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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
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.
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)).
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.