PMID- 19737122
OWN - NLM
STAT- MEDLINE
DCOM- 20091020
LR  - 20181201
IS  - 1441-2772 (Print)
IS  - 1441-2772 (Linking)
VI  - 11
IP  - 3
DP  - 2009 Sep
TI  - Assessment of the clinical utility of an ultrasonic monitor of cardiac output 
      (the USCOM) and agreement with thermodilution measurement.
PG  - 198-203
AB  - OBJECTIVE: To assess the clinical utility of an ultrasonic monitor of cardiac 
      output (USCOM), its reliability in tracking cardiac output (CO) changes and 
      agreement with thermodilution (TD) measurements of CO. DESIGN: Prospective 
      comparison study. SETTING AND PARTICIPANTS: 55 adults undergoing thermodilution 
      (TD) CO monitoring in a cardiothoracic or general intensive care unit between 
      December 2006 and December 2007. MAIN OUTCOME MEASURES: USCOM and TD measurements 
      of CO on two occasions in each patient were compared by Bland-Altman analysis for 
      bias and limit of agreement. A mean percentage error <30% was considered 
      acceptable. Per cent change in cardiac index (CI) was determined by each method. 
      Doppler profiles obtained by the USCOM were assessed against an ideal standard 
      ("acceptable"). RESULTS: 55 patients had measurements on 110 occasions, but 
      Doppler waveforms were not obtained on 18 of these (16%), leaving 39 patients 
      with paired comparisons for analysis (including 27 men; mean age, 64.7 [SD, 14.5] 
      years). Mean TD CI was 3.4 +/-1.0L/min/m(2) (range, 2.0-6.0L/min/m(2)). The bias 
      was 0.6L/min/m(2) (95% confidence limits [CLs], 0.4-0.8 L/min/m(2)), and the mean 
      percentage error was 56% (95% CLs, 45%-65%). Twenty-two Doppler profiles (28%) 
      were classed as acceptable; the mean percentage error for these was 62% (95% CLs, 
      38%-65%). On 15/19 occasions (74%) where TD CI changed > 15%, USCOM CI also 
      changed >15%, but three of these changes (16%) were in the opposite direction. 
      USCOM CI changed >15% on 9/20 occasions (45%) when TD CI did not. CONCLUSIONS: 
      Poor agreement with TD and a substantial rate of failure to obtain an USCOM 
      measurement suggest that this device is unsuitable as a monitoring tool in 
      intensive care.
FAU - Boyle, Martin
AU  - Boyle M
AD  - Department of Intensive Care, Prince of Wales Hospital, Sydney, NSW. 
      martin.boyle@sesiahs.health.nsw.gov.au
FAU - Steel, Liz
AU  - Steel L
FAU - Flynn, Gordon M
AU  - Flynn GM
FAU - Murgo, Margherita
AU  - Murgo M
FAU - Nicholson, Lisa
AU  - Nicholson L
FAU - O'Brien, Maureen
AU  - O'Brien M
FAU - Bihari, David
AU  - Bihari D
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - Netherlands
TA  - Crit Care Resusc
JT  - Critical care and resuscitation : journal of the Australasian Academy of Critical 
      Care Medicine
JID - 100888170
SB  - IM
MH  - Aged
MH  - Cardiac Surgical Procedures
MH  - Echocardiography, Doppler/*statistics & numerical data
MH  - Female
MH  - Follow-Up Studies
MH  - Heart Diseases/*diagnosis/physiopathology/surgery
MH  - Humans
MH  - Intensive Care Units
MH  - Male
MH  - Observer Variation
MH  - Prospective Studies
MH  - Reproducibility of Results
MH  - Stroke Volume/*physiology
MH  - Thermodilution/*statistics & numerical data
EDAT- 2009/09/10 06:00
MHDA- 2009/10/21 06:00
CRDT- 2009/09/10 06:00
PHST- 2009/09/10 06:00 [entrez]
PHST- 2009/09/10 06:00 [pubmed]
PHST- 2009/10/21 06:00 [medline]
PST - ppublish
SO  - Crit Care Resusc. 2009 Sep;11(3):198-203.