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Intensivist bedside ultrasound (INBU) for volume assessment in the intensive care unit: a pilot study.
J Trauma. 2007 Sep; 63(3):495-500; discussion 500-2.JT

Abstract

BACKGROUND

Estimation of volume status in the high-acuity surgical population can be challenging. The use of intensivist bedside ultrasound (INBU) to rapidly assess volume status in the surgical intensive care unit (SICU) was hypothesized to be feasible and as accurate as invasive measures.

METHODS

Clinician sonographers (CSs) were trained to perform basic cardiac ultrasound and sonographic assessment of the inferior vena cava (IVC). A convenience sample of general surgery and trauma patients was enrolled in the SICU. The CS interpreted IVC and cardiac parameters and then categorized the subject as hypovolemic or not hypovolemic. Intensivists caring for the patients were blinded to the INBU findings and made a real-time expert clinical judgment (ECJ) of the patient's volume status (hypovolemic vs. not hypovolemic) using all available traditional data.

RESULTS

A total of nine CSs performed 70 studies; three of the CSs performed the majority of the studies (86%). Adequate ultrasound (US) views for cardiac and IVC assessment were obtained in 96% and 89% of studies, respectively. The ECJ was considered to be the standard to which comparisons were made. The concordance rate between ECJ and central venous pressure was 62%. ECJ concordance with sonographic measures were similar (cardiac US = 75%, IVC US = 67%, and IVC collapse index = 65%). All pairwise comparisons against the ECJ/CVP agreement were not significantly different.

CONCLUSIONS

INBU is feasible in the SICU and is equivalent to central venous pressure in assessing volume status. Noninvasive methods to assess volume status may decrease the need for invasive procedures.

Authors+Show Affiliations

Department of Emergency Medicine, and Division of Trauma and Surgical Critical Care, University of Pennsylvania School of MedicinePhiladelphia, Pennsylvania 19104-6021, USA. Brendan.Carr@uphs.upenn.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18073592

Citation

Carr, Brendan G., et al. "Intensivist Bedside Ultrasound (INBU) for Volume Assessment in the Intensive Care Unit: a Pilot Study." The Journal of Trauma, vol. 63, no. 3, 2007, pp. 495-500; discussion 500-2.
Carr BG, Dean AJ, Everett WW, et al. Intensivist bedside ultrasound (INBU) for volume assessment in the intensive care unit: a pilot study. J Trauma. 2007;63(3):495-500; discussion 500-2.
Carr, B. G., Dean, A. J., Everett, W. W., Ku, B. S., Mark, D. G., Okusanya, O., Horan, A. D., & Gracias, V. H. (2007). Intensivist bedside ultrasound (INBU) for volume assessment in the intensive care unit: a pilot study. The Journal of Trauma, 63(3), 495-500; discussion 500-2.
Carr BG, et al. Intensivist Bedside Ultrasound (INBU) for Volume Assessment in the Intensive Care Unit: a Pilot Study. J Trauma. 2007;63(3):495-500; discussion 500-2. PubMed PMID: 18073592.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Intensivist bedside ultrasound (INBU) for volume assessment in the intensive care unit: a pilot study. AU - Carr,Brendan G, AU - Dean,Anthony J, AU - Everett,Worth W, AU - Ku,Bon S, AU - Mark,Dustin G, AU - Okusanya,Olugbenga, AU - Horan,Annamarie D, AU - Gracias,Vicente H, PY - 2007/12/13/pubmed PY - 2008/1/25/medline PY - 2007/12/13/entrez SP - 495-500; discussion 500-2 JF - The Journal of trauma JO - J Trauma VL - 63 IS - 3 N2 - BACKGROUND: Estimation of volume status in the high-acuity surgical population can be challenging. The use of intensivist bedside ultrasound (INBU) to rapidly assess volume status in the surgical intensive care unit (SICU) was hypothesized to be feasible and as accurate as invasive measures. METHODS: Clinician sonographers (CSs) were trained to perform basic cardiac ultrasound and sonographic assessment of the inferior vena cava (IVC). A convenience sample of general surgery and trauma patients was enrolled in the SICU. The CS interpreted IVC and cardiac parameters and then categorized the subject as hypovolemic or not hypovolemic. Intensivists caring for the patients were blinded to the INBU findings and made a real-time expert clinical judgment (ECJ) of the patient's volume status (hypovolemic vs. not hypovolemic) using all available traditional data. RESULTS: A total of nine CSs performed 70 studies; three of the CSs performed the majority of the studies (86%). Adequate ultrasound (US) views for cardiac and IVC assessment were obtained in 96% and 89% of studies, respectively. The ECJ was considered to be the standard to which comparisons were made. The concordance rate between ECJ and central venous pressure was 62%. ECJ concordance with sonographic measures were similar (cardiac US = 75%, IVC US = 67%, and IVC collapse index = 65%). All pairwise comparisons against the ECJ/CVP agreement were not significantly different. CONCLUSIONS: INBU is feasible in the SICU and is equivalent to central venous pressure in assessing volume status. Noninvasive methods to assess volume status may decrease the need for invasive procedures. SN - 1529-8809 UR - https://www.unboundmedicine.com/medline/citation/18073592/Intensivist_bedside_ultrasound__INBU__for_volume_assessment_in_the_intensive_care_unit:_a_pilot_study_ L2 - http://dx.doi.org/10.1097/TA.0b013e31812e51e5 DB - PRIME DP - Unbound Medicine ER -