Original Article
Lack of correlation between left ventricular outflow tract velocity time integral and stroke volume index in mechanically ventilated patients
Ausencia de correlación entre la integral velocidad tiempo en el tracto de salida del ventrículo izquierdo y el índice volumen sistólico en pacientes en ventilación mecánica
R. Blancasa,
, Ó. Martínez-Gonzálezb, D. Ballesterosb, A. Núñezc, J. Lujánd, D. Rodríguez-Serranoe, A. Hernándezf, C. Martínez-Díazg, C.M. Parrab, B.L. Matamalab, M.A. Alonsob, M. Chanab
Autor para correspondencia
a Critical Care Department, Hospital Universitario del Tajo, Alfonso X El Sabio University, Eco Club Madrid, Aranjuez, Spain
b Critical Care Department, Hospital Universitario del Tajo, Alfonso X El Sabio University, Aranjuez, Spain
c Critical Care Department, Hospital Universitario Clínico de San Carlos, Eco Club Madrid, Madrid, Spain
d Critical Care Department, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Spain
e Critical Care Department, Hospital Universitario de la Princesa, Eco Club Madrid, Madrid, Spain
f Critical Care Department, Hospital Universitario Fundación Alcorcón, Eco Club Madrid, Alcorcón, Spain
g Critical Care Department, Hospital Universitario Príncipe de Asturias, Eco Club Madrid, Alcalá de Henares, Spain
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"apellidos" => "Chana" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:7 [ 0 => array:3 [ "entidad" => "Critical Care Department, Hospital Universitario del Tajo, Alfonso X El Sabio University, Eco Club Madrid, Aranjuez, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Critical Care Department, Hospital Universitario del Tajo, Alfonso X El Sabio University, Aranjuez, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Critical Care Department, Hospital Universitario Clínico de San Carlos, Eco Club Madrid, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Critical Care Department, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Critical Care Department, Hospital Universitario de la Princesa, Eco Club Madrid, Madrid, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Critical Care Department, Hospital Universitario Fundación Alcorcón, Eco Club Madrid, Alcorcón, Spain" "etiqueta" => "f" "identificador" => "aff0030" ] 6 => array:3 [ "entidad" => "Critical Care Department, Hospital Universitario Príncipe de Asturias, Eco Club Madrid, Alcalá de Henares, Spain" "etiqueta" => "g" "identificador" => "aff0035" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Ausencia de correlación entre la integral velocidad tiempo en el tracto de salida del ventrículo izquierdo y el índice volumen sistólico en pacientes en ventilación mecánica" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1266 "Ancho" => 1610 "Tamanyo" => 96310 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Correlation between mean LVOT VTI and SVI. Dash lines denote 95% confidence interval.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Since the introduction of ultrasound into the routine monitoring of critical patients the interest in achieving a reliable and accurate evaluation of cardiac function and hemodynamic values by echocardiography has been a subject of concern. Transthoracic cardiac ultrasound has the advantage of being available at bedside even outside of the intensive care unit (ICU), as a quick examination method avoiding discomfort to the patient and the complications associated with invasive monitoring.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Several echocardiographic methods and measurements are available for hemodynamic monitoring. In spite of the previously encouraging publications and recommendations, especially in the field of perioperative medicine, most of these measurements are experience dependent and difficult to obtain in mechanically ventilated patients.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">1–3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Data on the feasibility and accuracy of ultrasound application for hemodynamic monitoring in critically ill ventilated patients are limited. Echocardiography has several limitations primarily related to difficulties in obtaining reliable acoustic windows in the critical care settings.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Left ventricular outflow tract velocity time integral (LVOT VTI) can be measured in most critical care patients and has shown better reproducibility to assess left ventricular systolic function in mechanically ventilated and hemodynamically unstable patients, when compared with the Simpson method, the estimated “eyeball” ejection fraction, mean atrioventricular plane displacement and with the septal tissue velocity imaging methods.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">4</span></a> The lack of correlation between LVOT VTI and other invasive hemodynamic measurements would make obtained data inaccurate.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Left ventricular outflow tract (LVOT) could be considered as having fixed dimensions through the cardiac cycle and to be independent on preload state. Calculation of cardiac output requiring LVOT diameter measurement is strongly dependent on skills and observers.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Previous studies have demonstrated that LVOT mean velocity determined by pulsed wave Doppler allows cardiac index quantification through a simple formula.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">5</span></a> Hence, the requirement of calculate LVOT diameter to estimate cardiac output could be obviated. The aim of our study is to evaluate the correlation between LVOT VTI and stroke volume index (SVI), as a way to preclude the need for LVOT diameter size measurement.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Patients and methods</span><p id="par0035" class="elsevierStylePara elsevierViewall">The primary end-point of the study was to assess the correlation between LVOT VTI and SVI calculated by thermodilution methods. For this purpose, a prospective, descriptive study was performed. Five medical-surgical ICUs from different university hospitals participated in the study.</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Selection of participants</span><p id="par0040" class="elsevierStylePara elsevierViewall">From November 2015 to February 2016, consecutive patients older than 17 years admitted to the ICU needing mechanical ventilation and invasive hemodynamic monitoring were included in the study. Patients with aortic valve regurgitation, dynamic obstruction of the LVOT or with intra-aortic balloon pump insertion were excluded from the analysis.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Interventions and measurements</span><p id="par0045" class="elsevierStylePara elsevierViewall">Anthropometric data were obtained from medical report or from relatives. In some cases, weight and size were measured in the ICU.</p><p id="par0050" class="elsevierStylePara elsevierViewall">LVOT VTI was measured by pulsed wave Doppler transthoracic echocardiography from the apical 5 chamber view as usually defined and recommended.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">1</span></a> In every examination, performed by a single intensivist, five measurements of LVOT VTI were obtained and the mean and maximum values were recorded. The operator made a strong effort to align the probe with the LVOT flow. Operators were senior intensivists with experience in performing daily echocardiographic studies in critically ill patients.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Simultaneously, five calculations of SVI through a floating pulmonary artery catheter (PAC) or a Pulse index Contour Cardiac Output (PiCCO<span class="elsevierStyleSup">®</span>, Pulsion Medical Systems, Germany) thermodilution methods (using cold saline) were performed by experienced staff nurses and the mean value was recorded. PAC or PiCCO<span class="elsevierStyleSup">®</span> system were chosen according to the staff physician criteria, prior to patient inclusion in the study. Calculation of PAC and PiCCO<span class="elsevierStyleSup">®</span> thermodilution values was performed using the software incorporated in the bedside monitors (IntelliVue MP60, Philips, Eindhoven, The Netherlands). Calibration of the system was carried out every eight hours.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Those thermodilution curves showing irregularities or lacking a clear early peak were considered inadequate and therefore rejected. If the difference between the lowest and highest values of the five measurements was >10%, additional cardiac output measurements were performed, and extreme values discarded. Physician performing the Doppler study was unaware of the results of the thermodilution study results.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Simultaneous results of LVOT VTI (mean and maximum) and SVI (mean) were paired for statistical analysis.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Measurements were recorded under stable hemodynamic and cardiac rhythm conditions, as often as needed by the responsible intensivist, but at least eight hours apart.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Statistical analysis</span><p id="par0075" class="elsevierStylePara elsevierViewall">Quantitative variables are expressed as mean<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>standard deviation (SD). Mean and maximum LVOT VTI were correlated with mean SVI obtained by PAC or by PiCCO<span class="elsevierStyleSup">®</span>. Correlation was assessed by the Pearson correlation index and concordance by the intraclass correlation coefficient (ICC).</p><p id="par0080" class="elsevierStylePara elsevierViewall">The relation between continuous variables was tested by linear regression analysis. The Student's <span class="elsevierStyleItalic">t</span> test was used to test the systematic differences among methods. A <span class="elsevierStyleItalic">p</span> value <0.05 was considered statistically significant.</p><p id="par0085" class="elsevierStylePara elsevierViewall">IBM SPSS Statistics for Windows, Version 20.0. software (IBM Corp., Armonk, United States) provided statistical analysis.</p><p id="par0090" class="elsevierStylePara elsevierViewall">The study protocol was approved by the institutional Investigational Committee from the principal investigator hospital. This committee ascertained that the study protocol was in accordance with the ethical standards collected in the Declaration of Helsinki, its amendments and that the national laws were observed.</p><p id="par0095" class="elsevierStylePara elsevierViewall">Informed consent for the investigational use of the clinical data was obtained from patients when possible or, otherwise, from their relatives.</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Results</span><p id="par0100" class="elsevierStylePara elsevierViewall">Fifty patients were eligible for the study. One patient was excluded from the analysis due to the lack of a reliable acoustic window. Two additional patients were excluded because an intra-aortic balloon pump was inserted during the study period. Finally, 156 paired measurements were compared: 97 (62.2%) recorded with PiCCO<span class="elsevierStyleSup">®</span> and 59 (37.8%) with PAC. In 19 evaluated patients PAC was inserted and in 28 the PiCCO<span class="elsevierStyleSup">®</span> system was chosen for hemodynamic monitoring. As a mean, 3.3 paired measurements were registered in every patient (range 1–13). Thirty-nine paired measurements (25%) were recorded in atrial fibrillation.</p><p id="par0105" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the baseline characteristics of the remaining 47 patients.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">Mean LVOT VTI was 20.83<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4.86<span class="elsevierStyleHsp" style=""></span>cm and mean SVI was 41.55<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>9.55<span class="elsevierStyleHsp" style=""></span>mL/m<span class="elsevierStyleSup">2</span>. Pearson correlation index for these variables was <span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.644, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001; ICC 0.52 (CI 95% 0.4–0.63). When SVI and maximum LVOT VTI were compared, Pearson correlation index was <span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.62, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001. Correlation worsened for extreme values, especially for those with higher LVOT VTI (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">Results obtained by PAC and PiCCO<span class="elsevierStyleSup">®</span> are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>. LVOT VTI was different when both invasive monitoring systems were compared (LVOT VTI for PAC 22.22<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>5.25<span class="elsevierStyleHsp" style=""></span>cm, for PiCCO<span class="elsevierStyleSup">®</span> 19.99<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4.39, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.005). Body mass index (BMI) was higher for patients in whom the PAC was chosen as the invasive monitoring method (BMI for PAC 32.66<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>10.92, BMI for PiCCO<span class="elsevierStyleSup">®</span> 28.44<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>6.76, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001). PiCCO<span class="elsevierStyleSup">®</span> was preferably employed in men (male gender represented for PAC and PiCCO<span class="elsevierStyleSup">®</span> 35.6% and 69% respectively, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001).</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Discussion</span><p id="par0120" class="elsevierStylePara elsevierViewall">Non-invasive calculation of cardiac index by ultrasound uses to be performed by the conventional method that includes the calculation of aortic annular area. This method is exposed to mistakes related to operator experience and to the pitfalls and difficulties to secure a suitable acoustic window, especially in ventilated patients. This is the reason why it would be of great interest to develop a simple echocardiographic method, minimizing unnecessary calculations. Beside this, assessing the concordance between LVOT VTI and invasive hemodynamic parameters is of great importance for developing accurate methods of echocardiographic monitoring. These concerns set up the stage for the aim of our study.</p><p id="par0125" class="elsevierStylePara elsevierViewall">Echocardiography has significant limitations in critically ill patients. Therefore, it is of great value to find out patient characteristics and conditions that could lead to inaccurate results. In the present study, we excluded patients with aortic regurgitation and LVOT abnormalities. Other cardiac abnormalities that can interfere with LVOT VTI measurements, such as dilated left ventricles, are common in fluid overloaded critical care patients. Atrial fibrillation, frequently present in seriously ill patients, could interfere with echocardiographic assessment. Nevertheless, we recorded five measurements of LVOT VTI in every patient, in accordance with current recommendation for patients on atrial fibrillation.</p><p id="par0130" class="elsevierStylePara elsevierViewall">Our results show a modest agreement between LVOT VTI and SVI determined by thermodilution. The subsets of patients included have some characteristics than can lead to several pitfalls for accurately assessing cardiac function by ultrasound. These pitfalls are derived not exclusively from the quality of acoustic windows but also from physiological changes induced by mechanical ventilation or preload conditions.</p><p id="par0135" class="elsevierStylePara elsevierViewall">Previously published studies pointed out to the fact that cardiac index monitoring in critically ill patients by cardiac ultrasound is feasible and accurate, including some ventilated patients. Evangelista et al. reported a close correlation (<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.97) between left ventricular outflow tract mean velocity determined by pulsed wave Doppler and cardiac index determined by the thermodilution method, in the absence of left ventricular outflow abnormalities.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">5</span></a> In their study, cardiac index was calculated through a simple formula (CITD<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>172 MVpwD – 172, where CITD denotes cardiac index by thermodilution and MVpwD denotes mean velocity by pulsed wave Doppler). This study excluded patients with severe obesity and was not designed for patients on mechanical ventilation.</p><p id="par0140" class="elsevierStylePara elsevierViewall">In the recent study published by Muñoz et al., cardiac output measured by thermodilution in patient after cardiac surgery was compared with cardiac output calculated (area<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>VTI) through transesophageal echocardiography (measuring VTI in LVOT and mitral annulus). Results from cardiac output measurements by transesophageal echocardiography did not correlate with those obtained by thermodilution.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">6</span></a> The authors did not discuss explanations for their findings.</p><p id="par0145" class="elsevierStylePara elsevierViewall">LVOT obstruction can modify LVOT VTI values leading to uncertain results. This problem is not restricted to the dynamic obstruction observed in some hypertrophic cardiomyopathies, but can also be present in some low preload states (e.g. hypovolemic and distributive shock). In patients with left ventricular hypertrophy, obstruction can be precipitated by hypovolemia or by exogenous or endogenous catecholamines.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">7</span></a> These circumstances are common in the critical care setting and were present in most of the patients included in this study. The influence of these factors in our results has to be determined in future studies.</p><p id="par0150" class="elsevierStylePara elsevierViewall">Although the aim of our study did not include to compare PAC and PiCCO<span class="elsevierStyleSup">®</span> methods, correlation was closer to 1 for paired measurements with PiCCO<span class="elsevierStyleSup">®</span> (<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.766, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001) than for those assessed with PAC (<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.493, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001). BMI was different for these two monitoring methods (32.66<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>10.92 and 28.44<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>6.76 for PAC and PiCCO<span class="elsevierStyleSup">®</span> respectively; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001). Physician responsible could have chosen the monitoring method taking into account obesity and its associated pathologies, such as pulmonary hypertension.</p><p id="par0155" class="elsevierStylePara elsevierViewall">We did not have added anthropometric data to the calculation of LVOT VTI to improve correlation with SVI. Leye et al., have demonstrated that LVOT diameter is linearly correlated with body surface area (BSA). In their study they proposed BMI, height and gender specific equations to calculate LVOT diameter.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">8</span></a> Nevertheless, when their validated formula has been included to calculate LVOT dimensions, the correlation with Fick and thermodilution methods was poor, even for patients with preserved left ventricle function and normal ventricle size, as concluded by Maeder et al.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">9</span></a> These investigators did not find a good correlation between those gold standards and echocardiographic left ventricular function assessed by four methods (considering LVOT VTI, LVOT diameter as measured as well as estimated from body surface area and stroke volume indices assessed using the biplane and monoplane methods).</p><p id="par0160" class="elsevierStylePara elsevierViewall">Pulmonary hypertension, a common issue in the critical care setting, can lead to right ventricle failure and tricuspid regurgitation, which are associated with underestimation of cardiac output measured by thermodilution. One study from Balik et al., concluded that high degree tricuspid regurgitation can cause inaccurate cardiac output calculated by thermodilution through a PAC.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">10</span></a> Additionally, there are some concerns about the accuracy of transthoracic Doppler echocardiography to evaluate pulmonary hypertension, which can be underestimated when compared with measurements determined by PAC.<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">11,12</span></a> In our study, pulmonary pressures were measured only in the case of PAC insertion. Hence, we are lacking data about right ventricle function in most patients and we are unable to draw some conclusions about the impact that pulmonary hypertension could exerts on our results.</p><p id="par0165" class="elsevierStylePara elsevierViewall">Although widely employed for critically ill patients monitoring, several concerns exist about the reliability of PiCCO<span class="elsevierStyleSup">®</span> system in some settings, including patients receiving positive end-expiratory pressure, those suffering from pulmonary vascular occlusion, inhomogeneous lung injury or pleural effusions.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">13</span></a> All these circumstances are common among ICU patients and raise doubts about the accuracy of transpulmonary thermodilution as a reference when compared with other monitoring methods.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Conclusions</span><p id="par0170" class="elsevierStylePara elsevierViewall">LVOT VTI could be a complementary hemodynamic evaluation tool in selected patients, but does not eliminate the need for invasive monitoring at the present time. LVOT VTI could introduce additional mistakes to those derived from the cross section of the aorta in the calculation of stroke volume in ventilated patients. The weak correlation between LVOT VTI and invasive measurement of SVI in extreme values deserves additional assessment in larger studies that could identify the factors affecting this disagreement.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Authors’ contributions</span><p id="par0175" class="elsevierStylePara elsevierViewall">R. Blancas has full access to all the data in the study and he takes responsibility for the integrity of the data and the accuracy of the data analysis. The corresponding author assumes full responsibility for the integrity of the submission as a whole.</p><p id="par0180" class="elsevierStylePara elsevierViewall">Dr. R. Blancas confirms that the study objectives and procedures are honestly disclosed. Moreover, he has reviewed study execution data and confirms that procedures were followed to an extent that convinces all authors that the results are valid and generalizable to a population similar to that enrolled in this study.</p><p id="par0185" class="elsevierStylePara elsevierViewall">Dr. Óscar Martínez-González has performed statistical analysis.</p><p id="par0190" class="elsevierStylePara elsevierViewall">Dr. Daniel Ballesteros, Dr. Antonio Núñez, Dr. Jimena Luján, Dr. Diego Serrano, Dr. Alberto Hernández, Dr. Cristina Martínez-Díaz, Dr. Carmen Martín Parra, Blanca López Matamala, Dr. María Angeles Alonso and Dr. Miriam Chana have performed echocardiographic studies and collected data.</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Conflicts of interest</span><p id="par0195" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:3 [ "identificador" => "xres1152558" "titulo" => "Abstract" "secciones" => array:8 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Design" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Setting" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Patients" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Interventions" ] 5 => array:2 [ "identificador" => "abst0030" "titulo" => "Main variables" ] 6 => array:2 [ "identificador" => "abst0035" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1080861" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1152559" "titulo" => "Resumen" "secciones" => array:8 [ 0 => array:2 [ "identificador" => "abst0045" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0050" "titulo" => "Diseño" ] 2 => array:2 [ "identificador" => "abst0055" "titulo" => "Ámbito" ] 3 => array:2 [ "identificador" => "abst0060" "titulo" => "Pacientes" ] 4 => array:2 [ "identificador" => "abst0065" "titulo" => "Intervenciones" ] 5 => array:2 [ "identificador" => "abst0070" "titulo" => "Variables principales" ] 6 => array:2 [ "identificador" => "abst0075" "titulo" => "Resultados" ] 7 => array:2 [ "identificador" => "abst0080" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1080862" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Patients and methods" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Selection of participants" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Interventions and measurements" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Statistical analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0030" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0035" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0040" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0045" "titulo" => "Authors’ contributions" ] 10 => array:2 [ "identificador" => "sec0050" "titulo" => "Conflicts of interest" ] 11 => array:2 [ "identificador" => "xack393284" "titulo" => "Acknowledgments" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-09-26" "fechaAceptado" => "2017-11-26" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1080861" "palabras" => array:4 [ 0 => "Intensive care" 1 => "Hemodynamic monitoring" 2 => "Echocardiography" 3 => "Mechanical ventilation" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1080862" "palabras" => array:4 [ 0 => "Cuidados intensivos" 1 => "Monitorización hemodinámica" 2 => "Ecocardiografía" 3 => "Ventilación mecánica" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To assess the correlation between left ventricular outflow tract velocity time integral (LVOT VTI) and stroke volume index (SVI) calculated by thermodilution methods in ventilated critically ill patients.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Design</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A prospective, descriptive, multicenter study was performed.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Setting</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Five intensive care units from university hospitals.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Patients</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Patients older than 17 years needing mechanical ventilation and invasive hemodynamic monitoring were included.</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Interventions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">LVOT VTI was measured by pulsatile Doppler echocardiography. Calculations of SVI were performed through a floating pulmonary artery catheter (PAC) or a Pulse index Contour Cardiac Output (PiCCO<span class="elsevierStyleSup">®</span>) thermodilution methods.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Main variables</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The relation between LVOT VTI and SVI was tested by linear regression analysis.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">One hundred and fifty-six paired measurements were compared. Mean LVOT VTI was 20.83<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4.86<span class="elsevierStyleHsp" style=""></span>cm and mean SVI was 41.55<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>9.55<span class="elsevierStyleHsp" style=""></span>mL/m<span class="elsevierStyleSup">2</span>. Pearson correlation index for these variables was <span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.644, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001; ICC was 0.52 (CI 95% 0.4–0.63). When maximum LVOT VTI was correlated with SVI, Pearson correlation index was <span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.62, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001. Correlation worsened for extreme values, especially for those with higher LVOT VTI.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">LVOT VTI could be a complementary hemodynamic evaluation in selected patients, but does not eliminate the need for invasive monitoring at the present time. The weak correlation between LVOT VTI and invasive monitoring deserves additional assessment to identify the factors affecting this disagreement.</p></span>" "secciones" => array:8 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Design" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Setting" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Patients" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Interventions" ] 5 => array:2 [ "identificador" => "abst0030" "titulo" => "Main variables" ] 6 => array:2 [ "identificador" => "abst0035" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Objetivo</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Evaluar la correlación entre la integral velocidad tiempo del tracto de salida del ventrículo izquierdo (IVT TSVI) y el índice volumen sistólico (IVS) calculado por métodos de termodilución en pacientes ventilados críticamente enfermos.</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Diseño</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Se realizó un estudio prospectivo, descriptivo y multicéntrico.</p></span> <span id="abst0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Ámbito</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Cinco unidades de cuidados intensivos de hospitales universitarios.</p></span> <span id="abst0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Pacientes</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron pacientes mayores de 17 años que necesitaron ventilación mecánica y monitorización hemodinámica invasiva.</p></span> <span id="abst0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Intervenciones</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">La IVT TSVI se midió mediante Doppler pulsátil. Los cálculos de SVI se realizaron a través de un catéter de arteria pulmonar (CAP) o un método de <span class="elsevierStyleItalic">Pulse index Contour Cardiac Output</span> (PiCCO<span class="elsevierStyleSup">®</span>), con métodos de termodilución.</p></span> <span id="abst0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Variables principales</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">La relación entre IVT TSVI e IVS se evaluó mediante análisis de regresión lineal.</p></span> <span id="abst0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Resultados</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Se compararon 156 mediciones pareadas. La IVT TSVI media fue de 20,83<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4,86<span class="elsevierStyleHsp" style=""></span>cm y la media de IVS fue de 41,55<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>9,55<span class="elsevierStyleHsp" style=""></span>ml/m<span class="elsevierStyleSup">2</span>. El índice de correlación de Pearson para estas variables fue r<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,644, p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,001; ICC fue 0,52 (IC 95%: 0,4-0,63). Cuando la IVT TSVI máxima se correlacionó con el IVS, el índice de correlación de Pearson fue r<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,62, p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,001. La correlación empeoró para los valores extremos, especialmente para aquellos con mayor IVT TSVI.</p></span> <span id="abst0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conclusiones</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">La IVT TSVI podría ser una evaluación hemodinámica complementaria en pacientes seleccionados, pero no elimina la necesidad de un control invasivo en la actualidad. La débil correlación entre la IVT TSVI y la monitorización invasiva requiere estudios adicionales para identificar los factores que afectan a este desacuerdo.</p></span>" "secciones" => array:8 [ 0 => array:2 [ "identificador" => "abst0045" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0050" "titulo" => "Diseño" ] 2 => array:2 [ "identificador" => "abst0055" "titulo" => "Ámbito" ] 3 => array:2 [ "identificador" => "abst0060" "titulo" => "Pacientes" ] 4 => array:2 [ "identificador" => "abst0065" "titulo" => "Intervenciones" ] 5 => array:2 [ "identificador" => "abst0070" "titulo" => "Variables principales" ] 6 => array:2 [ "identificador" => "abst0075" "titulo" => "Resultados" ] 7 => array:2 [ "identificador" => "abst0080" "titulo" => "Conclusiones" ] ] ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1266 "Ancho" => 1610 "Tamanyo" => 96310 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Correlation between mean LVOT VTI and SVI. Dash lines denote 95% confidence interval.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1238 "Ancho" => 1561 "Tamanyo" => 97000 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Correlation between maximum LVOT VTI and SVI. Dash lines denote 95% confidence interval.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Baseline characteristics and main diagnosis \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Overall<br>(<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>47) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Age (years), mean (SD)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">66.2 (12) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Gender, male (%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21 (44.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Weight (kg), mean (SD)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">83.4 (26.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Height (cm), mean (SD)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">166 (9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">BMI, mean (SD)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30.03 (8.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">BSA (m</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">), mean (SD)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.9 (0.32) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Atrial fibrillation (%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 (25.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Main diagnosis on admission</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Cardiogenic shock \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Distributive shock \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Pulmonary hypertension \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Pneumonia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Hypoventilation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Hypovolemic shock \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Other causes of acute respiratory failure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1967142.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Baseline characteristics of the overall population.</p>" ] ] 3 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">N</span> denotes the number of paired measurements; SD: standard deviation.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variable \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Overall<br><span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>156 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">PAC<br><span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>59 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">PiCCO<span class="elsevierStyleSup">®</span><br><span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>97 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>-Value \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gender, male (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">88 (56.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21 (35.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">67 (69) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">BMI, mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30.03 (8.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">32.66 (10.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28.44 (6.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Weight (kg), mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">83.4 (26.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">89.1 (35.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">79.9 (19.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.07 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age (years), mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">66.2 (12) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">65.88 (11.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">66.39 (25) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.899 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Atrial fibrillation (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">39 (25) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 (28.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22 (22.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.335 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">LVOT VTI (cm), mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20.83 (4.86) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22.22 (5.25) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19.99 (4.39) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.005 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">SVI (mL/m<span class="elsevierStyleSup">2</span>), mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41.55 (9.55) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41.97 (7.99) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41.29 (10.41) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.647 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Difference mean SVI–LVOT VTI (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20.72 (7.41) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19.75 (7.08) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21.32 (7.58) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.465 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1967143.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Comparison of paired measurements performed with PAC and PiCCO<span class="elsevierStyleSup">®</span>.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:13 [ 0 => array:3 [ "identificador" => "bib0070" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R.M. 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Oliva, from the Centro Nacional de Investigaciones Cardiovasculares Carlos III (Madrid, Spain) for their critical review of this manuscript.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/02105691/0000004300000002/v1_201902210707/S0210569117303601/v1_201902210707/en/main.assets" "Apartado" => array:4 [ "identificador" => "434" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Originales" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/02105691/0000004300000002/v1_201902210707/S0210569117303601/v1_201902210707/en/main.pdf?idApp=WMIE&text.app=https://medintensiva.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569117303601?idApp=WMIE" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 18 | 8 | 26 |
| 2024 Octubre | 84 | 106 | 190 |
| 2024 Septiembre | 109 | 61 | 170 |
| 2024 Agosto | 121 | 77 | 198 |
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| 2024 Enero | 92 | 50 | 142 |
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| 2023 Noviembre | 116 | 57 | 173 |
| 2023 Octubre | 104 | 58 | 162 |
| 2023 Septiembre | 88 | 34 | 122 |
| 2023 Agosto | 76 | 14 | 90 |
| 2023 Julio | 49 | 28 | 77 |
| 2023 Junio | 59 | 16 | 75 |
| 2023 Mayo | 83 | 41 | 124 |
| 2023 Abril | 92 | 34 | 126 |
| 2023 Marzo | 113 | 35 | 148 |
| 2023 Febrero | 65 | 42 | 107 |
| 2023 Enero | 51 | 22 | 73 |
| 2022 Diciembre | 112 | 39 | 151 |
| 2022 Noviembre | 70 | 35 | 105 |
| 2022 Octubre | 91 | 43 | 134 |
| 2022 Septiembre | 94 | 47 | 141 |
| 2022 Agosto | 98 | 49 | 147 |
| 2022 Julio | 96 | 64 | 160 |
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| 2022 Abril | 132 | 64 | 196 |
| 2022 Marzo | 109 | 75 | 184 |
| 2022 Febrero | 113 | 50 | 163 |
| 2022 Enero | 84 | 63 | 147 |
| 2021 Diciembre | 90 | 78 | 168 |
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| 2021 Octubre | 82 | 116 | 198 |
| 2021 Septiembre | 44 | 72 | 116 |
| 2021 Agosto | 37 | 60 | 97 |
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| 2020 Noviembre | 53 | 61 | 114 |
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| 2018 Noviembre | 2 | 4 | 6 |
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