Kaul et al 1994 21 blinded interpreters evaluated

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Kaul et al. 1994 [ 21 ] Blinded interpreters evaluated cause of hypotension (cardiac vs. non-cardiac) in critical ICU patients receiving both 2-D cardiac US and PA catheters. Cardiac US and PA catheter evaluations agreed on cause of hypotension in 86% (36/42) patients evaluated. Fewer complications with US, and it was performed faster. Proves the utility of bedside cardiac US in more rapidly evaluating etiology of hypotension, with fewer complications. Amico et al. 1989 [ 16 ] Comparison of multiple methods for calculating the ejection fraction with subjective visual estimation. Best correlation of methods studied between expert observers was with visual estimate. Support for determination of left ventricular ejection fraction by expert visual estimation. Moore et al. 2002 [ 8 ] Comparison of visual estimations of ejection fraction grouped as normal, depressed, and severely depressed by echocardiographers and trained EPs. Cardiology and EP ventricular function estimation had similar interobserver correlation ( r ¼ 0.86) to two cardiology estimations ( r ¼ 0.84). Showed non- echocardiologists and cardiologists make similar estimates of global cardiac function. Randazzo et al. 2003 [ 7 ] Comparison of EP-estimated ejection fraction (poor, moderate, normal) and central venous pressure (low, moderate, high) with formal US. EPs were ACEP level III trained (3 h formal course). 86% overall agreement in ejection fraction estimation. 70.2% agreement in central venous pressure. With minimal training, overall agreement in broad categorical EF and CVP assessment is still good. Diagnostic ultrasound 87 Cardiac ultrasound
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New directions There are many new directions that bedside cardiac ultrasound could take in the next few years. As three-dimensional cardiac ultrasound technology becomes more widespread, and as the cost of three-dimensional cardiac ultrasound machines decreases, it is easy to imagine that ejection fraction calculations could be made much more accurately. Machine automated protocols for estimating global cardiac function could even become standard. Estimations of volume status and central venous pressure could likewise be accurately generated by three-dimensional cardiac ultrasound and could finally replace invasive monitoring [ 30,31 ]. As this technology spreads throughout critical care medicine, it is likely that ultrasound-guided protocols for evaluating critically ill hypotensive patients could be helpful in many critical care settings, and it is expected that with the diffusion of this technology, research in this area will continue. An expanding role for transesophageal cardiac ultrasound may even be realized as more intensivists and emergency physicians become familiar with the technology [ 32 ]. References 1. Cheitlin MD, Alpert JS, Armstrong WF, et al. ACC/AHA guidelines for the clinical application of echocardiography. Circulation 1997; 95 : 1686–744.
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