Validation of maternal cardiac output assessed by transthoracic echocardiography against pulmonary artery catheterization in severely ill pregnant women: prospective comparative study and systematic review

• Objectives To compare physicians’ estimates of cardiac index and intravascular volume with transesophageal Doppler measurements obtained by critical care nurses, to assess the overall safety of transesophageal Doppler imaging by critical care nurses, and to compare hemodynamic measurements obtained via transesophageal Doppler imaging with those obtained via pulmonary artery catheterization. • Methods Data were collected prospectively on 106 patients receiving mechanical ventilation. Physicians estimated cardiac index and intravascular volume status by using bedside clinical assessment; critical care nurses, by using transesophageal Doppler imaging. In 24 patients, Doppler measurements were obtained within 6 hours of placement of a pulmonary artery catheter and recording of cardiac output and pulmonary artery occlusion pressure. • Results With Doppler measurements as the reference, physicians correctly estimated cardiac index in 46 (43.8%) of 105 patients, underestimated it in 24 (22.9%), and overestimated it in 35 (33.3%). They correctly estimated volume status in 31 patients (29.5%), underestimated it in 16 (15.2%), and overestimated it in 58 (55.2%). Doppler measurements of cardiac output correlated with those obtained via pulmonary artery catheterization (r = 0.778; P < .001). Two patients had minor complications: dislodgement of a nasogastric tube and inability to obtain a Doppler signal. • Conclusion Physicians’ assessment of cardiac index and intravascular volume in patients receiving mechanical ventilation is correct less than half of the time. Transesophageal Doppler imaging by critical care nurses appears to be a safe method for measuring cardiac index and estimating intravascular volume. Measurements obtained via Doppler imaging correlate well with those obtained via pulmonary artery catheterization.

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Prevalence of sub clinical hypothyroidism and pregnancy outcome: a prospective comparative study

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20200909 ◽

2020 ◽

Vol 9 (3) ◽

pp. 1250

Author(s):

Bilal Ur Rehman ◽

Hiba Gull

Keyword(s):

Comparative Study ◽

Pregnant Women ◽

Pregnancy Outcome ◽

Subclinical Hypothyroidism ◽

Apgar Score ◽

Adverse Pregnancy Outcome ◽

Significant Risk ◽

Overt Hypothyroidism ◽

Prospective Comparative Study ◽

Adverse Pregnancy

Background: In pregnancy, subclinical hypothyroidism is more common than overt hypothyroidism, ranging from 15% to 28% in Iodine sufficient region. Evidence suggests that subclinical hypothyroidism is associated with adverse pregnancy outcome. The aim of this study was to find the prevalence of subclinical hypothyroidism in pregnant women and adverse pregnancy outcome.Methods: This hospital based prospective comparative study was conducted over a period of 6 months from 1st July 2018 to 31st December 2018 in department of obstetrics and gynecology SKIMS Soura Kashmir. All the subjects who fulfilled the inclusion criteria and who consented to participate were screened for subclinical hypothyroidism.Results: A total of 175 pregnant women participated in the study and subclinical hypothyroidism was diagnosed in 25 pregnant women (14.2%). Most of our patients were in age group 21 to 30 years (69.1%). Pregnant women with subclinical hypothyroidism had significant risk of preeclampsia (35%) and higher cesarean section rate (29.6%). Neonate of women with subclinical hypothyroidism had higher incidence poor Apgar score, NICU admission.Conclusions: The prevalence of subclinical hypothyroidism is high in pregnant women and the gravity of the complications like pre-eclampsia, neonate with low Apgar score, increased NICU admission, overweight the cost of screening. In this view, we propose screening of all pregnant women in the first trimester for diagnosis.

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PULMONARY ARTERY CATHETERIZATION IN CARDIOGENIC SHOCK: A SYSTEMATIC REVIEW AND META-ANALYSIS

Canadian Journal of Cardiology ◽

10.1016/j.cjca.2020.07.037 ◽

2020 ◽

Vol 36 (10) ◽

pp. S13-S14

Author(s):

J. Chow ◽

M. Vadakken ◽

R. Whitlock ◽

A. Koziarz ◽

C. Ainsworth ◽

...

Keyword(s):

Systematic Review ◽

Pulmonary Artery ◽

Cardiogenic Shock ◽

Meta Analysis ◽

Pulmonary Artery Catheterization

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Pulmonary artery catheterization and thermodilution cardiac output determination in the management of critically burned patients

Plastic & Reconstructive Surgery ◽

10.1097/00006534-197903000-00086 ◽

1979 ◽

Vol 63 (3) ◽

pp. 442

Author(s):

Eugene H. Courtiss ◽

N. Aikawa

Keyword(s):

Cardiac Output ◽

Pulmonary Artery ◽

Pulmonary Artery Catheterization ◽

Thermodilution Cardiac Output ◽

Cardiac Output Determination

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Prospective observational study of serial cardiac output by transthoracic echocardiography in healthy pregnant women undergoing elective caesarean delivery

International Journal of Obstetric Anesthesia ◽

10.1016/j.ijoa.2009.06.007 ◽

2010 ◽

Vol 19 (2) ◽

pp. 142-148 ◽

Cited By ~ 18

Author(s):

A. Dennis ◽

I. Arhanghelschi ◽

S. Simmons ◽

C. Royse

Keyword(s):

Cardiac Output ◽

Observational Study ◽

Pregnant Women ◽

Transthoracic Echocardiography ◽

Caesarean Delivery ◽

Prospective Observational Study ◽

Elective Caesarean Delivery

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The Influence of Limited Dynamic Response of the Indicator Detector in a Swan-Ganz Catheter on the Overestimation of Cardiac Output Measurement By Means of Thermodilution

Metrology and Measurement Systems ◽

10.2478/v10178-012-0066-z ◽

2012 ◽

Vol 19 (4) ◽

pp. 751-758

Author(s):

Maciej Gawlikowski ◽

Tadeusz Pustelny

Keyword(s):

Cardiac Output ◽

Pulmonary Artery ◽

Dynamic Response ◽

Cardiac Output Measurement ◽

Slew Rate ◽

Pulmonary Artery Catheterization ◽

Output Measurement ◽

The Relationship ◽

Cardiac Output Measurements

Abstract Nowadays the “gold clinical standard” of hemodynamics diagnostic and cardiac output measurements is pulmonary artery catheterization by means of the Swan-Ganz catheter and thermodilution. The method itself is sensitive to numerous disturbances which cause inaccurate results. One of the well-known disadvantages of thermodilution is the overestimation of results at low values of cardiac output. This effect may concern the limited slew rate of the thermoelement mounted at the tip of the catheter. In this paper the relationship between the dynamic response of the thermoelement and the uncertainty of cardiac output measurements by means of thermodilution has been investigated theoretically and experimentally.

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