only SP-B was independently associated with CHF hospitalization (Pϭ0.005). The 53 patients underwent a total of 210 outpatient visits. When the diuretic dosage was increased on clinical grounds, SP-B had increased 39% (PϽ0.001) and NT-proBNP had increased 32% (PϽ0.001).Conversely, at the next visit, SP-B fell 12% (PϽ0.001), whereas NT-proBNP fell 39% (PϽ0.001). Conclusions-Plasma SP-B is increased in CHF, and levels are related to clinical severity. Furthermore, within individual patients, SP-B levels vary with dynamic clinical status and NT-proBNP levels. Because plasma SP-B is independently associated with CHF hospitalization, it may, by virtue of its differing release mechanism to NT-proBNP, be a clinically useful biomarker of the pulmonary consequences of raised P mv .

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Clinical evaluation compared to pulmonary artery catheterization in the hemodynamic assessment of critically ill patients

Cited by 378 publications

References 0 publications

Ultrasound evaluation of the inferior vena cava collapsibility index in congestive heart failure patients treated with intravenous diuretics: new insights about its relationship with renal function: An observational study

Ultrasound evaluation of the inferior vena cava collapsibility index in congestive heart failure patients treated with intravenous diuretics: new insights about its relationship with renal function: An observational study

Point-of-care cardiac ultrasound in acute medicine – the quick scan

Plasma Surfactant Protein-B

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