Artigo Original\Original Article
Avaliação não invasiva da pressão venosa central por ecocardiografia em cuidados intensivos – Particularidades nos doentes com dilatação do ventrículo direito e exacerbação de doença pulmonar crónica
Non invasive evaluation of central venous pressure using echocardiography in the intensive care – Specific features of patients with right ventricular enlargement and chronic exacerbated pulmonary disease
Paulo Marcelino1,
, Alexandra Borba2, Ana Paula Fernandes1, Susan Marum1, Nuno Germano3, Mário G. Lopes4
Corresponding author
pmarcelino@fm.ul.pt
Correspondência/Correspondence to: Paulo Marcelino Hospital de Curry Cabral, Unidade de Cuidados Intensivos Rua da Beneficência, 8 1069-166 Lisboa, Portugal.
Correspondência/Correspondence to: Paulo Marcelino Hospital de Curry Cabral, Unidade de Cuidados Intensivos Rua da Beneficência, 8 1069-166 Lisboa, Portugal.
1 Assistente Hospitalar de Medicina Interna, subespecialista de Medicina Intensiva / Hospital Assistant, Internal Medicine, sub-speciality Intensive Medicine
2 Interna do Internato Complementar de Pneumologia / Intern, Complementary Internship, Pulmonology, Hospital de Curry Cabral, Unidade de Cuidados Intensivos e Centro de Cardiologia da Universidade de Lisboa (CCUL)
3 Assistente Eventual de Medicina Interna / Future Assistant, Internal Medicine, Hospital de Curry Cabral, Unidade de Cuidados Intensivos e Centro de Cardiologia da Universidade de Lisboa (CCUL)
4 Professor Agregado da Faculdade de Medicina de Lisboa, chefe de Serviço de Cardiologia, director do Serviço de Cardiologia do Hospital de Santa Maria, Lisboa / / Institute Professor, Lisbon University School of Medicine, Head, Cardiology Unit, Director, Cardiology Unit, Hospital de Santa Maria, Lisbon
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Para a correlação foram utilizados testes estatísticos paramétricos e não paramétricos.</p><p id="sp0025" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Resultados:</span> Admitidos 560 doentes com registo simultâneo de PVC e ETT e incluídos 477 doentes em que foi possível visualizar a VCI, com idade média de 62,6<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>17,3 anos, média de internamento de 11,9<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>18,7 dias, um índice APACHE II médio de 23,9<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>8,9 e SAPS II médio de 55,7<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>20,4. Por análise de regressão linear verificou-se uma relação entre a PVC e a dimensão máxima da VCI (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,013), o índice da VCI (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,001) e a presença de ventilação mecânica (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,002). A correlação linear entre a PVC e a dimensão máxima da VCI e respectivo índice foi de 0,34 e 0,44. Por teste de qui-quadrado, verificou-se uma relação estatisticamente significativa entre os seguintes intervalos de valores: índice da VCI ><span class="elsevierStyleHsp" style=""></span>25% e PVC<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>13<span class="elsevierStyleHsp" style=""></span>mmHg; índice da VCI entre 26 e 50% e PVC entre 8 e 12<span class="elsevierStyleHsp" style=""></span>mmHg; índice da VCI<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>51% e PVC<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>7<span class="elsevierStyleHsp" style=""></span>mmHg; dimensão máxima da VCI<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>20<span class="elsevierStyleHsp" style=""></span>mmHg e PVC<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>13<span class="elsevierStyleHsp" style=""></span>mmHg; dimensão máxima da VCI<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleHsp" style=""></span>mm e PVC<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>7<span class="elsevierStyleHsp" style=""></span>mmHg. Nos doentes com dilatação do ventrículo direito (VD) observou-se uma relação mais fraca entre a PVC ><span class="elsevierStyleHsp" style=""></span>7<span class="elsevierStyleHsp" style=""></span>mmHg e a dimensão máxima da VCI ><span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleHsp" style=""></span>mm; nos doentes admitidos por exacerbação de doença pulmonar crónica verificou-se uma correlação fraca entre a PVC ><span class="elsevierStyleHsp" style=""></span>7<span class="elsevierStyleHsp" style=""></span>mmHg e o índice da VCI<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>50%. A dimensão máxima da VCI, mas não o seu índice, correlacio-nou-se com a dilatação do VD e AD.</p><p id="sp0030" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Conclusões:</span> A análise da VCI por ETT revelou-se útil na avaliação qualitativa da PVC em doentes admitidos numa UCIP. Em doentes com dilatação do VD e admitidos por exacerbação de doença pulmonar crónica, os métodos avaliados não foram fidedignos para valores baixos de PVC. A dilatação da VCI traduz melhor a cronicidade da doença, enquanto o índice da VCI reflecte melhor o estado de volemia.</p><p id="sp0035" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Rev Port Pneumol 2006; XII (6): 637-658</span></p></span>" ] "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="as0010" class="elsevierStyleSection elsevierViewall"><p id="sp0040" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Objectives:</span> To determine the possibility of non-invasive estimation of central venous pressure (CVP) through inferior vena cava (IVC) analysis, using transthoracic echocardiography (TTE).</p><p id="sp0045" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Design:</span> A prospective 3-year study.</p><p id="sp0050" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Setting:</span> A 16-bed medical/surgical Intensive Care Unit (ICU).</p><p id="sp0055" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Methods:</span> Patients admitted to the ICU were enrolled. CVP measurement and TTE (determining cardiac chambers dimension and left ventricular shortening fraction) with IVC analysis (maximum dimension and IVC index) were performed simultaneously. Parametric and non-parametric statistical analysis was performed to establish correlations between variables. Results: 560 patients were admitted to the study, including 477 in whom IVC was analysed, aging 62.2<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>17.3<span class="elsevierStyleHsp" style=""></span>years, a mean ICU stay 11.9<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>18.7<span class="elsevierStyleHsp" style=""></span>days, a APACHE II score 23.9<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>8.9 and a SAPS II score 55.7<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>20.4. Through linear regression analysis CVP was influenced by IVC index (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.001), IVC maximum dimension (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.013) and presence of mechanical ventilation (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.002). A statistically significant correlation was found between the following parameters: an IVC index<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>25% and a CVP <<span class="elsevierStyleHsp" style=""></span>13<span class="elsevierStyleHsp" style=""></span>mmHg; an IVC index and a CVP 26%-50%; an IVC index <<span class="elsevierStyleHsp" style=""></span>51% and CVP<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>7<span class="elsevierStyleHsp" style=""></span>mmHg; an IVC maximum dimension<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>20<span class="elsevierStyleHsp" style=""></span>mm and a CVP <<span class="elsevierStyleHsp" style=""></span>13<span class="elsevierStyleHsp" style=""></span>mmHg; an IVC maximum dimension ><span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleHsp" style=""></span>mmHg and CVP<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>7<span class="elsevierStyleHsp" style=""></span>mmHg. Patients with right ventricle enlargement presented a lack of agreement between IVC maximum dimension and CVP<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>7<span class="elsevierStyleHsp" style=""></span>mmHg was observed, and in patients with chronic respiratory failure (who presented a high prevalence of right ventricular enlargement) a lack of agreement between IVC index <<span class="elsevierStyleHsp" style=""></span>50% and CVP<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>7<span class="elsevierStyleHsp" style=""></span>mmHg was also observed.</p><p id="sp0060" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Conclusions:</span> IVC analysis is a possible way to noninvasively estimate CVP in a medical/surgical ICU. However, patients with right ventricular enlargement and admitted with chronic respiratory failure present a lack of agreement between IVC parameters and low values of CVP. IVC dimension is a marker of chronic disease and IVC index correlated better with CVP.</p><p id="sp0065" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Rev Port Pneumol 2006; XII (6): 637-658</span></p></span>" ] ] "lecturaRecomendada" => array:1 [ 0 => array:3 [ "vista" => "all" "titulo" => "<span class="elsevierStyleSectionTitle" id="st0025">Bibliografia/Bibliography</span>" "seccion" => array:1 [ 0 => array:2 [ "vista" => "all" "bibliografiaReferencia" => array:20 [ 0 => array:3 [ "identificador" => "bb0005" "etiqueta" => "1." 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Article information
ISSN: 08732159Original language: Portuguese
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