Focused rapid echocardiographic evaluation versus vascular cather-based assessment of cardiac output and function in critically ill trauma patients.
BACKGROUND
Focused rapid echocardiographic evaluation (FREE) is a comprehensive transthoracic echocardiogram tailored for the intensive care unit. It assesses both the cardiac index (CI) and left ventricular ejection fraction (EF). FREE and vascular catheter-derived CI was compared, and the ability of CI to detect moderate to severe dysfunction (EF <40%) was determined.


METHODS
FREE quality assurance database was reviewed to identify patients who had a hemodynamic catheter.


RESULTS
Of 507 FREEs, 115 patients were identified, 25 pulmonary artery catheters (PACs) and 90 FloTrac Vigileo (FT/V) arterial catheters. There were 27 patients with an EF <40%. In 86%, the CI was determined by FREE, and it changed care in 59%. The CI correlation for FREE versus PAC was r = 0.88 and versus FT/V was r = 0.63 (p < 0.05). The PAC-FREE bias was -0.07 (95% confidence interval -0.89 to 0.74) and the FT/V-FREE bias was -0.13 (95% confidence interval -1.4 to 1.1). FREE-PAC categorized patients the same way 87% and FREE-FT/V 76%; in patients with EF <40%, this changed to 90% and 63%, respectively. Using a threshold value (CI ≤ 2.5), the PAC detected dysfunction in 62.5% and the F/VT in 6%, p < 0.05.


CONCLUSIONS
There was excellent agreement between FREE and PAC but less with FT/V, especially in patients with and EF <40%. FREE can be used to validate catheter-derived data and provide important additional information. Further studies are needed to determine its impact on patient outcome.


METHODS
III, diagnostic study.
Division of Trauma and Surgical Critical Care, Department of Surgery, R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA. smurthi@umm.edu
Sarah B
SB
Murthi
John R
JR
Hess
Aaron
A
Hess
Lynn G
LG
Stansbury
Thomas M
TM
Scalea
D006328:Cardiac Catheterization / Q000379:methods*; D002302:Cardiac Output / Q000502:physiology*; D016638:Critical Illness; D004452:Echocardiography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011651:Pulmonary Artery; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018754:Ventricular Dysfunction / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D014947:Wounds and Injuries / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology