PMID- 37698504
OWN - NLM
STAT- MEDLINE
DCOM- 20231023
LR  - 20231024
IS  - 1540-0514 (Electronic)
IS  - 1073-2322 (Linking)
VI  - 60
IP  - 4
DP  - 2023 Oct 1
TI  - CARDIAC OUTPUT IN CRITICALLY ILL PATIENTS CAN BE ESTIMATED EASILY AND ACCURATELY 
      USING THE MINUTE DISTANCE OBTAINED BY PULSED-WAVE DOPPLER.
PG  - 553-559
LID - 10.1097/SHK.0000000000002210 [doi]
AB  - Background: Cardiac output (CO) assessment is essential for management of 
      patients with circulatory failure. Among the different techniques used for their 
      assessment, pulsed-wave Doppler cardiac output (PWD-CO) has proven to be an 
      accurate and useful tool. Despite this, assessment of PWD-CO could have some 
      technical difficulties, especially in the measurement of left ventricular outflow 
      tract diameter (LVOTd). The use of a parameter such as minute distance (MD) which 
      avoids LVOTd in the PWD-CO formula could be a simple and useful way to assess the 
      CO in critically ill patients. Therefore, the aim of this study was to evaluate 
      the correlation and agreement between PWD-CO and MD. Methods: A prospective and 
      observational study was conducted over 2 years in a 30-bed intensive care unit 
      (ICU). Adult patients who required CO monitoring were included. Clinical 
      echocardiographic data were collected within the first 24 h and at least once 
      more during the first week of ICU stay. PWD-CO was calculated using the average 
      value of three LVOTd and left ventricular outflow tract velocity-time integral 
      (LVOT-VTI) measurements, and heart rate. Minute distance was obtained from the 
      product of LVOT-VTI x heart rate. Pulsed-wave Doppler cardiac output was 
      correlated with MD using linear regression. Cardiac output was quantified from 
      the MD using the equation defined by linear regression. Bland-Altman analysis was 
      also used to evaluate the level of agreement between CO calculated from MD 
      (MD-CO) and PWD-CO. The percentage error was calculated. Results: A total of 98 
      patients and 167 CO measurements were analyzed. Sixty-seven (68%) were male, the 
      median age was 66 years (interquartile range [IQR], 53-75 years), and the median 
      Acute Physiology and Chronic Health Evaluation II score was 22 (IQR, 16-26). The 
      most common cause of admission was shock in 81 patients (82.7%). Sixty-nine 
      patients (70.4%) were mechanically ventilated, and 68 (70%) required vasoactive 
      drugs. The median CO was 5.5 L/min (IQR, 4.8-6.6 L/min), and the median MD was 
      1,850 cm/min (IQR, 1,520-2,160 cm/min). There was a significant correlation 
      between PWD-CO and MD-CO in the general population ( R2 = 0.7; P < 0.05). This 
      correlation improved when left ventricular ejection fraction (LVEF) was less than 
      60% ( R2 = 0.85, P < 0.05). Bland-Altman analysis showed good agreement between 
      PWD-CO and MD-CO in the general population, the median bias was 0.02 L/min, the 
      limits of agreement were -1.92 to +1.92 L/min. The agreement was better in 
      patients with LVEF less than 60% with a median bias of 0.005 L/min and limits of 
      agreement of -1.56 to 1.55 L/min. The percentage error was 17% in both cases. 
      Conclusion: Measurement of MD in critically ill patients provides a simple and 
      accurate estimate of CO, especially in patients with reduced or preserved LVEF. 
      This would allow earlier cardiovascular assessment in patients with circulatory 
      failure, which is of particular interest in difficult clinical or technical 
      conditions.
CI  - Copyright (c) 2023 by the Shock Society.
FAU - Villavicencio, Christian
AU  - Villavicencio C
AD  - Critical Care Department, Joan XXIII-University Hospital, Tarragona, Spain.
FAU - Daniel, Xavier
AU  - Daniel X
AD  - Critical Care Department, Joan XXIII-University Hospital, Tarragona, Spain.
FAU - Cartanya, Marc
AU  - Cartanya M
AD  - Critical Care Department, Joan XXIII-University Hospital, Tarragona, Spain.
FAU - Leache, Julen
AU  - Leache J
AD  - Critical Care Department, Joan XXIII-University Hospital, Tarragona, Spain.
FAU - Ferre, Cristina
AU  - Ferre C
AD  - Critical Care Department, Joan XXIII-University Hospital, Tarragona, Spain.
FAU - Roure, Marina
AU  - Roure M
AD  - Critical Care Department, Joan XXIII-University Hospital, Tarragona, Spain.
FAU - Bodi, Maria
AU  - Bodi M
AD  - Critical Care Department, Hospital Universitari Joan XXIII, URV/IISPV/CIBERES, 
      Tarragona, Spain.
FAU - Vives, Marc
AU  - Vives M
AD  - Department of Anesthesiology and Critical Care, Clinica Universidad de Navarra, 
      Universidad de Navarra, Navarra, Spain.
FAU - Rodriguez, Alejandro
AU  - Rodriguez A
AD  - Critical Care Department, Hospital Universitari Joan XXIII, URV/IISPV/CIBERES, 
      Tarragona, Spain.
LA  - eng
PT  - Journal Article
PT  - Observational Study
DEP - 20230912
PL  - United States
TA  - Shock
JT  - Shock (Augusta, Ga.)
JID - 9421564
SB  - IM
MH  - Adult
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Aged
MH  - Female
MH  - Stroke Volume
MH  - *Ventricular Function, Left/physiology
MH  - Critical Illness
MH  - Prospective Studies
MH  - Cardiac Output/physiology
MH  - *Shock
COIS- The authors report no conflicts of interest.
EDAT- 2023/09/12 12:41
MHDA- 2023/10/23 00:42
CRDT- 2023/09/12 10:12
PHST- 2023/10/23 00:42 [medline]
PHST- 2023/09/12 12:41 [pubmed]
PHST- 2023/09/12 10:12 [entrez]
AID - 00024382-202310000-00010 [pii]
AID - 10.1097/SHK.0000000000002210 [doi]
PST - ppublish
SO  - Shock. 2023 Oct 1;60(4):553-559. doi: 10.1097/SHK.0000000000002210. Epub 2023 Sep 
      12.