Resumo
INTENSIVE CARE HEMODYNAMIC MONITORING: IS THERE A PLACE FOR NON INVASIVE METHODS?
Joana Mascarenhas, Cristiana Paulo, Conceição Sousa Dias, Carla Basílio, Paulo Bettencourt, José
Artur Paiva. Hospital de São João
Introduction: Understanding the hemodynamic profile of patients admitted to the intensive care unit
(ICU) with shock can be clinically challenging. Invasive methods have been developed in order to
evaluate and manage those patients. The role of impedance cardiography (ICG), a noninvasive method
that provides accurate hemodynamic measurements, was not fully addressed in this clinical setting.
Objective: To assess the role of ICG compared to pulse contour cardiac output analysis (PicCo®) in
hemodynamic profiling of patients admitted to the ICU in shock. Methods: We prospectively enrolled 37
patients admitted to a polyvalent ICU in shock. Patients with recent cardiac surgery, major pulmonary
embolism, moderate to severe aortic disease, tachyarrhythmia or aortic aneurism were excluded (n=15).
Data on hemodynamic parameters simultaneously obtained by ICG (BioZ ICG Monitor, Cardiodynamics,
San Diego, California) and PicCo® within 6 hours of admission were available for 14 patients. For each
method, patients were divided in 4 groups according to hemodynamic profile: group 1 – cardiac output
(CO) below and systemic vascular resistance (SVR) above the sample’s median; group 2 – CO and SVR
above the median; group 3 – CO and SVR below the median; group 4 – CO above and SVR below the
median. We calculated Cohen’s kappa to assess the agreement between the two methods for
hemodynamic profiling of patients.
Results: The sample’s mean (SD) age was 58.8 (15.8) years, 71% were men and 36.4% had systolic
dysfunction by echocardiography. The distribution of patients in terms of different hemodynamic profiles
assessed by PicCo® was: 6 (42.9%) patients in group 1, 1 (7.1%) patient in group 2, 1 (7.1%) patient in
group 3 and 6 (42.9%) patients in group 4. For ICG, the number of patients in each group was the same.
The agreement between the two methods in hemodynamic profiling of patients was moderate and
statistically significant (k=0.66, 95% CI 0.33-0.99, p=0.001). Conclusion: In our sample, we found a
clinically acceptable agreement between PicCo® and ICG for the classification of patients in shock in
terms of different hemodynamic profiles. Our results support the use of ICG in hemodynamic monitoring
in this setting.
Nome do apresentador – Cristiana Paulo ______________________________________________________________________________
Direcção – Alameda Prof. Hernâni Monteiro, Serviço de Medicina, Piso 4 _______ Cidade/Código Postal 4202-451 Porto _________
Telefone - 912911238_________________________ Fax - ____________________________ E-mail- [email protected] ____
Instituição – Hospital de São João ____________________________________________________________________________________
Nota: A Comissão de escolha dos trabalhos decidirá o formato do trabalho apresentado: Poster ou Comunicação Livre Oral