Abstract:
PURPOSE:Clinical examination is often the first step to diagnose shock and estimate cardiac index. In the Simple Intensive Care Studies-I, we assessed the association and diagnostic performance of clinical signs for estimation of cardiac index in critically ill patients. METHODS:In this prospective, single-centre cohort study, we included all acutely ill patients admitted to the ICU and expected to stay > 24 h. We conducted a protocolised clinical examination of 19 clinical signs followed by critical care ultrasonography for cardiac index measurement. Clinical signs were associated with cardiac index and a low cardiac index (< 2.2 L min-1 m2) in multivariable analyses. Diagnostic test accuracies were also assessed. RESULTS:We included 1075 patients, of whom 783 (73%) had a validated cardiac index measurement. In multivariable regression, respiratory rate, heart rate and rhythm, systolic and diastolic blood pressure, central-to-peripheral temperature difference, and capillary refill time were statistically independently associated with cardiac index, with an overall R2 of 0.30 (98.5% CI 0.25-0.35). A low cardiac index was observed in 280 (36%) patients. Sensitivities and positive and negative predictive values were below 90% for all signs. Specificities above 90% were observed only for 110/280 patients, who had atrial fibrillation, systolic blood pressures < 90 mmHg, altered consciousness, capillary refill times > 4.5 s, or skin mottling over the knee. CONCLUSIONS:Seven out of 19 clinical examination findings were independently associated with cardiac index. For estimation of cardiac index, clinical examination was found to be insufficient in multivariable analyses and in diagnostic accuracy tests. Additional measurements such as critical care ultrasonography remain necessary.
journal_name
Intensive Care Medjournal_title
Intensive care medicineauthors
Hiemstra B,Koster G,Wiersema R,Hummel YM,van der Harst P,Snieder H,Eck RJ,Kaufmann T,Scheeren TWL,Perner A,Wetterslev J,de Smet AMGA,Keus F,van der Horst ICC,SICS Study Group.doi
10.1007/s00134-019-05527-ysubject
Has Abstractpub_date
2019-02-01 00:00:00pages
190-200issue
2eissn
0342-4642issn
1432-1238pii
10.1007/s00134-019-05527-yjournal_volume
45pub_type
杂志文章abstract::A study was conducted to evaluate repeated intrathecal injections of baclofen, without artificial ventilation, in the treatment of severe tetanus. Ten patients, 5 men and 5 women, with a mean age of 34 +/- 7 years, were included in the study. The dose of baclofen injected was 1000 micrograms between the ages of 16 and...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF01709840
更新日期:1992-01-01 00:00:00
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journal_title:Intensive care medicine
pub_type: 杂志文章
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abstract:: ...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-018-5213-x
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doi:10.1007/s00134-018-5159-z
更新日期:2018-05-01 00:00:00
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journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF01710656
更新日期:1994-07-01 00:00:00
abstract:OBJECTIVES:To examine whether urgent orotracheal intubation (OI) can induce bacteremia. To find predictive factors for post-intubation bacteremia. DESIGN:Prospective observational study. SETTING:Seventeen-bed medical intensive care unit in a university hospital. PATIENTS:Sixty-eight adult intensive care patients und...
journal_title:Intensive care medicine
pub_type: 杂志文章
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更新日期:2001-02-01 00:00:00
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journal_title:Intensive care medicine
pub_type: 信件
doi:10.1007/s00134-002-1492-2
更新日期:2002-11-01 00:00:00
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pub_type: 杂志文章
doi:10.1007/s00134-012-2584-2
更新日期:2012-08-01 00:00:00
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journal_title:Intensive care medicine
pub_type: 临床试验,杂志文章
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journal_title:Intensive care medicine
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更新日期:2014-12-01 00:00:00
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journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-005-0051-z
更新日期:2006-03-01 00:00:00
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journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-006-0264-9
更新日期:2006-11-01 00:00:00
abstract:OBJECTIVE:To compare some of the confirmatory investigations of brain death with clinical criteria in order to achieve the most sensitive and accurate diagnosis of brain death. DESIGN:All patients with isolated brain lesions and Glasgow Coma Scale (GCS) = 3 were subjected to neurological examination after ruling out h...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF01711544
更新日期:1995-08-01 00:00:00
abstract:OBJECTIVE:(1) To describe the pattern of intracranial pressure (ICP) and cerebral perfusion pressure (CPP) in a group of severe head-injured patients, (2) to quantify complications of ICP monitoring, and (3) to describe a management protocol and its results. DESIGN:Prospective observational study. SETTING:General int...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s001340050860
更新日期:1999-04-01 00:00:00
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journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF01709742
更新日期:1996-07-01 00:00:00
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pub_type: 杂志文章
doi:10.1007/s00134-009-1638-6
更新日期:2009-12-01 00:00:00
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journal_title:Intensive care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1007/s00134-005-2561-0
更新日期:2005-04-01 00:00:00
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journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF01699238
更新日期:1996-10-01 00:00:00
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journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s001340051214
更新日期:2000-05-01 00:00:00
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journal_title:Intensive care medicine
pub_type: 杂志文章,随机对照试验
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更新日期:2010-08-01 00:00:00
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journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF00315379
更新日期:1986-01-01 00:00:00
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journal_title:Intensive care medicine
pub_type: 临床试验,杂志文章
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更新日期:1997-10-01 00:00:00
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journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-010-2043-x
更新日期:2011-02-01 00:00:00
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journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-009-1735-6
更新日期:2010-03-01 00:00:00
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journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-004-2314-5
更新日期:2004-08-01 00:00:00
abstract:OBJECTIVE:We propose that higher airway occlusion pressure (P0.1) responses to hypercapnic challenge (HC) indicate less severe injury. The study aim was to determine whether P0.1 responses to HC were associated with successful weaning after prolonged mechanical ventilation (PMV) in patients with brainstem lesions and t...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-008-1197-2
更新日期:2009-01-01 00:00:00
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journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-005-2686-1
更新日期:2005-08-01 00:00:00
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journal_title:Intensive care medicine
pub_type: 杂志文章,多中心研究
doi:10.1007/s00134-018-5342-2
更新日期:2018-09-01 00:00:00
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journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-020-05930-w
更新日期:2020-06-01 00:00:00
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journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-013-3133-3
更新日期:2014-01-01 00:00:00