Nursing Care and Treatment of Ambulatory Patients With Percutaneously Placed Axillary Intra-aortic Balloon Pump Before Heart Transplant

Intra-Aortic Balloon Pumping in Acute Decompensated Heart Failure With Hypoperfusion: From Pathophysiology to Clinical Practice

Trials on intra-aortic balloon pump (IABP) use in cardiogenic shock related to acute myocardial infarction have shown disappointing results. The role of IABP in cardiogenic shock treatment remains unclear, and new (potentially more potent) mechanical circulatory supports with arguably larger device profile are emerging. A reappraisal of the physiological premises of intra-aortic counterpulsation may underpin the rationale to maintain IABP as a valuable therapeutic option for patients with acute decompensated heart failure and tissue hypoperfusion. Several pathophysiological features differ between myocardial infarction- and acute decompensated heart failure-related hypoperfusion, encompassing cardiogenic shock severity, filling status, systemic vascular resistances rise, and adaptation to chronic (if preexisting) left ventricular dysfunction. IABP combines a more substantial effect on left ventricular afterload with a modest increase in cardiac output and would therefore be most suitable in clinical scenarios characterized by a disproportionate increase in afterload without profound hemodynamic compromise. The acute decompensated heart failure syndrome is characterized by exquisite afterload-sensitivity of cardiac output and may be an ideal setting for counterpulsation. Several hemodynamic variables have been shown to predict response to IABP within this scenario, potentially guiding appropriate patient selection. Finally, acute decompensated heart failure with hypoperfusion may frequently represent an end stage in the heart failure history: IABP may provide sufficient hemodynamic support and prompt end-organ function recovery in view of more definitive heart replacement therapies while preserving ambulation when used with a transaxillary approach.

Experiences of Patients Using a Fitness Tracker to Promote Ambulation Before a Heart Transplant

BACKGROUND

Patients who have an intra-aortic balloon pump or a pulmonary artery catheter with vasoactive infusion while awaiting heart transplant have reduced mobility due to heart failure and activity restrictions. Stroke volume, respiratory capacity, and muscle strength decrease, and sleep disturbances occur. Patients require motivation to enhance ambulation.

OBJECTIVE

To explore patients' experiences with a fitness tracker to promote ambulation before heart transplant.

METHODS

In 2017, a fitness tracker was issued to 43 patients before heart transplant who met the study criteria, which included orders to ambulate. Semistructured interviews were conducted after 2 weeks of fitness tracker use with 8 random participants, who were followed up to enhance the credibility of and validate the findings. Responses were interpreted by using descriptive phenomenology and purposive sampling. An expert in phenomenology examined the transcript interpretations and attested that the findings were supported by the data and were internally coherent. The Colaizzi method was used to analyze data.

RESULTS

A total of 361 significant statements were identified during the participants' interviews and yielded 224 formulated meanings and 16 themes. Themes were categorized into 4 clusters: happy/delighted, motivator, beneficial, and future potential.

CONCLUSIONS

Participants were happy to get a fitness tracker and motivated to be active and increase activity/ambulation. Patients expressed benefits from walks: better sleep, more stamina, and feeling stronger. They believed that this intervention could have potential benefit for future patients.

A computational model for adaptive recording of vital signs through context histories

Wearable devices emerged from the advancement of communication technology and the miniaturization of electronic components. These devices periodically monitor the user's vital signs and generally have a short battery life. This work introduces ODIN, a model for optimized vital signs collection based on adaptive rules. Analyzing vital sign values requires preciseness, so the adaption of these collected data allows a personalized analysis of the user's health condition. The comparison with related works indicates that ODIN is the only model that presents context-aware-adaptive vital signs collection. The implementation of a prototype allowed to perform three evaluations of ODIN. The first evaluation used simulations in different scenarios, with the adaptive approach increasing battery life by 119% through the analysis of input data compared to data collection without adaptivity. The second evaluation applied the prototype to a database of real physiologic data, which allowed reduced data collection when the user has regular vital signs. This reduction optimized battery consumption by 66% compared to collection without adaptivity. Finally, the third evaluation applied ODIN through an Arduino and a heart rate monitor (Polar H7). The average power saved across mobile devices was 21%. Consequently, the adaptive strategy presented in this work allows the optimization of computational resources during the collection and analysis of vital signs. This optimization occurs because of the reduction in energy expenditure and the reduction in the amount of data that needs to be collected and stored.