Diagnostic ability of hand-held echocardiography in ventilated critically ill patients

STUDY OBJECTIVES: To compare the diagnostic capability of recently available hand-held echocardiography (HHE) and of conventional transthoracic echocardiography (TTE) used as a gold standard in critically ill patients under mechanical ventilation. DESIGN: A prospective and descriptive study. SETTING: The general intensive care unit of a teaching hospital. PATIENTS: All mechanically ventilated patients requiring a TTE study with a full-feature echocardiographic platform (Sonos 5500(®); Philips Medical Systems, Andover, MA, USA) also underwent an echocardiographic examination using a small battery-operated device (33 × 23 cm(2), 3.5 kg) (Optigo(®); Philips Medical Systems). INTERVENTIONS: Each examination was performed independently by two intensivists experienced in echocardiography and was interpreted online. For each patient, the TTE videotape was reviewed by a cardiologist experienced in echocardiography and the final interpretation was used as a reference diagnosis. RESULTS: During the study period, 106 TTE procedures were performed in 103 consecutive patients (age, 59 ± 18 years; Simplified Acute Physiology Score, 46 ± 14; body mass index, 26 ± 9 kg/m(2); positive end-expiratory pressure, 8 ± 4 cmH(2)O). The number of acoustic windows was comparable using HHE and TTE (233/318 versus 238/318, P = 0.72). HHE had a lower overall diagnostic capacity than TTE (199/251 versus 223/251 clinical questions solved, P = 0.005), mainly due to its lack of spectral Doppler capability. In contrast, diagnostic capacity based on two-dimensional imaging was comparable for both approaches (129/155 versus 135/155 clinical questions solved, P = 0.4). In addition, HHE and TTE had a similar therapeutic impact in 45 and 47 patients, respectively (44% versus 46%, P = 0.9). CONCLUSIONS: HHE appears to have a narrower diagnostic field when compared with conventional TTE, but promises to accurately identify diagnoses based on two-dimensional imaging in ventilated critically ill patients

Evaluation de l'efficacité et de la tolérance des manœuvres de recrutement alvéolaire en réanimation

LIMOGES-BU Médecine pharmacie (870852108) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Hand-held echocardiography with Doppler capability for the assessment of critically-ill patients: is it reliable?

International audienceOBJECTIVE: To evaluate the diagnostic capability of a hand-carried ultrasound device (HCU) in critically ill patients when using conventional transthoracic echocardiography (TTE) as a reference. DESIGN: Prospective, descriptive study. SETTING: Medical-surgical intensive care unit of a teaching hospital. PATIENTS: All patients requiring a TTE study were eligible. INTERVENTIONS: Each patient underwent an echocardiographic examination using a full-feature echocardiographic platform (Sonos 5500, Philips Medical Systems, Andover, MA) and a small battery-operated device (SonoHeart Elite, SonoSite, Bothell, WA). The operators (level III training in echocardiography) were randomized (HCU vs. TTE) and they independently interpreted the echocardiograms at the patient bedside. RESULTS: During a 2-month period, 55 consecutive patients (age: 61+/-16 years, simplified acute physiology score 46+/-15, body mass index 26+/-7) were studied, 40 of them being mechanically ventilated (73%). The number of acoustic windows was comparable using HCU and TTE (2.3+/-0.8 vs. 2.4+/-0.8: P=0.24). The overall diagnostic accuracy of HCU was lower compared with conventional TTE (137/171 vs. 158/171 clinical questions solved: P=0.002), reaching 80% and 92%, respectively. Despite its spectral Doppler capability, HCU missed diagnoses that were adequately identified by TTE: elevated left ventricular pressure ( n=2), relevant valvulopathy ( n=2) and moderate ( n=4) or severe ( n=2) pulmonary hypertension. Acute management was altered by HCU and TTE findings in 27 patients (49%) and 28 patients (51%), respectively. CONCLUSIONS: In this study, HCU had a lower diagnostic accuracy compared with conventional TTE, despite its spectral Doppler capability. Further studies are needed to validate these evolving diagnostic tools in critical care settings

S'appuyer sur l'oxymétrie de pouls pour éviter l'hypoxémie et l'hyperoxie : une étude de cohorte prospective multicentrique chez des patients en insuffisance circulatoire

International audiencePurposeThe purpose of this study was to assess the predictive performance of pulse oximetry (SpO2) to rule out hypoxaemia and hyperoxia in critically ill patients.MethodsSpO2, arterial oxygenation (SaO2), and arterial partial pressure of oxygen (PaO2) were prospectively and simultaneously measured every 6 h during the first 24 h of intensive care unit admission in a multicentre cohort of critically ill patients suffering acute circulatory failure. Likelihood ratios associated with different cutoff values of SpO2 to rule out hypoxaemia (SaO2 95% or PaO2 > 100 mmHg) and post-test probabilities were calculated. Mean bias between SpO2 and SaO2 and agreement interval were calculated. Area under the receiver operating characteristics associated with SpO2 to predict different threshold values of SaO2 and PaO2 were calculated.ResultsFive hundred seventy-one patients (mean [standard deviation] Simplified Acute Physiology Score II: 58.7 [20.1]; mechanically ventilated 75.6%) with 2643 available SaO2 and PaO2 samples and corresponding 2643 SpO2 values were analysed. Mean bias between SpO2 and SaO2 was 1.1%, and its agreement interval ranged from −8.2 to +11.1%. SpO2 cutoff values of 88%, 90%, and 92% left the possibility that 8%–13% of patients had hypoxaemia. SpO2 < 95% left the possibility that 31% of patients had hyperoxia. All calculated areas under the receiver operating characteristics showed a lower limit of their 95% confidence interval below 0.85ConclusionIn this cohort of patients with circulatory failure, SpO2 had poor discriminative ability to rule out hypoxaemia and hyperoxia. Overconfidence upon SpO2 monitoring may be dangerous

Low versus standard calorie and protein feeding in ventilated adults with shock: a randomised, controlled, multicentre, open-label, parallel-group trial (NUTRIREA-3)

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