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Related Experiment Videos

Cardiopulmonary assessment: is improvement needed?

Joseph M Van De Water1, Martin L Dalton, David C Parish

  • 1Department of Surgery, Mercer University School of Medicine, Medical Center of Central Georgia, 801 Spring Street, Macon, Georgia 31201, USA. vandewater_j@mercer.edu

World Journal of Surgery
|April 9, 2005
PubMed
Summary

Physician assessments of cardiac index and thoracic fluid content are unreliable in unstable patients. Noninvasive impedance cardiography (ICG) offers a more accurate diagnostic tool for cardiopulmonary status, improving patient care.

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Area of Science:

  • Cardiology
  • Critical Care Medicine
  • Medical Devices

Background:

  • Clinical assessment of cardiopulmonary status is often unreliable, particularly in hemodynamically unstable patients.
  • Traditional methods for assessing cardiac index (CI) and thoracic fluid content (TFC) have limitations.

Purpose of the Study:

  • To evaluate the diagnostic accuracy of physician assessments of CI and TFC compared to impedance cardiography (ICG).
  • To determine if ICG can provide a more reliable measure of cardiopulmonary status in unstable patients.

Main Methods:

  • A prospective study comparing physician assessments of CI and TFC with values obtained from the BioZ ICG monitor in 186 hemodynamically unstable patients.
  • Defined normal ranges for CI (2.5-4.2 L/min m(2)) and TFC (males: 30-50 kohm(-1), females: 21-37 kohm(-1)).

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Main Results:

  • Physician assessment showed low concordance with ICG: 51% for CI (Kappa=0.14) and 58% for TFC (Kappa=0.19).
  • Serious conditions like low CI and high TFC were misdiagnosed 42% and 46% of the time, respectively.
  • Physician use of available hemodynamic data did not improve accuracy.

Conclusions:

  • Physician assessment of cardiopulmonary status using clinical parameters is unreliable in hemodynamically unstable patients.
  • Impedance cardiography (ICG) offers a potentially valuable, noninvasive tool for accurate hemodynamic assessment.
  • ICG could significantly improve the management of critically ill patients, especially with decreasing use of pulmonary artery catheters.