Comparação da avaliação do débito cardíaco e do volume sistólico por ecocardiografia transtorácica e pelo sistema PiCCO em pacientes críticos agudos

Abstract

Introduction: Maintaining adequate oxygen transport is essential in managing critically ill patients to preserve a supply of oxygen sufficient to maintain cellular metabolism. Output (DC) is the main factor that determines oxygen transport, which, in turn, is influenced by systolic volume (SV) and heart rate. Several less invasive methods for monitoring CO have been proposed to replace the pulmonary artery catheter. Among these methods, Pulse index Continuous Cardiac Output (PiCCO) has been used for over ten years. However, this is still invasive compared to transthoracic echocardiography (TTEcho) performed at the bedside, which has become popular in recent years. Objectives: The primary objective of this study was to compare the agreement and correlation between CO and SV measurements by TTEcho and PiCCO in adult critically ill adult patients. The secondary objectives were to evaluate the feasibility of TTEcho for CO and SV measurements and the concordance for reduced CI measurements between PiCCO and TTECho methods. Methods: This prospective cross-sectional study included adult critically ill patients (aged 18 years or older) admitted to the adult ICU of the Hospital Ortopédico e Medicina Especializada (HOME), Brasília, Distrito Federal, Brazil, from January 2019 to January 2021. Results: Twenty-nine patients were included. The mean age was 78.7 ± 14.9 years, and 75.0% were female (n = 22). The main reasons for hospitalization were femur fracture repair surgery (n = 10, 34.5%), followed by sepsis (n = 6, 20.6%), and acute coronary syndrome (n = 4, 13.8%). Adequate TTEcho evaluations were obtained in all 29 patients. There was a very strong positive correlation between CO-TTEcho and CO-PiCCO measurements (r = 0.845, p < 0.001) and a very strong positive correlation between SV-TTEcho and SV-PiCCO-SV measurements (r = 0.800, p < 0.001). According to the Bland-Altman method, TTEcho estimations of CO and SV were feasible within the limits of agreement in 96.6% of cases (28/29) compared to PiCCO. The mean difference between CO-PiCCO and CO-TTEcho values was 0.250 L/min, giving limits of agreement of -1.083 to 1.583 L/min and a percentage error of 21.0%. In contrast, the mean with SV-PiCCO and SV-TTEcho values was 2.000 mL, giving limits of agreement of -16.960 to 20.960 and a percentage error of 24.3%, and there was no significant difference between PiCCO and TTEcho regarding CO (4.8 ± 1.4 versus 4.6 ± 1.0, p = 0.619) and SV (54.9 ± 11.4 versus 53.5 ± 11.4, p = 0.419) values. There was a significant concordance in the measurements for reduced CI by PiCCO and TTECho (89.1%, Cohen's kappa coefficient: 0.751, p < 0.001). Considering the PICCO values as the gold standard measurements for CI, a sensitivity of 95.0% (76.4%-99.1%) and a specificity of 77.8% (45.3%-93.7%) were found for reduced IC value by TTECho. Considering the PICCO values as the gold standard measurements for CI, a sensitivity of 95.0% (76.4%-99.1%) and a specificity of 77.8% (45.3%-93.7%) were found for reduced IC value by TTECho. Conclusion: In adult critically ill patients, the TTEcho is a feasible alternative to the PiCOO for monitoring CO and SV volume. There was a very strong correlation or strong correlation between the measurements by these methods and a good agreement between methods. TTEcho can be used as a safe and accurate hemodynamic monitoring tool at the bedside when performed by trained professionals.