Arango-Granados María Camila, Quintero-Ramírez Jaime Andrés, Mejía-Herrera Felipe, Henao-Cardona Lina Mayerly, Muñoz-Patiño Valentina, Bustamante-Cristancho Luis Alfonso
Emergency Department, Fundación Valle del Lili, Carrera 98 # 18-49, 760032, Cali, Colombia.
Health Sciences Faculty, Universidad Icesi, Cali, Colombia.
Intensive Care Med Exp. 2024 Aug 12;12(1):69. doi: 10.1186/s40635-024-00653-4.
Critical care management heavily relies on accurate cardiac output (CO) measurement. Echocardiography has been a mainstay in non-invasive cardiac monitoring; however, its comparability to invasive methods warrants further exploration. Recent studies have suggested the potential of carotid Doppler measurements as a promising approach to estimate CO. Despite this potential, the literature presents mixed outcomes regarding its reliability and accuracy. This study aims to evaluate the correlation and concordance between carotid Doppler ultrasonography and invasive hemodynamic monitoring in estimating CO in critically ill patients. Furthermore, it assesses the concordance and correlation between echocardiography CO and the standard invasive CO measurements.
This concordance study involved critically ill adults requiring invasive CO measurement. Patients with arrhythmias, severe valvulopathy, pregnancy, and poor acoustic window were excluded. Statistical analyses comprised univariate analysis, Wilcoxon signed-rank test, Spearman correlation, and intraclass correlation coefficient. Ethical approval was granted by the institution's ethics committee.
A total of 49 critically ill patients were included, predominantly male (63.27%), with a median age of 57 years. Diagnoses included subarachnoid hemorrhage (53.06%) and heart failure (8.16%). Mean cardiac index was 3.36 ± 0.81 L/min/m and mean cardiac output was 5.98 ± 1.47 L/min. Spearman correlation coefficient between echocardiography and invasive CO measurements was 0.58 (p-value = p < 0.001), with an ICC of 0.59 for CO and 0.52 for cardiac index. Carotid measurements displayed no significant correlation with invasive CO.
There is a moderate correlation and concordance between echocardiography and invasive CO measurements. There is no significant correlation between carotid variables and invasive CO, underscoring the necessity for cautious interpretation and application, particularly in patients with distinctive cerebral blood flow dynamics.
重症监护管理严重依赖准确的心输出量（CO）测量。超声心动图一直是无创心脏监测的主要手段；然而，其与有创方法的可比性仍需进一步探索。最近的研究表明，颈动脉多普勒测量有可能成为估计CO的一种有前景的方法。尽管有这种潜力，但文献中关于其可靠性和准确性的结果参差不齐。本研究旨在评估颈动脉多普勒超声与有创血流动力学监测在估计重症患者CO方面的相关性和一致性。此外，还评估了超声心动图CO与标准有创CO测量之间的一致性和相关性。
本一致性研究纳入了需要进行有创CO测量的成年重症患者。排除患有心律失常、严重瓣膜病、妊娠和声学窗口不佳的患者。统计分析包括单变量分析、Wilcoxon符号秩检验、Spearman相关性分析和组内相关系数分析。该研究获得了机构伦理委员会的伦理批准。
共纳入49例成年重症患者，以男性为主（63.27%），中位年龄为57岁。诊断包括蛛网膜下腔出血（53.06%）和心力衰竭（8.16%）。平均心脏指数为3.36±0.81L/min/m，平均心输出量为5.98±1.47L/min。超声心动图与有创CO测量之间的Spearman相关系数为0.58（p值=p<0.001），CO的组内相关系数为0.59，心脏指数的组内相关系数为0.52。颈动脉测量与有创CO无显著相关性。
超声心动图与有创CO测量之间存在中度相关性和一致性。颈动脉变量与有创CO之间无显著相关性，这突出了谨慎解释和应用的必要性，特别是在具有独特脑血流动力学的患者中。
