Assessment of the clinical utility of an ultrasonic monitor of cardiac output (the USCOM) and agreement with thermodilution measurement.

Full Abstract

OBJECTIVE: To assess the clinical utility of an ultrasonic monitor of cardiac output (USCOM), its reliability in tracking cardiac output (CO) changes and agreement with thermodilution (TD) measurements of CO. DESIGN: Prospective comparison study. SETTING AND PARTICIPANTS: 55 adults undergoing thermodilution (TD) CO monitoring in a cardiothoracic or general intensive care unit between December 2006 and December 2007. MAIN OUTCOME MEASURES: USCOM and TD measurements of CO on two occasions in each patient were compared by Bland-Altman analysis for bias and limit of agreement. A mean percentage error <30% was considered acceptable. Per cent change in cardiac index (CI) was determined by each method. Doppler profiles obtained by the USCOM were assessed against an ideal standard ("acceptable"). RESULTS: 55 patients had measurements on 110 occasions, but Doppler waveforms were not obtained on 18 of these (16%), leaving 39 patients with paired comparisons for analysis (including 27 men; mean age, 64.7 [SD, 14.5] years). Mean TD CI was 3.4 +/-1.0L/min/m(2) (range, 2.0-6.0L/min/m(2)). The bias was 0.6L/min/m(2) (95% confidence limits [CLs], 0.4-0.8 L/min/m(2)), and the mean percentage error was 56% (95% CLs, 45%-65%). Twenty-two Doppler profiles (28%) were classed as acceptable; the mean percentage error for these was 62% (95% CLs, 38%-65%). On 15/19 occasions (74%) where TD CI changed > 15%, USCOM CI also changed >15%, but three of these changes (16%) were in the opposite direction. USCOM CI changed >15% on 9/20 occasions (45%) when TD CI did not. CONCLUSIONS: Poor agreement with TD and a substantial rate of failure to obtain an USCOM measurement suggest that this device is unsuitable as a monitoring tool in intensive care.

Author information

Author/s: Boyle, Martin (M); Steel, Liz (L); Flynn, Gordon M (GM); Murgo, Margherita (M); Nicholson, Lisa (L); O'Brien, Maureen (M); Bihari, David (D);

Affiliation: Department of Intensive Care, Prince of Wales Hospital, Sydney, NSW. martin.boyle(-atsign-)sesiahs.health.nsw.gov.au

Journal and publication information

Publication Type: Comparative Study; Journal Article

Journal: Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine (Crit Care Resusc), published in Australia. (Language: eng)

Reference: 2009-Sep; vol 11 (issue 3) : pp 198-203

Dates: Created 2009/09/09; Completed 2009/10/20;

PMID: 19737122, status: MEDLINE (last retrieval date: 10/20/2009, IMS Date: )

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

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