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Zheng C, Wang B, Fu J, Peng H, Chen Y, Hu X. Effect of phenylephrine versus ephedrine on the incidence of postoperative delirium in olderly adults undergoing knee arthroplasty under general anesthesia: a single-center trial. Sci Rep 2024; 14:17333. [PMID: 39068245 PMCID: PMC11283455 DOI: 10.1038/s41598-024-68273-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 07/22/2024] [Indexed: 07/30/2024] Open
Abstract
In addition to stabilizing blood pressure (BP), ephedrine and phenylephrine have distinct effects on regional cerebral oxygen saturation (rSO2). However, whether its effect on rSO2 affects the occurrence of postoperative delirium (POD) remains unclear. Therefore, the aim of this study is to compare the effects of ephedrine and phenylephrine for BP maintenance on the incidence of POD in olderly adults who underwent knee arthroplasty under general anesthesia. One hundred twenty patients who were between 60 and 90 years old and underwent knee arthroplasty were included in this study. The patients were randomly divided into two groups: the ephedrine group and the phenylephrine group. After anesthesia induction, ephedrine and phenylephrine were continuously infused to maintain the intraoperative mean arterial pressure within the normal range (baseline mean arterial pressure ± 20%). The primary outcome measures included the incidence of POD within 1-3 days after surgery. The incidence of POD on the first day after surgery was lower in the ephedrine group than in the phenylephrine group (33% vs. 7%, P < 0.001). However, there was no significant difference in the incidence of POD between the two groups on the second and third postoperative days. Compared with the phenylephrine group, the ephedrine group experienced significantly greater cardiac output (CO) and rSO2 (P < 0.05).Clinical Trials Registry: ChiCTR2200064849, principal investigator: Changjian Zheng.
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Affiliation(s)
- Changjian Zheng
- Department of Anesthesiology, The Second Affiliated Hospital of Anhui Medical University, Hefei, 230032, China
- Department of Anesthesiology, The First Affiliated Hospital of Wannan Medical College, Wuhu, 241000, China
| | - Bin Wang
- Department of Anesthesiology, The First Affiliated Hospital of Wannan Medical College, Wuhu, 241000, China
| | - Jiuzhou Fu
- Department of Anesthesiology, The First Affiliated Hospital of Wannan Medical College, Wuhu, 241000, China
| | - Hui Peng
- Department of Anesthesiology, The First Affiliated Hospital of Wannan Medical College, Wuhu, 241000, China
| | - Yongquan Chen
- Department of Anesthesiology, The First Affiliated Hospital of Wannan Medical College, Wuhu, 241000, China
| | - Xianwen Hu
- Department of Anesthesiology, The Second Affiliated Hospital of Anhui Medical University, Hefei, 230032, China.
- Key Laboratory of Anesthesiology and Perioperative Medicine of Anhui Higher Education Institutes, Anhui Medical University, Hefei, 230032, Anhui, China.
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2
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Gautam A, Haldar R, Srivastava S, Gupta D, Jaiswal AK, Mishra P. Comparison of Cardiac Indices Using Two Different Concentrations of Topical Adrenaline during Endoscopic Transsphenoidal Pituitary Surgery: A Prospective Randomized Observational Study. Asian J Neurosurg 2023; 18:734-741. [PMID: 38161619 PMCID: PMC10756811 DOI: 10.1055/s-0043-1775585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
Introduction Adrenaline-soaked wicks are often employed to decongest nasal mucosa during transsphenoidal pituitary surgeries to ensure proper hemostasis and visibility of the operating field. Considerable debate exists regarding the optimum concentration of adrenaline that strikes a balance between hemostasis as well as the hemodynamic side effects of adrenaline. This study assessed cardiac indices like cardiac output and cardiac index using a FloTrac Vigileo cardiac output monitor to compare two different concentrations of adrenaline used for topical instillation. Materials and Methods 60 adult patients undergoing transsphenoidal pituitary surgery were randomly assigned to receive cotton wicks soaked in adrenaline solution (either 1:100,000 or 1:200,000) for nasal decongestion. Following a standardized anesthetic regime, a FloTrac Vigileo cardiac output monitor was attached with the invasive arterial line for precise monitoring and recording of cardiac indices (cardiac output and cardiac index). Additionally, quality of surgical field (as reported by the operating surgeon) blood loss, incidences of adverse hemodynamic events, and rescue drug usage were recorded. Results No difference in cardiac outputs and cardiac indexes of the patients was observed during baseline to 55 minutes and at 80 minutes and onward, whereas difference rose to statistical significance at the time points of 60 minutes and 70 minutes ( p < 0.05). Other parameters like stroke volume, stroke volume variation, and hemodynamic parameters were similar. Quality of the surgical fields (as reported by the surgeon), intraoperative bleeding, incidences of adverse effects, and frequency of rescue drugs usage were similar. Conclusion Instillation of 1:100,000 dilution of adrenaline solution compared with 1:200,000 for nasal decongestion is associated with significant rise in cardiac output and cardiac index at 60 and 70 minutes of the surgery with similar blood loss and hemodynamic variables. Therefore, the lower concentration of adrenaline can be recommended for usage during transsphenoidal pituitary surgeries.
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Affiliation(s)
- Archana Gautam
- Department of Anaesthesiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Rudrashish Haldar
- Department of Anaesthesiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Shashi Srivastava
- Department of Anaesthesiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Devendra Gupta
- Department of Anaesthesiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Awadhesh Kumar Jaiswal
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Prabhaker Mishra
- Department of Biostatistics and Health Informatics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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3
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Zhang Y, McCurdy MT, Ludmir J. Sepsis Management in the Cardiac Intensive Care Unit. J Cardiovasc Dev Dis 2023; 10:429. [PMID: 37887876 PMCID: PMC10606987 DOI: 10.3390/jcdd10100429] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/11/2023] [Accepted: 10/13/2023] [Indexed: 10/28/2023] Open
Abstract
Septic shock management in the cardiac intensive care unit (CICU) is challenging due to the complex interaction of pathophysiology between vasodilatory and cardiogenic shock, complicating how to optimally deploy fluid resuscitation, vasopressors, and mechanical circulatory support devices. Because mixed shock portends high mortality and morbidity, familiarity with quality, contemporary clinical evidence surrounding available therapeutic tools is needed to address the resultant wide range of complications that can arise. This review integrates pathophysiology principles and clinical recommendations to provide an organized, topic-based review of the nuanced intricacies of managing sepsis in the CICU.
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Affiliation(s)
- Yichi Zhang
- Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA;
| | - Michael T. McCurdy
- Division of Pulmonary & Critical Care, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
| | - Jonathan Ludmir
- Corrigan Minehan Heart Center, Cardiology Division, Massachusetts General Hospital, Boston, MA 02114, USA
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Diagnostic Value of the Variations in Internal Jugular Vein Diameter and Blood Flow Rate in Patients with Intestinal Obstruction. Indian J Surg 2023. [DOI: 10.1007/s12262-023-03681-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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5
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Oh C, Lee S, Oh P, Chung W, Ko Y, Yoon SH, Kim YH, Ji SM, Hong B. Comparison between Fourth-Generation FloTrac/Vigileo System and Continuous Thermodilution Technique for Cardiac Output Estimation after Time Adjustment during Off-Pump Coronary Artery Bypass Graft Surgery: A Retrospective Cohort Study. J Clin Med 2022; 11:jcm11206093. [PMID: 36294414 PMCID: PMC9605331 DOI: 10.3390/jcm11206093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/11/2022] [Accepted: 10/13/2022] [Indexed: 12/01/2022] Open
Abstract
(1) Background: Previous studies reported limited performance of arterial pressure waveform-based cardiac output (CO) estimation (FloTrac/Vigileo system; CO-FloTrac) compared with the intermittent thermodilution technique (COint). However, errors due to bolus maneuver and intermittent measurements of COint could limit its use as a reference. The continuous thermodilution technique (COcont) may relieve such limitations. (2) Methods: The performance of CO-FloTrac was retrospectively assessed using continuous recordings of intraoperative physiological data acquired from patients who underwent off-pump coronary artery bypass graft (OPCAB) surgery with CO monitoring using both CO-FloTrac and COcont. Optimal time adjustments between the two measurements were determined based on R-squared values. (3) Results: A total of 134.2 h of data from 30 patients was included in the final analysis. The mean bias was -0.94 (95% CI, -1.35 to -0.52) L/min and the limits of agreements were -3.64 (95% CI, -4.44 to -3.08) L/min and 1.77 (95% CI, 1.21 to 2.57) L/min. The percentage error was 66.1% (95% CI, 52.4 to 85.8%). Depending on the time scale and the size of the exclusion zone, concordance rates ranged from 61.0% to 75.0%. (4) Conclusion: Despite the time adjustments, CO-FloTrac showed non-negligible overestimation, clinically unacceptable precision, and poor trending ability during OPCAB surgery.
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Affiliation(s)
- Chahyun Oh
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon 35015, Korea
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon 34134, Korea
| | - Soomin Lee
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon 35015, Korea
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon 34134, Korea
| | - Pyeonghwa Oh
- Department of Anesthesiology and Pain Medicine, Dankook University Hospital, Cheonan 31116, Korea
| | - Woosuk Chung
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon 35015, Korea
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon 34134, Korea
| | - Youngkwon Ko
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon 35015, Korea
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon 34134, Korea
| | - Seok-Hwa Yoon
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon 35015, Korea
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon 34134, Korea
| | - Yoon-Hee Kim
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon 35015, Korea
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon 34134, Korea
| | - Sung-Mi Ji
- Department of Anesthesiology and Pain Medicine, Dankook University Hospital, Cheonan 31116, Korea
- Correspondence: (S.-M.J.); (B.H.)
| | - Boohwi Hong
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon 35015, Korea
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon 34134, Korea
- Big Data Center, Biomedical Research Institute, Chungnam National University Hospital, Daejeon 35015, Korea
- Correspondence: (S.-M.J.); (B.H.)
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6
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The Pulmonary Artery Catheter in the Perioperative Setting: Should It Still Be Used? Diagnostics (Basel) 2022; 12:diagnostics12010177. [PMID: 35054343 PMCID: PMC8774775 DOI: 10.3390/diagnostics12010177] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 12/29/2021] [Accepted: 01/10/2022] [Indexed: 12/13/2022] Open
Abstract
The pulmonary artery catheter (PAC) was introduced into clinical practice in the 1970s and was initially used to monitor patients with acute myocardial infarctions. The indications for using the PAC quickly expanded to critically ill patients in the intensive care unit as well as in the perioperative setting in patients undergoing major cardiac and noncardiac surgery. The utilization of the PAC is surrounded by multiple controversies, with literature claiming its benefits in the perioperative setting, and other publications showing no benefit. The right interpretation of the hemodynamic parameters measured by the PAC and its clinical implications are of the utmost essence in order to guide a specific therapy. Even though clinical trials have not shown a reduction in mortality with the use of the PAC, it still remains a valuable tool in a wide variety of clinical settings. In general, the right selection of the patient population (high-risk patients with or without hemodynamic instability undergoing high-risk procedures) as well as the right clinical setting (centers with experience and expertise) are essential in order for the patient to benefit most from PAC use.
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7
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Labak CM, Shammassian BH, Zhou X, Alkhachroum A. Multimodality Monitoring for Delayed Cerebral Ischemia in Subarachnoid Hemorrhage: A Mini Review. Front Neurol 2022; 13:869107. [PMID: 35493831 PMCID: PMC9043346 DOI: 10.3389/fneur.2022.869107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/14/2022] [Indexed: 12/13/2022] Open
Abstract
Aneurysmal subarachnoid hemorrhage is a disease with high mortality and morbidity due in large part to delayed effects of the hemorrhage, including vasospasm, and delayed cerebral ischemia. These two are now recognized as overlapping yet distinct entities, and supportive therapies for delayed cerebral ischemia are predicated on identifying DCI as quickly as possible. The purpose of this overview is to highlight diagnostic tools that are being used in the identification of DCI in the neurocritical care settings.
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Affiliation(s)
- Collin M. Labak
- Department of Neurosurgery, Case Western Reserve University School of Medicine, Cleveland, OH, United States
- Department of Neurosurgery, University Hospitals Cleveland Medicine Center, Cleveland, OH, United States
| | - Berje Haroutuon Shammassian
- Department of Neurology, Division of Neurocritical Care, University of Miami Leonard M. Miller School of Medicine, Miami, FL, United States
- Department of Neurology, Jackson Memorial Hospital, Miami, FL, United States
| | - Xiaofei Zhou
- Department of Neurosurgery, Case Western Reserve University School of Medicine, Cleveland, OH, United States
- Department of Neurosurgery, University Hospitals Cleveland Medicine Center, Cleveland, OH, United States
| | - Ayham Alkhachroum
- Department of Neurology, Division of Neurocritical Care, University of Miami Leonard M. Miller School of Medicine, Miami, FL, United States
- Department of Neurology, Jackson Memorial Hospital, Miami, FL, United States
- *Correspondence: Ayham Alkhachroum
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8
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Oh C, Noh C, Hong B, Shin S, Jeong K, Lim C, Kim YH, Lee S, Lee SY. Is measurement of central venous pressure required to estimate systemic vascular resistance? A retrospective cohort study. BMC Anesthesiol 2021; 21:310. [PMID: 34893034 PMCID: PMC8662880 DOI: 10.1186/s12871-021-01522-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 11/17/2021] [Indexed: 11/17/2022] Open
Abstract
Background The clinical range of central venous pressure (CVP) (typically 5 to 15 mmHg) is much less than the range of mean arterial blood pressure (60 to 120 mmHg), suggesting that CVP may have little impact on estimation of systemic vascular resistance (SVR). The accuracy and feasibility of using an arbitrary CVP rather than actual CVP for the estimation of SVR during intraoperative period is not known. Methods Using vital records obtained from patients who underwent neurological and cardiac surgery, the present study retrospectively calculated SVR using fixed values of CVP (0, 5, 10, 15, and 20 mmHg) and randomly changing values of CVP (5 to 15 mmHg) and compared these calculated SVRs with actual SVR, calculated using actual CVP. Differences between actual SVR and SVRs based on fixed and random CVPs were quantified as root mean square error (RMSE) and mean absolute percentage error (MAPE). Bland-Altman analysis and four-quadrant plot analysis were performed. Results A total of 34 patients are included, including 18 who underwent neurosurgery and 16 who underwent cardiac surgery; 501,380 s (139.3 h) of data was analyzed. The SVR derived from a fixed CVP of 10 mmHg (SVRf10) showed the highest accuracy (RMSE: 115 and 104 [dynes/sec/cm− 5] and MAPE: 6.3 and 5.7% in neurological and cardiac surgery, respectively). The 95% limits of agreement between SVRf10 and actual SVR were − 208.5 (95% confidence interval [CI], − 306.3 to − 148.1) and 242.2 (95% CI, 181.8 to 340.0) dynes/sec/cm− 5 in neurosurgery and − 268.1 (95% CI, − 367.5 to − 207.7) and 163.2 (95% CI, 102.9 to 262.6) dynes/sec/cm− 5 in cardiac surgery. All the SVRs derived from the fixed CVPs (regardless of its absolute value) showed excellent trending ability (concordance rate > 0.99). Conclusions SVR can be estimated from a fixed value of CVP without causing significant deviation or a loss of trending ability. However, caution is needed when using point estimates of SVR when the actual CVP is expected to be out of the typical clinical range. Trial registration This study was registered Clinical Research Information Service, a clinical trial registry in South Korea (KCT0006187).
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Affiliation(s)
- Chahyun Oh
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, South Korea.,Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon, South Korea
| | - Chan Noh
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, South Korea.,Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon, South Korea
| | - Boohwi Hong
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, South Korea.,Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon, South Korea
| | - Suyeon Shin
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, South Korea
| | - Kuhee Jeong
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, South Korea
| | - Chaeseong Lim
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, South Korea.,Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon, South Korea
| | - Yoon-Hee Kim
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, South Korea.,Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon, South Korea
| | - Soomin Lee
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, South Korea. .,Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon, South Korea.
| | - Sun Yeul Lee
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, South Korea. .,Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon, South Korea.
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9
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Chen PN, Ramachandran S, Kuo YR. Application of stroke volume variation for optimized hemodynamic monitoring in hand allotransplantation. Microsurgery 2021; 42:97-98. [PMID: 34713916 DOI: 10.1002/micr.30833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 06/15/2021] [Accepted: 09/13/2021] [Indexed: 12/31/2022]
Affiliation(s)
- Po-Nien Chen
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Savitha Ramachandran
- Department of Plastic and Reconstructive Surgery, Singapore General Hospital, Singapore, Singapore.,Department of Plastic and Reconstructive Surgery, KK Women's and Children's Hospital, Kaohsiung, Taiwan
| | - Yur-Ren Kuo
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Biological Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan.,Academic Clinical Programme for Musculoskeletal Sciences, Duke-NUS Graduate Medical School, Singapore
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10
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Gupta P, Chaudhari SH, Nagar V, Jain D, Bansal A, Dutt A. Prospective analysis of goal-directed fluid therapy vs conventional fluid therapy in perioperative outcome of composite resections of head and neck malignancy with free tissue transfer. Indian J Anaesth 2021; 65:606-611. [PMID: 34584284 PMCID: PMC8445214 DOI: 10.4103/ija.ija_178_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/04/2021] [Accepted: 08/02/2021] [Indexed: 11/23/2022] Open
Abstract
Background and Aim: Head and neck cancer surgeries with free tissue transfer are complex procedures, and fluid management can grossly affect the microvascular anastomosis. We hypothesise that intra-operative goal-directed fluid therapy (GDFT) is the key to administer fluid individualised to a patient's requirement. The aim of this study was to observe the role of GDFT in perioperative flap outcome and length of hospital stay. Methods: A randomised prospective controlled study was performed in 106 patients undergoing composite resection of head and neck cancer with free tissue transfer. Patients in Group A received GDFT based on stroke volume variation whereas Group B received conventional fluid therapy intra-operatively. The endpoints of this study were total perioperative fluid, fluid boluses, vasopressor requirement, flap outcome and length of intensive care unit and hospital stay. Statistical analysis was done using Chi-square test. Results: The total intra-operative fluid given to both the groups was comparable but patients in Group A received more boluses and vasopressors compared to Group B during intra-operative period. The amount of fluid given in the first 24 hours post-operatively was significantly less in Group A (1807 + 476 ml) compared to Group B (2205 + 382 ml). Incidence of hypotension with tachycardia was observed in three patients in Group B and none in Group A. Poor flap outcome was observed in one patient in Group A versus four in Group B due to thrombosis. Conclusion: GDFT helps in early detection of fluid deficit and may avoid complications arising due to inadequate microvascular perfusion during the peri-operative period.
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Affiliation(s)
- Pushplata Gupta
- Department of Anaesthesia, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, Rajasthan, India
| | - Soumi H Chaudhari
- Department of Anaesthesia, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, Rajasthan, India
| | - Vaibhav Nagar
- Department of Anaesthesia, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, Rajasthan, India
| | - Deepshikha Jain
- Department of Anaesthesia, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, Rajasthan, India
| | - Anita Bansal
- Department of Anaesthesia, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, Rajasthan, India
| | - Akanksha Dutt
- Department of Anaesthesia, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, Rajasthan, India
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11
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Premkumar M, Kajal K, Kulkarni AV, Gupta A, Divyaveer S. Point-of-Care Echocardiography and Hemodynamic Monitoring in Cirrhosis and Acute-on-Chronic Liver Failure in the COVID-19 Era. J Intensive Care Med 2021; 36:511-523. [PMID: 33438491 DOI: 10.1177/0885066620988281] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Point-of-Care (POC) transthoracic echocardiography (TTE) is transforming the management of patients with cirrhosis presenting with septic shock, acute kidney injury, hepatorenal syndrome and acute-on-chronic liver failure (ACLF) by correctly assessing the hemodynamic and volume status at the bedside using combined echocardiography and POC ultrasound (POCUS). When POC TTE is performed by the hepatologist or intensivist in the intensive care unit (ICU), and interpreted remotely by a cardiologist, it can rule out cardiovascular conditions that may be contributing to undifferentiated shock, such as diastolic dysfunction, myocardial infarction, myocarditis, regional wall motion abnormalities and pulmonary embolism. The COVID-19 pandemic has led to a delay in seeking medical treatment, reduced invasive interventions and deferment in referrals leading to "collateral damage" in critically ill patients with liver disease. Thus, the use of telemedicine in the ICU (Tele-ICU) has integrated cardiology, intensive care, and hepatology practices across the spectrum of ICU, operating room, and transplant healthcare. Telecardiology tools have improved bedside diagnosis when introduced as part of COVID-19 care by remote supervision and interpretation of POCUS and echocardiographic data. In this review, we present the contemporary approach of using POC echocardiography and offer a practical guide for primary care hepatologists and gastroenterologists for cardiac assessment in critically ill patients with cirrhosis and ACLF. Evidenced based use of Tele-ICU can prevent delay in cardiac diagnosis, optimize safe use of expert resources and ensure timely care in the setting of critically ill cirrhosis, ACLF and liver transplantation in the COVID-19 era.
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Affiliation(s)
- Madhumita Premkumar
- Department of Hepatology, 29751Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kamal Kajal
- Department of Anesthesia and Intensive Care, 29751Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anand V Kulkarni
- Department of Hepatology, 78470Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - Ankur Gupta
- Department of Cardiology, 29751Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Smita Divyaveer
- Department of Nephrology, 29751Postgraduate Institute of Medical Education and Research, Chandigarh, India
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12
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Engel D, Beilstein CM, Löffel LM, Wuethrich PY. The impact of fluid optimisation before induction of anaesthesia on hypotension after induction. Anaesthesia 2020; 75:1402. [DOI: 10.1111/anae.15080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- D. Engel
- Bern University Hospital Bern Switzerland
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13
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Porhomayon J, Pourafkari L, Mahmoodpoor A, Nader ND. The utilization spectrum of cardiac output monitoring devices among anesthesiology programs across Veterans Health Administration in the United States. Ann Card Anaesth 2020; 22:199-203. [PMID: 30971603 PMCID: PMC6489392 DOI: 10.4103/aca.aca_107_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Electronic monitoring of physiologic variables has gained widespread support over the past decade for critical patients in the intensive care setting. Specifically, anesthesiologists have increased the emphasis and practice of hemodynamic control through monitoring cardiac output (CO). However, these physicians are presented with several options in terms of how they wish to study the trend of this physiologic parameter. Materials and Methods A survey was distributed to 250 general and subspecialty-trained anesthesiologists. A series of questions were presented in terms of preference of patient monitoring methods requiring yes or no answers. Anesthesiologists were asked about subspecialty training, years since residency graduation, and preferences toward specific hemodynamic monitoring tools. Nonparametric statistical analysis and Chi-squared tests were used to analyze both normal and nonnormally distributed data. Results CO monitoring devices were implemented by 106 out of 133 anesthesiologists, with 98 of these physicians utilizing CO monitoring for fluid and vasopressors response. Of the physicians implementing a monitoring device, 48 out of 107 physicians preferred pulmonary artery catheter, while pulse contour analysis was preferred by 17 anesthesiologists. An echocardiography unit was available to the department for 90 anesthesiologists, and 77 anesthesiologists were trained to use this technology for monitoring cardiac function. Conclusion Many anesthesiologists have placed emphasis on the importance of CO monitoring within the intensive care setting. However, physicians are still faced with multiple options in terms of how they wish to specifically monitor this hemodynamic variable. Factors that influence such decisions include the time of physician's residency training along with patient and clinical case characteristics.
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Affiliation(s)
| | | | - Ata Mahmoodpoor
- Department of Anesthesiology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Nader D Nader
- Department of Anesthesiology, SUNY-Buffalo, Buffalo, NY, USA
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14
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Lee JM, Lee SK, Kim KM, Kim YJ, Park EY. Comparison of volume-controlled ventilation mode and pressure-controlled ventilation with volume-guaranteed mode in the prone position during lumbar spine surgery. BMC Anesthesiol 2019; 19:133. [PMID: 31351445 PMCID: PMC6661081 DOI: 10.1186/s12871-019-0806-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 07/18/2019] [Indexed: 11/29/2022] Open
Abstract
Background During lumbar spine surgery, patients are placed in the prone position for surgical access. The prone position has various effects on cardiac and pulmonary function, including a decreased cardiac index (CI), decreased dynamic lung compliance (Cdyn), and increased peak inspiratory pressure (Ppeak). In this study, we compared the volume-controlled ventilation mode (VCV) and pressure-controlled ventilation with volume guaranteed mode (PCV-VG) based on hemodynamic and pulmonary variables in the prone position during lumbar spine surgery. Methods Thirty-six patients scheduled for lumbar spine surgery in the prone position were enrolled in this prospective, randomized clinical trial. The patients were randomly assigned to receive VCV or PCV-VG. Hemodynamic variables, respiratory variables, and arterial blood gases were measured in the supine position 15 min after the induction of anesthesia, 15 min after placement in the prone position, 30 min after placement in the prone position, and 15 min after placement in the supine position at the end of anesthesia. Results The hemodynamic variables and arterial blood gas results did not differ significantly between the two groups. Lower Ppeak values were observed in the PCV-VG group than in the VCV group (p = 0.045). The Cdyn values in the VCV group were lower than those in the PCV-VG group (p = 0.040). Conclusion PCV-VG led to lower Ppeak and improved Cdyn values compared with VCV, showing that it may be a favorable alternative mode of mechanical ventilation for patients in the prone position during lumbar spine surgery. Trial registration The study was retrospectively registered at ClinicalTrials.gov (NCT 03571854). The initial registration date was 6/18/2018.
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Affiliation(s)
- Jung Min Lee
- Department of Anesthesiology and Pain Medicine, Hallym University Sacred Heart Hospital, College of Medicine, Hallym University, 22, Gwanpyeong-ro 170beon-gil, Dongan-gu, Gyeonggi-do, 14068, Anyang-si, Republic of Korea
| | - Soo Kyung Lee
- Department of Anesthesiology and Pain Medicine, Hallym University Sacred Heart Hospital, College of Medicine, Hallym University, 22, Gwanpyeong-ro 170beon-gil, Dongan-gu, Gyeonggi-do, 14068, Anyang-si, Republic of Korea
| | - Kyung Mi Kim
- Department of Anesthesiology and Pain Medicine, Hallym University Sacred Heart Hospital, College of Medicine, Hallym University, 22, Gwanpyeong-ro 170beon-gil, Dongan-gu, Gyeonggi-do, 14068, Anyang-si, Republic of Korea
| | - You Jung Kim
- Department of Anesthesiology and Pain Medicine, Hallym University Sacred Heart Hospital, College of Medicine, Hallym University, 22, Gwanpyeong-ro 170beon-gil, Dongan-gu, Gyeonggi-do, 14068, Anyang-si, Republic of Korea
| | - Eun Young Park
- Department of Anesthesiology and Pain Medicine, Hallym University Sacred Heart Hospital, College of Medicine, Hallym University, 22, Gwanpyeong-ro 170beon-gil, Dongan-gu, Gyeonggi-do, 14068, Anyang-si, Republic of Korea.
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15
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Sohda M, Kuriyama K, Kumakura Y, Yoshida T, Honjyo H, Sakai M, Miyazaki T, Kanemoto M, Tobe M, Hinohara H, Saito S, Kuwano H. Evaluation of Surgical Procedures that Affect the Hemodynamics Using the FloTrac System in Esophageal Cancer Patients. In Vivo 2019; 33:1221-1226. [PMID: 31280212 PMCID: PMC6689371 DOI: 10.21873/invivo.11593] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 06/10/2019] [Accepted: 06/20/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND/AIM Esophagectomy is more invasive compared to other gastrointestinal surgery types. Perioperative circulatory management is important to avoid postoperative heart complications. The FloTrac sensor along with the Vigileo monitor is a minimally invasive haemodynamic monitoring device. Here, we examined different surgical procedures affecting hemodynamics using the FloTrac system in esophageal cancer patients following esophagectomy. PATIENTS AND METHODS Thirty-one patients undergoing postoperative monitoring with the FloTrac sensor/Vigileo monitor system following esophagectomy were included. Evaluation of cardiac index (CI) and stroke volume variation (SVV) measurements were performed by analyzing the number of aberrant values. We evaluated the correlation between the number of aberrant values of CI, SVV and surgical methods of esophagectomy and perioperative factors. RESULTS There was no significant correlation between the number of aberrant values of CI, SVV and operative approach or fields of lymphadenectomy. Regarding the reconstruction route following esophagectomy, there was a significant correlation between the number of aberrant values of CI, SVV and retrosternal route compared with other routes. There was a significant correlation between the number of aberrant values of SVV and preoperative heart complication. CONCLUSION Hemodynamic stability management using FloTrac/Vigileo system following esophagectomy is useful for safe performance of postoperative management of esophageal cancer patients.
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Affiliation(s)
- Makoto Sohda
- Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Kengo Kuriyama
- Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Yuji Kumakura
- Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Tomonori Yoshida
- Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Hiroaki Honjyo
- Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Makoto Sakai
- Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Tatsuya Miyazaki
- Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Masafumi Kanemoto
- Department of Anesthesiology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Masaru Tobe
- Department of Anesthesiology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Hiroshi Hinohara
- Department of Anesthesiology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Shigeru Saito
- Department of Anesthesiology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Hiroyuki Kuwano
- Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Japan
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16
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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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17
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Laher AE, Watermeyer MJ, Buchanan SK, Dippenaar N, Simo NCT, Motara F, Moolla M. A review of hemodynamic monitoring techniques, methods and devices for the emergency physician. Am J Emerg Med 2017; 35:1335-1347. [PMID: 28366285 DOI: 10.1016/j.ajem.2017.03.036] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 03/15/2017] [Accepted: 03/16/2017] [Indexed: 02/07/2023] Open
Abstract
The emergency department (ED) is frequently the doorway to the intensive care unit (ICU) for a significant number of critically ill patients presenting to the hospital. Hemodynamic monitoring (HDM) which is a key component in the effective management of the critically ill patient presenting to the ED, is primarily concerned with assessing the performance of the cardiovascular system and determining the correct therapeutic intervention to optimise end-organ oxygen delivery. The spectrum of hemodynamic monitoring ranges from simple clinical assessment and routine bedside monitoring to point of care ultrasonography and various invasive monitoring devices. The clinician must be aware of the range of available techniques, methods, interventions and technological advances as well as possess a sound approach to basic hemodynamic monitoring prior to selecting the optimal modality. This article comprises an in depth discussion of an approach to hemodynamic monitoring techniques and principles as well as methods of predicting fluid responsiveness as it applies to the ED clinician. We review the role, applicability and validity of various methods and techniques that include; clinical assessment, passive leg raising, blood pressure, finger based monitoring devices, the mini-fluid challenge, the end-expiratory occlusion test, central venous pressure monitoring, the pulmonary artery catheter, ultrasonography, bioreactance and other modern invasive hemodynamic monitoring devices.
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Affiliation(s)
- Abdullah E Laher
- Department of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, South Africa; Department of Critical Care, Faculty of Health Sciences, University of the Witwatersrand, South Africa.
| | - Matthew J Watermeyer
- Department of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Sean K Buchanan
- Department of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Nicole Dippenaar
- Department of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | | | - Feroza Motara
- Department of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Muhammed Moolla
- Department of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, South Africa; Department of Critical Care, Faculty of Health Sciences, University of the Witwatersrand, South Africa
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18
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Power P, Bone A, Simpson N, Yap CH, Gower S, Bailey M. Comparison of pulmonary artery catheter, echocardiography, and arterial waveform analysis monitoring in predicting the hemodynamic state during and after cardiac surgery. Int J Crit Illn Inj Sci 2017; 7:156-162. [PMID: 28971029 PMCID: PMC5613407 DOI: 10.4103/2229-5151.214411] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Objective: The aim of this trial was to determine whether Flotrac Vigileo™ (FV™) provides a reliable representation of the hemodynamic state of a cardiac surgical patient population when compared to pulmonary artery catheter (PAC) and echocardiography in the peril-operative period. Design: This was a prospective observational trial comparing perioperative hemodynamic states using transesophageal echocardiography (TEE), transthoracic echocardiography (TTE), FV™ and PAC during and post cardiothoracic surgery. Setting: Tertiary regional hospital Intensive Care Unit (ICU). Participants: 50 consecutive adult cardiothoracic patients with written consent provided. Intervention: Comparison of the perioperative hemodynamic states using echocardiography, FV™ and PAC was performed. Evaluation of the hemodynamic state (HDS) was performed using TEE, TTE, PAC and FV™ during and after cardiac surgery. Data were compared between the three hemodynamic assessment modalities. Main Outcome Measure: Predicted hemodynamic state. Results: FV™ and PAC were shown to correlate poorly with TEE/TTE assessment of the hemodynamic state. Both PAC and FV™ showed significant discordance with echocardiographic assessment of the hemodynamic state. Conclusions: In this trial, FV™ and PAC were shown to agree poorly with TTE/TEE assessment of the HDS in an adult cardiothoracic population. Agreement between the FV™ and PAC was also poor. Caution is recommended in interpreting isolated hemodynamic monitoring data. All hemodynamic monitoring devices have inherent sources of error. Caution is advised in interpreting any single device or measurement as a gold standard. We suggest that hemodynamic measuring devices such as FV™/PAC may act as triggers for a global hemodynamic assessment including consideration of TTE/TEE.
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Affiliation(s)
- Paul Power
- Intensive Care Unit, University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia
| | - Allison Bone
- Intensive Care Unit, University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia
| | - Nicholas Simpson
- Intensive Care Unit, University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia.,Deakin University School of Medicine, Barwon Health, Geelong, Victoria, Australia
| | - Cheng-Hon Yap
- Department of Cardiothoracic Surgery, University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Simon Gower
- Department of Anaesthesia, University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia
| | - Michael Bailey
- Department of Epidemiology and Preventive Medicine, Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
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Abstract
The shock index (SI) equals the heart rate/systolic blood pressure and has been used to predict clinical outcomes, especially in trauma and surgery patients. The authors reviewed the literature to determine its utility in the management of patients with sepsis and in the prediction of adverse outcomes in these patients. The medical literature was searched using PubMed, Scopus, Web of Science and Google Scholar databases to identify articles in English on the SI in humans. These studies demonstrated that the SI could help evaluate the adequacy of fluid resuscitation and the potential response to additional fluid. It can predict the presence of lactic acidosis. The SI also helps predict the development of organ failure and mortality. Consequently, this easily available bedside measurement has utility in the identification, management and prediction of prognosis in patients with sepsis.
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