Accuracy of cardiac function and volume status estimates using the bedside echocardiographic assessment in trauma/critical care.
BACKGROUND
Critically ill patients often require invasive monitoring to evaluate and optimize cardiac function and preload. With questionable outcomes associated with pulmonary artery catheters (PACs), some have evaluated the role of less invasive monitors. We hypothesized that the Bedside Echocardiographic Assessment in Trauma (BEAT) examination would generate cardiac index (CI) and central venous pressure (CVP) estimates that correlate with that of a PAC.


METHODS
BEAT was performed on all SICU patients with a PAC in place. Prospective data included stroke volume and the inferior vena cava (IVC) diameter. The CI was calculated and correlated with that from the PAC. Each CI was then categorized as low, normal, or high. The IVC diameter was used to estimate the CVP. The association between the BEAT and PAC estimates of CI and CVP was evaluated using chi.


RESULTS
Eighty-five BEAT examinations were performed, 57% on trauma and 37% on general surgery patients. Fifty-nine percent of the CI examinations and 97% of the IVC examinations contained quality images. Of these, the overall correlation coefficient was 0.70 (p < 0.0001). When CI was categorized, there was a significant association between the BEAT and PAC (p = 0.021). There was a significant association between the CVP estimate from the BEAT examination and the PAC (p = 0.031).


CONCLUSIONS
Our data show a significant correlation between the CI and CVP estimates obtained from the BEAT examination and that from a PAC. BEAT provides a noninvasive method of evaluating cardiac function and volume status. Bedside echocardiography is teachable and should become a part of future critical care curricula.
Gunst
Mark
M
Department of Surgery, University of Texas Southwestern Medical School, Dallas, TX 75390-9158, USA.
Ghaemmaghami
Vafa
V
Sperry
Jason
J
Robinson
Melissa
M
O'Keeffe
Terence
T
Friese
Randall
R
Frankel
Heidi
H
D000368:Aged; D002302:Cardiac Output / Q000502:physiology*; D002306:Cardiac Volume / Q000502:physiology*; D002496:Central Venous Pressure / Q000502:physiology; D015331:Cohort Studies; D003422:Critical Care; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019095:Point-of-Care Systems; D015203:Reproducibility of Results; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging / Q000503:physiopathology; D014947:Wounds and Injuries / Q000000981:diagnostic imaging* / Q000503:physiopathology* / Q000628:therapy