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        "resumen" => "<span class="elsevierStyleSectionTitle">Objectives</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">To determine the possibility of non-invasive estimation of central venous pressure &#40;CVP&#41; through inferior vena cava &#40;IVC&#41; analysis&#44; using transthoracic echocardiography &#40;TTE&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Design</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">A prospective 3-year study&#46;</p> <span class="elsevierStyleSectionTitle">Setting</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">A 16-bed medical&#47;surgical Intensive Care Unit &#40;ICU&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Methods</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Patients admitted to the ICU were enrolled&#46; CVP measurement and TTE &#40;determining cardiac chambers dimension and left ventricular shortening fraction&#41; with IVC analysis &#40;maximum dimension and IVC index&#41; were performed simultaneously&#46; Parametric and non-parametric statistical analysis was performed to establish correlations between variables&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">560 patients were admitted to the study&#44; including 477 in whom IVC was analysed&#44; aging 62&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17&#46;3 years&#44; a mean ICU stay 11&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>18&#46;7 days&#44; a APACHE II score 23&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;9 and a SAPS II score 55&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>20&#46;4&#46; Through linear regression analysis CVP was influenced by IVC index &#40;p&#61;0&#46;001&#41;&#44; IVC maximum dimension &#40;p&#61;0&#46;013&#41; and presence of mechanical ventilation &#40;p&#61;0&#46;002&#41;&#46; A statistically significant correlation was found between the following parameters&#58; an IVC index&#60; 25&#37; and a CVP &#62;13<span class="elsevierStyleHsp" style=""></span>mmHg&#59; an IVC index and a CVP 26&#37;-50&#37;&#59; an IVC index &#62;51&#37; and CVP&#60; 7<span class="elsevierStyleHsp" style=""></span>mmHg&#59; an IVC maximum dimension &#62; 20<span class="elsevierStyleHsp" style=""></span>mm and a CVP &#62;13<span class="elsevierStyleHsp" style=""></span>mmHg&#59; an IVC maximum dimension &#60;10<span class="elsevierStyleHsp" style=""></span>mmHg and CVP&#60; 7<span class="elsevierStyleHsp" style=""></span>mmHg&#46; Patients with right ventricle enlargement presented a lack of agreement between IVC maximum dimension and CVP&#62; 7<span class="elsevierStyleHsp" style=""></span>mmHg was observed&#44; and in patients with chronic respiratory failure &#40;who presented a high prevalence of right ventricular enlargement&#41; a lack of agreement between IVC index &#62;50&#37; and CVP&#60; 7<span class="elsevierStyleHsp" style=""></span>mmHg was also observed&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">IVC analysis is a possible way to noninvasively estimate CVP in a medical&#47;surgical ICU&#46; However&#44; patients with right ventricular enlargement and admitted with chronic respiratory failure present a lack of agreement between IVC parameters and low values of CVP&#46; IVC dimension is a marker of chronic disease and IVC index correlated better with CVP&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Objectivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Determinar a possibilidade de avalia&#231;&#227;o n&#227;o invasiva da press&#227;o venosa central &#40;PVC&#41; atrav&#233;s da an&#225;lise da veia cava inferior &#40;VCI&#41;&#44; obtida por ecocardiografia transtor&#225;cica &#40;ETT&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Desenho</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudo prospectivo com 3 anos de dura&#231;&#227;o&#46;</p> <span class="elsevierStyleSectionTitle">Local</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Unidade de Cuidados Intensivos Polivalente &#40;UCIP&#41; de 16 camas&#46;</p> <span class="elsevierStyleSectionTitle">M&#233;todos</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Estudados doentes admitidos numa UCIP nos quais se avaliou a PVC em simult&#226;neo com exame ETT que&#44; para al&#233;m da visualiza&#231;&#227;o da VCI&#44; consistiu na obten&#231;&#227;o da dimens&#227;o das cavidades card&#237;acas e fun&#231;&#227;o sist&#243;lica do ventr&#237;culo esquerdo&#46; Para a correla&#231;&#227;o foram utilizados testes estat&#237;sticos param&#233;tricos e n&#227;o param&#233;tricos&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Admitidos 560 doentes com registo simult&#226;neo de PVC e ETT e inclu&#237;dos 477 doentes em que foi poss&#237;vel visualizar a VCI&#44; com idade m&#233;dia de 62&#44;6 &#177; &#177;17&#44;3 anos&#44; m&#233;dia de internamento de 11&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>18&#44;7 dias&#44; um &#237;ndice APACHE II m&#233;dio de 23&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#44;9 e SAPS II m&#233;dio de 55&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>20&#44;4&#46; Por an&#225;lise de regress&#227;o linear verificou-se uma rela&#231;&#227;o entre a PVC e a dimens&#227;o m&#225;xima da VCI &#40;p&#61;0&#44;013&#41;&#44; o &#237;ndice da VCI &#40;p&#61;0&#44;001&#41; e a presen&#231;a de ventila&#231;&#227;o mec&#226;nica &#40;p&#61;0&#44;002&#41;&#46; A correla&#231;&#227;o linear entre a PVC e a dimens&#227;o m&#225;xima da VCI e respectivo &#237;ndice foi de 0&#44;34 e 0&#44;44&#46; Por teste de qui-quadrado&#44; verificou-se uma rela&#231;&#227;o estatisticamente significativa entre os seguintes intervalos de valores&#58; &#237;ndice da VCI &#60;25&#37; e PVC&#62; 13<span class="elsevierStyleHsp" style=""></span>mmHg&#59; &#237;ndice da VCI entre 26 e 50&#37; e PVC entre 8 e 12<span class="elsevierStyleHsp" style=""></span>mmHg&#59; &#237;ndice da VCI&#62; 51&#37; e PVC&#62; 7<span class="elsevierStyleHsp" style=""></span>mmHg&#59; dimens&#227;o m&#225;xima da VCI&#62; 20<span class="elsevierStyleHsp" style=""></span>mmHg e PVC&#62; 13<span class="elsevierStyleHsp" style=""></span>mmHg&#59; dimens&#227;o m&#225;xima da VCI&#62; 10<span class="elsevierStyleHsp" style=""></span>mm e PVC&#62; 7<span class="elsevierStyleHsp" style=""></span>mmHg&#46; Nos doentes com dilata&#231;&#227;o do ventr&#237;culo direito &#40;VD&#41; observou-se uma rela&#231;&#227;o mais fraca entre a PVC &#60;7<span class="elsevierStyleHsp" style=""></span>mmHg e a dimens&#227;o m&#225;xima da VCI &#60;10<span class="elsevierStyleHsp" style=""></span>mm&#59; nos doentes admitidos por exacerba&#231;&#227;o de doen&#231;a pulmonar cr&#243;nica verificou-se uma correla&#231;&#227;o fraca entre a PVC &#60;7<span class="elsevierStyleHsp" style=""></span>mmHg e o &#237;ndice da VCI&#62; 50&#37;&#46; A dimens&#227;o m&#225;xima da VCI&#44; mas n&#227;o o seu &#237;ndice&#44; correlacionou-se com a dilata&#231;&#227;o do VD e AD&#46;</p> <span class="elsevierStyleSectionTitle">Conclus&#245;es</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A an&#225;lise da VCI por ETT revelou-se &#250;til na avalia&#231;&#227;o qualitativa da PVC em doentes admitidos numa UCIP&#46; Em doentes com dilata&#231;&#227;o do VD e admitidos por exacerba&#231;&#227;o de doen&#231;a pulmonar cr&#243;nica&#44; os m&#233;todos avaliados n&#227;o foram fidedignos para valores baixos de PVC&#46; A dilata&#231;&#227;o da VCI traduz melhor a cronicidade da doen&#231;a&#44; enquanto o &#237;ndice da VCI reflecte melhor o estado de volemia&#46;</p>"
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Vol. 12. Issue 6.
Pages 637-658 (November - December 2006)
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Vol. 12. Issue 6.
Pages 637-658 (November - December 2006)
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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
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
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Paulo Marcelino1,
Corresponding author
pmarcelino@fm.ul.pt

Correspondence to/Correspondência: Hospital de Curry Cabral, Unidade de Cuidados Intensivos Rua da Beneficência, 8 1069-166 Lisboa, Portugal.
, Alexandra Borba2, Ana Paula Fernandes1, Susan Marum1, Nuno Germano3, Mário G. Lopes4
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
3 Assistente Eventual de Medicina Interna / Future Assistant, Internal Medicine
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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Abstract
Objectives

To determine the possibility of non-invasive estimation of central venous pressure (CVP) through inferior vena cava (IVC) analysis, using transthoracic echocardiography (TTE).

Design

A prospective 3-year study.

Setting

A 16-bed medical/surgical Intensive Care Unit (ICU).

Methods

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±17.3 years, a mean ICU stay 11.9±18.7 days, a APACHE II score 23.9±8.9 and a SAPS II score 55.7±20.4. Through linear regression analysis CVP was influenced by IVC index (p=0.001), IVC maximum dimension (p=0.013) and presence of mechanical ventilation (p=0.002). A statistically significant correlation was found between the following parameters: an IVC index< 25% and a CVP >13mmHg; an IVC index and a CVP 26%-50%; an IVC index >51% and CVP< 7mmHg; an IVC maximum dimension > 20mm and a CVP >13mmHg; an IVC maximum dimension <10mmHg and CVP< 7mmHg. Patients with right ventricle enlargement presented a lack of agreement between IVC maximum dimension and CVP> 7mmHg 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 >50% and CVP< 7mmHg was also observed.

Conclusions

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.

Key-words:
Echocardiography
intensive care
central venous pressure
inferior vena cava
chronic respiratory failure
Resumo
Objectivos

Determinar a possibilidade de avaliação não invasiva da pressão venosa central (PVC) através da análise da veia cava inferior (VCI), obtida por ecocardiografia transtorácica (ETT).

Desenho

Estudo prospectivo com 3 anos de duração.

Local

Unidade de Cuidados Intensivos Polivalente (UCIP) de 16 camas.

Métodos

Estudados doentes admitidos numa UCIP nos quais se avaliou a PVC em simultâneo com exame ETT que, para além da visualização da VCI, consistiu na obtenção da dimensão das cavidades cardíacas e função sistólica do ventrículo esquerdo. Para a correlação foram utilizados testes estatísticos paramétricos e não paramétricos.

Resultados

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 ± ±17,3 anos, média de internamento de 11,9±18,7 dias, um índice APACHE II médio de 23,9±8,9 e SAPS II médio de 55,7±20,4. Por análise de regressão linear verificou-se uma relação entre a PVC e a dimensão máxima da VCI (p=0,013), o índice da VCI (p=0,001) e a presença de ventilação mecânica (p=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 <25% e PVC> 13mmHg; índice da VCI entre 26 e 50% e PVC entre 8 e 12mmHg; índice da VCI> 51% e PVC> 7mmHg; dimensão máxima da VCI> 20mmHg e PVC> 13mmHg; dimensão máxima da VCI> 10mm e PVC> 7mmHg. Nos doentes com dilatação do ventrículo direito (VD) observou-se uma relação mais fraca entre a PVC <7mmHg e a dimensão máxima da VCI <10mm; nos doentes admitidos por exacerbação de doença pulmonar crónica verificou-se uma correlação fraca entre a PVC <7mmHg e o índice da VCI> 50%. A dimensão máxima da VCI, mas não o seu índice, correlacionou-se com a dilatação do VD e AD.

Conclusões

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.

Palavras-chave:
Pressão venosa central
ecocardiografia
cuidados intensivos
doença pulmonar crónica
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Proveniência / Study undertaken at: Hospital de Curry Cabral, Unidade de Cuidados Intensivos e Centro de Cardiologia da Universidade de Lisboa (CCUL) / Intensive Care Unit, Hospital de Curry Cabral and Cardiology Unit, Universidade de Lisboa (CCUL).

Copyright © 2006. Sociedade Portuguesa de Pneumologia
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