Resumo
INTENSIVE
CARE HEMODYNAMIC MONITORING: ASSESSING AGREEMENT BETWEEN MINIMALLY INVASIVE AND
NONINVASIVE METHODS
Cristiana Paulo, Joana Mascarenhas, Conceição Sousa Dias, Carla Basílio, Paulo Bettencourt, José
Artur Paiva. Hospital de São João
Introduction: Hemodynamic monitoring has become crucial in the evaluation of critically ill patients.
Current strategies involve the use of invasive techniques. Impedance cardiography (ICG) is an emerging
noninvasive method requiring validation in the intensive care unit (ICU) setting. We aimed to evaluate the
agreement between ICG and pulse contour cardiac output analysis (PicCo®) in the determination of
cardiac index (CI) and systemic vascular resistance index (SVRI) in ICU patients presenting with shock.
Methods: Among 37 patients consecutively admitted to a polivalent ICU in shock, 15 were excluded due
to recent cardiac surgery, major pulmonary embolism, moderate to severe aortic disease,
tachyarrhythmia or aortic aneurism. Hemodynamic monitoring using ICG (BioZ ICG Monitor
(Cardiodynamics, San Diego, California) and PicCo® were performed simultaneously to all eligible
patients at admission and after 12 hours. We used Bland-Altman analysis to assess the agreement
between the two methods within 6 hours of admission.
Results: Data on hemodynamic parameters were available for 14 from the 22 included patients. The
mean ± standard deviation age was 58.8±15.8 years, 71.4% were men and 36.4% had depressed left
ventricular systolic function by echocardiography. The median (interquartile range) CI acquired by
PicCo® and ICG was 2.9 (1.8-3.7) and 2.4 (2.0-3.3) L/min/m2, respectively. The mean difference between
the two methods was 0.26 L/min/m2. The limits of agreement were -2.37 and 2.89 L/min/m2, widening
with increasing CI values. After logarithmic transformation, the limits of agreement reflected a variation in
CI from -49% to 230% between methods. For SVRI the median (interquartile range) was 1545 (10722260) and 1890 (1182-2270) dyn*s*cm-5*m2, respectively determined by PicCo® and ICG. The mean
difference between the two methods was -69.2 dyn*s*cm-5*m2. ICG measured higher SVRI values in the
majority of patients. The limits of agreement were - 651 and 649 dyn*s*cm-5*m2. After logarithmic
transformation the ICG measurement may differ from the PicCo measurement by 39% below to 230%
above.
Conclusion: Our results failed to confirm good agreement between ICG and PicCo® for the
determination of CI and SVRI in ICU patients admitted with shock. The limits of agreement between the
two methods were too wide to be clinically acceptable. The small sample size is a major limitation of our
study.
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