Accuracy and precision of cardiac output estimation by an automated, brachial cuff-based oscillometric device in patients with shock

Non-invasive monitoring of cardiac output is a technological and clinical challenge, especially for critically ill, surgically operated, or intensive care unit patients. A brachial cuff-based, automated, oscillometric device used for blood pressure and arterial stiffness ambulatory monitoring (Mobil-O-Graph) provides a non-invasive estimation of cardiac output values simultaneously with regular blood pressure measurement. The aim of the study was to evaluate the feasibility of this apparatus to estimate cardiac output in intensive care unit patients and to compare the non-invasive estimated cardiac output values with the respective gold standard method of thermodilution during pulmonary artery catheterization. Repeated sequential measurements of cardiac output were performed, in random order, by thermodilution (reference) and Mobil-O-Graph (test), in 24 patients hospitalized at intensive care unit. Reproducibility and accuracy of the test device were evaluated by Bland–Altman analysis, intraclass correlation coefficient, and percentage error. Mobil-O-Graph underestimated significantly the cardiac output by −1.12 ± 1.38 L/min ( p < 0.01) compared to thermodilution. However, intraclass correlation coefficient was >0.7 indicating a fair agreement between the test and the reference methods, while percentage error was approximately 39% which is considered to be within the acceptable limits. Cardiac output measurements were reproducible by both Mobil-O-Graph (intraclass correlation coefficient = 0.73 and percentage error = 27.9%) and thermodilution (intraclass correlation coefficient = 0.91 and percentage error = 26.7%). We showed for the first time that cardiac output estimation in intensive care unit patients using a non-invasive, automated, oscillometric, cuff-based apparatus is reproducible (by analyzing two repeated cardiac output measurements), exhibiting similar precision to thermodilution. However, the accuracy of Mobil-O-Graph (error compared to thermodilution) could be considered fairly acceptable. Future studies remain to further examine the reliability of this technology in monitoring cardiac output or stroke volume acute changes which is a more clinically relevant objective.

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Interrater Reliability of Muscle Ultrasonography Image Acquisition by Physical Therapists in Patients Who Have or Who Survived Critical Illness

Physical Therapy ◽

10.1093/ptj/pzaa068 ◽

2020 ◽

Vol 100 (9) ◽

pp. 1701-1711 ◽

Cited By ~ 1

Author(s):

Kirby P Mayer ◽

Sanjay Dhar ◽

Evan Cassity ◽

Aaron Denham ◽

Johnny England ◽

...

Keyword(s):

Skeletal Muscle ◽

Intensive Care Unit ◽

Intensive Care ◽

Correlation Coefficient ◽

Intraclass Correlation Coefficient ◽

Interrater Reliability ◽

Physical Therapists ◽

Physical Therapist ◽

Image Acquisition ◽

Intraclass Correlation

Abstract Objective Previous studies have demonstrated that muscle ultrasound (US) can be reliably performed at the patient bedside by novice assessors with minimal training. The primary objective of this study was to determine the interrater reliability of muscle US image acquisition by physical therapists and physical therapist students. Secondarily, this study was designed to elucidate the process for training physical therapists to perform peripheral skeletal muscle US. Methods This was a cross-sectional observational study. Four novices and 1 expert participated in the study. Novice sonographers engaged in a structured training program prior to implementation. US images were obtained on the biceps brachii, quadriceps femoris, and tibialis anterior muscles in 3 groups: patients in the intensive care unit, patients on the hospital ward, and participants in the outpatient gym who were healthy. Reliability of image acquisition was analyzed compared with the expert sonographer. Results Intraclass correlation coefficient values ranged from 0.76 to 0.97 with an average for all raters and all muscles of 0.903, indicating excellent reliability of image acquisition. In general, the experienced physical therapist had higher or similar intraclass correlation coefficient values compared with the physical therapist students in relation to the expert sonographer. Conclusions Excellent interrater reliability for US was observed regardless of the level of experience, severity of patient illness, or patient setting. These findings indicate that the use of muscle US by physical therapists can accurately capture reliable images in patients with a range of illness severity and different clinical practice settings across the continuum of care. Impact Physical therapists can utilize US to obtain images to assess muscle morphology. Lay Summary Physical therapists can use noninvasive US as an imaging tool to assess the size and quality of peripheral skeletal muscle. This study demonstrates that physical therapists can receive training to reliably obtain muscle images in patients admitted to the intensive care unit who may be at risk for muscle wasting and may benefit from early rehabilitation.

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A preliminary study of intensivist-performed DVT ultrasound screening in trauma ICU patients (APSIT Study)

Annals of Intensive Care ◽

10.1186/s13613-020-00739-8 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Lloyd Roberts ◽

Tom Rozen ◽

Deirdre Murphy ◽

Adam Lawler ◽

Mark Fitzgerald ◽

...

Keyword(s):

Intensive Care ◽

Deep Vein Thrombosis ◽

High Risk ◽

Correlation Coefficient ◽

Intraclass Correlation Coefficient ◽

Major Trauma ◽

Intraclass Correlation ◽

Trauma Patients ◽

Vein Thrombosis ◽

Deep Vein

Abstract Background Multiple screening Duplex ultrasound scans (DUS) are performed in trauma patients at high risk of deep vein thrombosis (DVT) in the intensive care unit (ICU). Intensive care physician performed compression ultrasound (IP-CUS) has shown promise as a diagnostic test for DVT in a non-trauma setting. Whether IP-CUS can be used as a screening test in trauma patients is unknown. Our study aimed to assess the agreement between IP-CUS and vascular sonographer performed DUS for proximal lower extremity deep vein thrombosis (PLEDVT) screening in high-risk trauma patients in ICU. Methods A prospective observational study was conducted at the ICU of Alfred Hospital, a major trauma center in Melbourne, Australia, between Feb and Nov 2015. All adult major trauma patients admitted with high risk for DVT were eligible for inclusion. IP-CUS was performed immediately before or after DUS for PLEDVT screening. The paired studies were repeated twice weekly until the DVT diagnosis, death or ICU discharge. Written informed consent from the patient, or person responsible, or procedural authorisation, was obtained. The individuals performing the scans were blinded to the others’ results. The agreement analysis was performed using Cohen’s Kappa statistics and intraclass correlation coefficient for repeated binary measurements. Results During the study period, 117 patients had 193 pairs of scans, and 45 (39%) patients had more than one pair of scans. The median age (IQR) was 47 (28–68) years with 77% males, mean (SD) injury severity score 27.5 (9.53), and a median (IQR) ICU length of stay 7 (3.2–11.6) days. There were 16 cases (13.6%) of PLEDVT with an incidence rate of 2.6 (1.6–4.2) cases per 100 patient-days in ICU. The overall agreement was 96.7% (95% CI 94.15–99.33). The Cohen’s Kappa between the IP-CUS and DUS was 0.77 (95% CI 0.59–0.95), and the intraclass correlation coefficient for repeated binary measures was 0.75 (95% CI 0.67–0.81). Conclusions There is a substantial agreement between IP-CUS and DUS for PLEDVT screening in trauma patients in ICU with high risk for DVT. Large multicentre studies are needed to confirm this finding.

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Feasibility, Reliability, Responsiveness, and Validity of the Patient-Reported Functional Scale for the Intensive Care Unit: A Pilot Study

Journal of Intensive Care Medicine ◽

10.1177/0885066618824534 ◽

2019 ◽

Vol 35 (12) ◽

pp. 1396-1404

Author(s):

Julie C. Reid ◽

France Clarke ◽

Deborah J. Cook ◽

Alexander Molloy ◽

Jill C. Rudkowski ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Physical Function ◽

Correlation Coefficient ◽

Intraclass Correlation ◽

Stair Climbing ◽

Minimal Detectable Change ◽

Functional Scale ◽

Number Of Patients ◽

Patient Reported

Background: Although many performance-based measures assess patients’ physical function in intensive care unit (ICU) survivors, to our knowledge, there are no patient-reported ICU rehabilitation-specific measures assessing function. We developed the Patient-Reported Functional Scale-ICU (PRFS-ICU), which measures patients’ perceptions of their ability to perform 6 activities (rolling, sitting edge of bed, sit-to-stand and bed-to-chair transfers, ambulation, and stair climbing). Each item is scored from 0 (unable) to 10 (able to perform at pre-ICU level) to a maximum of 60. Objectives: Estimate the feasibility, reliability, responsiveness, and validity of the PRFS-ICU. Methods: This was a substudy of TryCYCLE, a single-center, prospective cohort examining the safety and feasibility of early in-bed cycling with mechanically ventilated patients (NCT01885442). To determine feasibility, we calculated the number of patients with at least 1 PRFS-ICU assessment during their hospital stay. To assess reliability, 2 raters blinded to each other’s assessments administered the PRFS-ICU within 24-hours of each other. We calculated the intraclass correlation coefficient (ICC; 95% confidence interval [CI]), standard error of measurement (SEM, 95% CI), and minimal detectable change (MDC90). To assess validity, we estimated convergent validity of the PRFS-ICU with the Functional Status Score for ICU (FSS-ICU), Medical Research Council Sum Score (MRC-SS), Physical Function Test for ICU (PFIT-s), Katz Index of Independence in Activities of Daily Living (Katz ADLs), and a pooled index using Pearson's correlation coefficient ( r, 95% CI). Results: Feasibility: 20 patients completed a PRFS-ICU assessment. Reliability and responsiveness: 16 patients contributed data. The ICC, SEM, and MDC90 were 0.91 (0.76, 0.97), 4.75 (3.51, 7.35), and 11.04 points, respectively. Validity: 19 patients contributed data and correlations were ( r [95% CI]): FSS-ICU (0.40 [−0.14, 0.76]), MRC-SS (0.51 [0.02, 0.80]), PFIT-s (0.43 [−0.13, 0.78]), Katz ADLs (0.53 [0.10, 0.79]), and pooled index (0.48 [−0.14, 0.82]). Conclusions: Our pilot work suggests the PRFS-ICU may be a useful tool to assess and monitor patients’ perceptions of function over time.

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Comparative evaluation of tractography-based direct targeting and atlas-based indirect targeting of the ventral intermediate (Vim) nucleus in MRgFUS thalamotomy

Scientific Reports ◽

10.1038/s41598-021-93058-2 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Federico Bruno ◽

Alessia Catalucci ◽

Marco Varrassi ◽

Francesco Arrigoni ◽

Patrizia Sucapane ◽

...

Keyword(s):

Clinical Response ◽

Correlation Coefficient ◽

Intraclass Correlation Coefficient ◽

Comparative Evaluation ◽

Intraclass Correlation ◽

Percentage Error ◽

Absolute Percentage Error ◽

Spatial Coordinates ◽

Direct Targeting

AbstractTo analyze and compare direct and indirect targeting of the Vim for MRgFUS thalamotomy. We retrospectively evaluated 21 patients who underwent unilateral MRgFUS Vim ablation and required targeting repositioning during the procedures. For each patient, in the three spatial coordinates, we recorded: (i) indirect coordinates; (ii) the coordinates where we clinically observed tremor reduction during the verification stage sonications; (iii) direct coordinates, measured on the dentatorubrothalamic tract (DRTT) at the after postprocessing of DTI data. The agreement between direct and indirect coordinates compared to clinically effective coordinates was evaluated through the Bland–Altman test and intraclass correlation coefficient. The median absolute percentage error was also calculated. Compared to indirect targeting, direct targeting showed inferior error values on the RL and AP coordinates (0.019 vs. 0.079 and 0.207 vs. 0.221, respectively) and higher error values on the SI coordinates (0.263 vs. 0.021). The agreement between measurements was higher for tractography along the AP and SI planes and lower along the RL planes. Indirect atlas-based targeting represents a valid approach for MRgFUS thalamotomy. The direct tractography approach is a valuable aid in assessing the possible deviation of the error in cases where no immediate clinical response is achieved.

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Interrater reliability of 2 sedation scales in a medical intensive care unit: a preliminary report

American Journal of Critical Care ◽

10.4037/ajcc2001.10.2.79 ◽

2001 ◽

Vol 10 (2) ◽

pp. 79-83 ◽

Cited By ~ 23

Author(s):

LH Hogg ◽

MB Bobek ◽

LC Mion ◽

BM Legere ◽

S Banjac ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Motor Activity ◽

Correlation Coefficient ◽

Interrater Reliability ◽

Medical Intensive Care Unit ◽

Intraclass Correlation ◽

Assessment Scale ◽

Activity Assessment ◽

Medical Intensive Care

BACKGROUND: Critical care nurses must assess the effectiveness of sedatives and analgesic agents in order to titrate doses. OBJECTIVES: To measure the interrater reliability of 2 sedation scales used to assess patients in medical intensive care units. METHODS: The interrater reliabilities of the Motor Activity Assessment Scale and the Luer sedation scale were compared prospectively in 31 patients receiving mechanical ventilation in an 18-bed medical intensive care unit of a tertiary care institution. Three registered nurses, 1 clinical pharmacist, and 1 physician simultaneously and independently followed a standardized procedure to rate each patient by using the 2 scales. Scales were randomly ordered to counteract ordering effect. Analysis of variance with post hoc Duncan multiple range tests was used to detect bias; a correlation coefficient matrix was used to examine degree of association among raters; and the intraclass correlation coefficient was measured to control for multiple raters. RESULTS: No significant bias was detected with either scale. The Motor Activity Assessment Scale had less variation (Pearson r = 0.75-0.92) than did the Luer scale (Pearson r = 0.37-0.94) and had a stronger intraclass correlation coefficient (0.81 vs 0.79). CONCLUSIONS: The Motor Activity Assessment Scale showed the highest consistency among raters.

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