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.

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.

Comparison between invasive and non-invasive assessment of dp/dt-max obtained with two pulse wave analysis devices

FRANCHI, FEDERICO;SCOLLETTA, SABINO
2013-01-01

Abstract

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.
2013
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.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11365/975350
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