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Titolo:
Radiologic determination of intravascular volume status using portable, digital chest radiography: A prospective investigation in 100 patients
Autore:
Ely, EW; Smith, AC; Chiles, C; Aquino, SL; Harle, TS; Evans, GW; Haponik, EF;
Indirizzi:
Vanderbilt Univ, Med Ctr E, Div Allergy Pulm Crit Care Med, Ctr Hlth Serv Res,Dept Internal Med, Nashville, TN 37232 USA Vanderbilt Univ Nashville TN USA 37232 ernal Med, Nashville, TN 37232 USA Vanderbilt Univ, Med Ctr, Dept Radiol Sci, Nashville, TN 37232 USA Vanderbilt Univ Nashville TN USA 37232 adiol Sci, Nashville, TN 37232 USA Vanderbilt Univ, Med Ctr, Dept Publ Hlth Sci, Nashville, TN 37232 USA Vanderbilt Univ Nashville TN USA 37232 Hlth Sci, Nashville, TN 37232 USA Wake Forest Univ, Bowman Gray Sch Med, Winston Salem, NC USA Wake Forest Univ Winston Salem NC USA ray Sch Med, Winston Salem, NC USA Johns Hopkins Univ, Sch Med, Baltimore, MD USA Johns Hopkins Univ Baltimore MD USA ins Univ, Sch Med, Baltimore, MD USA Massachusetts Gen Med Ctr, Boston, MA USA Massachusetts Gen Med Ctr Boston MA USA etts Gen Med Ctr, Boston, MA USA
Titolo Testata:
CRITICAL CARE MEDICINE
fascicolo: 8, volume: 29, anno: 2001,
pagine: 1502 - 1512
SICI:
0090-3493(200108)29:8<1502:RDOIVS>2.0.ZU;2-#
Fonte:
ISI
Lingua:
ENG
Soggetto:
CRITICALLY ILL PATIENTS; PULMONARY-ARTERY CATHETERIZATION; RESPIRATORY-DISTRESS SYNDROME; RECEIVING MECHANICAL VENTILATION; RIGHT-HEART CATHETERIZATION; SWAN-GANZ CATHETER; VASCULAR PEDICLE; SURGICAL ICU; SCREEN-FILM; EDEMA;
Keywords:
thoracic radiography; pulmonary edema; intravascular volume; blood volume; intensive care units; intensive care; Swan-Ganz catheterization; pulmonary artery catheterization; likelihood ratio; likelihood functions; diagnostic tests; congestive heart failure; cardiogenic shock; sepsis; acute respiratory distress syndrome; pneumonia; myocardial infarction; thoracic disease;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
65
Recensione:
Indirizzi per estratti:
Indirizzo: Ely, EW Vanderbilt Univ, Med Ctr E, Div Allergy Pulm Crit Care Med, Ctr Hlth Serv Res,Dept Internal Med, 6th Floor, Nashville, TN 37232 USA Vanderbilt Univ 6th Floor Nashville TN USA 37232 lle, TN 37232 USA
Citazione:
E.W. Ely et al., "Radiologic determination of intravascular volume status using portable, digital chest radiography: A prospective investigation in 100 patients", CRIT CARE M, 29(8), 2001, pp. 1502-1512

Abstract

Objective. To answer the following questions: Can the digital chest roentgenogram (CXR) be used to differentiate patients' volume status? Do clinicaldata alter radiologists' accuracy in interpreting the digital CXR? Design. Prospective cohort study. Setting., Nine adult intensive care units of a tertiary care medical center. Patients. One hundred thirty-five consecutive patients with pulmonary artery catheters, of whom 35 were excluded because of unacceptable pulmonary artery occlusion pressure (PAOP) tracings. Methods. Each patient had a portable, anteroposterior, supine digital CXR. Clinicians evaluated volume status and then measured hemodynamic data within 1 hr of the CXR. Digital CXRs were independently interpreted on two separate occasions (with and without clinical information) by three experiencedchest radiologists, and these interpretations were compared with hemodynamic data. Results. Of the 100 patients, 39 had PAOP > 18 mm Hg, whereas 61 had PAOP < 18 mm Hg. Radiologists' accuracy in differentiating volume status increased with incorporation of clinical data (56% without vs. 65% with clinical data, p = .009). Using objective receiver operating characteristic- derived cutoffs of 70 mm for vascular pedicle width and 0.55 for cardiothoracic ratio, radiologists' accuracy in differentiating PAOP >18 mm Hg from PAOP < 18mm Hg was 70%. The intrareader and the inter-reader correlation coefficients were very high. The likelihood ratio of the CXR in determining volume status using the objective vascular pedicle width and cardiothoracic ratio measures was 3.1 (95% confidence interval, 1.9-6.0), significantly higher than subjective CXR interpretations with and without clinical data (p < .001). Conclusions. Differentiating intravascular volume status with portable, supine, digital CXRs may be improved by using objective cutoffs of vascular pedicle width > 70 mm and cardiothoracic ratio >0.55 or by incorporating clinical data.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 25/01/20 alle ore 19:34:46