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Titolo:
Analysis of physician ability in the measurement of pulsus paradoxus by sphygmomanometry
Autore:
Jay, GD; Onuma, K; Davis, R; Chen, MH; Mansell, A; Steele, D;
Indirizzi:
Brown Univ, Sch Med, Dept Med, Providence, RI 02912 USA Brown Univ Providence RI USA 02912 ed, Dept Med, Providence, RI 02912 USA Brown Univ, Sch Med, Dept Pediat, Providence, RI 02912 USA Brown Univ Providence RI USA 02912 Dept Pediat, Providence, RI 02912 USA Brown Univ, Ctr Stat Sci, Providence, RI USA Brown Univ Providence RI USA rown Univ, Ctr Stat Sci, Providence, RI USA Tohoku Univ, Dept Mol Med, Sendai, Miyagi 980, Japan Tohoku Univ Sendai Miyagi Japan 980 pt Mol Med, Sendai, Miyagi 980, Japan
Titolo Testata:
CHEST
fascicolo: 2, volume: 118, anno: 2000,
pagine: 348 - 352
SICI:
0012-3692(200008)118:2<348:AOPAIT>2.0.ZU;2-T
Fonte:
ISI
Lingua:
ENG
Soggetto:
INDUCED ASTHMA; PRESSURE;
Keywords:
asthma; BP; physical examination; pulsus paradoxus;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
24
Recensione:
Indirizzi per estratti:
Indirizzo: Jay, GD Rhode Isl Hosp, Dept Emergency Med, 593 Eddy St, Providence, RI 02903 USA Rhode Isl Hosp 593 Eddy St Providence RI USA 02903 e, RI 02903 USA
Citazione:
G.D. Jay et al., "Analysis of physician ability in the measurement of pulsus paradoxus by sphygmomanometry", CHEST, 118(2), 2000, pp. 348-352

Abstract

Context: Measurement of pulsus paradoxus (PP) is one of several measures previously advocated in the National Heart, Lung, and Blood Institute asthmamanagement guidelines: a pulsus of > 12 mm Hg warranted hospital admission. It is one of only a few measures that is not effort dependent and therefore important in the evaluation of patients with asthma. Objective: Determination of physician accuracy in measuring PP. Design: A model of induced PP in a trained healthy subject without respiratory disease was constructed with a fixed inspiratory resistance with measurement of inspiratory air pressure and beat-to-beat BP noninvasively,Setting: Laboratory. Participants: Attending physicians from emergency medicine and critical care disciplines who served as consecutive examiners of the trained referencesubject generating known PP. Interventions: A total of 19 attending physicians were assessed for ability in measuring PP by sphygmomanometry and by palpation. The reference subject generated 4 degrees of PP sequentially, with each examiner blinded to the value of negative inspiratory pressure and PP, Examiners first assessed PP qualitatively by palpation, followed by its measurement within 2 min. Main outcome measure: Proximity of physician-measured PP (PPm) to true PP (PPt). Results: At inspiratory pressures of -10, -15, -20, and -25 mm Hg, PPt was 13.7, 16.2, 19.1, and 20.7 mm Hg, respectively (F = 14.8, p < 0.0001; analysis of variance [ANOVA]). At the same pressures, PPm was 13.1, 17.5,17.7, and 18.0 mm Hg (p > 0.10; ANOVA). Linear regression of PPm against PPt for each examiner revealed a slope (SE) of 0.53 (0.23), and not a 1:1 relationship. Conclusions: Past and present guidelines do not account for the challengesin measuring PP, especially in tachypneic patients. Sphygmomanometric determination of PP should be augmented by new aids developed through technological innovation.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 30/11/20 alle ore 17:00:14