0260: 3D-transeosphageal echocardiography usefulness for assessment of cardiac output in intensive care unit: an ultrasound versus thermo-dilution comparative study for patients under mechanical ventilation - 12/02/16
Résumé |
Introduction |
Hemodynamic evaluation is a major tool for management of intensive care unit (ICU) patients. Due to insufficient echogenicity, transthoracic echocardiography could be noninformative (dorsal decubitus, mechanical ventilation).
Three-dimensional trans-oesophageal echocardiography (3D-TEE) is a new non-invasive ultrasound modality for quantitative and semi-quantitative assessment of cardiac output. Only few validation data are available in this indication.
Aim |
To evaluate feasibility and diagnostic performance of 3D-TEE for assessment of cardiac output in ICU. Intermittent thermodilution measurement via transpulmonary method was used as benchmark.
Methods |
Fifteen patients under mechanical ventilation, without any significant valvular disease or mechanical hemodynamic support were prospectively included. Cardiac output was calculated with transpulmonary thermodilution (PICCO monitoring). 3D-TEE (Philips, IE33) was performed just after invasive measure. Left ventricular volume loops were recorded then semi-automatic analysis of 3D-loops were performed off-line and blinded to thermodilution values. We used correlation coefficient and Bland-Altman method to compared these two modalities.
Results |
Thirty invasive measures were recorded for fifteen patients under mechanical ventilation. 29 (97%) 3D-TEE were usable for semi-automatic analysis of left ventricular volume and cardiac output. Correlation coefficient between invasive and non-invasive methods was 0.78. Cardiac output estimation with 3D-TEE were associated with a mean bias of 0.35 l/min with 95% limits of agreement between -2.8 et 2.2 l/min. Mean duration of 3D-TEE semi-automatic analysis was 5minutes.
Conclusion |
Cardiac output assessment with 3D-TEE is feasible with ICU patients under mechanical ventilation. Data obtained with this new non-invasive ultrasound modality have a good correlation with thermodilution values. Bias seems to be acceptable but 95% limits of agreement of both methods are quite broad.
Le texte complet de cet article est disponible en PDF.Vol 8 - N° 1
P. 111 - janvier 2016 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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