Association of physical examination with pulmonary artery catheter parameters in acute lung injury
The authors found that physical findings had good specificity in predicting low cardiac index (CI) and low central oxygenation; however, at the low prevalence of low CI in this study, even when all three physical findings were present, the positive predictive value was 40%.
This cross sectional study looked at three physical findings (delayed capillary refill time, knee mottling, and cool skin temperature) in predicting cardiac index, central venous oxygen saturation (ScvO2 – a quality measure of IHI), and mixed venous oxygen saturation (SvO2) among 392 patients with acute lung injury studied by ARDSNet.
Results:
For cardiac index < 2.5 (similar results for the measures of oxygenation):
| Sensitivity | Specificity | Predictive values at prevalence of 8% | ||
| Positive | Negative | |||
| Any one of three findings* present | 52% | 78% | 17% | 95% |
| All three findings* present | 12% | 98% | 40% | 93% |
| * Findings are: delayed capillary refill time, knee mottling, and cool skin temperature. | ||||
Did not look at proportional pulse pressure < 25% which has previously been found to be predictive (PMID: 2913385; PMID: 11420761)
The Rational Clinical Examination previously concluded that the capillary refill time did not help predict hyovolemia in adults (PMID: 10086438).
Nice to see that the National Institutes of Health/National Heart, Lung and Blood Institute Acute Respiratory Distress Syndrome Network (ARDSNet) is interested in the physical examination.
Citation:
Grissom CK, Morris AH, Lanken PN, Ancukiewicz M, Orme JF Jr, Schoenfeld DA, Thompson BT, & National Institutes of Health/National Heart, Lung and Blood Institute Acute Respiratory Distress (2009). Association of physical examination with pulmonary artery catheter parameters in acute lung injury. Critical care medicine, 37 (10), 2720-6 PMID: 19885995
