title: Echocardiography and pulse contour analysis to assess cardiac output in trauma patients.
abstract: BACKGROUND
  Echocardiography is a valuable technique to assess cardiac output (CO) in trauma patients, but it does not allow a continuous bedside monitoring. Beat-to-beat CO assessment can be obtained by other techniques, including the pulse contour method MostCare. The aim of our study was to compare CO obtained with MostCare (MC-CO) with CO estimated by transthoracic echocardiography (TTE-CO) in trauma patients.
  
  
  METHODS
  Forty-nine patients with blunt trauma admitted to an intensive care unit and requiring hemodynamic optimization within 24 hours from admission were studied. TTE-CO and MC-CO were estimated simultaneously at baseline, after a fluid challenge and after the start of vasoactive drug therapy.
  
  
  RESULTS
  One hundred sixteen paired CO values were obtained. TTE-CO values ranged from 2.9 to 7.6 L·min(-1), and MC-CO ranged from 2.8 to 8.2 L·min(-1). The correlation between the two methods was 0.94 (95% confidence interval [CI]=0.89 to 0.97; P<0.001). The mean bias was -0.06 L·min(-1) with limits of agreements (LoA) of -0.94 to 0.82 L·min(-1) (lower 95% CI, -1.16 to -0.72; upper 95% CI, 0.60 to 1.04) and a percentage error of 18%. Changes in CO showed a correlation of 0.91 (95% CI=0.87 to 0.95; P<0.001), a mean bias of -0.01 L·min(-1) with LoA of -0.67 to 0.65 L·min(-1) (lower 95% CI, -0.83 to -0.51; upper 95% CI, 0.48 to 0.81).
  
  
  CONCLUSIONS
  CO measured by MostCare showed good agreement with CO obtained by transthoracic echocardiography. Pulse contour analysis can complement echocardiography in evaluating hemodynamics in trauma patients.
authors.affiliation: Department of Anesthesia and Intensive Care, University of Siena, Siena, Italy. franchif@unisi.it
authors.forename: F
authors.initials: F
authors.lastname: Franchi
authors.forename: E
authors.initials: E
authors.lastname: Falciani
authors.forename: K
authors.initials: K
authors.lastname: Donadello
authors.forename: V
authors.initials: V
authors.lastname: Zacà
authors.forename: R
authors.initials: R
authors.lastname: Silvestri
authors.forename: F S
authors.initials: FS
authors.lastname: Taccone
authors.forename: L
authors.initials: L
authors.lastname: Cubattoli
authors.forename: P
authors.initials: P
authors.lastname: Mongelli
authors.forename: P
authors.initials: P
authors.lastname: Giomarelli
authors.forename: S
authors.initials: S
authors.lastname: Scolletta
mesh_terms: D000328:Adult; D000368:Aged; D002302:Cardiac Output / Q000502:physiology*; D003627:Data Interpretation, Statistical; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D011674:Pulse / Q000379:methods*; D058067:Wavelet Analysis; D014947:Wounds and Injuries / Q000000981:diagnostic imaging / Q000503:physiopathology*; D055815:Young Adult