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Vol. 47. Issue 3.
Pages 149-156 (March 2023)
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Vol. 47. Issue 3.
Pages 149-156 (March 2023)
Original article
Improving echographic monitoring of hemodynamics in critically ill patients: Validation of right cardiac output measurements through the modified subcostal window
Mejorando la monitorización hemodinámica ecográfica en el paciente crítico: validación de la medición del gasto cardíaco derecho a través de la ventana subcostal modificada
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L. Colinas Fernándeza,
Corresponding author
lauracolinasfernandez@gmail.com

Corresponding author.
, G. Hernández Martíneza, M.B. Serna Gandíab, G. Tuero Leónc, P. Cuesta-Monterod, R. Cuena Boye, R. Vicho Pereiraf
a Virgen de la Salud University Hospital, Toledo, Spain
b Dénia – MarinaSalud Hospital, Dénia, Spain
c Can Misses Hospital, Ibiza, Spain
d University Albacete General Hospital, Albacete, Spain
e Research Unit, Medical Council, Toledo, Spain
f Quirónsalud Rotger Clinic, Palma de Mallorca, Spain
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Abstract
Objective

We aimed to assess the usefulness of using the right ventricle outflow tract (RVOT) velocity-time integral (VTI) for echocardiographic monitoring of cardiac output compared to the gold standard, the VTI along the left ventricle outflow tract (LVOT).

Design

Prospective observational study.

Setting

A tertiary intensive care unit.

Patients

100 consecutive patients. Interventions: echocardiographic monitoring in critically ill patients.

Main variables of interest

We used intraclass correlation coefficients (ICC) to compare echocardiographic measurements of LVOT VTI through apical window with RVOT VTI through the parasternal and modified subcostal windows and to assess interobserver reproducibility. Preplanned post hoc analyses compared the ICC between ventilated and nonventilated patients.

Results

At the time of echocardiography, 44 (44%) patients were mechanically ventilated and 28 (28%) were receiving vasoactive drugs. Good-quality measurements were obtained through the parasternal short-axis and/or apical views in 81 (81%) patients and in 100 (100%) patients through the subcostal window. Consistency with LVOT VTI was moderate for RVOT VTI measured from the modified subcostal view (ICC 0.727; 95%CI: 0.62–0.808) and for RVOT VTI measured from the transthoracic view (0.715; 95%CI: 0.59–0.807).

Conclusions

Measurements of RVOT VTI are moderately consistent with measurements of LVOT VTI. Adding the modified subcostal window allows monitoring RVOT VTI in all the patients of this selected cohort, even those under mechanical ventilation.

Keywords:
Echocardiography
Hemodynamic monitoring
Cardiac output
Velocity time-integral
Abbreviations:
ICC
ICU
LVOT
MAPE
MSE
PEEP
RMSE
RVOT
VTI
Resumen
Objetivo

Valorar la utilidad de la integral velocidad-tiempo (IVT) del tracto de salida del ventrículo derecho (TSVD) para la monitorización del gasto cardíaco comparado con el gold standard, el IVT del tracto de salida del ventrículo izquierdo (TSVI).

Diseño

Estudio prospectivo observacional.

Ámbito

UCI de un hospital terciario.

Pacientes

Cien pacientes consecutivos.

Intervenciones

Ecocardiografías realizadas para monitorización hemodinámica.

Variables de interés principales

Usamos el coeficiente de correlación intraclase (CCI) para comparar las mediciones de IVT TSVI a través de la ventana apical con el IVT TSVD a través de la ventana paraesternal y subcostal modificada y la reproducibilidad interobservador. Se planeó un análisis post hoc para comparar los resultados en pacientes ventilados con no ventilados.

Resultados

En el momento de la ecografía, 44 (44%) pacientes estaban en ventilación mecánica y 28 (28%) recibían fármacos vasoactivos. Mediciones de buena calidad se obtuvieron a través de la ventana paraesternal o apical en 81 (81%) pacientes, y en 100 (100%) con la ventana subcostal modificada. La consistencia del IVT TSVI fue moderada con el IVT TSVD medido con la ventana subcostal modificada (CCI 0,727; IC 95%: 0,62-0,808) y la transtorácica (0,715; IC 95%: 0,59-0,807).

Conclusiones

El IVT TSVD presenta una consistencia moderada cuando se compara con el IVT TSVI. Añadir la ventana subcostal modificada permite monitorizar el IVT TSVD en todos los pacientes de esta cohorte, incluso aquellos con ventilación mecánica.

Palabras clave:
Ecocardiografía
Monitorización hemodinámica
Gasto cardíaco
Integral velocidad-tiempo

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