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Analytic Reviews : Radiological Assessment of Central Vascular Volume Status in an Intensive Care Unit Setting

Critical Care Division and the Department of Medicine

Jay S. Steingrub, MD, FACP

Critical Care Division and the Department of Medicine, Surgery

Daniel Teres, MD, FACP

Critical Care Division and the Department of Medicine, Surgery

Maureen Vickers-Lahti, MBBS

University of Massachusetts School of Public Health, Amherst, MA

Thomas Parker, MD

Radiology, Baystate Medical Center, Springfield, Tufts University School of Medicine, Boston

Thomas E. Vaughan, MD

Radiology, Baystate Medical Center, Springfield, Tufts University School of Medicine, Boston

We studied the chest radiographs of 126 patients under going pulmonary artery catheterization. An experienced radiologist, unaware of the patient's clinical condition and results of pulmonary artery catheterization and without review of prior films, evaluated each radiograph focusing exclusively on fluid status, and assigned each one to one of the following four categories: definitely or probably elevated central vascular volume status, or definitely or probably nonelevated central vascular vol ume status. This assessment was then compared with the "official" reading, performed with knowledge of the patient's clinical status and with availability of previous chest radiographs. The radiologist's prediction was more accurate than the official report (65% proportion of correct classification vs. 59% ) (p < 0.05). Patients with actual high pulmonary artery wedge pressure read ings were more difficult to diagnose correctly than pa tients with low or normal pulmonary artery wedge pres sure. In those patients in whom the radiologist felt more confident of his prediction (25% of patients), diagnostic accuracy improved considerably for both the high and normal pulmonary artery wedge pressure groups of pa tients to a proportion of correct classification of 71% and 80%, respectively. Although the radiological assess ment was not accurate enough to replace pulmonary artery catheterization, the official reading can be im proved by focusing on specific radiological features to estimate central vascular volume status.

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