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Non-invasive arterial pressures do not reflect central ...2010477245

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					                                               Abstract

  Non-Invasive Hemodynamic Monitoring in Critically Ill Patients -
  Initial Experience with the Ultrasonic Cardiac Output Monitoring
     (USCOM) Device and Correlation to Invasive Measurements
             F. Brettner1, V. Lange1, S. Geiger1, A. Hausmann1, K. G. Parhofer2, H.-J. Stemmler1




Introduction: Hemodynamic monitoring is of particular importance, especially in
critically ill patients on an intensive care unit. This study aimed to compare
hemodynamic parameters assessed by non-invasive measurements using a novel
Doppler device (USCOM: ultrasonic cardiac output monitoring) with invasive
measurements based on the PiCCO system (PiCCO: pulse-induced contour cardiac
output).

Methods: 53 patients on mechanical ventilation and catecholamine support (median
age 45 years, median SAPS II Score 43), were examined parallelly using both the
USCOM and PiCCO devices (n=53) and invasive measurements by a Swan-Ganz
catheter (PAC, n=4).

 Results: 103 paired measurements were evaluated. Mean non-invasive and
invasive values were 3.74±1.3 L/min/m² vs 3.8 ±1.4 L/min/m² (USCOM vs PiCCO)
and 2.7 ±0.32 L/min/m² vs 2.89±0.47 L/min/m² (USCOM vs PAC), respectively
(r=0.64, p=<0.05) (figure 1, 2). Changes in CI determined by USCOM were in good
agreement with changes in CI determined with PiCCO ( CI PiCCO vs CI
USCOM: r=0.75, p<0.05).
In 9 patients paralleled USCOM and PiCCO CO measurements were undertaken to
evaluate the hemodynamic influence of PEEP. Within a PEEP level of 8 cm H2O the
median CO was 0.7 L/min lower when compared to mechanical ventilation without
PEEP (figure 3).

Conclusions: Using the ultrasonic cardiac output monitoring (USCOM) device, it is
possible to determine non-invasive beat-to-beat analyses of essential hemodynamic
parameters without the possible complications associated with invasive methods
such as PAC or the PiCCO device. USCOM CO correlated well with invasive CO
measurements and therefore provides an interesting tool in the arsenal of
hemodynamic measurement devices in critically ill patients on the ICU.
114th Congress of DGIM (German Society for Internal Medicine), 29. March – 2.
April 2008 Wiesbaden, Germany (abstract #YIA2).
Figure 1

                        Herzindex (CI): PAC vs PiCCO vs USCOM
                              2.89 vs 2.89 vs 2.7 L/min/m²
                  5,0


                  4,5


                  4,0


                  3,5
  CI (L/min/m²)




                  3,0


                  2,5


                  2,0


                  1,5
                                                                     Min-Max
                                                                     25%-75%
                  1,0
                        PAC               PiCCO              USCOM   Median



Figure 2
Figure 3



                                                    Einfluß von PEEP auf CI und CO (n = 9)

                               8

                                                                           7,6
                              7,5


                               7
                                           6,9

                              6,5
   CI L/min/m² und CO L/min




                                                                                                    6,35

                               6


                              5,5


                               5


                              4,5

                                                                           4,15
                               4           3,95
                                                                                                    3,8
                              3,5


                               3
                                    PEEP median 8                      PEEP 0                PEEP median 8

				
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Description: Non-invasive arterial pressures do not reflect central ...2010477245