Effect of airway pressure display on interobserver agreement in the assessment of vascular pressures in patients with acute lung injury and acute respiratory distress syndrome. Crit Care Med 2005 Jan;33(1):98-103; discussion 243-4
Date
01/13/2005Pubmed ID
15644654DOI
10.1097/01.ccm.0000150650.70142.e9Scopus ID
2-s2.0-12244297783 (requires institutional sign-in at Scopus site) 39 CitationsAbstract
BACKGROUND: Previous investigations have identified significant interobserver variability in the measurements of central venous pressure and pulmonary artery occlusion pressure in critically ill patients. Large interobserver variability in the measurement of vascular pressures could potentially lead to inappropriate treatment decisions.
OBJECTIVE: We postulated that adding an airway pressure signal (Paw) to pressure tracings of central venous pressure and pulmonary artery occlusion pressure would improve interobserver agreement by facilitating identification of end-expiration.
DESIGN: To test this hypothesis, six independent experts used a standard protocol to interpret strip-chart recordings of central venous pressure and pulmonary artery occlusion pressure with or without Paw. Two observers were said to agree if their measurements were within 2 mm Hg of each other. SETTING/SUBJECTS/INTERVENTIONS: A total of 459 strip-chart recordings (303 without Paw and 156 with Paw) were obtained from 121 patients enrolled in the ARDSnet Fluids and Catheters Treatment Trial (FACTT) in 16 different hospitals.
RESULTS: Agreement within 2 mm Hg between two measurements was 79% for central venous pressure strips without Paw vs. 86% with Paw. For pulmonary artery occlusion pressure, agreement increased from 71% without Paw to 83% with Paw. The increase in agreement with the addition of Paw was greater for strips demonstrating >8 mm Hg phasic respiratory variation compared with strips demonstrating less phasic respiratory variation.
CONCLUSION: Paw display is a simple, inexpensive method to facilitate the identification of end-expiration that can significantly improve interobserver agreement.
Author List
Rizvi K, Deboisblanc BP, Truwit JD, Dhillon G, Arroliga A, Fuchs BD, Guntupalli KK, Hite D, Hayden D, NIH/NHLBI ARDS Clinical Trials NetworkMESH terms used to index this publication - Major topics in bold
Airway ResistanceBlood Pressure Determination
Central Venous Pressure
Critical Care
Humans
Hydrostatic Pressure
Inservice Training
Lung Injury
Monitoring, Physiologic
Observer Variation
Positive-Pressure Respiration
Pulmonary Wedge Pressure
Quality Assurance, Health Care
Reproducibility of Results
Signal Processing, Computer-Assisted
Transducers
