TY - JOUR
T1 - Value of Two-dimensional Echocardiography for Determining the Basis of Hemodynamic Compromise in Critically Ill Patients
T2 - A Prospective Study
AU - Kaul, Sanjiv
AU - Stratienko, Alexander A.
AU - Pollock, Stewart G.
AU - Marieb, Mark A.
AU - Keller, Mark W.
AU - Sabia, Peter J.
N1 - Funding Information:
From the Cardiovascular Division, University of Virginia School of Medicine. Supported in part by grant ROI-HL48890 from the National Institutes of Health, Bethesda, Maryland, and an equipment grant from Kontron Instruments, Everert, Massachusetts. 'Established Investigator of the American Heart Association, Dallas, Texas. Presented in part at the Sixty-second Annual Scientific Session of the American Heart Association, Adanta, Georgia, November 13-16, 1989. Reprint requests: Sanjiv Kaul, MD, Cardiovascular Division, Box 158, University of Virginia, Charlottesville, VA 22908. Copyright © 1994 by the American Society of Echo cardiography. 0894-7317/94 $3.00 + 0 27/1/55194
PY - 1994
Y1 - 1994
N2 - We postulated that because the first step in the management of critically ill patients with hypotension, pulmonary edema, or both is to determine whether the cause is cardiac or noncardiac, direct visualization of the heart with two-dimensional echocardiography would be useful for determining the basis of hemodynamic compromise in such patients. Accordingly, 49 consecutive patients (33 men and 16 women; mean age 61 ± 15 years) underwent two-dimensional echocardiography within 2 hours of placement of a pulmonary artery flotation catheter for determining the reason for hypotension, pulmonary edema, or both. To discriminate between cardiac and noncardiac causes, hemodynamic and two-dimensional echocardiographic data were evaluated independently by two to three blinded interpreters based on predetermined criteria. There was complete agreement between pulmonary artery catheter and two-dimensional echocardiographic data in 36 (86%) of the 42 patients in whom interpretable data were available in terms of cardiac versus noncardiac causes. The two modalities agreed in all patients with hypotension alone and disagreed in 2 of the 20 patients with pulmonary edema alone and 4 of the 14 patients with combined hypotension and pulmonary edema. In cases of discordance, the two tests provided complimentary information, particularly in patients with sepsis in whom the stroke volume may be normal to high but left ventricular systolic function may be depressed. The time taken for pulmonary artery catheter placement was 63 ± 45 minutes versus 19 ± 7 minutes for two-dimensional echocardiography. One patient had pneumothorax and cardiac arrest during pulmonary artery catheter placement. It is concluded that two-dimensional echocardiography is effective in determining the basis of hemodynamic compromise in critically ill patients. It could obviate the need for pulmonary artery catheter placement in most of these patients, and in those with sepsis it could provide information that is complimentary to that obtained from pulmonary artery catheterization.
AB - We postulated that because the first step in the management of critically ill patients with hypotension, pulmonary edema, or both is to determine whether the cause is cardiac or noncardiac, direct visualization of the heart with two-dimensional echocardiography would be useful for determining the basis of hemodynamic compromise in such patients. Accordingly, 49 consecutive patients (33 men and 16 women; mean age 61 ± 15 years) underwent two-dimensional echocardiography within 2 hours of placement of a pulmonary artery flotation catheter for determining the reason for hypotension, pulmonary edema, or both. To discriminate between cardiac and noncardiac causes, hemodynamic and two-dimensional echocardiographic data were evaluated independently by two to three blinded interpreters based on predetermined criteria. There was complete agreement between pulmonary artery catheter and two-dimensional echocardiographic data in 36 (86%) of the 42 patients in whom interpretable data were available in terms of cardiac versus noncardiac causes. The two modalities agreed in all patients with hypotension alone and disagreed in 2 of the 20 patients with pulmonary edema alone and 4 of the 14 patients with combined hypotension and pulmonary edema. In cases of discordance, the two tests provided complimentary information, particularly in patients with sepsis in whom the stroke volume may be normal to high but left ventricular systolic function may be depressed. The time taken for pulmonary artery catheter placement was 63 ± 45 minutes versus 19 ± 7 minutes for two-dimensional echocardiography. One patient had pneumothorax and cardiac arrest during pulmonary artery catheter placement. It is concluded that two-dimensional echocardiography is effective in determining the basis of hemodynamic compromise in critically ill patients. It could obviate the need for pulmonary artery catheter placement in most of these patients, and in those with sepsis it could provide information that is complimentary to that obtained from pulmonary artery catheterization.
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U2 - 10.1016/S0894-7317(14)80082-5
DO - 10.1016/S0894-7317(14)80082-5
M3 - Article
C2 - 7840987
AN - SCOPUS:0028545117
SN - 0894-7317
VL - 7
SP - 598
EP - 606
JO - Journal of the American Society of Echocardiography
JF - Journal of the American Society of Echocardiography
IS - 6
ER -