Sensitivity of routine intensive care unit surveillance for detecting myocardial ischemia.


OBJECTIVE:To assess the effectiveness of routine intensive care unit surveillance compared with frequent 12-lead electrocardiogram monitoring for detecting electrocardiogram evidence suggestive of prolonged myocardial ischemia in vascular surgery patients. DESIGN:Prospective cohort trial. SETTING:Intensive care unit. PARTICIPANTS:We studied 149 patients undergoing elective infrainguinal or aortic vascular surgery who were admitted to the intensive care unit postoperatively. INTERVENTIONS:Patients were simultaneously monitored with a 10-electrode/12-lead electrocardiogram obtained every 2 mins (criterion standard) and routine intensive care unit surveillance that included standard monitoring (five-electrode/two-lead electrocardiogram with ST segment trends and routine 12-lead electrocardiogram) and clinical assessment for detecting myocardial ischemia. The results of the criterion standard were not available to the caregivers. MEASUREMENTS AND MAIN RESULTS:We measured the ability of routine intensive care unit surveillance to detect the first 20 mins of electrocardiogram evidence suggestive of myocardial ischemia, defined as ST segment depression or elevation of >/=1 mm in two consecutive leads, during the first postoperative day. Seventeen patients (11%) had electrocardiogram evidence suggestive of prolonged myocardial ischemia, the majority of which occurred in leads V2-V4. The sensitivity of routine intensive care unit surveillance for detecting the first episode of electrocardiogram evidence suggestive of prolonged myocardial ischemia in a patient was 12% (95% confidence interval, 7-17%), and the specificity was 98% (95% confidence interval, 95-100%) with a positive predictive value of 40% (95% confidence interval, 32-48%), a negative predictive value of 90% (95% confidence interval, 85-94%), a positive likelihood ratio of 6, and a negative likelihood ratio of 1. The sensitivity of routine intensive care unit surveillance for detecting all episodes was 3% (95% confidence interval, 2-3%) and the specificity 99% (95% confidence interval, 99-100%) per 20-min monitoring interval, with a positive predictive value of 17% (95% confidence interval, 16-18%), negative predictive value of 95% (95% confidence interval, 95-96%), positive likelihood ratio of 3, and negative likelihood ratio of 1. CONCLUSIONS:Routine intensive care unit surveillance has low sensitivity for detecting electrocardiogram evidence suggestive of prolonged myocardial ischemia compared with frequent 12-lead electrocardiograms. Because detecting electrocardiogram evidence suggestive of prolonged postoperative myocardial ischemia is important, physicians should consider alternative strategies to detect myocardial ischemia.


Crit Care Med


Critical care medicine


Martinez EA,Kim LJ,Faraday N,Rosenfeld B,Bass EB,Perler BA,Williams GM,Dorman T,Pronovost PJ




Has Abstract


2003-09-01 00:00:00












  • Determinants of tidal volume during high-frequency oscillation.

    abstract:OBJECTIVE:High-frequency oscillation has been proposed for use in adult acute respiratory distress syndrome. However, limited data are available on the effect of pressure amplitude and rate (Hz) on tidal volumes delivered during high-frequency oscillation in adults. DESIGN:Prospective, animal model, lung injury study....

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Sedeek KA,Takeuchi M,Suchodolski K,Kacmarek RM

    更新日期:2003-01-01 00:00:00

  • Passive leg raising is predictive of fluid responsiveness in spontaneously breathing patients with severe sepsis or acute pancreatitis.

    abstract:OBJECTIVE:Rapid fluid loading is standard treatment for hypovolemia. Because volume expansion does not always improve hemodynamic status, predictive parameters of fluid responsiveness are needed. Passive leg raising is a reversible maneuver that mimics rapid volume expansion. Passive leg raising-induced changes in stro...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Préau S,Saulnier F,Dewavrin F,Durocher A,Chagnon JL

    更新日期:2010-03-01 00:00:00

  • Ventilatory support by tracheal gas insufflation and chest vibration during bronchoconstriction.

    abstract:OBJECTIVE:To determine whether chest wall vibration with tracheal gas insufflation during bronchoconstriction maintains gas exchange at lower airway and intrathoracic pressures than those that occur during positive pressure ventilation. DESIGN:Prospective study. SETTING:Experimental laboratory. SUBJECTS:Six anesthet...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Eckmann DM

    更新日期:2000-07-01 00:00:00

  • Stroke as a complication of carotid sinus massage.

    abstract::A 77-yr-old white man recovering from aortobiiliac bypass surgery suffered a sudden stroke within 30 min after carotid sinus massage was performed in an attempt to treat supraventricular tachycardia. Even though carotid digital subtraction angiography and angiograms were negative for carotid artery disease, we believe...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Bastulli JA,Orlowski JP

    更新日期:1985-10-01 00:00:00

  • Iced temperature injectate for thermodilution cardiac output determination causes minimal effects on cardiodynamics.

    abstract:OBJECTIVES:Controversy exists regarding the ideal injectate temperature for measuring cardiac output. Iced temperature injectate gives a higher signal/noise ratio and less variability in the measured cardiac output. Thus, less volume and fewer measurements are required. Advocates of room temperature injectate have sugg...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Fang HK,Krahmer RL,Rypins EB,Law WR

    更新日期:1996-03-01 00:00:00

  • Tracheostomy does not improve the outcome of patients requiring prolonged mechanical ventilation: a propensity analysis.

    abstract:OBJECTIVE:To examine the association between the performance of a tracheostomy and intensive care unit and postintensive care unit mortality, controlling for treatment selection bias and confounding variables. DESIGN:Prospective, observational, cohort study. SETTING:Twelve French medical or surgical intensive care un...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Clec'h C,Alberti C,Vincent F,Garrouste-Orgeas M,de Lassence A,Toledano D,Azoulay E,Adrie C,Jamali S,Zaccaria I,Cohen Y,Timsit JF

    更新日期:2007-01-01 00:00:00

  • Clinical implications of the oxyhemoglobin dissociation curve in the neonatal period.

    abstract::Factors responsible for determining the position of the oxyhemoglobin equilibrium curve during the neonatal period are briefly reviewed and the clinical implications of these changes are examined. Two clinical trials employing exchange transfusions as an adjunct to conventional therapy of the severe respiratory distre...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Oski FA

    更新日期:1979-09-01 00:00:00

  • Iontophoretic delivery of calcium for experimental hydrofluoric acid burns.

    abstract:OBJECTIVE:To examine the efficacy of iontophoretic delivery of calcium to experimental hydrofluoric acid burns. DESIGN:Prospective, controlled study. SETTING:Institutional laboratory. SUBJECTS:Male nude rats. INTERVENTIONS:For the in vitro experiment, a full-thickness skin from the back was set in a vertical flow-t...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Yamashita M,Yamashita M,Suzuki M,Hirai H,Kajigaya H

    更新日期:2001-08-01 00:00:00

  • Long-Term Mental Health Problems After Delirium in the ICU.

    abstract:OBJECTIVES:To determine whether delirium during ICU stay is associated with long-term mental health problems defined as symptoms of anxiety, depression, and posttraumatic stress disorder. DESIGN:Prospective cohort study. SETTING:Survey study, 1 year after discharge from a medical-surgical ICU in the Netherlands. PAT...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Wolters AE,Peelen LM,Welling MC,Kok L,de Lange DW,Cremer OL,van Dijk D,Slooter AJ,Veldhuijzen DS

    更新日期:2016-10-01 00:00:00

  • Development and Validation of an Empiric Tool to Predict Favorable Neurologic Outcomes Among PICU Patients.

    abstract:OBJECTIVES:To create a novel tool to predict favorable neurologic outcomes during ICU stay among children with critical illness. DESIGN:Logistic regression models using adaptive lasso methodology were used to identify independent factors associated with favorable neurologic outcomes. A mixed effects logistic regressio...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Gupta P,Rettiganti M,Gossett JM,Daufeldt J,Rice TB,Wetzel RC

    更新日期:2018-01-01 00:00:00

  • Increased morbidity with increased pulmonary albumin flux in sepsis-related adult respiratory distress syndrome.

    abstract:OBJECTIVE:To determine the feasibility of utilizing a scintigraphic technique to differentiate patients with adult respiratory distress syndrome due to sepsis syndrome from control volunteers and patients with congestive heart failure. Gamma scintigraphy was compared with chest roentgenograms to predict mortality rate ...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Byrne K,Tatum JL,Henry DA,Hirsch JI,Crossland M,Barnes T,Thompson JA,Young J,Sugerman HJ

    更新日期:1992-01-01 00:00:00

  • Validation of a compact system for measuring gas exchange.

    abstract::Measuring gas exchange in critically ill patients can provide valuable information on their nutritional status and energy expenditure. Several semiautomated machines are available for measuring oxygen consumption (VO2) and carbon dioxide production (VCO2). This study evaluated, under controlled laboratory conditions, ...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Eccles RC,Swinamer DL,Jones RL,King EG

    更新日期:1986-09-01 00:00:00

  • Predictors of patients who present to the emergency department with sepsis and progress to septic shock between 4 and 48 hours of emergency department arrival.

    abstract:OBJECTIVES:Approximately one in every four patients who present to the emergency department with sepsis progresses to septic shock within 72 hours of arrival. In this study, we describe key patient characteristics present within 4 hours of emergency department arrival that are associated with developing septic shock be...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Capp R,Horton CL,Takhar SS,Ginde AA,Peak DA,Zane R,Marill KA

    更新日期:2015-05-01 00:00:00

  • Reversal of late septic shock with supraphysiologic doses of hydrocortisone.

    abstract:OBJECTIVES:Preliminary studies have suggested that low doses of corticosteroids might rapidly improve hemodynamics in late septic shock treated with catecholamines. We examined the effect of hydrocortisone on shock reversal, hemodynamics, and survival in this particular setting. DESIGN:Prospective, randomized, double-...

    journal_title:Critical care medicine

    pub_type: 临床试验,杂志文章,多中心研究,随机对照试验


    authors: Bollaert PE,Charpentier C,Levy B,Debouverie M,Audibert G,Larcan A

    更新日期:1998-04-01 00:00:00

  • Associations between intramucosal acidosis in the gut and organ failure.

    abstract:OBJECTIVE:To alert health professionals to the need for early detection and prevention of shock in critically ill patients. By describing the associations between intramucosal acidosis in the gut and multiple system organ failure, the author demonstrates how noninvasive measurement of gut intramucosal pH can be used to...

    journal_title:Critical care medicine

    pub_type: 杂志文章,评审


    authors: Fiddian-Green RG

    更新日期:1993-02-01 00:00:00

  • Increases in lung and brain water following experimental stroke: effect of mannitol and hypertonic saline.

    abstract:OBJECTIVE:Pulmonary edema is a serious condition following brain injury of diverse etiologies, including large hemispheric infarctions. We have previously shown that treatment with hypertonic saline attenuates cerebral edema associated with experimental ischemic stroke. In a well-characterized animal model of large isc...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Toung TJ,Chang Y,Lin J,Bhardwaj A

    更新日期:2005-01-01 00:00:00

  • Pulmonary hypertension in acute respiratory failure.

    abstract::In order to examine the prognostic value of pulmonary arterial hypertension (PAH) in patients with moderate and severe acute respiratory failure (ARF), 225 patients with ARF who had been treated with mechanical ventilation and admitted to our ICU during a 3-yr period (January, 1983 to January, 1986) were prospectively...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Villar J,Blazquez MA,Lubillo S,Quintana J,Manzano JL

    更新日期:1989-06-01 00:00:00

  • Understanding the antecedents of the acceptance of donation after cardiac death by healthcare professionals.

    abstract:OBJECTIVE:A 3-yr study funded by the U.S. Department of Health and Human Services was conducted to identify potential barriers to and opportunities for increasing the number hospitals with donation after cardiac death (DCD) protocols, the support of DCD by individuals involved in the donation request process, and the n...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: D'Alessandro AM,Peltier JW,Phelps JE

    更新日期:2008-04-01 00:00:00

  • Nitrogen balance, protein loss, and the open abdomen.

    abstract:OBJECTIVE:Goal-directed nutritional support is essential to improving morbidity and mortality. Open abdominal decompression is similarly crucial to the successful treatment of intra-abdominal hypertension and abdominal compartment syndrome. The open abdomen, however, places the patient at risk for potentially significa...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Cheatham ML,Safcsak K,Brzezinski SJ,Lube MW

    更新日期:2007-01-01 00:00:00

  • Pneumonia as a complication of blood product transfusion in the critically ill: transfusion-related immunomodulation (TRIM).

    abstract:BACKGROUND:An increased risk of postoperative infection (including pneumonia) attributable to the receipt of allogeneic blood transfusion has been investigated as a possible manifestation of transfusion-related immunomodulation (TRIM) in 16 randomized controlled trials (RCTs) and approximately 40 observational studies....

    journal_title:Critical care medicine

    pub_type: 杂志文章,meta分析,评审


    authors: Vamvakas EC

    更新日期:2006-05-01 00:00:00

  • Comparison of arterial and venous blood samples for the diagnosis of bacteremia in critically ill patients.

    abstract::We compared the blood culture results obtained either by venipuncture or through an arterial catheter in 51 critically ill patients with 217 clinically suspected episodes of bacteremia. During each episode, three blood culture samples, two arterial and one venous, were drawn within 1 h. One or more cultures were posit...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Väisänen IT,Michelsen T,Valtonen V,Mäkeläinen A

    更新日期:1985-08-01 00:00:00

  • Temperature monitored on the cuff surface of an endotracheal tube reflects body temperature.

    abstract:OBJECTIVE:When treating patients with cardiac arrest with mild therapeutic hypothermia, a reliable and easy-to-use temperature probe is desirable. This study was conducted to investigate the accuracy and safety of tracheal temperature as a measurement of body temperature. DESIGN:Observational cohort study. SETTING:Em...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Haugk M,Stratil P,Sterz F,Krizanac D,Testori C,Uray T,Koller J,Behringer W,Holzer M,Herkner H

    更新日期:2010-07-01 00:00:00

  • Education of trainees in the intensive care unit.

    abstract::The focus on improving education in critical care medicine must begin early in medical school training and further be promoted during residency if there is to be an increase in intensivists in the hospital workforce. This is "critical" to healthcare reform movements that are endorsing full-time critical care coverage ...

    journal_title:Critical care medicine

    pub_type: 杂志文章,评审


    authors: Croley WC,Rothenberg DM

    更新日期:2007-02-01 00:00:00

  • Inhibiting α5 Subunit-Containing γ-Aminobutyric Acid Type A Receptors Attenuates Cognitive Deficits After Traumatic Brain Injury.

    abstract:OBJECTIVES:Cognitive deficits after traumatic brain injury are a leading cause of disability worldwide, yet no effective pharmacologic treatments exist to improve cognition. Traumatic brain injury increases proinflammatory cytokines, which trigger excess function of α5 subunit-containing γ-aminobutyric acid type A rece...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Khodaei S,Avramescu S,Wang DS,Sheng H,Chan NK,Lecker I,Fernandez-Escobar A,Lei G,Dewar MB,Whissell PD,Baker AJ,Orser BA

    更新日期:2020-04-01 00:00:00

  • Cardiorespiratory function before and after chest physiotherapy in mechanically ventilated patients with post-traumatic respiratory failure.

    abstract::Chest physiotherapy (CPT) is used frequently in the ICU, but there is little available information that quantitates its effect on cardiac or respiratory function. Nineteen mechanically ventilated patients with post-traumatic respiratory failure were studied before, immediately after, and 2 h after CPT was used to mana...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Mackenzie CF,Shin B

    更新日期:1985-06-01 00:00:00

  • Nuclear factor-kappaB activation in peripheral blood mononuclear cells in children with sepsis.

    abstract:OBJECTIVE:To determine the activation of nuclear factor-[kappa]B in peripheral blood CD14+ monocyte/macrophages and CD3+, CD4+, and CD8+ T cells in children with sepsis. DESIGN:Observational study. SETTING:University hospital. PATIENTS:Twenty-six children with sepsis (nine females and 17 males, aged between 10 days ...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Hotta N,Ichiyama T,Shiraishi M,Takekawa T,Matsubara T,Furukawa S

    更新日期:2007-10-01 00:00:00

  • Swan-Ganz catheterization in the critically ill newborn.

    abstract::The authors placed Swan-Ganz catheters in 11 preterm and 2 term infants with severe cardiopulmonary distress. The infants ranged in weight from 1100-4000 g. The procedure was performed in the neonatal ICU by jugular venous cutdown. Intracardiac pressures and oxygen saturations were measured in each chamber entered. Th...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Todres ID,Crone RK,Rogers MC,Shannon DC

    更新日期:1979-08-01 00:00:00

  • Alterations in pulmonary mechanics after transfusion in anemic preterm infants.

    abstract::Pulmonary mechanics were studied in ten anemic preterm infants using an esophageal balloon and mask, before and after transfusion with 10 ml/kg of packed RBC. Their mean birth weight was 1212 +/- 323 g and gestational age was 29.27 +/- 2.4 wk. Transfusions were carried out at a mean postnatal age of 41.9 +/- 21.8 days...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Sasidharan P,Heimler R

    更新日期:1990-12-01 00:00:00

  • Effect of full-time, specialized physician supervision on the success of a large, urban emergency medical services system.

    abstract:OBJECTIVES:Despite the universal proliferation of emergency medical services programs throughout the United States since 1970, only a few have ever documented a valid lifesaving effect, particularly in large, urban centers. The purpose of this study was to demonstrate the effect of specialized physician supervision on ...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Pepe PE,Mattox KL,Duke JH,Fisher PB,Prentice FD

    更新日期:1993-09-01 00:00:00

  • Risk factors predicting laryngeal injury in intubated neonates.

    abstract::We evaluated 95 extubated neonates to determine if certain risk factors could predict the development of laryngeal injury. Risk factors were recorded prospectively during the intubation period and correlated with laryngeal injury determined by laryngoscopy after extubation. Duration of intubation greater than or equal...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Fan LL,Flynn JW,Pathak DR

    更新日期:1983-06-01 00:00:00