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Correlation of clinical evaluation and invasive monitoring evaluation in critically ill patients

Introduction

Shock is a critical condition. The knowledge and skills of the physician can improve the outcome of these patients. We therefore studied the factors that affect physician knowledge and skill.

Methods

We enrolled 12 shocked patients admitted to the medical ICU, their symptoms having been evaluated by the patient-care team for defining the type of shock [1, 2]. Venous catheterization (central venous pressure) and arterial catheterization (A-line) had been performed for invasive monitoring data [3]. After that either clinical evaluation data or invasive monitoring data were collected for analysis [4].

Results

All 12 shock patients, seven men and five women, were defined in four groups: hypovolemic, cardiogenic, obstructive and distributive/septic shock in four cases, two cases, one case, and five cases, respectively. Shock was defined by 38 volunteer physicians, 27 men and 11 women. All physicians were studying in the training program: 28 were in the residency program (first, second and third years – 12, eight and eight physicians, respectively), 10 in the fellowship training program (first and second years equally). We found that training physicians can define the type of shock by clinical evaluation in 65.7% (residents vs. fellows 64.29% vs. 80%, P < 0.05), and fellowship physicians can define the type of shock significantly better than residency physicians (P < 0.05). Male physicians can define the type of shock significantly better than females (male vs. female 70.37% vs. 54.54%, P < 0.05). In meta-analysis, clinical evaluating factors such as jugular venous pressure, capillary filling time and lung fine crepitation are correlated significantly with invasive monitoring factors.

Conclusion

Physician experience is important for clinical evaluation. It can be used for evaluating shocked patients nearly as well as invasive monitoring. It can decrease procedure complications and cost. Gender is an interesting factor that affected evaluating abilities, it should be studied in greater numbers and in a different population for other significant statistics.

References

  1. 1.

    Piyavechwiratana K: The Best Care of Shock: Diagnosis and Goal Setting, Best Practices in Critical Care. Pramongkutklao Hospital; 147-152.

  2. 2.

    Holmes CL, Walley KR: The evaluation and management of shock. Clin Chest Med 2003, 24: 775-789. 10.1016/S0272-5231(03)00107-2

  3. 3.

    Cheatham ML: Hemodynamic Calculations I 2002.[http://www.surgicalcriticalcare.net/Lectures/PDF/hemodynamic_calculations_I.pdf]

  4. 4.

    Kress JP, et al.: Clinical examination reliability detects intrinsic positive end-expiratory pressure in critically ill, mechanical ventilated patients. Am J Respir Crit Care Med 1999, 159: 290-294.

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Wongsrichanalai, V., Piyavechwiratana, K. & Tiyanont, W. Correlation of clinical evaluation and invasive monitoring evaluation in critically ill patients. Crit Care 13, P223 (2009). https://doi.org/10.1186/cc7387

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Keywords

  • Venous Pressure
  • Central Venous Pressure
  • Residency Program
  • Fellowship Training
  • Procedure Complication