RAPID ECHOCARDIOGRAPHIC ASSESSMENT OF LEFT AND RIGHT HEART HEMODYNAMICS IN CRITICALLY ILL OBSTETRIC PATIENTS

OBJECTIVE: Our purpose was to compare noninvasive two-dimensional and Doppler echocardiography and right heart catheterization with a pulmon ary artery catheter in the estimation of stroke volume, cardiac output , cardiac index, left ventricular filling pressure, pulmonary artery s ystolic pressure, and right atrial pressure in a heterogeneous group o f critically ill obstetric patients. STUDY DESIGN: Eleven critically i ll obstetric patients requiring invasive monitoring for clinical manag ement were prospectively studied. Simultaneous Doppler and pulmonary a rtery catheter readings of stroke volume, cardiac output, cardiac inde x, left ventricular filling pressure, pulmonary artery systolic pressu re, and right atrial pressure were acquired. Mean +/- SD or median and range, as appropriate, of each parameter were compared, and data for all parameters were subjected to regression analysis. A two-tailed p v alue < 0.05 was regarded as significant. RESULTS: There was no signifi cant difference between the two techniques in the estimation of cardia c index, intracardiac pressures, or pulmonary artery systolic pressure . There was a good correlation between the two methods for stroke volu me (R(2) = 0.98), cardiac output (R(2) = 0.98), cardiac index (R(2) = 0.96), left ventricular filling pressure (R(2) = 0.79), pulmonary arte ry systolic pressure (R(2) = 0.85), and right atrial pressure (R(2) = 0.86). CONCLUSION: Two-dimensional and Doppler echocardiography allow rapid, reliable, noninvasive assessment of hemodynamic parameters in c ritically ill obstetric patients and may give the clinician valuable i nformation that may influence therapeutic and clinical management.