Use of the esophageal echo-Doppler to guide intensive care unit resuscitations: A retrospective study|
Stawicki, Peter S; Hoff, WilliamS; Cipolla, James; McQuay Jr, Nathaniel & Grossman, Michael D
Purpose: The esophageal Doppler monitoring (EDM) has emerged as an alternative to the pulmonary artery catheter (PAC). The purpose of this study is to better define its role in the ICU.
Materials and Methods: Retrospective review of Hemosonic 100 EDM probe use between 2003 and 2005. Patient- and EDM-related characteristics, indications, complications, resuscitation end points (lactate, base excess - BE, left ventricular ejection time - LVET) were recorded. Comparisons between EDM and PAC were made.
Results: Thirty-nine patients were monitored using the EDM. EDM-guided interventions resulted in significantly improved lactate, BE and LVET (all, P < 0.01). The change in BE correlated with change in LVET (R=0.7143, P < 0.0002). Cardiac output (CO) measurements by EDM and PAC were compared using the Bland-Altman method (mean = 0.0167, standard deviation = 0.9351, variance = 0.8745, 95% CI -1.854 to 1.887), which demonstrated that the EDM tended to underestimate CO in the lower ranges of measurements and overestimate CO in the upper ranges.
Conclusions: EDM may be most helpful in ventilated/sedated patients requiring short-term hemodynamic monitoring. When compared to PAC, the EDM tends to underestimate CO in the lower range and overestimate CO in the upper range of measurements. We recommend EDM use concurrently with end-points of resuscitation.
Clinical algorithm, esophageal Doppler monitor, indications and contraindications