TY - JOUR
T1 - Rapid response team review of hemodynamically unstable ward patients
T2 - The accuracy of cardiac index assessment
AU - Eyeington, Christopher T.
AU - Lloyd-Donald, Patryck
AU - Chan, Matthew J.
AU - Eastwood, Glenn M.
AU - Young, Helen
AU - Peck, Leah
AU - Jones, Daryl A.
AU - Bellomo, Rinaldo
PY - 2019/2
Y1 - 2019/2
N2 - Purpose: Intensive care doctors commonly attend rapid response team (RRT) reviews of hospital-ward patients with hemodynamic instability and estimate the patient's likely cardiac index (CI). We aimed to non-invasively measure the CI of such patients and assess the level of agreement between such measurements and clinically estimated CI categories (low <2L/min/m2, normal 2-2.99L/min/m2 or high ≥3L/min/m2). Materials and methods: A prospective, observational study of non-invasive measurement and clinical estimation of CI categories in 50 adult hospital-ward patients who activated the RRT for ‘hemodynamic instability’ (tachycardia > 100BPM or hypotension < 90mmHg or both). Results: The CI was measured in 47/50(94%) patients and the mean CI was 3.5(95% CI 3.2-3.7) L/min/m2. Overall, 30(64%) patients had a high CI, 13(28%) and 4(9%) had a normal and a low CI, respectively. The level of agreement between measured and clinically estimated CI categories was low(19.2%). Sensitivity and positive predictive values of clinical estimation were low(0% and 3.3% for high CI, and 0% and 50% for low CI, respectively). Conclusions: Non-invasive CI measurement was possible in almost all hospital-ward patients triggering RRT review for hemodynamic instability. In such patients, the CI was high, and intensive care clinicians were unable to identify a low or a high CI state.
AB - Purpose: Intensive care doctors commonly attend rapid response team (RRT) reviews of hospital-ward patients with hemodynamic instability and estimate the patient's likely cardiac index (CI). We aimed to non-invasively measure the CI of such patients and assess the level of agreement between such measurements and clinically estimated CI categories (low <2L/min/m2, normal 2-2.99L/min/m2 or high ≥3L/min/m2). Materials and methods: A prospective, observational study of non-invasive measurement and clinical estimation of CI categories in 50 adult hospital-ward patients who activated the RRT for ‘hemodynamic instability’ (tachycardia > 100BPM or hypotension < 90mmHg or both). Results: The CI was measured in 47/50(94%) patients and the mean CI was 3.5(95% CI 3.2-3.7) L/min/m2. Overall, 30(64%) patients had a high CI, 13(28%) and 4(9%) had a normal and a low CI, respectively. The level of agreement between measured and clinically estimated CI categories was low(19.2%). Sensitivity and positive predictive values of clinical estimation were low(0% and 3.3% for high CI, and 0% and 50% for low CI, respectively). Conclusions: Non-invasive CI measurement was possible in almost all hospital-ward patients triggering RRT review for hemodynamic instability. In such patients, the CI was high, and intensive care clinicians were unable to identify a low or a high CI state.
KW - Cardiac index
KW - Cardiac output
KW - Hemodynamic monitoring
KW - Medical emergency team
KW - Non-invasive
KW - Rapid response team
UR - https://www.scopus.com/pages/publications/85053900832
U2 - 10.1016/j.jcrc.2018.09.002
DO - 10.1016/j.jcrc.2018.09.002
M3 - Article
C2 - 30482613
AN - SCOPUS:85053900832
SN - 0883-9441
VL - 49
SP - 187
EP - 192
JO - Journal of Critical Care
JF - Journal of Critical Care
ER -