Philippe Vignon1, Emmanuelle Begot2, Arnaud Mari3, Stein Silva3, Loïc Chimot4, Pierre Delour4, Frédéric Vargas5, Bruno Filloux5, David Vandroux6, Julien Jabot6, Bruno François2, Nicolas Pichon2, Marc Clavel2, Bruno Levy7, Michel Slama8, Béatrice Riu-Poulenc3. 1. Medical-surgical Intensive Care Unit, Teaching Hospital of Limoges, Limoges, France; INSERM CIC 1435, Teaching Hospital of Limoges, Limoges, France. Electronic address: philippe.vignon@unilim.fr. 2. Medical-surgical Intensive Care Unit, Teaching Hospital of Limoges, Limoges, France; INSERM CIC 1435, Teaching Hospital of Limoges, Limoges, France. 3. Medical-Surgical Intensive Care Unit, Teaching Hospital of Toulouse, Toulouse, France. 4. Medical Intensive Care Unit, Hospital of Périgueux, Périgueux, France. 5. Medical Intensive Care Unit, Teaching Hospital of Bordeaux, Bordeaux, France. 6. Medical-Surgical Intensive Care Unit, Teaching Hospital of La Réunion, La Réunion, France. 7. Medical Intensive Care Unit, Teaching Hospital of Nancy, Nancy, France. 8. Medical Intensive Care Unit, Teaching Hospital of Amiens, Amiens, France.
Abstract
BACKGROUND: To assess the agreement between transpulmonary thermodilution (TPT) and critical care echocardiography (CCE) in ventilated patients with septic shock. METHODS: Ventilated patients in sinus rhythm requiring advanced hemodynamic assessment for septic shock were included in this prospective multicenter descriptive study. Patients were assessed successively using TPT and CCE in random order. Data were interpreted independently at bedside by two investigators who proposed therapeutic changes on the basis of predefined algorithms. TPT and CCE hemodynamic assessments were reviewed offline by two independent experts who identified potential sources of discrepant results by consensus. Lactate clearance and outcome were studied. RESULTS: A total of 137 patients were studied (71 men; age, 61 ± 15 years; Simplified Acute Physiologic Score, 58 ± 18; Sequential Organ Failure Assessment, 10 ± 3). TPT and CCE interpretations at bedside were concordant in 87/132 patients (66%) without acute cor pulmonale (ACP), resulting in a moderate agreement (kappa, 0.48; 95% CI, 0.37-0.60). Experts' adjudications were concordant in 100/129 patients without ACP (77.5%), resulting in a good intertechnique agreement (kappa, 0.66; 95% CI, 0.55-0.77). In addition to ACP (n = 8), CCE depicted a potential source of TPT inaccuracy in 8/29 patients (28%). Lactate clearance at H6 was similar irrespective of the concordance of online interpretations of TPT and CCE (55/84 [65%] vs 32/45 [71%], P = .55). ICU and day 28 mortality rates were similar between patients with concordant and discordant interpretations (29/87 [36%] vs 13/45 [29%], P = .60; and 31/87 [36%] vs 16/45 [36%], P = .99, respectively). CONCLUSIONS: Agreement between TPT and CCE was moderate when interpreted at bedside and good when adjudicated offline by experts, but without impact on lactate clearance and mortality.
BACKGROUND: To assess the agreement between transpulmonary thermodilution (TPT) and critical care echocardiography (CCE) in ventilated patients with septic shock. METHODS: Ventilated patients in sinus rhythm requiring advanced hemodynamic assessment for septic shock were included in this prospective multicenter descriptive study. Patients were assessed successively using TPT and CCE in random order. Data were interpreted independently at bedside by two investigators who proposed therapeutic changes on the basis of predefined algorithms. TPT and CCE hemodynamic assessments were reviewed offline by two independent experts who identified potential sources of discrepant results by consensus. Lactate clearance and outcome were studied. RESULTS: A total of 137 patients were studied (71 men; age, 61 ± 15 years; Simplified Acute Physiologic Score, 58 ± 18; Sequential Organ Failure Assessment, 10 ± 3). TPT and CCE interpretations at bedside were concordant in 87/132 patients (66%) without acute cor pulmonale (ACP), resulting in a moderate agreement (kappa, 0.48; 95% CI, 0.37-0.60). Experts' adjudications were concordant in 100/129 patients without ACP (77.5%), resulting in a good intertechnique agreement (kappa, 0.66; 95% CI, 0.55-0.77). In addition to ACP (n = 8), CCE depicted a potential source of TPT inaccuracy in 8/29 patients (28%). Lactate clearance at H6 was similar irrespective of the concordance of online interpretations of TPT and CCE (55/84 [65%] vs 32/45 [71%], P = .55). ICU and day 28 mortality rates were similar between patients with concordant and discordant interpretations (29/87 [36%] vs 13/45 [29%], P = .60; and 31/87 [36%] vs 16/45 [36%], P = .99, respectively). CONCLUSIONS: Agreement between TPT and CCE was moderate when interpreted at bedside and good when adjudicated offline by experts, but without impact on lactate clearance and mortality.
Authors: Tobias M Merz; Luca Cioccari; Pascal M Frey; Andreas Bloch; David Berger; Bjoern Zante; Stephan M Jakob; Jukka Takala Journal: Intensive Care Med Date: 2019-07-04 Impact factor: 17.440
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