INTRODUCTION. Left ventricular (LV) function is often assessed with echocardiography in critically ill patients. Unfortunately, this technique requires an experienced operator and it cannot provide a beat-by-beat evaluation of LV function. Some pulse wave analysis (PWA) systems allow evaluating LV performance on a beat-by-beat basis with an indirect estimation of “dP/dt-max” (maximum rate of pressure change in the left ventricle). Among these PWA systems, SphygmoCor (AtCor Medical, Australia) offers semi-continuously, non-invasively, but operator-dependently, dP/dt-max. Conversely, MostCare (Vygon, Padua, Italy) has the main advantage of being an operator- independent technique that provides continuously, but invasively, dP/dt-max. OBJECTIVES. Our aim was to compare dP/dt-max obtained by SphygmoCor (Sphy-dP/dt-max) and by MostCare (MC-dP/dt-max) in critically ill patients. METHODS. We studies 20 heterogeneous patients (age 55±10 years, 15 male, 5 female) admitted to Intensive Care Unit (ICU) who were equipped with a radial artery catheter. Exclusion criteria were: age < 18 years, pathologies that could affect the reliability of the arterial signal (e.g., aortic valve and ascending aorta pathologies, cardiac arrhythmias). dP/dt-max was estimated after ICU admission from the analysis of the left or right radial artery during haemodynamic stability, defined as no more than a 5 % variation in heart rate and mean systemic arterial pressure during the time needed for SphygmoCor measurements. Sphy-dP/dt-max was assessed applying the tonometer at the opposite site of the radial artery catheter. MC-dP/dt-max values were averaged over the time needed for each Sphy-dP/dt-max measurement. Linear correlation and Bland Altman analysis were applied. RESULTS. The mean Sphy-dP/dt-max was 982 ± 328 (range 506-1452 mmHg/msec). Mean MC- dP/dt-max was 1013 ± 375 mmHg/msec (range 548-1500 mmHg/msec). The correlation between Sphy-dP/dt-max and MC-dp/dt-max was 0.82 (95% CI 0.76-0.88; p< 0.001). The mean bias between dP/dt obtained with the two systems was 30.3 mmHg/msec (Limits of agreement from -313 to 374 mmHg/msec). CONCLUSIONS. There is a good agreement between dP/dt-max obtained with SphygmoCor and MostCare. These two methods show similar capability of providing an evaluation of LV function in critically ill patients.
|Titolo:||Comparison between invasive and non-invasive assessment of dp/dt-max obtained with two pulse wave analysis devices|
|Citazione:||Franchi, F., Mongelli, P., Nocci, M., Donadello, K., Taccone, F.S., Ragozzino, C., et al. (2013). Comparison between invasive and non-invasive assessment of dp/dt-max obtained with two pulse wave analysis devices. In Intensive Care Medicine.|
|Appare nelle tipologie:||4.1 Contributo in Atti di convegno|
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