Hostname: page-component-586b7cd67f-g8jcs Total loading time: 0 Render date: 2024-11-27T01:19:53.308Z Has data issue: false hasContentIssue false
  • English
  • Français

Clinical validation of the non-invasive cardiac output monitor USCOM-1A in critically ill patients

Published online by Cambridge University Press:  01 November 2008

L. E. M. van Lelyveld-Haas ,
A. R. H. van Zanten ,
G. F. Borm  and
D. H. T. Tjan
L. E. M. van Lelyveld-Haas
Affiliation:
Gelderse Vallei Hospital, Department of Intensive Care, Ede, Nijmegen, The Netherlands
A. R. H. van Zanten
Affiliation:
Gelderse Vallei Hospital, Department of Intensive Care, Ede, Nijmegen, The Netherlands
G. F. Borm
Affiliation:
Radboud University Nijmegen Medical Centre, Department of Epidemiology and Biostatistics, Nijmegen, The Netherlands
D. H. T. Tjan*
Affiliation:
Gelderse Vallei Hospital, Department of Intensive Care, Ede, Nijmegen, The Netherlands
*
Correspondence to: David H.T. Tjan, Anesthesiologist-Intensivist, Department of Intensive Care, Gelderse Vallei Hospital, PO Box 9025, 6716 RP Ede, The Netherlands. E-mail: [email protected]; Tel: +31 318 43 4115; Fax: +31 318 43 4116
Get access

Summary

Background and objective

Cardiac output is frequently monitored to maintain and improve cardiac function with the primary goal of adequate tissue perfusion. The pulmonary artery catheter is considered to be the gold standard although several non-invasive devices are being introduced and gaining attention. To evaluate the accuracy of the ultrasonic cardiac output monitor (USCOM)-1A (Pty Ltd, Coffs Harbour, NSW, Australia), a non-invasive cardiac output device including its capability to differentiate between different shock states in haemodynamically unstable ICU patients was used in this single-centre, prospective, observational study.

Methods

Cardiac output was measured with a pulmonary artery catheter and transcutaneously via a suprasternal approach with the USCOM-1A by continuous-wave Doppler ultrasound in 25 adult patients in a mixed medical and surgical ICU in a major teaching hospital in the Netherlands.

Results

A total of 1315 USCOM-1A cardiac output measurements were performed. In order to reduce time-variability, the mean of five consecutive USCOM-1A measurements was calculated. Total 263 values were compared with 263 thermodilution cardiac output measurements performed with a pulmonary artery catheter. Data were analysed for systematic error, precision and correlation. Systematic and random errors were found. On average USCOM-1A values were 12% lower than thermodilution measurements (systematic error), while the random error was 17% (coefficient of variation). The error comprised an inter-operator variability of 3%, an inter-patient variability of 11% and residual variability of 15%. The correlation coefficient of the calculated cardiac index with the USCOM-1A and the pulmonary artery catheter was r = 0.8024 and 0.6438, respectively. Temperature and gender did not influence correlations. The learning curve for USCOM-1A skill acquisition was steep.

Conclusions

The correlation between the two techniques was acceptable, although relevant systematic and variable errors were detected. USCOM-1A provided adequate data to distinguish non-invasively different shock types in ICU patients.

Keywords

CARDIAC OUTPUTULTRASONOGRAPHY DOPPLER COLOURCATHETERIZATION SWAN–GANZCRITICAL CARE
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 25 , Issue 11 , November 2008 , pp. 917 - 924
Copyright
Copyright © European Society of Anaesthesiology 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Guyatt, G. A randomized control trial of right-heart catheterization in critically ill patients. Ontario Intensive Care Study Group. J Intensive Care Med 1991; 6: 91–95.CrossRefGoogle ScholarPubMed
2.Gattinoni, L, Brazzi, L, Pelosi, P et al. A trial of goal-oriented hemodynamic therapy in critically ill patients. SvO2 Collaberative Group. N Engl J Med 1995; 333: 1025–1032.CrossRefGoogle Scholar
3.Swan, HJC, Ganz, W, Forrester, J, Marcus, H, Diamond, G, Chonette, D. Catherization of the heart in man with the use of a flow-directed balloon-tipped catheter. N Engl J Med 1970; 283: 447–451.CrossRefGoogle Scholar
4.The American Society of Anesthesiologists Task force on pulmary artery catheterization. Practice guidelines for pulmonary artery catheterization. Anesthesiology 1993; 78: 380–384.CrossRefGoogle Scholar
5.Dalen, JE. The pulmonary artery catheter-friend, foe, or accomplice? JAMA 2001; 286: 348–350.CrossRefGoogle ScholarPubMed
6.Connors, AF Jr, Speroff, T, Dawson, NV et al. The effectiveness of right heart catheterization in the initial care of critically ill patients. SUPPORT Investigators. JAMA 1996; 276: 889–897.CrossRefGoogle ScholarPubMed
7.Rhodes, A, Cusack, RJ, Newman, PJ, Grounds, RM, Bennett, ED. A randomised, controlled trial of the pulmonary artery catheter in critically ill patients. Intensive Care Med 2002; 28: 256–264.CrossRefGoogle ScholarPubMed
8.Richard, C, Warszawski, J, Anguel, N et al. Early use of the pulmonary artery catheter and outcomes in patients with shock and acute respiratory distress syndrome: a randomized controlled trial. French Pulmonary Artery Catheter Study Group. JAMA 2003; 290: 2713–2720.CrossRefGoogle Scholar
9.Sandham, JD, Hull, RD, Brant, RF et al. A randomized, controlled trial of the use of pulmonary-artery catheters in high-risk surgical patients. Canadian Critical Care Clinical Trials Group. N Engl J Med 2003; 348: 5–14.CrossRefGoogle Scholar
10.Yu, DT, Platt, R, Lanken, PN et al. Relationship of pulmonary artery catheter use to mortality and resource utilization in patients with severe sepsis. AMCC Sepsis Project Working Group. Crit Care Med 2003; 31: 2734–2741.CrossRefGoogle Scholar
11.Berlauk, JF, Abrams, JH, Gilmour, IJ, O’Connor, SR, Knighton, DR, Cerra, FB. Preoperative optimisation of cardiovascular hemodynamics improves outcome in peripheral vascular surgery. A prospective randomised, clinical trial. Ann Surg 1991; 214: 289–297.CrossRefGoogle Scholar
12.Ivanov, R, Allen, J, Calvin, JE. The incidence of major morbidity in critically ill patients managed with pulmonary artery catheters: a meta-analysis. Crit Care Med 2000; 28: 615–619.CrossRefGoogle ScholarPubMed
13.Harvey, S, Harrison, DA, Singer, M et al. Assessment of the clinical effectiveness of pulmonary artery catheters in management of patients in intensive care (PAC-Man): a randomised controlled trial. PAC-Man Study Collaboration. Lancet 2005; 366: 472–477.CrossRefGoogle Scholar
14.Rivers, E, Ngyen, B, Havstad, S et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. Early Goal-Directed Therapy Collaborative Group. N Engl Med 2001; 345: 1368–1377.CrossRefGoogle Scholar
15.Gadsboll, N, Hoilund-Carlsen, PF, Nielsen, GG et al. Interobserver agreement and accuracy of bedside estimation of right and left ventricular ejection fraction in acute myocardial infarction. Am J Cardiol 1989; 63: 1301–1307.CrossRefGoogle ScholarPubMed
16.Iregui, MG, Prentice, D, Sherman, G, Schallom, L, Sona, C, Kollef, MH. Physicians’estimates of cardiac index and intravascular volume based on clinical assessment versus transesophageal Doppler measurements obtained by critical care nurses. Am J Crit Care 2003; 12: 336–342.CrossRefGoogle ScholarPubMed
17.Tan, HL, Pinder, M, Parsons, R, Roberts, B, Heerden, PV. Clinical evaluation of USCOM ultrasonic cardiac output monitor in cardiac surgical patients in intensive care unit. Br J Anaesth 2005; 94: 287–291.CrossRefGoogle ScholarPubMed
18.Knobloch, K, Hubrich, V, Rohmann, P et al. Non-invasive determination of cardiac output by continuous wave Doppler in air rescue service. Anasthesiol Intensiv Med Notfallmed Schmerzther 2005; 40: 750–755.CrossRefGoogle ScholarPubMed
19.Dey, I, Sprivulis, P. Emergency physicians can reliably assess emergency department patient cardiac output using the USCOM continuous wave Doppler cardiac output monitor. Emerg Med Australas 2005; 17: 193–199.CrossRefGoogle ScholarPubMed
20.Nidorf, SM, Picard, MH, Triulzi, MO et al. New perspectives in the assessment of cardiac chamber dimensions during development and adulthood. J Am Coll Cardiol 1992; 19: 983–988.CrossRefGoogle ScholarPubMed
21.Dubois, D, Dubois, EF. A formula to estimate the approximate surface area if height and weight be known. Arch Intern Medicine 1916; 17: 863–871.CrossRefGoogle Scholar
22.Bland, JM, Altman, JD. Statistical methods for assessing agreement between 2 methods of clinical measurement. Lancet 1986; 1: 307–310.CrossRefGoogle Scholar
23.Demidenko, E, Stukel, TA. Influence analysis for linear mixed-effects models. Stat Med 2005; 24: 893–909.CrossRefGoogle ScholarPubMed
24. Critchley L. Flow probe study, Prince of Wales Hospital. Presented at the World Congress of Anaesthesiology in Paris, April 2004.Google Scholar
25.Critchley, LA, Peng, ZY, Fok, BS. Testing the reliability of a new ultrasonic cardiac output monitor, the USCOM, by using aortic flow probes in anesthetised dogs. Anesth Analg 2005; 100: 748–753.CrossRefGoogle Scholar
26. Philips RA, Paradis M, Evans NJ, Southwell DL, Burstow DJ, West MJ. Comparison with echocardiography in preterm neonates. Presented at the International Symposium on Intensive Care and Emergency Medicine in Brussels, Belgium, March 24 2006.Google Scholar
27.Knobloch, K, Lichtenberg, A, Winterhalter, M, Rossner, D, Pichlmaier, M, Phillips, R. Non-invasive cardiac output determination by two-dimensional independent Doppler during and after cardiac surgery. Ann Thorac Surg 2005; 80: 1479–1484.CrossRefGoogle ScholarPubMed
28.Critchley, LA, Critchley, JA. A meta-analysis of studies using bias and precision statistics to compare cardiac output measurement techniques. J Clin Monit Comput 1999; 15: 85–91.CrossRefGoogle ScholarPubMed