Zijlstra, H.W. (Hendrik Wietse) (2012) A pilot study to determine whether Non Invasive Cardiac Output Monitoring (NICOM) is as accurate as echocardiography in measuring fluid responsiveness in the emergency department. thesis, Medicine.
Full text available on request.Abstract
Background: The main treatment of sepsis and septic shock is based on early goal-directed therapy (EGDT) and giving fluids. The amount of fluids given to a patient is nowadays based on experience and estimations of the physician instead of a protocol. Fluid responsiveness seems to be a useful assessment to guide fluid therapy. Amongst others echocardiography and Non-Invasive Cardiac Output Monitoring (NICOM) are technologies used for this purpose. In this pilot study we wanted to determine whether NICOM is using passive leg raise and a fluid bolus Methods : Cardiac assessments from patients that received fluid resuscitation in the ED are recorded with NICOM. The cardiac assessments were done with NICOM and on all the patients. As fluid challenges we used passive leg raise and 5cc/kg fluid bolus. PLR and the bolus test were both done twice to test reproducibility. As a definition of fluid responsiveness we used a stroke volume increase of >10% after a fluid challenge. We compared the two consecutive PLR and bolus tests with each other, using Bland-Altman plots and Cohen’s Kappa. Results: We found that the two PLR test, measured by NICOM, gave an average stroke volume increase of respectively 24 % and 20.2% with 67.2% and 60.2% of the subjects fluid responsive. The bolus test gave an increase of 16.5 % and 15.4% with 60.0% and 60.0% fluid responsive. We found no difference between PLR as measured by NICOM, 5cc/kg bolus test by NICOM. According to Cohen’s Kappa the two PLR tests had a moderate agreement and the bolus test a poor agreement. Conclusion : .The conclusion of this pilot study is that NICOM is reproducible if passive leg raise is used as a fluid challenge, but can not be used alone as a predictor of fluid responsiveness. Discussion: Our patient group gives us an estimation of reproducibility in a broad spectrum of patients. No conclusion on specific patients groups can be drawn.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Faculty supervisor: and Meurs, Matijs van MD PhD and Department of Critical Care and Universitair Medisch Centrum Groningen |
| Supervisor name: | Local supervisor: and Shapiro, Nathan I MD MPH and Assistant Professor of Medicine Harvard Medical School and Beth Israel Deaconess Medical Center |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 11:03 |
| Last Modified: | 25 Jun 2020 11:03 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2340 |
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