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Parenti N, Scalese M, Palazzi C, Agrusta F, Cahill J, Agnelli G. Role of Internal Jugular Vein Ultrasound Measurements in the Assessment of Central Venous Pressure in Spontaneously Breathing Patients: A Systematic Review. J Acute Med 2019; 9:39-48. [PMID: 32995230 PMCID: PMC7440374 DOI: 10.6705/j.jacme.201906_9(2).0001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 06/28/2018] [Accepted: 07/04/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND Few studies have tested the role of the internal jugular vein (IJV) ultrasonographic (US) diameters in the assessment of central venous pressure (CVP) in spontaneously breathing patients. No review or meta-analysis is currently available on the role of IJV assessment in this setting. The aim of this systematic review is to check the reliability and accuracy of IJV US diameters in predicting CVP and to evaluate its correlation with CVP in spontaneously breathing patients. METHODS This systematic review was based on the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. We included studies on the accuracy and reliability of the IJV ultrasound measures and studies exploring its correlation with CVP in adult spontaneously breathing patients. The studies' report quality was assessed by Standards for Reporting of Diagnostic Accuracy (STARD) and Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 scales. RESULTS A total of five studies was eligible for final analysis. The studies on IJV ultrasound measures showed a good quality in reporting. The anterior-posterior diameter maximum of IJV (AP-IJV Dmax) showed the best correlation with the CVP with a good inter-rater reliability and validity in predicting CVP. All measures showed good inter-rater reliability and validity in predicting CVP, but only the AP-IJV Dmax showed good correlation with CVP. CONCLUSIONS The AP-IJV Dmax could be a potential surrogate of CVP because of its good reliability and validity in predicting CVP value and its fair-moderate correlation with CVP. Anyway, further research should confi rm these conclusions.
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Affiliation(s)
- Nicola Parenti
- University of Modena e Reggio EmiliaLargo del Pozzo, 71Modena41125Italy
| | - Marco Scalese
- Institute of Clinical Physiology-Italian National Research Council (IFC-CNR)PisaItaly
| | - Carmela Palazzi
- University of Modena e Reggio EmiliaLargo del Pozzo, 71Modena41125Italy
| | - Federica Agrusta
- University of Modena e Reggio EmiliaLargo del Pozzo, 71Modena41125Italy
| | - Jane Cahill
- University of LeedsSchool of HealthcareLeedsUK
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202
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Campos ID, Salgado A, Azevedo P, Vieira C. Dressler's syndrome: are we underdiagnosing what we think to be rare? BMJ Case Rep 2019; 12:12/5/e227772. [PMID: 31118169 DOI: 10.1136/bcr-2018-227772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 46-year-old man was admitted to the emergency department with fever and pleuritic thoracic pain. Six weeks prior to admission, the patient had undergone cardiac surgery. The ECG showed diffuse ST segment elevation and PR segment depression. The blood tests revealed increased inflammatory markers and negative myocardial necrosis markers. Pericardial and left-sided pleural effusion were noted. Sterile blood cultures were negative. Hence, the hypothesis of Dressler's syndrome was established. The patient improved clinically and analytically with a short course of anti-inflammatory therapy and was discharged with colchicine and acetylsalicylic acid. A thoracic radiography performed 2 months after showed complete remission of pleural effusion.
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Affiliation(s)
| | | | - Pedro Azevedo
- Cardiology Department, Hospital de Braga, Braga, Portugal
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203
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Park HS, Kim SH, Park YS, Thiele RH, Shin WJ, Hwang GS. Respiratory Variations in Electrocardiographic R-Wave Amplitude during Acute Hypovolemia Induced by Inferior Vena Cava Clamping in Patients Undergoing Liver Transplantation. J Clin Med 2019; 8:jcm8050717. [PMID: 31137521 PMCID: PMC6572700 DOI: 10.3390/jcm8050717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 05/14/2019] [Accepted: 05/17/2019] [Indexed: 12/05/2022] Open
Abstract
The aim of this study was to analyze whether the respiratory variation in electrocardiogram (ECG) standard lead II R-wave amplitude (ΔRDII) could be used to assess intravascular volume status following inferior vena cava (IVC) clamping. This clamping causes an acute decrease in cardiac output during liver transplantation (LT). We retrospectively compared ΔRDII and related variables before and after IVC clamping in 34 recipients. Receiver operating characteristic (ROC) curve and area under the curve (AUC) analyses were used to derive a cutoff value of ΔRDII for predicting pulse pressure variation (PPV). After IVC clamping, cardiac output significantly decreased while ΔRDII significantly increased (p = 0.002). The cutoff value of ΔRDII for predicting a PPV >13% was 16.9% (AUC: 0.685) with a sensitivity of 57.9% and specificity of 77.6% (95% confidence interval 0.561 – 0.793, p = 0.015). Frequency analysis of ECG also significantly increased in the respiratory frequency band (p = 0.016). Although significant changes in ΔRDII during vena cava clamping were found at norepinephrine doses <0.1 µg/kg/min (p = 0.032), such changes were not significant at norepinephrine doses >0.1 µg/kg/min (p = 0.093). ΔRDII could be a noninvasive dynamic parameter in LT recipients presenting with hemodynamic fluctuation. Based on our data, we recommended cautious interpretation of ΔRDII may be requisite according to vasopressor administration status.
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Affiliation(s)
- Hee-Sun Park
- Department of Anesthesiology and Pain Medicine, University of Ulsan College of Medicine, Asan Medical Center, 05505 Seoul, Korea.
| | - Sung-Hoon Kim
- Department of Anesthesiology and Pain Medicine, University of Ulsan College of Medicine, Asan Medical Center, 05505 Seoul, Korea.
| | - Yong-Seok Park
- Department of Anesthesiology and Pain Medicine, University of Ulsan College of Medicine, Asan Medical Center, 05505 Seoul, Korea.
| | - Robert H Thiele
- Departments of Anesthesiology and Biomedical Engineering, University of Virginia School of Medicine, Charlottesville, VA 22903, USA.
| | - Won-Jung Shin
- Department of Anesthesiology and Pain Medicine, University of Ulsan College of Medicine, Asan Medical Center, 05505 Seoul, Korea.
| | - Gyu-Sam Hwang
- Department of Anesthesiology and Pain Medicine, University of Ulsan College of Medicine, Asan Medical Center, 05505 Seoul, Korea.
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204
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Kesävuori R, Vento A, Lundbom N, Schramko A, Jokinen JJ, Raivio P. Minimal volume ventilation during robotically assisted mitral valve surgery. Perfusion 2019; 34:705-713. [PMID: 31090485 DOI: 10.1177/0267659119847917] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION A minimal volume ventilation method for robotically assisted mitral valve surgery is described in this study. In an attempt to reduce postoperative pulmonary dysfunction, 40 of 174 patients undergoing robotically assisted mitral valve surgery were ventilated with a small tidal volume during cardiopulmonary bypass. METHODS After propensity score matching, 31 patients with minimal volume ventilation were compared with 54 patients with no ventilation. Total ventilation time, PaO2/FiO2 ratio, arterial lactate concentration, and the rate of unilateral pulmonary edema in the matched minimal ventilation and standard treatment groups were evaluated. RESULTS Patients in the minimal ventilation group had shorter ventilation times, 12.0 (interquartile range: 9.9-15.0) versus 14.0 (interquartile range: 12.0-16.3) hours (p = 0.036), and lower postoperative arterial lactate levels, 0.99 (interquartile range: 0.81-1.39) versus 1.28 (interquartile range: 0.99-1.86) mmol/L (p = 0.01), in comparison to patients in the standard treatment group. There was no difference in postoperative PaO2/FiO2 ratio levels or in the rate of unilateral pulmonary edema between the groups. CONCLUSION Minimal ventilation appeared beneficial in terms of total ventilation time and blood lactatemia, while there was no improvement in arterial blood gas measurements or in the rate of unilateral pulmonary edema. The lower postoperative arterial lactate levels may suggest improved lung perfusion among patients in the minimal volume ventilation group. The differences in the ventilation times were in fact small, and further studies are required to confirm the possible advantages of the minimal volume ventilation method in robotically assisted cardiac surgery.
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Affiliation(s)
- Risto Kesävuori
- Department of Cardiac Surgery, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland.,Department of Radiology, HUS Medical Imaging Center, Helsinki University Hospital, Helsinki, Finland
| | - Antti Vento
- Department of Cardiac Surgery, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Nina Lundbom
- Department of Radiology, HUS Medical Imaging Center, Helsinki University Hospital, Helsinki, Finland
| | - Alexey Schramko
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital, Helsinki, Finland
| | - Janne J Jokinen
- Department of Surgery, Päijät-Häme Central Hospital, Lahti, Finland
| | - Peter Raivio
- Department of Cardiac Surgery, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
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205
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Burlacu A, Artene B, Covic A. A Narrative Review on Thrombolytics in Advanced CKD: Is it an Evidence-Based Therapy? Cardiovasc Drugs Ther 2019; 32:463-475. [PMID: 30187347 DOI: 10.1007/s10557-018-6824-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE A timely pharmacoinvasive strategy consisting of thrombolytic therapy (TT) plays a pivotal role in three major scenarios: acute ischemic stroke (AIS), acute myocardial infarction (STEMI), and massive pulmonary embolism (PE). Presence of advanced chronic kidney disease (CKD) (estimated glomerular filtration rate < 30 mL/min/1.73 m2), known to disturb thrombotic/thrombolytic equilibrium, causes difficulties for clinicians in evaluating risk-benefit balance, as current guidelines do not address the relationship between TT and the advanced CKD. This narrative review aims to evaluate the most important scientific resources regarding the evidences, benefits, and risks of using thrombolytics in advanced CKD. METHODS We searched the electronic database of PubMed for studies evaluating the relationship between renal dysfunction and TT in patients with STEMI, AIS, and massive PE. Randomized controlled trials (RCTs), observational studies including prospective or retrospective cohort studies, reviews, meta-analyses, and guidelines were included if referring to TT for one of the three scenarios in advanced CKD. RESULTS Prothrombotic conditions in CKD, associated with an increased risk of hemorrhages, can affect the safety and efficacy of TT. Concerns regarding in-hospital bleeding events and poor clinical outcomes subsequent to TT in advanced CKD continue to cause underutilization or delaying routine reperfusion therapy. CONCLUSIONS The impact of TT on the outcomes of advanced CKD patients is poorly understood to date, with scarce data available in current guidelines and conflicting results from observational studies. Until evidence-based data from RCTs will be obtained, the clinical challenge of maximizing benefits for this high-risk subgroup lays in the hands of practicing clinicians.
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Affiliation(s)
- Alexandru Burlacu
- Department of Interventional Cardiology, Cardiovascular Diseases Institute, Iasi, Romania.,University of Medicine and Pharmacy Gr. T. Popa, Iasi, Romania
| | - Bogdan Artene
- Department of Interventional Cardiology, Cardiovascular Diseases Institute, Iasi, Romania. .,University of Medicine and Pharmacy Gr. T. Popa, Iasi, Romania.
| | - Adrian Covic
- University of Medicine and Pharmacy Gr. T. Popa, Iasi, Romania.,Nephrology Department, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
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206
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Eisenried A, Klarwein R, Ihmsen H, Wehrfritz A, Tandler R, Heim C, Fechner J. Accuracy and Trending Ability of the Fourth-Generation FloTrac/EV1000 System in Patients With Severe Aortic Valve Stenosis Before and After Surgical Valve Replacement. J Cardiothorac Vasc Anesth 2019; 33:1230-1236. [DOI: 10.1053/j.jvca.2018.09.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Indexed: 11/11/2022]
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207
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Bermejo-Martin JF, Andaluz-Ojeda D, Martin-Fernandez M, Aldecoa C, Almansa R. Composed endotypes to guide antibiotic discontinuation in sepsis. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2019; 23:140. [PMID: 31018868 PMCID: PMC6482544 DOI: 10.1186/s13054-019-2439-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 04/15/2019] [Indexed: 11/23/2022]
Abstract
Overuse of empiric antibiotic therapy in the ICU is responsible for promoting the dissemination of multidrug-resistant (MDR) bacteria. Shortened antibiotic treatment duration could contribute to palliating the emergence of MDR. Uncertainty about patient evolution is a major concern for deciding to stop antibiotics. Biomarkers could represent a complementary tool to identify those patients for whom antibiotic treatment could be safely discontinued. The biomarker most extensively studied to guide antibiotic withdrawal is procalcitonin (PCT), but its real impact on decreasing the duration of antibiotic treatment is a matter of controversy. Combining biomarkers to rule out complicated outcomes in sepsis patients could represent a better option. Some candidate biomarkers, including mid-regional proadrenomedullin, the percentage of human leukocyte antigen DR (HLA-DR)-positive monocytes, means of fluorescence intensities of HLA-DR on monocytes, interleukin-7 receptor expression levels, immunoglobulin M levels in the serum or the absence of increased proteolysis, have already demonstrated the potential to exclude the risk of progression to septic shock, nosocomial infections, and mortality when tested along the sepsis course. Other promising biomarkers to rule out complicated outcomes are neutrophil protease activity, the adaptive/coagulopathic signatures identified by whole transcriptome analysis by Sweeney et al., and the SRS1 signature identified by Davenport et al. In conclusion, there are a number of promising biomarkers involved in proteolytic, vascular, immunological, and coagulation alterations that could be useful to build composed endotypes to predict uncomplicated outcomes in sepsis. These endotypes could help to identify patients deserving the discontinuation of antibiotics.
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Affiliation(s)
- Jesus F Bermejo-Martin
- Group for Biomedical Research in Sepsis (BioSepsis), Hospital Clínico Universitario de Valladolid/IECSCYL, Av. Ramón y Cajal, 3, 47003, Valladolid, Spain. .,Centro de Investigación Biomedica en Red-Enfermedades Respiratorias (CibeRes, CB06/06/0028), Instituto de salud Carlos III (ISCIII), Av. de Monforte de Lemos, 5, 28029, Madrid, Spain.
| | - David Andaluz-Ojeda
- Group for Biomedical Research in Sepsis (BioSepsis), Hospital Clínico Universitario de Valladolid/IECSCYL, Av. Ramón y Cajal, 3, 47003, Valladolid, Spain.,Intensive Care Medicine Service, Hospital Clínico Universitario de Valladolid/IECSCYL, Av. Ramón y Cajal, 3, 47003, Valladolid, Spain
| | - Marta Martin-Fernandez
- Group for Biomedical Research in Sepsis (BioSepsis), Hospital Clínico Universitario de Valladolid/IECSCYL, Av. Ramón y Cajal, 3, 47003, Valladolid, Spain
| | - Cesar Aldecoa
- Group for Biomedical Research in Sepsis (BioSepsis), Hospital Clínico Universitario de Valladolid/IECSCYL, Av. Ramón y Cajal, 3, 47003, Valladolid, Spain.,Anesthesiology and Reanimation Service, Hospital Universitario Río Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Raquel Almansa
- Group for Biomedical Research in Sepsis (BioSepsis), Hospital Clínico Universitario de Valladolid/IECSCYL, Av. Ramón y Cajal, 3, 47003, Valladolid, Spain.,Centro de Investigación Biomedica en Red-Enfermedades Respiratorias (CibeRes, CB06/06/0028), Instituto de salud Carlos III (ISCIII), Av. de Monforte de Lemos, 5, 28029, Madrid, Spain
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208
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Dhawan R, Shahul S, Roberts JD, Smith ND, Steinberg GD, Chaney MA. Prospective, randomized clinical trial comparing use of intraoperative transesophageal echocardiography to standard care during radical cystectomy. Ann Card Anaesth 2019; 21:255-261. [PMID: 30052211 PMCID: PMC6078029 DOI: 10.4103/aca.aca_183_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Purpose: Our prospective, randomized clinical study aims to evaluate the utility of intraoperative transesophageal echocardiography (TEE) in patients undergoing radical cystectomy. Materials and Methods: Eighty patients were randomized to a standard of care group or the intervention group that received continuous intraoperative TEE. Data are presented as means ± standard deviations, median (25th percentile, 75th percentile), or numbers and percentages. Characteristics were compared between groups using independent sample t-tests, Wilcoxon–Mann–Whitney tests or Chi-square tests, as appropriate. All tests were two-sided and P < 0.05 was considered to indicate statistical significance. Results: Both groups had similar preoperative demographic characteristics. There was a significant difference between central line insertion with all insertions in the control group (15%, 6 vs. 0%, 0; P < 0.003). Of all the perioperative complications, 80% occurred in the control group versus 20% in the TEE group, with 21% of controls experiencing a cardiac or pulmonary complication compared to 5% in the TEE group (8 vs. 2, P < 0.04). The control group patients were more likely to have adverse cardiac complications than the TEE group (15%, 6 vs. 3%, 1; P < 0.040). Postoperative cardiac arrhythmia was observed only in the control group (13%, 5 vs. 0%, 0; P <.007). Prolonged intubation was only observed in the control group (10%, 4 vs. 0%, 0; P < 0.017). Conclusion: TEE can be a useful monitoring tool in patients undergoing radical cystectomy, limiting the use of central line insertion and potentially translating into earlier extubation and decreased postoperative cardiac morbidities.
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Affiliation(s)
- Richa Dhawan
- Department of Anesthesia and Critical Care, University of Chicago Medical Center, Chicago, IL, USA
| | - Sajid Shahul
- Department of Anesthesia and Critical Care, University of Chicago Medical Center, Chicago, IL, USA
| | - Joseph Devin Roberts
- Department of Anesthesia and Critical Care, University of Chicago Medical Center, Chicago, IL, USA
| | - Norm D Smith
- Department of Surgery/Section of Urology, University of Chicago Medical Center, Chicago, IL, USA
| | - Gary D Steinberg
- Department of Surgery/Section of Urology, University of Chicago Medical Center, Chicago, IL, USA
| | - Mark A Chaney
- Department of Anesthesia and Critical Care, University of Chicago Medical Center, Chicago, IL, USA
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209
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Knippa S. Blood Pressure Monitoring During Intra-Aortic Balloon Pumping. Crit Care Nurse 2019; 39:99-101. [PMID: 30936134 DOI: 10.4037/ccn2019675] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Sara Knippa
- Sara Knippa is a clinical nurse specialist and educator in the cardiac intensive care unit at the University of Colorado Hospital, Aurora, Colorado
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210
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Kaydu A, Gokcek E. Inferior vena cava diameter measurements and BUN/creatinine values to determine dehydration in patients with hip fractures preoperatively: A prospective observational study. Medicine (Baltimore) 2019; 98:e15197. [PMID: 31027065 PMCID: PMC6831161 DOI: 10.1097/md.0000000000015197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 01/29/2019] [Accepted: 03/20/2019] [Indexed: 11/26/2022] Open
Abstract
Dehydration is a common problem in patients undergoing hip fracture surgery. Sonographic inferior vena cava (IVC) diameter measurement evaluates to estimate volume status. The aim of the study to evaluate the relationship between IVC measurements (expiratory diameter of IVC, collabsibility index [CI], inspiratory diameter of IVC) and blood urea nitrogen (BUN)/creatinine ratio in patients undergoing hip fracture surgery. Ultrasonography of IVC was performed on 35 patients underwent hip fracture surgery. The end-expiratory diameter of IVC, end-inspiratory diameter of IVC, and CI were assessed preoperatively. The patients were classified as group 1 for BUN/Cr ratio <20, group 2 for BUN/Cr ratio of >20. Sonographic IVC measurement was not successful in 14.2% of patients and 30 patients remained. The mean age was 80.43 ± 11.10 (58-95) years. The IVC diameter values had no discriminatory value for the prediction of dehydration according to BUN/creatinine ratio (P > .05). Receiver operating characteristic curve indicated that area under the curve (AUC) for CI: 49.5%, (95% CI 26.5-72.5) P > .05; for IVC inspiratory diameter: AUC: 43.3%, (95% CI, 19.9-66.6) P > .05; for IVC expiratory diameter: AUC: 45.5%, (95% CI, 26.6-65.4) P > .05. No correlations of BUN/creatinine ratio with CI and IVC expiratory diameter were found (as r = -0.262 [P = .163]; [r = 0.206, P = .274]; respectively). There were not any correlation in linear regression analysis model between BUN/Cr ratio according to independent variables (Age, CI, IVCmax, IVCmin) (P = .108, P = .419, P = .282, P = .257; respectively). No discriminatory relationship was found between the bedside ultrasonographic measurement of IVC parameters and BUN/creatinine ratio in patients underwent hip fracture surgery to predict the preoperative dehydration.
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211
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Saugel B, Flick M, Bendjelid K, Critchley LAH, Vistisen ST, Scheeren TWL. Journal of clinical monitoring and computing end of year summary 2018: hemodynamic monitoring and management. J Clin Monit Comput 2019; 33:211-222. [PMID: 30847738 PMCID: PMC6420447 DOI: 10.1007/s10877-019-00297-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 02/21/2019] [Indexed: 12/05/2022]
Abstract
Hemodynamic management is a mainstay of patient care in the operating room and intensive care unit (ICU). In order to optimize patient treatment, researchers investigate monitoring technologies, cardiovascular (patho-) physiology, and hemodynamic treatment strategies. The Journal of Clinical Monitoring and Computing (JCMC) is a well-established and recognized platform for publishing research in this field. In this review, we highlight recent advancements and summarize selected papers published in the JCMC in 2018 related to hemodynamic monitoring and management.
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Affiliation(s)
- Bernd Saugel
- Department of Anesthesiology, Centre of Anesthesiology and Intensive Care Medicine, University Medical Centre Hamburg- Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Moritz Flick
- Department of Anesthesiology, Centre of Anesthesiology and Intensive Care Medicine, University Medical Centre Hamburg- Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Karim Bendjelid
- Department of Anesthesiology and Intensive Care, Geneva University Hospitals, Geneva, Switzerland
| | - Lester A H Critchley
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Shantin, N.T., Hong Kong.,The Belford Hospital, Fort William, The Highlands, Scotland, UK
| | - Simon T Vistisen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Thomas W L Scheeren
- Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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212
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Khirfan G, Ahmed MK, Faulx MD, Dakkak W, Dweik RA, Tonelli AR. Gasometric gradients between blood obtained from the pulmonary artery wedge and pulmonary artery positions in pulmonary arterial hypertension. Respir Res 2019; 20:6. [PMID: 30621691 PMCID: PMC6325872 DOI: 10.1186/s12931-018-0969-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 12/20/2018] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Little is known on the pulmonary gradients of oxyhemoglobin, carboxyhemoglobin and methemoglobin in pulmonary arterial hypertension (PAH). We sought to determine these gradients in group 1 PAH and assess their association with disease severity and survival. METHODS During right heart catheterization (RHC) we obtained blood from pulmonary artery (PA) and pulmonary artery wedge (PAW) positions and used co-oximetry to test their gasometric differences. RESULTS We included a total of 130 patients, 65 had group 1 PAH, 40 had pulmonary hypertension (PH) from groups 2-5 and 25 had no PH during RHC. In all groups, PAW blood had higher pH, carboxyhemoglobin and lactate as well as lower pCO2 than PA blood. In group 1 PAH (age 58 ± 15 years, 72% females), methemoglobin in the PAW was lower than in the PA blood (0.83% ± 0.43 vs 0.95% ± 0.50, p = 0.03) and was directly associated with the degree of change in pulmonary vascular resistance (R = 0.35, p = 0.02) during inhaled nitric oxide test. Oxyhemoglobin in PA (HR (95%CI): 0.90 (0.82-0.99), p = 0.04) and PAW (HR (95%CI): 0.91 (0.84-0.98), p = 0.003) blood was associated with adjusted survival in PAH. CONCLUSIONS Marked differences were observed in the gasometric determinations between PAW and PA blood. The pulmonary gradient of methemoglobin was lower in PAH patients compared to controls and a higher PAW blood methemoglobin was associated with a more pronounced pulmonary vascular response to inhaled nitric oxide. Pulmonary artery and PAW oxyhemoglobin tracked with disease severity and survival in PAH.
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Affiliation(s)
- Ghaleb Khirfan
- Department of Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, 9500 Euclid Avenue A-90, Cleveland, OH 44195 USA
| | - Mostafa K. Ahmed
- Department of Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, 9500 Euclid Avenue A-90, Cleveland, OH 44195 USA
- Department of Chest Diseases, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Michael D. Faulx
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH USA
| | - Wael Dakkak
- Department of Internal Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, IL USA
| | - Raed A. Dweik
- Department of Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, 9500 Euclid Avenue A-90, Cleveland, OH 44195 USA
| | - Adriano R. Tonelli
- Department of Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, 9500 Euclid Avenue A-90, Cleveland, OH 44195 USA
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213
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Tavukcu Ozkan S, Arbatli H. Utility of transpulmonary thermodilution with Pulse Index Continuous Cardiac Output system for hemodynamic assessment in a hemodialysis patient with arteriovenous fistula and continuous renal replacement therapy: A case report. J Vasc Access 2019; 20:438-441. [PMID: 30608017 DOI: 10.1177/1129729818820206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Close hemodynamic monitoring is crucial for the patients to guide cardiovascular therapy for the optimal management. Transpulmonary thermodilution offers a less invasive hemodynamic monitoring with Pulse Index Continuous Cardiac Output system analysis. Intracardiac shunts have been associated with well-defined alterations in transpulmonary thermodilution-related hemodynamic parameters leading to inaccurate measurements and therefore are among the contraindications for transpulmonary thermodilution. However, data on the effects of arteriovenous fistulas as well as extracorporeal circuits on the thermodilution curves remain limited and inconclusive. Herein, we report generation of modified thermodilution curve forms leading to incorrect calculation of thermodilution-derived hemodynamic parameters by Pulse Index Continuous Cardiac Output system in a female patient in the presence of Continuous Veno-Venous Hemodiafiltration and a high flow arteriovenous fistula. Our findings revealed generation of modified thermodilution curves and unacceptably high extravascular lung water readings by Pulse Index Continuous Cardiac Output system. This seems consistent with early recirculation of cold indicator in case of a peripheral shunt emphasizing the potential impact of high flow arteriovenous fistula on reliability of transpulmonary thermodilution measurements in critically ill patients, limiting the use of Pulse Index Continuous Cardiac Output system in these conditions.
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Affiliation(s)
- Sedef Tavukcu Ozkan
- 1 Department of Anesthesia and Reanimation, General Intensive Care Unit, Memorial Hizmet Hospital, Istanbul, Turkey
| | - Harun Arbatli
- 2 Department of Cardiovascular Surgery, Memorial Hizmet Hospital, Istanbul, Turkey
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Shaik Z, Mulam SS. Efficacy of Stroke Volume Variation, Cardiac Output and Cardiac Index as Predictors of Fluid Responsiveness using Minimally Invasive Vigileo Device in Intracranial Surgeries. Anesth Essays Res 2019; 13:248-253. [PMID: 31198239 PMCID: PMC6545965 DOI: 10.4103/aer.aer_10_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Introduction: Functional hemodynamic monitoring using dynamic parameters such as stroke volume variations (SVVs) based on pulse contour analysis is considered more accurate than central venous pressure and mean arterial pressure (MAP) in predicting fluid responsiveness. New device, i.e., Vigileo system, allows automatic and continuous monitoring of cardiac output (CO) based on pulse contour analysis and respiratory stroke volume. Aim: The study aims to test the above hypothesis using graded volume loading step (VLS) to assess the accuracy of SVV as a predictor of fluid responsiveness in patients undergoing intracranial surgery. Materials and Methods: After taking ethical committee approval and informed consent, 60 patients aged between 18 and 55 years belonging to the American Society of Anesthesiologists physical status Class I and II, of either sex, scheduled for brain surgery were included in the study. In this study, 5 min after intubation, with stable hemodynamics, patients received volume loading in successive steps (VLS) of 200 ml of lactated Ringer's solution until the stroke volume increased to <10%. Blood pressure (BP), heart rate (HR), stroke volume (SV), and SVV were measured before and after each VLS. Optimal preload augmentation required by each patient was measured by the number of VLS after which an increase in SV was <10%. Results: There was a significant decrease in the baseline BP and SV in responsive and nonresponsive groups for the first VLS, but there is no change in HR statistically. There was a significant change in SV after first VLS. Receiver operating characteristic analysis showed a larger area under the curve of 0.758 for SVV compared to other measured variables. The median number of VLS administered were 2 per patient equating to a mean ± SD requirement of 368 ± 176 ml of crystalloid per patient as the optimal preoperative infusion volume. Conclusion: SVV is a better predictor of preload responsiveness measured with third-generation Vigileo device when compared to BP and HR.
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Affiliation(s)
- Zareena Shaik
- Department of Anaesthesiology, Siddhartha Medical College, Vijayawada, Andhra Pradesh, India
| | - Santhi Sree Mulam
- Department of Anaesthesiology, Siddhartha Medical College, Vijayawada, Andhra Pradesh, India
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216
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Tusman G, Acosta CM, Pulletz S, Böhm SH, Scandurra A, Arca JM, Madorno M, Sipmann FS. Photoplethysmographic characterization of vascular tone mediated changes in arterial pressure: an observational study. J Clin Monit Comput 2018; 33:815-824. [PMID: 30554338 DOI: 10.1007/s10877-018-0235-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Accepted: 12/11/2018] [Indexed: 03/14/2023]
Abstract
To determine whether a classification based on the contour of the photoplethysmography signal (PPGc) can detect changes in systolic arterial blood pressure (SAP) and vascular tone. Episodes of normotension (SAP 90-140 mmHg), hypertension (SAP > 140 mmHg) and hypotension (SAP < 90 mmHg) were analyzed in 15 cardiac surgery patients. SAP and two surrogates of the vascular tone, systemic vascular resistance (SVR) and vascular compliance (Cvasc = stroke volume/pulse pressure) were compared with PPGc. Changes in PPG amplitude (foot-to-peak distance) and dicrotic notch position were used to define 6 classes taking class III as a normal vascular tone with a notch placed between 20 and 50% of the PPG amplitude. Class I-to-II represented vasoconstriction with notch placed > 50% in a small PPG, while class IV-to-VI described vasodilation with a notch placed < 20% in a tall PPG wave. 190 datasets were analyzed including 61 episodes of hypertension [SAP = 159 (151-170) mmHg (median 1st-3rd quartiles)], 84 of normotension, SAP = 124 (113-131) mmHg and 45 of hypotension SAP = 85(80-87) mmHg. SAP were well correlated with SVR (r = 0.78, p < 0.0001) and Cvasc (r = 0.84, p < 0.0001). The PPG-based classification correlated well with SAP (r = - 0.90, p < 0.0001), SVR (r = - 0.72, p < 0.0001) and Cvasc (r = 0.82, p < 0.0001). The PPGc misclassified 7 out of the 190 episodes, presenting good accuracy (98.4% and 97.8%), sensitivity (100% and 94.9%) and specificity (97.9% and 99.2%) for detecting episodes of hypotension and hypertension, respectively. Changes in arterial pressure and vascular tone were closely related to the proposed classification based on PPG waveform.Clinical Trial Registration NTC02854852.
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Affiliation(s)
- Gerardo Tusman
- Department of Anesthesiology, Hospital Privado de Comunidad, 7600, Mar del Plata, Buenos Aires, Argentina.
| | - Cecilia M Acosta
- Department of Anesthesiology, Hospital Privado de Comunidad, 7600, Mar del Plata, Buenos Aires, Argentina
| | - Sven Pulletz
- Department of Anesthesiology and Intensive Care Medicine, Klinikum Osnabrueck, Osnabrueck, Germany
| | - Stephan H Böhm
- Department of Anesthesiology and Intensive Care Medicine, Rostock University Medical Center, Rostock, Germany
| | - Adriana Scandurra
- Bioengineering Laboratory, Electronic Department, School of Engineering, Mar del Plata University, Mar del Plata, Argentina
| | - Jorge Martinez Arca
- Bioengineering Laboratory, Electronic Department, School of Engineering, Mar del Plata University, Mar del Plata, Argentina
| | - Matías Madorno
- Instituto Tecnológico Buenos Aires (ITBA), Buenos Aires, Argentina
| | - Fernando Suarez Sipmann
- Hedenstierna Laboratory, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.,CIBERES, Madrid, Spain.,Department of Critical Care, Hospital Universitario de La Princesa, Madrid, Spain
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217
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Li C, Xu J, Han F, Walline J, Zheng L, Fu Y, Zhu H, Chai Y, Yu X. Identification of return of spontaneous circulation during cardiopulmonary resuscitation via pulse oximetry in a porcine animal cardiac arrest model. J Clin Monit Comput 2018; 33:843-851. [PMID: 30498975 DOI: 10.1007/s10877-018-0230-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 11/26/2018] [Indexed: 10/27/2022]
Abstract
In this prospective study we investigated whether the pulse oximetry plethysmographic waveform (POP) could be used to identify return of spontaneous circulation (ROSC) during cardio-pulmonary resuscitation (CPR). Tweleve pigs (28 ± 2 kg) were randomly assigned to two groups: Group I (non-arrested with compressions) (n = 6); Group II (arrested with CPR and defibrillation) (n = 6). Hemodynamic parameters and POP were collected and analyzed. POP was analyzed using both a time domain method and a frequency domain method. In Group I, when compressions were carried out on subjects with a spontaneous circulation, a hybrid fluctuation or "envelope" phenomenon appeared in the time domain method and a "double" or "fusion" peak appeared in the frequency domain method. In Group II, after the period of ventricular fibrillation was induced, the POP waveform disappeared. With compressions, POP showed a regular compression wave. After defibrillation, ROSC, and continued compressions, a hybrid fluctuation or "envelope" phenomenon appeared in the time domain method and a "double" or "fusion" peak appeared in the frequency domain method, similar to Group I. Analysis of POP using the time and frequency domain methods could be used to identify ROSC during CPR.
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Affiliation(s)
- Chen Li
- Emergency Department, Tianjin Medical University General Hospital, Tianjin, China
| | - Jun Xu
- Emergency Department, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, China.
| | - Fei Han
- Institute of Life Monitoring, Mindray Corporation, Shenzhen, China
| | - Joseph Walline
- Division of Emergency Medicine, Department of Surgery, Saint Louis University Hospital, Saint Louis, MO, USA
| | - Liangliang Zheng
- Emergency Department, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, China
| | - Yangyang Fu
- Emergency Department, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, China
| | - Huadong Zhu
- Emergency Department, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, China
| | - Yanfen Chai
- Emergency Department, Tianjin Medical University General Hospital, Tianjin, China
| | - Xuezhong Yu
- Emergency Department, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, China
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218
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Jin X, Bighamian R, Hahn JO. Development and In Silico Evaluation of a Model-Based Closed-Loop Fluid Resuscitation Control Algorithm. IEEE Trans Biomed Eng 2018; 66:1905-1914. [PMID: 30452347 DOI: 10.1109/tbme.2018.2880927] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
OBJECTIVE To develop and evaluate in silico a model-based closed-loop fluid resuscitation control algorithm via blood volume feedback. METHODS Model-based adaptive control algorithm for fluid resuscitation was developed by leveraging a low-order lumped-parameter blood volume dynamics model, and then in silico evaluated based on a detailed mechanistic model of circulatory physiology. The algorithm operates in two steps: (1) the blood volume dynamics model is individualized based on the patient's fractional blood volume response to an initial fluid bolus via system identification; and (2) an adaptive control law built on the individualized blood volume dynamics model regulates the blood volume of the patient. RESULTS The algorithm was able to track the blood volume set point as well as accurately estimate and monitor the patient's absolute blood volume level. The algorithm significantly outperformed a population-based proportional-integral-derivative control. CONCLUSION Model-based development of closed-loop fluid resuscitation control algorithm may enable regulation of blood volume and monitoring of absolute blood volume level. SIGNIFICANCE Model-based closed-loop fluid resuscitation algorithm may offer opportunities for standardized and patient-tailored therapy and reduction of clinician workload.
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219
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García Martínez JJ, Bendjelid K. Artificial liver support systems: what is new over the last decade? Ann Intensive Care 2018; 8:109. [PMID: 30443736 PMCID: PMC6238018 DOI: 10.1186/s13613-018-0453-z] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 11/07/2018] [Indexed: 12/16/2022] Open
Abstract
The liver is a complex organ that performs vital functions of synthesis, heat production, detoxification and regulation; its failure carries a highly critical risk. At the end of the last century, some artificial liver devices began to develop with the aim of being used as supportive therapy until liver transplantation (bridge-to-transplant) or liver regeneration (bridge-to-recovery). The well-recognized devices are the Molecular Adsorbent Recirculating System™ (MARS™), the Single-Pass Albumin Dialysis system and the Fractionated Plasma Separation and Adsorption system (Prometheus™). In the following years, experimental works and early clinical applications were reported, and to date, many thousands of patients have already been treated with these devices. The ability of artificial liver support systems to replace the liver detoxification function, at least partially, has been proven, and the correction of various biochemical parameters has been demonstrated. However, the complex tasks of regulation and synthesis must be addressed through the use of bioartificial systems, which still face several developmental problems and very high production costs. Moreover, clinical data on improved survival are conflicting. This paper reviews the progress achieved and new data published on artificial liver support systems over the past decade and the prospects for these devices.
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Affiliation(s)
- Juan José García Martínez
- Intensive Care Unit, Geneva University Hospitals, 4 Rue Gabrielle-Perret-Gentil, 1205, Geneva, Switzerland. .,Faculty of Medicine, University of Geneva, Geneva, Switzerland.
| | - Karim Bendjelid
- Intensive Care Unit, Geneva University Hospitals, 4 Rue Gabrielle-Perret-Gentil, 1205, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Geneva Hemodynamic Research Group, Geneva, Switzerland
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220
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Vistisen ST, Berg JM, Boekel MF, Modestini M, Bergman R, Jainandunsing JS, Mariani MA, Scheeren TWL. Using extra systoles and the micro-fluid challenge to predict fluid responsiveness during cardiac surgery. J Clin Monit Comput 2018; 33:777-786. [PMID: 30414054 DOI: 10.1007/s10877-018-0218-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 11/01/2018] [Indexed: 11/28/2022]
Abstract
Fluid responsiveness prediction is difficult during cardiac surgery. The micro-fluid challenge (micro-FC; rapid central infusion of 50 ml) and the extrasystolic method utilising post-extrasystolic preload increases may predict fluid responsiveness. Two study windows during coronary artery bypass graft surgery were defined, 1: After anaesthesia induction until surgical incision, 2: Left internal mammarian artery surgical preparation period. Each window consisted of 10-15 min observation for extrasystoles before a micro-FC was performed, after which a traditional fluid challenge (FC) was performed (5 ml/kg). Extrasystolic and micro-FC induced changes in hemodynamic variables were derived as predictors of fluid responsiveness defined as stroke volume increasing > 10% following FC. 61 patients were studied. Post-ectopic changes in pulse pressure (PP) predicted fluid responsiveness with receiver operating characteristic area (AUC) of 0.69 [CI 0.40;0.97] in the first study window and 0.64 [0.44;0.86] in the second window. Other post-ectopic predictors such as pre-ejection period (PEP) and systolic blood pressure (SBP) had similar or lower AUCs. Heart rate was 52.9 (SD ±8.4) min- 1 and 53.6 (± 8.8) min- 1 in the two study windows. Micro-FC induced changes in PEP had AUC of 0.74 [0.57;0.90] in the first window and 0.60 [0.40;0.76] in the second window. Correcting micro-FC induced changes in PEP for the micro-FC induced changes in heart rate had AUCs of 0.84 [0.70;0.97] in the first window and 0.63 [0.47;0.79] in the second window. The investigated methods revealed insufficient validity during cardiac surgery. RR interval corrected changes during a micro-FC should be investigated further. Trial registration Clinicaltrials.gov: NCT03002129.
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Affiliation(s)
- Simon T Vistisen
- Research Centre for Emergency Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark. .,Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark. .,Department of Anaesthesiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O.Box 30.001, 9700 RB, Groningen, The Netherlands.
| | - Jonas M Berg
- Research Centre for Emergency Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.,Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Mattheus F Boekel
- Department of Anaesthesiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O.Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Marco Modestini
- Department of Anaesthesiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O.Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Remco Bergman
- Department of Anaesthesiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O.Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Jayant S Jainandunsing
- Department of Anaesthesiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O.Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Massimo A Mariani
- Department of Cardio-Thoracic Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O.Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Thomas W L Scheeren
- Department of Anaesthesiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O.Box 30.001, 9700 RB, Groningen, The Netherlands
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221
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Saragih RA, Pudjiadi AH, Tambunan T, Satari HI, Aulia D, Bardosono S, Munasir Z, Lubis M. Correlation between urinary albumin to creatinine ratio and systemic glycocalyx degradation in pediatric sepsis. MEDICAL JOURNAL OF INDONESIA 2018. [DOI: 10.13181/mji.v27i3.2156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Background: Increased capillary permeability in sepsis is associated with several complications and worse outcomes. Glycocalyx degradation, marked by increased serum syndecan-1 levels, alters vascular permeability, which can manifest as albuminuria in the glomerulus. Therefore, elevated urinary albumin to creatinine ratio (ACR) potentially provides an index of systemic glycocalyx degradation. The aim of this study was to analyze the correlation between urinary ACR and serum syndecan-1 levels.Methods: A longitudinal prospective study with repeated cross-sectional design was conducted on children with sepsis in pediatric intensive care unit, we evaluated serum syndecan-1 levels and urinary ACR on days 1, 2, 3, and 7. A descriptive study on healthy children was also conducted to determine the reference value of syndecan-1 in children.Results: 49 subjects with sepsis were recruited. Based on the data of the healthy children group (n=30), syndecan-1 level of >90th percentile (41.42 ng/mL) was defined as systemic glycocalyx degradation. The correlation coefficients (r) between urinary ACR and syndecan-1 levels were 0.32 (p<0.001) from all examination days (162 specimens), 0.298 (p=0.038) on day 1, and 0.469 (p=0.002) on day 3. The area under the curve of urinary ACR and systemic glycocalyx degradation was 65.7% (95% CI 54.5%–77%; p=0.012). Urinary ACR ≥157.5 mg/g was determined as the cut-off point for glycocalyx degradation, with a sensitivity of 77.4% and a specificity of 48%.Conclusion: Urinary ACR showed a weak correlation with systemic glycocalyx degradation, indicating that the pathophysiology of elevated urinary ACR in sepsis is not merely related to glycocalyx degradation.
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222
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Tomita K, Nakada TA, Oshima T, Oami T, Aizimu T, Oda S. Non-invasive monitoring using photoplethysmography technology. J Clin Monit Comput 2018; 33:637-645. [PMID: 30284687 DOI: 10.1007/s10877-018-0205-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 09/26/2018] [Indexed: 12/17/2022]
Abstract
We evaluated the accuracy and precision of a novel non-invasive monitoring device in comparison with conventional monitoring methods used in intensive care units (ICU). The study device was developed to measure blood pressure, pulse rate, respiratory rate, and oxygen saturation, continuously with a single sensor using the photoplethysmographic technique. Patients who were monitored with arterial pressure lines in the ICU were enrolled. Systolic and diastolic blood pressure, pulse rate, respiratory rate, and arterial oxygen saturation were measured continuously for 30 min at 5-min intervals using the conventional methods and the study device. The primary outcome variable was blood pressure. Blood pressure measured by the study device highly correlated with the arterial pressure line values (correlation coefficients > 0.95). Percent errors for systolic, diastolic and mean blood pressures were 2.4% and 6.7% and 6.5%, respectively. Percent errors for pulse rate, respiratory rate and oxygen saturation were 3.4%, 5.6% and 1.4%, respectively. The non-invasive, continuous, multi-parameter monitoring device presented high level of agreement with the invasive arterial blood pressure monitoring, along with sufficient accuracy and precision in the measurements of pulse rate, respiratory rate, and oxygen saturation.
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Affiliation(s)
- Keisuke Tomita
- Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo, Chiba, 260-8677, Japan
| | - Taka-Aki Nakada
- Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo, Chiba, 260-8677, Japan.
| | - Taku Oshima
- Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo, Chiba, 260-8677, Japan
| | - Takehiko Oami
- Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo, Chiba, 260-8677, Japan
| | - Tuerxun Aizimu
- Center for Frontier Medical Engineering, Chiba University, 1-8-1 Inohana, Chuo, Chiba, 260-8677, Japan
| | - Shigeto Oda
- Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo, Chiba, 260-8677, Japan
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Ramasamy V, Mayosi BM, Sturrock ED, Ntsekhe M. Established and novel pathophysiological mechanisms of pericardial injury and constrictive pericarditis. World J Cardiol 2018; 10:87-96. [PMID: 30344956 PMCID: PMC6189073 DOI: 10.4330/wjc.v10.i9.87] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 04/06/2018] [Accepted: 04/22/2018] [Indexed: 02/06/2023] Open
Abstract
This review article aims to: (1) discern from the literature the immune and inflammatory processes occurring in the pericardium following injury; and (2) to delve into the molecular mechanisms which may play a role in the progression to constrictive pericarditis. Pericarditis arises as a result of a wide spectrum of pathologies of both infectious and non-infectious aetiology, which lead to various degrees of fibrogenesis. Current understanding of the sequence of molecular events leading to pathological manifestations of constrictive pericarditis is poor. The identification of key mechanisms and pathways common to most fibrotic events in the pericardium can aid in the design and development of novel interventions for the prevention and management of constriction. We have identified through this review various cellular events and signalling cascades which are likely to contribute to the pathological fibrotic phenotype. An initial classical pattern of inflammation arises as a result of insult to the pericardium and can exacerbate into an exaggerated or prolonged inflammatory state. Whilst the implication of major drivers of inflammation and fibrosis such as tumour necrosis factor and transforming growth factor β were foreseeable, the identification of pericardial deregulation of other mediators (basic fibroblast growth factor, galectin-3 and the tetrapeptide Ac-SDKP) provides important avenues for further research.
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Affiliation(s)
- Vinasha Ramasamy
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory 7925, South Africa
- Department of Integrative Biomedical Sciences, University of Cape Town, Observatory 7925, South Africa
| | - Bongani M Mayosi
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory 7925, South Africa
- Division of Cardiology, University of Cape Town, Observatory 7925, South Africa
| | - Edward D Sturrock
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory 7925, South Africa
- Department of Integrative Biomedical Sciences, University of Cape Town, Observatory 7925, South Africa
| | - Mpiko Ntsekhe
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory 7925, South Africa
- Division of Cardiology, University of Cape Town, Observatory 7925, South Africa
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Balmer J, Pretty C, Davidson S, Desaive T, Kamoi S, Pironet A, Morimont P, Janssen N, Lambermont B, Shaw GM, Chase JG. Pre-ejection period, the reason why the electrocardiogram Q-wave is an unreliable indicator of pulse wave initialization. Physiol Meas 2018; 39:095005. [DOI: 10.1088/1361-6579/aada72] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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225
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The importance of sensor contacting force for predicting fluid responsiveness in children using respiratory variations in pulse oximetry plethysmographic waveform. J Clin Monit Comput 2018; 33:393-401. [DOI: 10.1007/s10877-018-0183-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 07/10/2018] [Indexed: 12/14/2022]
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226
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Oksanen T, Tiainen M, Vaahersalo J, Bendel S, Varpula T, Skrifvars M, Pettilä V, Wilkman E. Lower heart rate is associated with good one-year outcome in post-resuscitation patients. Resuscitation 2018; 128:112-118. [DOI: 10.1016/j.resuscitation.2018.05.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 04/30/2018] [Accepted: 05/03/2018] [Indexed: 01/12/2023]
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227
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Jozwiak M, Rex S, Bendjelid K. Boosting systemic pressure with phenylephrine: arterial or venous modulation? J Clin Monit Comput 2018; 32:967-968. [DOI: 10.1007/s10877-018-0177-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 06/21/2018] [Indexed: 10/28/2022]
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228
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Sano H, Seo J, Wightman P, Cave NJ, Gieseg MA, Johnson CB, Chambers P. Evaluation of pulse pressure variation and pleth variability index to predict fluid responsiveness in mechanically ventilated isoflurane-anesthetized dogs. J Vet Emerg Crit Care (San Antonio) 2018; 28:301-309. [PMID: 29898246 DOI: 10.1111/vec.12728] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 07/29/2016] [Accepted: 08/19/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate whether pulse pressure variation (PPV) and pleth variability index (PVI) are more accurate than central venous pressure (CVP) for predicting fluid responsiveness in mechanically ventilated isoflurane-anesthetized dogs after premedication with acepromazine. DESIGN Prospective experimental trial. SETTING University teaching hospital. ANIMALS Twelve Harrier hound dogs. INTERVENTIONS Each dog was anesthetized and had a fluid challenge performed. This was repeated 4 weeks later for a total of 24 fluid challenges. After premedication with intramuscular acepromazine, anesthesia was induced with propofol and maintained with isoflurane. The dogs were mechanically ventilated with constant settings. The fluid challenge consisted of 10 mL/kg of 6% hydroxyethyl starch intravenously over 13 minutes. MEASUREMENTS AND MAIN RESULTS Before and after the fluid challenge, PPV, PVI, CVP, and other hemodynamics were recorded. Change in velocity time integral of pulmonary arterial blood flow by echocardiography was calculated as an indication of change in stroke volume. A fluid responder was defined as an increase in velocity time integral ≥ 15%. Receiver operator characteristic (ROC) curves were used to determine cutoff values. Areas under ROC curve were calculated and compared. Dogs responded on 14 fluid challenges and did not on 10. Cutoff values for PPV and PVI were 11% (sensitivity 79%; specificity 80%) and 9.3% (sensitivity 86%; specificity 70%), respectively. The areas under the ROC curve of PPV [0.85, 95% confidence interval (CI): 0.70-1.00, P = 0.038] and PVI (0.84, 95% CI: 0.68-1.00, P = 0.043) were significantly higher than CVP (0.56, 95% CI: 0.32-0.81). CONCLUSIONS PPV and PVI predicted fluid responsiveness more accurately than CVP and may be useful to guide fluid administration in mechanically ventilated isoflurane-anesthetized dogs after premedication with acepromazine.
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Affiliation(s)
- Hiroki Sano
- Institute of Veterinary, Animal and Biomedical Sciences, College of Sciences, Massey University, Palmerston North 4442
| | - Joonbum Seo
- Institute of Veterinary, Animal and Biomedical Sciences, College of Sciences, Massey University, Palmerston North 4442
| | - Paul Wightman
- Institute of Veterinary, Animal and Biomedical Sciences, College of Sciences, Massey University, Palmerston North 4442
| | - Nick J Cave
- Institute of Veterinary, Animal and Biomedical Sciences, College of Sciences, Massey University, Palmerston North 4442
| | - Mike A Gieseg
- Veterinary Health Research NZ, Hamilton 3240, New Zealand
| | - Craig B Johnson
- Institute of Veterinary, Animal and Biomedical Sciences, College of Sciences, Massey University, Palmerston North 4442
| | - Paul Chambers
- Institute of Veterinary, Animal and Biomedical Sciences, College of Sciences, Massey University, Palmerston North 4442
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Abstract
PURPOSE OF REVIEW We will briefly review the classification of shock and the hallmark features of each subtype. Available modalities for monitoring shock patients will be discussed, along with evidence supporting the use, common pitfalls, and practical considerations of each method. RECENT FINDINGS As older, invasive monitoring methods such as the pulmonary artery catheter have fallen out of favor, newer technologies for cardiac output estimation, echocardiography, and noninvasive tests such as passive leg raising have gained popularity. Newer forms of minimally invasive or noninvasive monitoring (such as pulse contour analysis and chest bioreactance) show promise but will need further investigation before they are considered validated for practical use. There remains no 'ideal' test or standard of care for cardiopulmonary monitoring of shock patients. SUMMARY Shock has potentially reversible causes of morbidity and mortality if appropriately diagnosed and managed. Older methods of invasive monitoring have significant limitations but are still critical for managing shock in certain patients and settings. Newer methods are easier to employ, but further validation is needed. Multiple modalities along with careful clinical assessment are often useful in distinguishing shock subtypes. Best practice standards for monitoring should be based on institutional expertise.
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230
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Tagami T, Ong MEH. Extravascular lung water measurements in acute respiratory distress syndrome: why, how, and when? Curr Opin Crit Care 2018; 24:209-215. [PMID: 29608455 PMCID: PMC6037282 DOI: 10.1097/mcc.0000000000000503] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW Increase in pulmonary vascular permeability accompanied with accumulation of excess extravascular lung water (EVLW) is the hallmark of acute respiratory distress syndrome (ARDS). Currently, EVLW and pulmonary vascular permeability index (PVPI) can be quantitatively measured using the transpulmonary thermodilution (TPTD) technique. We will clarify why, how, and when EVLW and PVPI measurements should be performed. RECENT FINDINGS Although the Berlin criteria of ARDS are simple and widely used, several criticisms of them have been published. The last 2 decades have witnessed the introduction and evolution of the TPTD technique for measuring EVLW and PVPI. Several publications have recommended to evaluate EVLW and the PVPI during the treatment of critically ill patients. Accurate and objective diagnoses can be made for ARDS patients using EVLW and PVPI. EVLW more than 10 ml/kg is a reasonable criterion for pulmonary edema, and EVLW more than 15 ml/kg for a severe condition. In addition to EVLW more than 10 mL/kg, PVPI more than three suggests increased vascular permeability (i.e., ARDS), and PVPI less than 2 represent normal vascular permeability (i.e., cardiogenic pulmonary edema). SUMMARY EVLW and PVPI measurement will open the door to future ARDS clinical practice and research, and have potential to be included in the future ARDS definition.
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Affiliation(s)
- Takashi Tagami
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tokyo, Japan
| | - Marcus Eng Hock Ong
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
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232
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A comparison of ventricular systolic function indices provided by VolumeView/EV1000™ and left ventricular ejection fraction by echocardiography among septic shock patients. J Clin Monit Comput 2018; 33:233-239. [PMID: 29740730 DOI: 10.1007/s10877-018-0152-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 05/04/2018] [Indexed: 01/25/2023]
Abstract
The aim of this study was to compare the cardiac function index (CFI) and global ejection fraction (GEF) obtained by VolumeView/EV1000™, with the left ventricular ejection fraction (LVEF) by echocardiography in septic shock patients. A prospective observational study was conducted in a medical intensive care unit of a tertiary, teaching university hospital. Thirty-two, mechanical-ventilated septic shock patients were included in this study. We simultaneously measured CFI and GEF with LVEF. The correlation of CFI, GEF along with LVEF and ability of CFI and GEF to predict LVEF ≥ 40, 50 and 60% were evaluated. There were 192 pairs of CFI, GEF and LVEF. CFI was significantly correlated with GEF (r = 0.82, P < 0.0001). A significant correlation was observed between CFI and LVEF (r = 0.56, P < 0.0001) and GEF and LVEF (r = 0.71, P < 0.0001). The CFI and GEF had a good predictive ability for estimating LVEF ≥ 40, 50 and 60%, with an area under receiving operating characteristic (AUC) 0.875-0.934. The CFI ≥ 3/min predicted LVEF ≥ 40% with sensitivity 95.1% and specificity 48.3%. The GEF ≥ 15%, estimated LVEF ≥ 40% with sensitivity 92.6% and specificity 69%. There were 40 thermodilution and LVEF measurements obtained before and after norepinephrine adjustment. Blood pressure as well as the cardiac index were significantly increased, whereas there were no changes in CFI, GEF and LVEF values. Conclusions: Both CFI and GEF obtained by VolumeView/EV1000™, correlated with LVEF, so as to provide a reliable estimation of LV systolic function in septic shock patients.
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233
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Vetrugno L, Bignami E, Barbariol F, Langiano N, De Lorenzo F, Matellon C, Menegoz G, Della Rocca G. Cardiac output measurement in liver transplantation patients using pulmonary and transpulmonary thermodilution: a comparative study. J Clin Monit Comput 2018; 33:223-231. [PMID: 29725794 DOI: 10.1007/s10877-018-0149-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 04/26/2018] [Indexed: 11/24/2022]
Abstract
During liver transplantation surgery, the pulmonary artery catheter-despite its invasiveness-remains the gold standard for measuring cardiac output. However, the new EV1000 transpulmonary thermodilution calibration technique was recently introduced into the market by Edwards LifeSciences. We designed a single-center prospective observational study to determine if these two techniques for measuring cardiac output are interchangeable in this group of patients. Patients were monitored with both pulmonary artery catheter and the EV1000 system. Simultaneous intermittent cardiac output measurements were collected at predefined steps: after induction of anesthesia (T1), during the anhepatic phase (T2), after liver reperfusion (T3), and at the end of the surgery (T4). The 4-quadrant and polar plot techniques were used to assess trending ability between the two methods. We enrolled 49 patients who underwent orthotopic liver transplantation surgery. We analyzed a total of 588 paired measurements. The mean bias between pulmonary artery catheter and the EV1000 system was 0.35 L/min with 95% limits of agreement of - 2.30 to 3.01 L/min, and an overall percentage error of 35%. The concordance rate between the two techniques in 4-quadrant plot analysis was 65% overall. The concordance rate of the polar plot showed an overall value of 83% for all pairs. In the present study, in liver transplantation patients we found that intermittent cardiac output monitoring with EV1000 system showed a percentage error compared with pulmonary artery catheter in the acceptable threshold of 45%. On the others hand, our results showed a questionable trending ability between the two techniques.
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Affiliation(s)
- Luigi Vetrugno
- Anesthesiology and Intensive Care Clinic, Department of Medicine, University of Udine, P.le S. Maria della Misericordia n.15, 33100, Udine, Italy.
| | - Elena Bignami
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Viale Gramsci 14, 43126, Parma, Italy
| | - Federico Barbariol
- Anesthesiology and Intensive Care 1, University-Hospital of Udine, P.le S. Maria della Misericordia n.15, 33100, Udine, Italy
| | - Nicola Langiano
- Anesthesiology and Intensive Care Clinic, Department of Medicine, University of Udine, P.le S. Maria della Misericordia n.15, 33100, Udine, Italy
| | - Francesco De Lorenzo
- Anesthesiology and Intensive Care Clinic, Department of Medicine, University of Udine, P.le S. Maria della Misericordia n.15, 33100, Udine, Italy
| | - Carola Matellon
- Anesthesiology and Intensive Care 1, University-Hospital of Udine, P.le S. Maria della Misericordia n.15, 33100, Udine, Italy
| | - Giuseppe Menegoz
- Statistical Physics, SISSA, University of Trieste, via Bonomea 265, 34136, Trieste, Italy
| | - Giorgio Della Rocca
- Anesthesiology and Intensive Care Clinic, Department of Medicine, University of Udine, P.le S. Maria della Misericordia n.15, 33100, Udine, Italy
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234
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Schiffner R, Lehmann T, Bischoff SJ, Zippelius T, Nistor M, Schmidt M. Pulmonary hemodynamic effects and pulmonary arterial compliance during hypovolemic shock and reinfusion with human relaxin-2 (serelaxin) treatment in a sheep model. Clin Hemorheol Microcirc 2018; 70:311-325. [PMID: 29710689 DOI: 10.3233/ch-180382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Previous studies on the recombinant form of human relaxin-2 (serelaxin) have shown a decrease of pulmonary hemodynamics after serelaxin injection. Currently, the effect of serelaxin treatment during hypovolemia in a large animal model remains mostly unknown. METHODS 12 sheep were randomly assigned to a sham or serelaxin (30μg/kg serelaxin) group and underwent right heart catheterization. 50% of the estimated total blood volume were removed to induce hypovolemia, and subsequently retransfused 20 min later (reinfusion). Blood gases, heart rate, peripheral and pulmonary arterial oxygen saturation, systolic, diastolic and mean values of both pulmonary artery pressure (PAP) and pulmonary capillary wedge pressure (PCW) were measured. Cardiac output (CO), pulmonary vascular resistance (PVR), pulmonary arterial compliance (PAcompl) and systemic vascular resistance (SVR) were calculated. RESULTS Hypovolemia and shock led to a similar decrease of PAP and PCW in both groups (p≤0.001). CO, SV and PAcompl decreased only in the control group (p≤0.05) and remained higher in the serelaxin-treated group. The results of this study suggest that serelaxin treatment did not negatively influence hemodynamic parameters during hypovolemic shock. CONCLUSION The main conclusion of this study is that cardiopulmonary adaption mechanisms are not critically altered by serelaxin administration during severe hypovolemia and retransfusion.
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Affiliation(s)
- René Schiffner
- Department of Orthopaedics, Jena University Hospital, Friedrich Schiller University, Jena, Germany.,Department of Neurology, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - Thomas Lehmann
- Institute of Medical Statistics, Computer Sciences and Documentation Science, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - Sabine J Bischoff
- Central Animal Facility, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - Timo Zippelius
- Department of Orthopaedics, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - Marius Nistor
- Department of Neurology, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - Martin Schmidt
- Institute for Biochemistry II, Jena University Hospital, Friedrich Schiller University, Jena, Germany
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235
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236
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Huang SC, Liu KC, Wong AMK, Chang SC, Wang JS. Cardiovascular Autonomic Response to Orthostatic Stress Under Hypoxia in Patients with Spinal Cord Injury. High Alt Med Biol 2018; 19:201-207. [PMID: 29683363 DOI: 10.1089/ham.2017.0154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Huang, Shu-Chun, Kuo-Cheng Liu, Alice M.K. Wong, Shih-Chieh Chang, and Jong-Shyan Wang. Cardiovascular autonomic response to orthostatic stress under hypoxia in patients with spinal cord injury. High Alt Med Biol. 19:201-207, 2018. AIMS Determining whether systemic hypoxia aggravates the severity of autonomic cardiovascular dysfunction in orthostatic stress among patients with spinal cord injuries (SCIs). METHODS Twenty-four male patients with chronic SCI whose neurological levels were above T6 were recruited. Twenty-five healthy men were enrolled in the control group. Five-minute supine rest (SR) and head-up tilt (HUT) at 60° were performed in normoxia and after 1 hour, 13.5% fraction of inspired O2 exposure. A noninvasive cardiac output (CO) monitor was used to measure stroke volume (SV), CO, total peripheral resistance (TPR), and blood pressure (BP), whereas heart rate variability (HRV) was performed to determine cardiac autonomic activity. Digital volume pulse analysis was applied to measure arteriolar tone. RESULTS In normoxia from SR to HUT, systolic and diastolic BPs declined, SV decreased, and heart rate increased, whereas CO and TPR showed a declining trend in the SCI group. Sympathetic activation and vagal withdrawal were also disclosed in the HRV analysis. In hypoxia, the change of these cardiovascular responses from SR to HUT exhibited no difference to normoxia in the SCI group. No significant difference in arterial desaturation was observed between the two groups (82.9% vs. 80.4%). CONCLUSIONS Cardiovascular adaptation to orthostatic stress is not affected by subacute steady-state hypoxia in chronic SCI patients with neurological levels higher than T6.
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Affiliation(s)
- Shu-Chun Huang
- 1 Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital , Taoyuan, Taiwan
| | - Kuo-Cheng Liu
- 1 Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital , Taoyuan, Taiwan
| | - Alice M K Wong
- 1 Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital , Taoyuan, Taiwan
| | - Shih-Chieh Chang
- 1 Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital , Taoyuan, Taiwan
| | - Jong-Shyan Wang
- 2 Healthy Aging Research Center, Graduate Institute of Rehabilitation Science, Medical College, Chang Gung University , Taoyuan, Taiwan
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237
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Sun S, Peeters WH, Bezemer R, Long X, Paulussen I, Aarts RM, Noordergraaf GJ. Finger and forehead photoplethysmography-derived pulse-pressure variation and the benefits of baseline correction. J Clin Monit Comput 2018; 33:65-75. [PMID: 29644558 PMCID: PMC6314999 DOI: 10.1007/s10877-018-0140-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 04/05/2018] [Indexed: 11/25/2022]
Abstract
To non-invasively predict fluid responsiveness, respiration-induced pulse amplitude variation (PAV) in the photoplethysmographic (PPG) signal has been proposed as an alternative to pulse pressure variation (PPV) in the arterial blood pressure (ABP) signal. However, it is still unclear how the performance of the PPG-derived PAV is site-dependent during surgery. The aim of this study is to compare finger- and forehead-PPG derived PAV in their ability to approach the value and trend of ABP-derived PPV. Furthermore, this study investigates four potential confounding factors, (1) baseline variation, (2) PPV, (3) ratio of respiration and heart rate, and (4) perfusion index, which might affect the agreement between PPV and PAV. In this work, ABP, finger PPG, and forehead PPG were continuously recorded in 29 patients undergoing major surgery in the operating room. A total of 91.2 h data were used for analysis, from which PAV and PPV were calculated and compared. We analyzed the impact of the four factors using a multiple linear regression (MLR) analysis. The results show that compared with the ABP-derived PPV, finger-derived PAV had an agreement of 3.2 ± 5.1%, whereas forehead-PAV had an agreement of 12.0 ± 9.1%. From the MLR analysis, we found that baseline variation was a factor significantly affecting the agreement between PPV and PAV. After correcting for respiration-induced baseline variation, the agreements for finger- and forehead-derived PAV were improved to reach an agreement of − 1.2 ± 3.8% and 3.3 ± 4.8%, respectively. To conclude, finger-derived PAV showed better agreement with ABP-derived PPV compared to forehead-derived PAV. Baseline variation was a factor that significantly affected the agreement between PPV and PAV. By correcting for the baseline variation, improved agreements were obtained for both the finger and forehead, and the difference between these two agreements was diminished. The tracking abilities for both finger- and forehead-derived PAV still warrant improvement for wide use in clinical practice. Overall, our results show that baseline-corrected finger- and forehead-derived PAV may provide a non-invasive alternative for PPV.
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Affiliation(s)
- Shaoxiong Sun
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.
- Philips Research, Eindhoven, The Netherlands.
| | | | | | - Xi Long
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Philips Research, Eindhoven, The Netherlands
| | - Igor Paulussen
- Philips Research, Eindhoven, The Netherlands
- Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - Ronald M Aarts
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Philips Research, Eindhoven, The Netherlands
| | - Gerrit J Noordergraaf
- Philips Research, Eindhoven, The Netherlands
- Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
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238
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Bar S, Leviel F, Abou Arab O, Badoux L, Mahjoub Y, Dupont H, Lorne E, Guinot PG. Dynamic arterial elastance measured by uncalibrated pulse contour analysis predicts arterial-pressure response to a decrease in norepinephrine. Br J Anaesth 2018; 121:534-540. [PMID: 30115250 DOI: 10.1016/j.bja.2018.01.032] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 01/23/2018] [Accepted: 02/04/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Dynamic arterial elastance (Eadyn) has been proposed as an indicator of vascular tone that predicts the decrease in arterial pressure in response to changes in norepinephrine (NE). The purpose of this study was to determine whether Eadyn measured by uncalibrated pulse contour analysis (UPCA) can predict a decrease in arterial pressure when the NE dosage is decreased. METHODS We conducted a prospective study in a university hospital intensive care unit. Patients with vasoplegic syndrome for whom the intensive care physician planned to decrease the NE dosage were included. Haemodynamic and UPCA (VolumeView and FloTrac; Edwards Lifesciences, Irvine, CA, USA) values were obtained before and after decreasing the NE dosage. Responders were defined by a >10% decrease in mean arterial pressure (MAP). RESULTS Of 35 patients included, 11 (31%) were pressure responders with a median decrease of 13%. Eadyn was correlated to systolic arterial pressure (SAP) (r=0.255; P=0.033), diastolic arterial pressure (r=0.271; P=0.024), MAP (r=0.310; P=0.009), heart rate (r=0.543; P=0.0001), and transthoracic echography cardiac output (r=0.264; P=0.024). Baseline Eadyn was correlated with MAP changes (r=0.394; P=0.019) and SAP changes (r=0.431; P=0.009). Eadyn predicted the decrease in arterial pressure with an area under the receiver-operating-characteristic curve of 0.84 (95% confidence interval: 0.70-0.97). The best cut-off was 0.90. CONCLUSIONS The present study confirms the ability of Eadyn measured by UPCA to predict an arterial pressure response to a decrease in NE. Eadyn may constitute an easy-to-use functional approach to arterial tone assessment regardless of the monitor used to measure its determinant. CLINICAL TRIAL REGISTRATION DRCIT95.
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Affiliation(s)
- S Bar
- Department of Anaesthesiology and Critical Care Medicine, Amiens University Hospital, F-80054 Amiens, France.
| | - F Leviel
- Department of Anaesthesiology and Critical Care Medicine, Amiens University Hospital, F-80054 Amiens, France
| | - O Abou Arab
- Department of Anaesthesiology and Critical Care Medicine, Amiens University Hospital, F-80054 Amiens, France
| | - L Badoux
- Department of Anaesthesiology and Critical Care Medicine, Amiens University Hospital, F-80054 Amiens, France
| | - Y Mahjoub
- Department of Anaesthesiology and Critical Care Medicine, Amiens University Hospital, F-80054 Amiens, France; Institut National de la Santé et de la Recherche Médicale U1088, Jules Verne University of Picardy, F-80054 Amiens, France
| | - H Dupont
- Department of Anaesthesiology and Critical Care Medicine, Amiens University Hospital, F-80054 Amiens, France; Institut National de la Santé et de la Recherche Médicale U1088, Jules Verne University of Picardy, F-80054 Amiens, France
| | - E Lorne
- Department of Anaesthesiology and Critical Care Medicine, Amiens University Hospital, F-80054 Amiens, France; Institut National de la Santé et de la Recherche Médicale U1088, Jules Verne University of Picardy, F-80054 Amiens, France
| | - P-G Guinot
- Department of Anaesthesiology and Critical Care Medicine, Dijon University Hospital, 2 Bd Maréchal de Lattre of Tassigny, Dijon, France
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Saugel B, Bendjelid K, Critchley LAH, Scheeren TWL. Journal of Clinical Monitoring and Computing 2017 end of year summary: cardiovascular and hemodynamic monitoring. J Clin Monit Comput 2018; 32:189-196. [PMID: 29484529 DOI: 10.1007/s10877-018-0119-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 02/22/2018] [Indexed: 12/23/2022]
Abstract
Hemodynamic monitoring provides the basis for the optimization of cardiovascular dynamics in intensive care medicine and anesthesiology. The Journal of Clinical Monitoring and Computing (JCMC) is an ideal platform to publish research related to hemodynamic monitoring technologies, cardiovascular (patho)physiology, and hemodynamic treatment strategies. In this review, we discuss selected papers published on cardiovascular and hemodynamic monitoring in the JCMC in 2017.
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Affiliation(s)
- Bernd Saugel
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Karim Bendjelid
- Department of Anesthesiology and Intensive Care, Geneva University Hospitals, Geneva, Switzerland
| | - Lester A H Critchley
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Shatin, Hong Kong.,The Belford Hospital, Fort William, The Highlands, Scotland, UK
| | - Thomas W L Scheeren
- Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Peripheral Venous Waveform Analysis for Detecting Hemorrhage and Iatrogenic Volume Overload in a Porcine Model. Shock 2018; 46:447-52. [PMID: 27070329 DOI: 10.1097/shk.0000000000000615] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Unrecognized hemorrhage and unguided resuscitation is associated with increased perioperative morbidity and mortality. The authors investigated peripheral venous waveform analysis (PIVA) as a method for quantitating hemorrhage as well as iatrogenic fluid overload during resuscitation. METHODS The authors conducted a prospective study on Yorkshire Pigs (n = 8) undergoing hemorrhage, autologous blood return, and administration of balanced crystalloid solution beyond euvolemia. Intra-arterial blood pressure, electrocardiogram, and pulse oximetry were applied to each subject. Peripheral venous pressure was measured continuously through an upper extremity standard peripheral IV catheter and analyzed with LabChart. The primary outcome was comparison of change in the first fundamental frequency (f1) of PIVA with standard and invasive monitoring and shock index (SI). RESULTS Hemorrhage, return to euvolemia, and iatrogenic fluid overload resulted in significantly non-zero slopes of f1 amplitude. There were no significant differences in heart rate or mean arterial pressure, and a late change in SI. For the detection of hypovolemia the PIVA f1 amplitude change generated an receiver operator curves (ROC) curve with an area under the curve (AUC) of 0.93; heart rate AUC = 0.61; mean arterial pressure AUC = 0.48, and SI AUC = 0.72. For hypervolemia the f1 amplitude generated an ROC curve with an AUC of 0.85, heart rate AUC = 0.62, mean arterial pressure AUC = 0.63, and SI AUC = 0.65. CONCLUSIONS In this study, PIVA demonstrated a greater sensitivity for detecting acute hemorrhage, return to euvolemia, and iatrogenic fluid overload compared with standard monitoring and SI. PIVA may provide a low-cost, minimally invasive monitoring solution for monitoring and resuscitating patients with perioperative hemorrhage.
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Prediction of Fluid Responsiveness by a Non-invasive Respiratory Systolic Time Interval Variation Using Heart Sound Signals in Recipients Undergoing Liver Transplantation. Transplant Proc 2018; 49:1082-1086. [PMID: 28583532 DOI: 10.1016/j.transproceed.2017.03.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The fluid management of cirrhotic patients undergoing liver transplantation (LT) is challenging. Phonocardiography, a graphic recording of heart sounds, provides valuable information concerning heart function and hemodynamic condition. We assessed whether the systolic time interval (STI) and its respiratory variation could predict fluid responsiveness in cirrhotic patients undergoing LT. METHODS Thirty LT recipients who needed volume expansion were included. The fluid challenge consisted of 500 mL 5% albumin administered over a period of 10 minutes. STI was measured as the time interval between the maximal amplitude of each heart sound corrected with the corresponding RR interval (cSTI). The respiratory variation in STI (STV) induced by mechanical ventilation was calculated. Responders were defined as those showing a ≥10% increase in stroke volume index after volume expansion. RESULTS In all, 14 of the 30 patients were responders. Significant increases in cSTI were observed after volume expansion in both responders (P < .001) and non-responders (P = .008). Responders showed significant decreases in STV (11.1% ± 4.3% vs 6.1% ± 2.6%, P < .001) after fluid loading, whereas STV in non-responders remained unchanged (6.4% ± 2.6% vs 6.4% ± 4.2%, P = .86). A cut-off value of ≥7.5% STV from baseline could predict fluid responsiveness with an area under the receiver operating characteristic curve of 0.804 (95% confidence interval, 0.618-0.925). CONCLUSIONS Intra-operative STV can predict fluid responsiveness in patients undergoing LT. Beat-to-beat monitoring of STI and STV may be useful as a non-invasive hemodynamic index and for fluid management.
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Pugin D, Schmitz M, Bendjelid K. Difficult Removal of a Kinked Swan-Ganz Catheter. J Cardiothorac Vasc Anesth 2018; 32:e41-e42. [PMID: 29331551 DOI: 10.1053/j.jvca.2017.07.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Deborah Pugin
- Intensive Care Unit, Geneva University Hospitals, Geneva, Switzerland
| | - Marylin Schmitz
- Intensive Care Unit, Geneva University Hospitals, Geneva, Switzerland
| | - Karim Bendjelid
- Intensive Care Unit, Geneva University Hospitals, Geneva, Switzerland
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Viale JP, Bendjelid K. The challenge of exploring organ function: knowledge is not care, but care needs knowledge! J Clin Monit Comput 2017; 32:785-786. [PMID: 29247395 DOI: 10.1007/s10877-017-0091-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 12/10/2017] [Indexed: 10/18/2022]
Affiliation(s)
| | - Karim Bendjelid
- Intensive Care Service, Geneva University Hospitals, 1205, Geneva, Switzerland
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Zanobetti M, Prota A, Coppa A, Giordano L, Bigiarini S, Nazerian P, Innocenti F, Conti A, Trausi F, Vanni S, Pepe G, Pini R. Can non-invasive ventilation modify central venous pressure? Comparison between invasive measurement and ultrasonographic evaluation. Intern Emerg Med 2017; 12:1279-1285. [PMID: 27878445 DOI: 10.1007/s11739-016-1574-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 11/12/2016] [Indexed: 12/26/2022]
Abstract
Central venous pressure (CVP) is primarily measured to assess intravascular volume status and heart preload. In clinical practice, the measuring device most commonly used in emergency departments and intensive care units, is an electronic transducer that interconnects a central venous catheter (CVC) with a monitoring system. Non-invasive ventilation (NIV) consists in a breathing support that supplies a positive pressure in airways through a mask or a cask though not using an endotracheal prosthesis. In emergency settings, non-invasive ultrasonography evaluation of CVP, and hence of intravascular volume status entail the measurement by a subxiphoid approach of inferior vena cava diameter and its variations in relation to respiratory activity. In the literature, there are many studies analyzing the ability to estimate CVP through ultrasonography, rating inspiratory and expiratory vena cava diameters and their ratio, defined as inferior vena cava collapsibility index (IVC-CI). At the same time, the effects of invasive mechanical ventilation on blood volume and the correlation during ventilation between hemodynamic invasive measurement of CVP and inferior vena cava diameters have already been demonstrated. Nevertheless, there are no available data regarding the hemodynamic effects of NIV and the potential correlations during this kind of ventilation between invasive and non-invasive CVP measurements. Therefore, this study aims to understand whether there exists or not an interrelationship between the values of CVP assessed invasively through a CVC and non-invasively through the IVC-CI in patients with severe respiratory distress, and above all to evaluate if these means of assessment can be influenced using NIV.
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Affiliation(s)
- Maurizio Zanobetti
- Emergency Department, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy.
| | - Alessio Prota
- Emergency Department, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy
| | - Alessandro Coppa
- Emergency Department, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy
| | - Laura Giordano
- Emergency Department, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy
| | - Sofia Bigiarini
- Emergency Department, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy
| | - Peiman Nazerian
- Emergency Department, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy
| | - Francesca Innocenti
- Emergency Department, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy
| | - Alberto Conti
- Emergency Department, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy
| | - Federica Trausi
- Emergency Department, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy
| | - Simone Vanni
- Emergency Department, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy
| | - Giuseppe Pepe
- Emergency Department, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy
| | - Riccardo Pini
- Emergency Department, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy
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245
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Antal O, Mărginean M, Hagău N. Assessment of method agreement between two minimally invasive hemodynamic measurements in septic shock patients on high doses of vasopressor drugs. A preliminary study. Rom J Anaesth Intensive Care 2017; 24:89-100. [PMID: 29090260 DOI: 10.21454/rjaic.7518.242.min] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Minimally invasive hemodynamic monitoring is still controversial among the methods used to assess the hemodynamic profile of the septic shock patient. The aim of this study was to test the level of agreement between two different devices. METHODS We collected 385 data entries during 12-hour intervals from four critically ill patients with septic shock and high doses of vasoactive therapy using two minimally invasive methods at the same time: Vigileo™ device which uses the pulse contour principle, and EV1000™ monitoring platform which uses the transpulmonary thermodilution principle. The studied parameters were Stroke Volume (SV), Cardiac Output (CO) and Mean Arterial Pressure (MAP). We tested the agreement by performing the visual examination of data patterns using graphs and studying the bias, limits of agreement and creating Bland-Altman plots. For assessing the systematic, proportional and random differences, we computed a Passing-Bablock regression with the CUSUM test for linearity. RESULTS The one sample t-Test for the differences between the two methods against the null value was statistically significant for the studied parameters (p < 0.0001). The Bland-Altman analysis found no agreement between the data obtained using the two techniques, with calculated error percent as high as 88.28% for SV, 82.02% for CO and 42.06% for MAP. The Passing-Bablock regression analysis tested positive for systematic differences, but this could not be accounted for. CONCLUSION We found no agreement between data obtained from the studied devices; therefore, these cannot be used interchangeably for critically ill septic shock patients on high doses of vasoactive substances.
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Affiliation(s)
- Oana Antal
- University of Medicine and Pharmacy "Iuliu Haţieganu" Cluj-Napoca, Romania.,Emergency Clinical County Hospital Cluj-Napoca, Romania
| | - Mihai Mărginean
- University of Medicine and Pharmacy "Iuliu Haţieganu" Cluj-Napoca, Romania.,Emergency Military Hospital "Dr. Constantin Papilian" Cluj-Napoca, Romania
| | - Natalia Hagău
- University of Medicine and Pharmacy "Iuliu Haţieganu" Cluj-Napoca, Romania.,Emergency Clinical County Hospital Cluj-Napoca, Romania
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246
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Pişkin Ö, Öz İİ. Accuracy of pleth variability index compared with inferior vena cava diameter to predict fluid responsiveness in mechanically ventilated patients. Medicine (Baltimore) 2017; 96:e8889. [PMID: 29382017 PMCID: PMC5709016 DOI: 10.1097/md.0000000000008889] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
In the intensive care unit (ICU), stable hemodynamics are very important. Hemodynamic intervention is often effective against multiple organ failure, such as in tissue hypoxia and shock. The administration of intravenous fluids is the first step in regulating tissue perfusion.The main objective of this study is to compare the performance between 2 methods namely pleth variability index (PVI) and IVC distensibily index (dIVC).In this study, the hemodynamic measurements were performed before and after passive leg raising (PLR). Measurements were obtained, including, PVI, dIVC, and cardiac index (CI). Both CI and dIVC measurements were evaluated by transesophageal probe and convex probe respectively. The dIVC measurements were taken using M-mode, 2 cm from junction between the right atrium and the inferior vena cava. The PVI was measured by Masimo Radical-7 monitor, Masimo.A total of 72 patients were included. The dIVC at a threshold value of >23.8% provided 80% sensitivity and 87.5% specificity to predict fluid responsiveness and was statistically significant (P < .001), with an AUC 0.928 (0.842-0.975). The PVI at a threshold value of >14% provided 95% sensitivity and 81.2% specificity to predict fluid responsiveness and was statistically significant (P < .001), with an AUC 0.939 (0.857-0.982).Both PVI and dIVC can be used as a noninvasive method that can be easily applied at the bedside in determining fluid responsiveness in all patients with mechanical ventilation in intensive care.
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Affiliation(s)
| | - İbrahim İlker Öz
- Department of Radiology, School of Medicine, Bulent Ecevit University, Zonguldak, Turkey
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247
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Association of hemodynamic variables with in-hospital mortality and favorable neurological outcomes in post-cardiac arrest care with targeted temperature management. Resuscitation 2017; 120:146-152. [DOI: 10.1016/j.resuscitation.2017.07.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 06/17/2017] [Accepted: 07/09/2017] [Indexed: 01/08/2023]
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248
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Al-Mashani AM, Waje ND, Salhotra N, Das S, Suri N, Al-Sheheimi RA, Chatterjee N. Use of a Minimally Invasive Cardiac Output Monitor to Optimise Haemodynamics in a Patient with Mitral Valve Disease Undergoing Cerebrovascular Surgery. Sultan Qaboos Univ Med J 2017; 17:e343-e347. [PMID: 29062560 DOI: 10.18295/squmj.2017.17.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Revised: 02/19/2017] [Accepted: 05/18/2017] [Indexed: 11/16/2022] Open
Abstract
Patients with mitral valve disease undergoing cerebrovascular surgery face increased inherent risks due to their associated cardiac comorbidities. As such, the anaesthetic management of such patients is distinctly challenging. Simultaneous consideration of both the cerebrovascular and underlying cardiac conditions determines key anaesthetic issues, as fluids and vasopressors or inotropes need to be titrated according to haemodynamic variables in order to optimise cerebral blood flow without compromising cardiac function. We report a 45-year-old female patient with mild mitral stenosis and moderate-to-severe mitral regurgitation who presented to the Khoula Hospital, Muscat, Oman, in 2016 following a ruptured anterior communicating artery aneurysm requiring urgent surgical intervention. As highlighted in this case, the VolumeView EV1000™ (Edwards Lifesciences, Irvine, California, USA) system is a minimially invasive haemodynamic monitor that can help immensely in the perioperative management of such patients.
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Affiliation(s)
- Ali M Al-Mashani
- Departments of Neurosurgery, Intensive Care Unit & Pain Management, Khoula Hospital, Muscat, Oman
| | - Niranjan D Waje
- Department of Cardiac Anaesthesia, Royal Hospital, Muscat, Oman
| | - Neeraj Salhotra
- Departments of Neurosurgery, Intensive Care Unit & Pain Management, Khoula Hospital, Muscat, Oman
| | - Samaresh Das
- Departments of Anaesthesia, Intensive Care Unit & Pain Management, Khoula Hospital, Muscat, Oman
| | - Neelam Suri
- Departments of Anaesthesia, Intensive Care Unit & Pain Management, Khoula Hospital, Muscat, Oman
| | | | - Nilay Chatterjee
- Departments of Anaesthesia, Intensive Care Unit & Pain Management, Khoula Hospital, Muscat, Oman
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249
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Lin SY, Chou AH, Tsai YF, Chang SW, Yang MW, Ting PC, Chen CY. Evaluation of the use of the fourth version FloTrac system in cardiac output measurement before and after cardiopulmonary bypass. J Clin Monit Comput 2017; 32:807-815. [PMID: 29039063 DOI: 10.1007/s10877-017-0071-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 10/06/2017] [Indexed: 12/27/2022]
Abstract
The FloTrac system is a system for cardiac output (CO) measurement that is less invasive than the pulmonary artery catheter (PAC). The purposes of this study were to (1) compare the level of agreement and trending abilities of CO values measured using the fourth version of the FloTrac system (CCO-FloTrac) and PAC-originated continuous thermodilution (CCO-PAC) and (2) analyze the inadequate CO-discriminating ability of the FloTrac system before and after cardiopulmonary bypass (CPB). Fifty patients were included. After exclusion, 32 patients undergoing cardiac surgery with CPB were analyzed. All patients were monitored with a PAC and radial artery catheter connected to the FloTrac system. CO was assessed at 10 timing points during the surgery. In the Bland-Altman analysis, the percentage errors (bias, the limits of agreement) of the CCO-FloTrac were 61.82% (0.16, - 2.15 to 2.47 L min) and 51.80% (0.48, - 1.97 to 2.94 L min) before and after CPB, respectively, compared with CCO-PAC. The concordance rates in the four-quadrant plot were 64.10 and 62.16% and the angular concordance rates (angular mean bias, the radial limits of agreement) in the polar-plot analysis were 30.00% (17.62°, - 70.69° to 105.93°) and 38.63% (- 10.04°, - 96.73° to 76.30°) before and after CPB, respectively. The area under the receiver operating characteristic curve for CCO-FloTrac was 0.56, 0.52, 0.52, and 0.72 for all, ≥ ± 5, ≥ ± 10, and ≥ ± 15% CO changes (ΔCO) of CCO-PAC before CPB, respectively, and 0.59, 0.55, 0.49, and 0.46 for all, ≥ ± 5, ≥ ± 10, and ≥ ± 15% ΔCO of CCO-PAC after CPB, respectively. When CO < 4 L/min was considered inadequate, the Cohen κ coefficient was 0.355 and 0.373 before and after CPB, respectively. The accuracy, trending ability, and inadequate CO-discriminating ability of the fourth version of the FloTrac system in CO monitoring are not statistically acceptable in cardiac surgery.
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Affiliation(s)
- Sheng-Yi Lin
- Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, No.5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan
| | - An-Hsun Chou
- Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, No.5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan
| | - Yung-Fong Tsai
- Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, No.5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan.,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan
| | - Su-Wei Chang
- Clinical Informatics and Medical Statistics Research Center, Chang Gung University College of Medicine, Taoyuan, 333, Taiwan.,Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, 333, Taiwan
| | - Min-Wen Yang
- Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, No.5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan
| | - Pei-Chi Ting
- Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, No.5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan
| | - Chun-Yu Chen
- Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, No.5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan. .,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan.
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250
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Jeong DM, Ahn HJ, Park HW, Yang M, Kim JA, Park J. Stroke Volume Variation and Pulse Pressure Variation Are Not Useful for Predicting Fluid Responsiveness in Thoracic Surgery. Anesth Analg 2017; 125:1158-1165. [DOI: 10.1213/ane.0000000000002056] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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