The Accuracy of Diagnostic and Haemodynamic Data Obtained by Transthoracic Echocardiography in Critically Ill Adults: A Systematic Review

Colebourn, Claire; Barber, Vikki; Salmon, Jon; Young, Duncan

doi:10.1177/175114370800900207

Cited by 13 publications

(10 citation statements)

References 20 publications

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“…Clinical parameters, such as increase in urine output or improved survival, were not studied. Strengths of this study include its prospective nature and its measurement of cardiac index by echocardiography, which is more relevant to current clinical practice, and avoids the risks of assessing cardiac index with a pulmonary artery catheter(26). This study also more closely replicates the clinical setting, as the intensivist typically treats patients in septic shock who have already received initial emergency department resuscitation.…”

Section: Discussionmentioning

confidence: 99%

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Applying Dynamic Parameters to Predict Hemodynamic Response to Volume Expansion in Spontaneously Breathing Patients With Septic Shock

Lanspa¹,

Grissom²,

Hirshberg³

et al. 2013

Shock

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Background Volume expansion is a mainstay of therapy in septic shock, although its effect is difficult to predict using conventional measurements. Dynamic parameters, which vary with respiratory changes, appear to predict hemodynamic response to fluid challenge in mechanically ventilated, paralyzed patients. Whether they predict response in patients who are free from mechanical ventilation is unknown. We hypothesized that dynamic parameters would be predictive in patients not receiving mechanical ventilation. Methods This is a prospective, observational, pilot study. Patients with early septic shock and who were not receiving mechanical ventilation received 10 ml/kg volume expansion (VE) at their treating physician's discretion after initial resuscitation in the emergency department. We used transthoracic echocardiography to measure vena cava collapsibility index (VCCI) and aortic velocity variation (AoVV) prior to VE. We used a pulse contour analysis device to measure stroke volume variation (SVV). Cardiac index was measured immediately before and after VE using transthoracic echocardiography. Hemodynamic response was defined as an increase in cardiac index ≥ 15%. Results 14 patients received VE, 5 of which demonstrated a hemodynamic response. VCCI and SVV were predictive (Area under curve = 0.83, 0.92, respectively). Optimal thresholds were calculated: VCCI ≥ 15% (Positive predictive value, PPV 62%, negative predictive value, NPV 100%, p = 0.03); SVV ≥ 17% (PPV 100%, NPV 82%, p = 0.03). AoVV was not predictive. Conclusions VCCI and SVV predict hemodynamic response to fluid challenge patients with septic shock who are not mechanically ventilated. Optimal thresholds differ from those described in mechanically ventilated patients.

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Section: Discussionmentioning

confidence: 99%

“…We used transthoracic echocardiography (TTE) to assess cardiac index, according to standard technique(26-28). Images were obtained using a Philips CX50 ultrasound system (Philips Medical Systems, Bothell, WA).…”

Section: Methodsmentioning

confidence: 99%

Applying Dynamic Parameters to Predict Hemodynamic Response to Volume Expansion in Spontaneously Breathing Patients With Septic Shock

Lanspa¹,

Grissom²,

Hirshberg³

et al. 2013

Shock

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show abstract

“…Routine use of the pulmonary artery catheter has declined because of perceptions of increased risk and lack of therapeutic benefit. Transthoracic echocardiography can accurately assess CI and may be more accurate than the pulmonary artery catheter in some clinical scenarios such as tricuspid regurgitation [19]. Another potential limitation of this study is the use of CVP.…”

Section: Discussionmentioning

confidence: 99%

“…We used transthoracic echocardiography (TTE) to assess CI, according to standard technique [19,20]. Images were obtained using a Philips CX50 ultrasound system (Philips Medical Systems, Bothell, Wash).…”

Section: Methodsmentioning

confidence: 99%

Central venous pressure and shock index predict lack of hemodynamic response to volume expansion in septic shock: A prospective, observational study

Lanspa

Brown

Hirshberg

et al. 2012

Journal of Critical Care

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Purpose Volume expansion is a common therapeutic intervention in septic shock, although patient response to the intervention is difficult to predict. Central venous pressure (CVP) and shock index have been used independently to guide volume expansion, although their use is questionable. We hypothesize that a combination of these measurements will be useful. Methods In a prospective, observational study, patients with early septic shock received 10-mL/kg volume expansion at their treating physician’s discretion after brief initial resuscitation in the emergency department. Central venous pressure and shock index were measured before volume expansion interventions. Cardiac index was measured immediately before and after the volume expansion using transthoracic echocardiography. Hemodynamic response was defined as an increase in a cardiac index of 15% or greater. Results Thirty-four volume expansions were observed in 25 patients. A CVP of 8 mm Hg or greater and a shock index of 1 beat min−1 mm Hg−1 or less individually had a good negative predictive value (83% and 88%, respectively). Of 34 volume expansions, the combination of both a high CVP and a low shock index was extremely unlikely to elicit hemodynamic response (negative predictive value, 93%; P = .02). Conclusions Volume expansion in patients with early septic shock with a CVP of 8 mm Hg or greater and a shock index of 1 beat min−1 mm Hg−1 or less is unlikely to lead to an increase in cardiac index.

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“…(27, 51, 52) TTE on the other hand, is non-invasive and, other than misdiagnosis, is practically risk-free. With modern equipment, TTE provides excellent image quality in 80–90% of critically ill patients,(16, 30, 53–55) even with hand-held portable systems(45, 56–58) and is logistically simpler than TEE. Although some intensivists employ both modalities, most favor TTE in the evaluation of hemodynamic instability.…”

Section: Techniquementioning

confidence: 99%

Focused Critical Care Echocardiography

Oren-Grinberg¹,

Talmor²,

Brown

2013

Critical Care Medicine

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Objective Portable ultrasound is now used routinely in many intensive care units (ICUs) for various clinical applications. Echocardiography performed by non-cardiologists, both transesophageal (TEE) and transthoracic (TTE), has evolved to broad applications in diagnosis, monitoring, and management of critically ill patients. This review provides a current update on Focused Critical Care Echocardiography (FCCE) for the management of critically ill patients. Method Source data were obtained from a PubMed search of the medical literature, including the PubMed “related articles” search methodology. Summary and Conclusions While studies demonstrating improved clinical outcomes for critically ill patients managed by FCCE are generally lacking, there is evidence to suggest that some intermediate outcomes are improved. Furthermore, non-cardiologists can learn FCCE and adequately interpret the information obtained. Non-cardiologists can also successfully incorporate FCCE into advanced cardiopulmonary life support (ACLS). Formal training and proctoring are important for safe application of FCCE in clinical practice. Further outcomes-based research is urgently needed to evaluate the efficacy of FCCE

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The Accuracy of Diagnostic and Haemodynamic Data Obtained by Transthoracic Echocardiography in Critically Ill Adults: A Systematic Review

Abstract: JICS 128 the critically ill. Further studies should concentrate on Doppler-based assessments. The scene is now set for the development of this valuable non-invasive tool.

Cited by 13 publications

References 20 publications

Applying Dynamic Parameters to Predict Hemodynamic Response to Volume Expansion in Spontaneously Breathing Patients With Septic Shock

Applying Dynamic Parameters to Predict Hemodynamic Response to Volume Expansion in Spontaneously Breathing Patients With Septic Shock

Central venous pressure and shock index predict lack of hemodynamic response to volume expansion in septic shock: A prospective, observational study

Focused Critical Care Echocardiography

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