Table 3.
Combined signs of clinical examination for estimation of CO
| Variables of interest | ||||||
| Author, year | Patients | Population | Clinical profile | Clinical profile based on | CO-measurement | Results |
| Combined clinical profiles | ||||||
| Ramo et al. 1970 [63] | 98 | AMI | I (normal CI): no signs of HFII (normal CI): mild-to-moderate HFIII (low CI): overt pulmonary edemaIV (low CI): cardiogenic shock | Mean arterial pressure, cool extremities, urine output, mental status, third heart sound gallop rhythm and rales | PAC, indicator-dilution technique | I (normal CI): 23 of 45 (51%)II (normal CI): 19 of 30 (63%)III (low CI): 10 of 10 (100%)IV (low CI): 13 of 13 (100%) |
| Forrester et al. 1977 [64] | 200 | AMI | I (normal CI): no pulmonary congestion or peripheral hypoperfusionII (normal CI): pulmonary congestion onlyIII (low CI): hypoperfusion onlyIV (low CI): both | Heart rate, blood pressure, cool extremities, urine output and mental status | PAC, thermodilution | Overall: 81% correct estimations of CII & II (normal CI): 84 of 95 (88%)III & IV (low CI): 76 of 105 (72%) |
| Grissom et al. 2009 [65] | 405 | ALI | I: All three clinical signs aberrantII: Any one clinical sign aberrant | Capillary refill time, knee mottling and cool extremities | PAC, thermodilution | 92% correct estimations of CI in class I:Sens 12% (3–28%); Spec 98% (97–99%)PPV 40% (17–69%); NPV 93% (92–93%)LR+ 7.52 (2.23–25.3); LR– 0.89 (0.79–1.01)75% correct estimations of CI in class II:Sens 52% (34–69%); Spec 78% (73–82%)PPV 17% (12–23%); NPV 95% (93–96%)LR+ 2.31 (1.58–3.38); LR– 0.62 (0.44–0.89) |
| Multivariable analysis | ||||||
| Sasse et al. 1996 [66] | 23a | ICU patients | CO continuous | Heart rate, respiratory rate, mean arterial pressure and temperature | PAC, thermodilution | Heart rate: R2 = 0.05Respiratory rate: R2 = 0.14Mean arterial pressure: R2 = 0.03 |
a=repeated measurements in each patient.
ALI, acute lung injury; AMI, acute myocardial infarction; CI, cardiac index (l/min/m2); CO, cardiac output (l/min); HF, heart failure; LR–, negative likelihood ratio; LR+, positive likelihood ratio; NPV, negative predictive value; PAC, pulmonary artery catheter; PPV, positive predictive value; Sens, sensitivity; Spec, specificity.