Razavi Asma, Newth Christopher J L, Khemani Robinder G, Beltramo Fernando, Ross Patrick A
Loma Linda University Medical Center, Loma Linda, CA.
Children's Hospital Los Angeles, Los Angeles, CA; University of Southern California Keck School of Medicine, Los Angeles, CA.
J Crit Care. 2017 Jun;39:6-10. doi: 10.1016/j.jcrc.2016.12.018. Epub 2016 Dec 28.
To evaluate physician assessment of cardiac output and systemic vascular resistance in patients with shock compared with an ultrasonic cardiac output monitor (USCOM). To explore potential changes in therapy decisions if USCOM data were available using physician intervention answers.
Double-blinded, prospective, observational study in a tertiary hospital pediatric intensive care unit. Forty children (<18years) admitted with shock, requiring ongoing volume resuscitation or inotropic support. Two to 3 physicians clinically assessed cardiac output and systemic vascular resistance, categorizing them as high, normal, or low. An investigator simultaneously measured cardiac index (CI) and systemic vascular resistance index (SVRI) with USCOM categorized as high, normal, or low.
Overall agreement between physician and USCOM for CI (48.5% [κ = 0.18]) and SVRI (45.9% [κ = 0.16]) was poor. Interobserver agreement was also poor for CI (58.7% [κ = 0.33]) and SVRI (52.3% [κ = 0.28]). Comparing theoretical physician interventions to "acceptable" or "unacceptable" clinical interventions, based on USCOM measurement, 56 (21%) physician interventions were found to be "unacceptable."
There is poor agreement between physician-assessed CI and SVRI and USCOM, with significant interobserver variability among physicians. Objective measurement of CI and SVRI may reduce variability and improve diagnostic accuracy.
评估与超声心输出量监测仪（USCOM）相比，医生对休克患者心输出量和全身血管阻力的评估情况。利用医生的干预回答，探讨如果有USCOM数据，治疗决策可能发生的变化。
在一家三级医院儿科重症监护病房进行的双盲、前瞻性观察性研究。40名年龄小于18岁的休克患儿，需要持续进行容量复苏或使用血管活性药物支持。两到三名医生对心输出量和全身血管阻力进行临床评估，将其分为高、正常或低。一名研究人员同时使用USCOM测量心脏指数（CI）和全身血管阻力指数（SVRI），并将其分为高、正常或低。
医生与USCOM在CI（48.5%[κ=0.18]）和SVRI（45.9%[κ=0.16]）方面的总体一致性较差。CI（58.7%[κ=0.33]）和SVRI（52.3%[κ=0.28]）的观察者间一致性也较差。根据USCOM测量结果，将理论上医生的干预措施与“可接受”或“不可接受”的临床干预措施进行比较，发现56项（21%）医生的干预措施是“不可接受的”。
医生评估的CI和SVRI与USCOM之间的一致性较差，医生之间存在显著的观察者间变异性。CI和SVRI的客观测量可能会减少变异性并提高诊断准确性。
