Unfortunately, echocardiography for hemodynamic monitoring is limited by the availability of equipment and/or experienced examiners on a 24/24 hour basis. Considering the systolic function of the left ventricle, Doppler echocardiography has become the standard tool for measuring left ventricular ejection fraction (LVEF). There are several different methods and techniques for monitoring patients with circulatory failure, although none are ideal (namely non-invasive, safe, reproducible, assessing cardiac preload and myocardial function). Hemodynamic monitoring is essential for the diagnosis and therapeutic management of critically ill patients. Thus, the PiCCO transpulmonary thermodilution technique is useful for the monitoring of inotropic therapy during cardiogenic shock. CFI is correlated with LVEF provided that patient does not present severe right ventricular dysfunction. In patients with right ventricular dysfunction, CFI was not correlated with LVEF. A cardiac function index <3.47/min predicted a left ventricular ejection fraction ≤35% (sensitivity 81.1% and specificity 63%). CFI and GEF were significantly increased with inotropic infusion (resp., P = 0.005, P = 0.007). CFI and GEF were both positively correlated with LVEF ( P < 0.0001, r 2 = 0.27). In thirty-five patients with cardiogenic shock, we performed (i) simultaneous measurements of echocardiography LVEF and cardiac function index assessed by transpulmonary thermodilution ( n = 72) and (ii) transpulmonary thermodilution before/after increasing inotropic agents ( n = 18). The aim of the present study was to test the reliability of CFI as an indicator of LVEF in patients with cardiogenic shock. Both appear to be correlated with left ventricular ejection fraction (LVEF) measured by echocardiography in patients with circulatory failure, especially in septic shock. The PiCCO transpulmonary thermodilution technique provides two indices of cardiac systolic function, the cardiac function index (CFI) and the global ejection fraction (GEF).
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