per 1000 days of Intensive Care Unit stay), with a constant prevalence rate throughout the years. Methicillin-resistant Staphylococcus species have been the most frequently isolated micro-organisms in our Intensive Care Unit. 75% of St aureus and 95% of coagulase-negative Staphylococci were methicillin- resistant. In-hospital mortality in MRS-positive patients was 50.0% (59/118) while it was 1.7% (108/6305) in non-MRS patients (P  0.0001). On multivari- ate analysis methicillin-resistant Staphylococcus species isolation was the single risk factor with the strongest association with in-hospital death (odds ratio, 8.5, 95% confidence interval 4.9–14.7). In our series there were no iso- lates of vancomycin-resistant species (Enterococcus species or Staphylo- coccus species). Discussion: Staphylococcus species represent the most frequently isolated microorganisms in our Intensive Care Unit. In-hospital mortality in cardiac sur- gical patients is strongly correlated to the isolation of Methicillin-resistant Staphylococcus. Reference: 1 Bolon MK, Morlote M, Weber SG, et al. Glycopeptides are no more effective than beta-lactam agents for prevention of surgical site infection after cardiac surgery: a meta-analysis. Clini Infec Dis 2004; 38: 1357–1363. P-114 Transoesophageal echocardiography accurately detects cardiac output variation: a prospective comparison with thermodilution in cardiac surgery V. Parra, G. Fita, I. Rovira, E. Arcos, I. Bel, M. Sadurní, C. Paré, C. Gomar Hospital Clínico y Facultad de Medicina, Universidad de Chile, Santiago, Chile; Servicio de Anestesiología, Hospital Clinic; Servicio de Ecocardiografía, Hospital Clinic; Unidad de Epidemiología y Bioestadística, Hospital Clinic, Universidad de Barcelona, Barcelona, Spain Introduction: Intraoperative Doppler ultrasound can be used to measure CO by transoesophageal echocardiography (TOE). Recently, its reliability has been questioned compared to the thermodilution (TD) technique (1). The purpose of this study was to compare intraoperative changes in CO meas- ured by TOE (COTOE) and by TD (COTD) in cardiac surgery. We also assessed the agreement between the techniques. Method: Forty-six cardiac surgical patients (34 male, 12 female, mean age 63  14.6 years) were prospectively included after approval by the ethics committee of the Institution. CO was assessed simultaneously and in a blind manner by TD, with 10 mL saline at 12°C, and by TOE in deep transgastric view with pulsed wave Doppler at the level of the left ventricular outflow tract (LVOT). Matched COTD and COTOE measurements were obtained in tripli- cate, at the end of expiration and at two times during surgery, pre and post cardiopulmonary bypass (CPB). Patients with significant tricuspid or aortic regurgitation, atrial fibrillation, cardiac shunts or LVOT obstruction were excluded. Results: COTOE measurements were obtained in 39 patients (85%). In 4 patients, Doppler recordings could not be obtained adequately and 3 devel- oped LVOT obstruction after CPB. Bland-Altman analysis revealed a bias of -0.01 L min -1 , with narrow limits of agreement (-1.2 to 1.18 L min -1 ) and 28.5% of error. TOE was accurate (84% sensitivity and 71% specificity, P  0.01 by ROC curves) for detecting more than 15% of change in COTD. There were no complications related to the study. Discussion: The agreement between COTOE and COTD is clinically acceptable and TOE is a reliable tool to assess significant CO changes in a population of selected patients. However, these results cannot be general- ized and, therefore, COTOE does not seem to be an alternative to TD in daily clinical practice. Reference: 1 Bettex DA, Hinselman V, Hellermann JP, et al. Transoesophageal echocardiography is unreliable for cardiac output assessment after cardiac surgery compared with ther- modilution. Anaesthesia 2004; 59: 1184–1192. P-115 Cardiac papillary fibroelastoma of the mitral valve: case report D. Penzo, D. De Cosmo, A. Bossi Umberto I° Hospital, Mestre-Venezia, Italy Cardiac papillary fibroelastoma (CPF) is the second most common primary cardiac tumour and the most common valvular tumour of the heart. The location on the mitral valve does not occur frequently, with fewer than 50 cases being reported in the literature [1]. Case Report: A 54 year old female patient presented at our hospital with clinical signs of acute ischaemia of her left arm. A transthoracic echocardio- gram (TTE) revealed a mobile excrescence on the mitral valve. This finding was confirmed by transoesophageal echocardiography (TOE) which showed that the cardiac mass measured 14  15 mm on the midportion of the pos- terior mitral leaflet on the atrial side and it was attached to the endocardium by a small stalk. The echocardiographic characteristics, including location, size and appearance were consistent with CPF and the patient was sched- uled for surgical removal of the lesion. It was excised and the mitral valve was preserved. Postoperative pathological examination of the cardiac mass confirmed the diagnosis of a papillary fibroelastoma. Figure 1: TOE show a mass (arrows) attached to the posterior leaflet of mitral valve. Discussion: CPF is a rare cardiac neoplasm that originates mainly from the valvular endocardium. There have been rare reports of sudden death as a result of fibroelastoma, probably because of coronary occlusion or emboliza- tion. CPF may cause chest pain or myocardial infarction, neurovascular events (most currently) and rarely pulmonary emboli. Patients with events that may be embolic in nature and are not explained by other cardiovascular or neurological disease should undergo TTE and TOE if necessary to exclude cardiac sources of emboli, including CPF. Echocardiographically, they pre- sent as highly mobile excrescences, variable in size and number, with well- demarcated borders and homogeneous texture, typically located on one of the valves by a small stalk. The differential diagnosis should include other benign tumours, thrombi, degenerative valve tissue and vegetations. In summary, this case underlines that echocardiography is a convenient and non-invasive diagnostic technique and should be the first choice of tests to search for CPFs. Reference: 1 Remadi JP, Degandt A, Rakotoarivello Z. Cardiac papillary fibroelastoma of the mitral valve chordae. Heart 2004; 90: 1397. P-116 Comparison of manual and mechanical ventilation during transport of patients to the Intensive Care Unit after cardiac surgery A. Canbulat, S. Goren, E.B. Mogol, F.N. Kaya Department of Anaesthesiology and Intensive Care, Uludag University, School of Medicine, Bursa, Turkey 0 COTOE-COTD [Lmin -1 ] 0 1 1 2 2 3 Bland-Altman analysis 3 4 4 5 6 7 8 9 -4 -3 -2 -1 10 (COTOE + COTD)/2 [Lmin -1 ] Echocardiography/Intensive care medicine 39