Intensivist bedside ultrasound (INBU) for volume assessment in the intensive care unit: A pilot study
Intensivist bedside ultrasound (INBU) for volume assessment in the intensive care unit: A pilot study
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DOI：
10.1097/ta.0b013e31812e51e5
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发表时间：
2007-09-01
影响因子：
--
通讯作者：
Gracias, Vicente H.
中科院分区：
文献类型：
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作者：
Carr, Brendan G.;Dean, Anthony J.;Gracias, Vicente H.
背景：估计高敏锐度手术人群的体积状态可能具有挑战性。据推测，在外科重症监护病房 (SICU) 中使用重症监护床旁超声 (INBU) 快速评估容量状态是可行的，并且与侵入性测量一样准确。方法：临床超声医师 (CS) 接受过培训，可以对下腔静脉 (IVC) 进行基本心脏超声和超声评估。普通外科和创伤患者的方便样本被纳入 SICU。 CS 解读 IVC 和心脏参数，然后将受试者分类为低血容量或非低血容量。护理患者的重症监护医师对 INBU 结果不知情，并使用所有可用的传统数据对患者的容量状态（低血容量与非低血容量）做出实时专家临床判断 (ECJ)。 结果：总共 9 个 CS 进行了 70 项研究；其中三个 CS 完成了大部分研究 (86%)。 96% 和 89% 的研究分别获得了用于心脏和 IVC 评估的足够超声 (US) 视图。欧洲法院被认为是进行比较的标准。 ECJ与中心静脉压的一致性为62%。 ECJ 与超声检查指标的一致性相似（心脏 US = 75%，IVC US = 67%，IVC 塌陷指数 = 65%）。所有与 ECJ/CVP 一致性的成对比较均无显着差异。结论：INBU 在 SICU 中是可行的，并且在评估容量状态方面相当于中心静脉压。评估容量状态的无创方法可能会减少对侵入性手术的需求。
BaCkground: Estimation of volume status in the high-acuity surgical population can be challenging. The use of intensivist bedside ultrasound (INBU) to rapidly assess volume status in the surgical intensive care unit (SICU) was hypothesized to be feasible and as accurate as invasive measures.Methods: Clinician sonographers (CSs) were trained to perform basic cardiac ultrasound and sonographic assessment of the inferior vena cava (IVC). A convenience sample of general surgery and trauma patients was enrolled in the SICU. The CS interpreted IVC and cardiac parameters and then categorized subject as hypovolemic or not hypovolemic. Intensivists caring for the patients were blinded to the INBU findings and made a real-time expert clinical judgment (ECJ) of the patient's volume status (bypovolemic vs. not hypovolemic) using all available traditional data.Results: A total of nine CSs performed 70 studies; three of the CSs performed the majority of the studies (86%). Adequate ultrasound (US) views for cardiac and IVC assessment were obtained in 96% and 89% of studies, respectively. The ECJ was considered to be the standard to which comparisons were made. The concordance rate between ECJ and central venous pressure was 62%. ECJ concordance with sonographic measures were similar (cardiac US = 75%, IVC US = 67%, and IVC collapse index = 65%). All pairwise comparisons against the ECJ/CVP agreement were not significantly different.Conclusions: INBU is feasible in the SICU and is equivalent to central venous pressure in assessing volume status. Noninvasive methods to assess volume status may decrease the need for invasive procedures.