Volume 19 Supplement 1

35th International Symposium on Intensive Care and Emergency Medicine

Open Access

Volume assessment in critically ill patients: echocardiography, bioreactance and pulse contour thermodilution

  • S Hutchings1,
  • P Hopkins1 and
  • A Campanile2
Critical Care201519(Suppl 1):P176

https://doi.org/10.1186/cc14256

Published: 16 March 2015

Introduction

We performed an evaluation of three devices used for assessment of volume status in critically ill patients in our institution: transthoracic echocardiography (TTE) (CX50; Philips Ultrasound), bio reactance (NICOM; Cheetah Medical) and pulse contour-based thermodilution (PiCCO; Pulsion Medical).

Methods

Ten mechanically ventilated critically ill patients with PiCCO monitoring in situ and a good quality of images on transthoracic view were included. All study measurements were made in triplicate. A single trained cardiologist, blinded to the results from the other monitors, performed the TTE study. Differences among the three methods were assessed for significance using one-way ANOVA, Spearman's coefficient and Bland-Altman analysis. All statistical analyses were performed using Graph-pad Prism 5 and P < 0.05 was taken as significant.

Results

Ninety measurements were obtained. NICOM and TTE-derived stroke volume appeared well matched but PICCO-derived values showed significant variation (F = 2.4, P = 0.09). There was no correlation between TTE velocity time integer (VTI) and NICOM stroke volume variation (SVV) (r = 0.24, P = 0.20; Figure 1A) but a good correlation and small bias between TTE-VTI and PiCCO-SVV (r = 0.76, P < 0.0001; Figure 1B). Applying the following indications for volume expansion (PiCCO and NICOM SVV >15% and TTE VTI variability >15%) we found an agreement in 71% of cases between TTE and PiCCO and in 42% of cases between echocardiography and NICOM.

Figure 1

Conclusion

Stroke volume produced by bioreactance appeared to be comparable with that measured by echocardiography but not with PiCCO. There was a good agreement between decision-making as regards fluid administration between PiCCO and echocardiography. NICOM appeared unreliable in this setting.

Authors’ Affiliations

(1)
King's College Hospital
(2)
Papworth Hospital

Copyright

© Hutchings et al.; licensee BioMed Central Ltd. 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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