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Pal R, Rudas A, Kim S, Chiang J, Cannesson M. A signal processing tool for extracting features from arterial blood pressure and photoplethysmography waveforms. medRxiv 2024:2024.03.14.24304307. [PMID: 38559005 PMCID: PMC10980118 DOI: 10.1101/2024.03.14.24304307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Arterial blood pressure (ABP) and photoplethysmography (PPG) waveforms contain valuable clinical information and play a crucial role in cardiovascular health monitoring, medical research, and managing medical conditions. The features extracted from PPG waveforms have various clinical applications ranging from blood pressure monitoring to nociception monitoring, while features from ABP waveforms can be used to calculate cardiac output and predict hypertension or hypotension. In recent years, many machine learning models have been proposed to utilize both PPG and ABP waveform features for these healthcare applications. However, the lack of standardized tools for extracting features from these waveforms could potentially affect their clinical effectiveness. In this paper, we propose an automatic signal processing tool for extracting features from ABP and PPG waveforms. Additionally, we generated a PPG feature library from a large perioperative dataset comprising 17,327 patients using the proposed tool. This PPG feature library can be used to explore the potential of these extracted features to develop machine learning models for non-invasive blood pressure estimation.
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Affiliation(s)
- R. Pal
- David Geffen School of Medicine at University of California Los Angeles
| | - A. Rudas
- Department of Computational Medicine, University of California Los Angeles
| | - S. Kim
- David Geffen School of Medicine at University of California Los Angeles
| | - J.N. Chiang
- Department of Neurosurgery and Computational Medicine, University of California Los Angeles
| | - M. Cannesson
- David Geffen School of Medicine at University of California Los Angeles
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Joosten A, Desebbe O, Suehiro K, Murphy LL, Essiet M, Alexander B, Fischer MO, Barvais L, Van Obbergh L, Maucort-Boulch D, Cannesson M. Accuracy and precision of non-invasive cardiac output monitoring devices in perioperative medicine: a systematic review and meta-analysis † †This Article is accompanied by Editorial Aew442. Br J Anaesth 2017; 118:298-310. [DOI: 10.1093/bja/aew461] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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J, Lahmer T, Schmid R, Latham H, Bengtson CD, Satterwhite L, Stites M, Simpson SQ, Latham H, Bengtson CD, Satterwhite L, Stites M, Simpson SQ, Skladzien T, Cicio M, Garlicki J, Serednicki W, Wordliczek J, Vargas P, Salazar A, Mercado P, Espinoza M, Graf J, Kongpolprom N, Sanguanwong N, Jonnada S, Gerrard C, Jones N, Morley T, Thorburn PT, Trimmings A, Musaeva T, Zabolotskikh I, Salazar A, Vargas P, Mercado P, Espinoza M, Graf J, Horst S, Lipcsey M, Kawati R, Pikwer A, Rasmusson J, Castegren M, Shilova A, Yafarova A, Gilyarov M, Shilova A, Yafarova A, Gilyarov M, Stojiljkovic DLL, Ulici A, Reidt S, Lam T, Jancik J, Ragab D, Taema K, Farouk W, Saad M, Liu X, Holmberg MJ, Uber A, Montissol S, Donnino M, Andersen LW, Perlikos F, Lagiou M, Papalois A, Kroupis C, Toumpoulis I, Osawa E, Carter D, Sardo S, Almeida J, Galas F, Rizk S, Franco R, Hajjar L, Landoni G, Kongsayreepong S, Sungsiri R, Wongsripunetit P, Marchio P, Guerra-Ojeda S, Gimeno-Raga M, Mauricio MD, Valles SL, Aldasoro C, Jorda A, Aldasoro M, Vila JM, Borg UB, Neitenbach AM, García M, González PG, Romero MG, Orduña PS, Cano AG, Rhodes A, Grounds RM, Cecconi M, Lee C, Hatib F, Jian Z, Rinehart J, De Los Santos J, Canales C, Cannesson M, García MIM, Hatib F, Jian Z, Scheeren T, Jian Z, Hatib F, Pinsky M, Chantziara V, Vassi A, Michaloudis G, Sanidas E, Golemati S, Bateman RM, Mokhtar A, Omar W, Aziz KA, El Azizy H, Nielsen DLL, Holler JG, Lassen A, Eriksson M, Strandberg G, Lipcsey M, Larsson A, Capoletto C, Almeida J, Ferreira G, Fukushima J, Nakamura R, Risk S, Osawa E, Park C, Oliveira G, Galas F, Franco R, Hajjar L, Dias F, D’Arrigo N, Fortuna F, Redaelli S, Zerman L, Becker L, Serrano T, Cotes L, Ramos F, Fadel L, Coelho F, Mendes C, Real J, Pedron B, Kuroki M, Costa E, Azevedo L. 37th International Symposium on Intensive Care and Emergency Medicine (part 1 of 3). Crit Care 2017. [PMCID: PMC5374603 DOI: 10.1186/s13054-017-1628-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Hoppu S, Tiainen M, Mion MM, Plebani M, Pettilä V, Skrifvars M, Son Y, Kim KS, Suh GJ, Rocha LL, Kwon WY, Ko JI, Park MJ, Cavicchi FZ, Iesu E, Nobile L, Vincent JL, Creteur J, Taccone FS, Tanaka H, De Freitas FFM, Otani N, Ode S, Ishimatsu S, Martínez L, Algarte R, Sánchez B, Romero I, Martínez F, Quintana S, Trenado J, Cavalheiro AM, Vondrakova D, Ostadal P, Kruger A, Janotka M, Malek F, Neuzil P, Yeh YC, Chen YS, Wang CH, Huang CH, Lucinio NM, Chao A, Lee CT, Lai CH, Chan WS, Cheng YJ, Sun WZ, Kaese S, Horstmann C, Lebiedz P, Mourad M, Lobato MS, Gaudard P, Eliet J, Zeroual N, Colson P, Ostadal P, Mlcek M, Hrachovina M, Kruger A, Vondrakova D, Janotka M, Ebeling G, Mates M, Hala P, Kittnar O, Neuzil P, Jacky A, Rudiger A, Spahn DR, Bettex DA, Kara A, Akin S, Kraegpoeth A, Dos reis Miranda D, Struijs A, Caliskan K, van Thiel RJ, Dubois EA, de Wilde W, Zijlstra F, Gommers D, Ince C, Marca L, Laerkner E, Xini A, Mongkolpun W, Cordeiro CPR, Leite RT, Lheureux O, Bader A, Rincon L, 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E, Juliarena A, Bisso MC, Grando M, Tapia A, Camargo M, Ulla DV, Corzo L, dos Santos HP, Ramos A, Doglia JA, Estenssoro E, Carbonara M, Magnoni S, Donald CLM, Shimony JS, Conte V, Triulzi F, Stretti F, Macrì M, Snyder AZ, Stocchetti N, Brody DL, Podlepich V, Shimanskiy V, Savin I, Lapteva K, Chumaev A, Tjepkema-Cloostermans MC, Hofmeijer J, Beishuizen A, Hom H, Blans MJ, van Putten MJAM, Longhi L, Frigeni B, Curinga M, Mingone D, Beretta S, Patruno A, Gandini L, Vargiolu A, Ferri F, Ceriani R, Rottoli MR, Lorini L, Citerio G, Pifferi S, Battistini M, Cordolcini V, Agarossi A, Di Rosso R, Ortolano F, Stocchetti N, Lourido CM, Cabrera JLS, Santana JDM, Alzola LM, del Rosario CG, Pérez HR, Torrent RL, Eslami S, Dalhuisen A, Fiks T, Schultz MJ, Hanna AA, Spronk PE, Wood M, Maslove D. ESICM LIVES 2016: part three. Intensive Care Med Exp 2016. [PMCID: PMC5042925 DOI: 10.1186/s40635-016-0100-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Straaten HM, Mejeni N, Nsiala J, Kilembe A, Akilimali P, Thomas G, Egerod I, Andersson AE, Fagerdahl AM, Knudsen V, Meddeb K, Cheikh AB, Hamdaoui Y, Ayachi J, Guiga A, Fraj N, Romdhani S, Sma N, Bouneb R, Chouchene I, Khedher A, Bouafia N, Boussarsar M, Amirian A, Ziaian B, Masjedi M, Fleischmann C, Thomas-Rueddel DO, Schettler A, Schwarzkopf D, Stacke A, Reinhart K, Filipe E, Escoval A, Martins A, Sousa P, Velez N, Viegas E, Tomas E, Snell G, Matsa R, Paary TTS, Kalaiselvan MS, Cavalheiro AM, Rocha LL, Vallone CS, Tonilo A, Lobato MDS, Malheiro DT, Sussumo G, Lucino NM, Zand F, Rosenthal VD, Masjedi M, Sabetian G, Maghsudi B, Ghorbani M, Dashti AS, Yousefipour A, Goodall JR, Williamson M, Tant E, Thomas N, Balci C, Gonen C, Haftacı E, Gurarda H, Karaca E, Paldusová B, Zýková I, Šímová D, Houston S, D’Antona L, Lloyd J, Garnelo-Rey V, Sosic M, Sotosek-Tokmazic V, Kuharic J, Antoncic I, Dunatov S, Sustic A, Chong CT, Sim M, Lyovarin T, Díaz FMA, Galdó SN, Garach MM, Romero OM, Bailón AMP, Pinel AC, Colmenero M, Gritsan A, Gazenkampf A, Korchagin E, Dovbish N, Lee RM, Lim MPP, Chong CT, Lim BCL, See JJ, Assis R, Filipe F, Lopes N, Pessoa L, Pereira T, Catorze N, Aydogan MS, Aldasoro C, Marchio P, Jorda A, Mauricio MD, Guerra-Ojeda S, Gimeno-Raga M, Colque-Cano M, Bertomeu-Artecero A, Aldasoro M, Valles SL, Tonon D, Triglia T, Martin JC, Alessi MC, Bruder N, Garrigue P, Velly L, Spina S, Scaravilli V, Marzorati C, Colombo E, Savo D, Vargiolu A, Cavenaghi G, Citerio G, Andrade AHV, Bulgarelli P, Araujo JAP, Gonzalez V, Souza VA, Costa A, Massant C, Filho CACA, Morbeck RA, Burgo LE, van Groenendael R, van Eijk LT, Leijte GP, Koeneman B, Kox M, Pickkers P, García-de la Torre A, de la Torre-Prados M, Fernández-Porcel A, Rueda-Molina C, Nuevo-Ortega P, Tsvetanova-Spasova T, Cámara-Sola E, García-Alcántara A, Salido-Díaz L, Liao X, Feng T, Zhang J, Cao X, Wu Q, Xie Z, Li H, Kang Y, Winkler MS, Nierhaus A, Mudersbach E, Bauer A, Robbe L, Zahrte C, Schwedhelm E, Kluge S, Zöllner C, Morton B, Mitsi E, Pennington SH, Reine J, Wright AD, Parker R, Welters ID, Blakey JD, Rajam G, Ades EW, Ferreira DM, Wang D, Kadioglu A, Gordon SB, Koch R, Kox M, Rahamat-Langedoen J, Schloesser J, de Jonge M, Pickkers P, Bringue J, Guillamat-Prats R, Torrents E, Martinez ML, Camprubí-Rimblas M, Artigas A, Blanch L, Park SY, Park YB, Song DK, Shrestha S, Park SH, Koh Y, Park MJ, Hong CW, Lesur O, Coquerel D, Sainsily X, Cote J, Söllradl T, Murza A, Dumont L, Dumaine R, Grandbois M, Sarret P, Marsault E, Salvail D, Auger-Messier M, Chagnon F, Lauretta MP, Greco E, Dyson A, Singer M, Preau S, Ambler M, Sigurta A, Saeed S, Singer M, Sarıca LT, Zibandeh N, Genc D, Gul F, Akkoc T, Kombak E, Cinel L, Akkoc T, Cinel I, Pollen SJ, Arulkumaran N, Singer M, Torrance HD, Longbottom ER, Warnes G, Hinds CJ, Pennington DJ, Brohi K, O’Dwyer MJ, Kim HY, Na S, Kim J, Chang YF, Chao A, Shih PY, Lee CT, Yeh YC, Chen LW, Adriaanse M, Trogrlic Z, Ista E, Lingsma H, Rietdijk W, Ponssen HH, Schoonderbeek JF, Schreiner F, Verbrugge SJ, Duran S, Gommers DAMPJ, van der Jagt M, Funcke S, Sauerlaender S, Saugel B, Pinnschmidt H, Reuter DA, Nitzschke R, Perbet S, Biboulet C, Lenoire A, Bourdeaux D, Pereira B, Plaud B, Bazin JE, Sautou V, Mebazaa A, Constantin JM, Legrand M, Boyko Y, Jennum P, Nikolic M. ESICM LIVES 2016: part one. Intensive Care Med Exp 2016. [PMCID: PMC5042924 DOI: 10.1186/s40635-016-0098-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Lilot M, Ehrenfeld J, Lee C, Harrington B, Cannesson M, Rinehart J. Variability in practice and factors predictive of total crystalloid administration during abdominal surgery: retrospective two-centre analysis †. Br J Anaesth 2015; 114:767-76. [DOI: 10.1093/bja/aeu452] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2014] [Indexed: 11/12/2022] Open
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Joosten A, Rinehart J, Cannesson M. Perioperative goal directed therapy: evidence and compliance are two sides of the same coin. Rev Esp Anestesiol Reanim 2015; 62:181-183. [PMID: 25744652 DOI: 10.1016/j.redar.2015.01.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 01/19/2015] [Accepted: 01/23/2015] [Indexed: 06/04/2023]
Affiliation(s)
- A Joosten
- Department of Anesthesiology and Perioperative Care, University of California Irvine, 101 South City Drive, Orange, CA 92868, USA; Department of Anesthesiology and Perioperative Care, Erasme University Hospital, Free University of Brussels, 808 Route de Lennick, 1070 Brussels, Belgium
| | - J Rinehart
- Department of Anesthesiology and Perioperative Care, University of California Irvine, 101 South City Drive, Orange, CA 92868, USA
| | - M Cannesson
- Department of Anesthesiology and Perioperative Care, University of California Irvine, 101 South City Drive, Orange, CA 92868, USA.
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Joosten A, Huynh T, Suehiro K, Canales C, Cannesson M, Rinehart J. Goal-Directed fluid therapy with closed-loop assistance during moderate risk surgery using noninvasive cardiac output monitoring: A pilot study. Br J Anaesth 2015; 114:886-92. [PMID: 25690834 DOI: 10.1093/bja/aev002] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2014] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Goal directed fluid therapy (GDFT) has been shown to improve outcomes in moderate to high-risk surgery. However, most of the present GDFT protocols based on cardiac output optimization use invasive devices and the protocols may require significant practitioner attention and intervention to apply them accurately. The aim of this prospective pilot study was to evaluate the clinical feasibility of GDFT using a closed-loop fluid administration system with a non-invasive cardiac output monitoring device (Nexfin™, BMEYE, Amsterdam, Netherlands). METHODS Patients scheduled for elective moderate risk surgery under general anaesthesia were enrolled. The primary anaesthesia team managing the case selected GDFT targets using the controller interface and all patients received a baseline 3 ml kg(-1) h(-1) crystalloid infusion. Colloid solutions were delivered by the closed-loop system for intravascular volume expansion using data from the Nexfin™ monitor. Compliance with GDFT management was defined as acceptable when a patient spent more than 85% of the surgery time in a preload independent state (defined as pulse pressure variation <13%) or when average cardiac index during surgery was >2.5 litre min(-1) m(-2). RESULTS A total of 13 patients were included in the study group. All patients met the established criteria for delivery of GDFT for greater than 85% of case time. The median length of stay in the hospital was 5 [3-6] days. CONCLUSION In this pilot study, GDFT management using the closed-loop fluid administration system with a non-invasive CO monitoring device was feasible and maintained a high rate of protocol compliance. CLINICAL TRIAL REGISTRATION NCT02020863.
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Affiliation(s)
- A Joosten
- Department of Anesthesiology and Perioperative Care, University of California Irvine, Irvine, CA, USA Department of Anesthesiology and Critical Care, Erasme University Hospital, Free University of Brussels, Brussels, Belgium
| | - T Huynh
- Department of Anesthesiology and Perioperative Care, University of California Irvine, Irvine, CA, USA
| | - K Suehiro
- Department of Anesthesiology and Perioperative Care, University of California Irvine, Irvine, CA, USA Department of Anesthesiology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - C Canales
- Department of Anesthesiology and Perioperative Care, University of California Irvine, Irvine, CA, USA
| | - M Cannesson
- Department of Anesthesiology and Perioperative Care, University of California Irvine, Irvine, CA, USA
| | - J Rinehart
- Department of Anesthesiology and Perioperative Care, University of California Irvine, Irvine, CA, USA
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Cannesson M, Ani F, Mythen M, Kain Z. Anaesthesiology and perioperative medicine around the world: different names, same goals. Br J Anaesth 2015; 114:8-9. [DOI: 10.1093/bja/aeu265] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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Rinehart J, Le Manach Y, Douiri H, Lee C, Lilot M, Le K, Canales C, Cannesson M. First closed-loop goal directed fluid therapy during surgery: a pilot study. ACTA ACUST UNITED AC 2013; 33:e35-41. [PMID: 24378044 DOI: 10.1016/j.annfar.2013.11.016] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 11/20/2013] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Intraoperative haemodynamic optimization based on fluid management and stroke volume optimization (Goal Directed Fluid Therapy [GDFT]) can improve patients' postoperative outcome. We have described a closed-loop fluid management system based on stroke volume variation and stroke volume monitoring. The goal of this system is to apply GDFT protocols automatically. After conducting simulation, engineering, and animal studies the present report describes the first use of this system in the clinical setting. STUDY DESIGN Prospective pilot study. PATIENTS Patients undergoing major surgery. METHODS Twelve patients at two institutions had intraoperative GDFT delivered by closed-loop controller under the direction of an anaesthesiologist. Compliance with GDFT management was defined as acceptable when a patient spent more than 85% of the surgery time in a preload independent state (defined as stroke volume variation<13%), or when average cardiac index during the case was superior or equal to 2.5l/min/m(2). RESULTS Closed-loop GDFT was completed in 12 patients. Median surgery time was 447 [309-483] min and blood loss was 200 [100-1000] ml. Average cardiac index was 3.2±0.8l/min/m(2) and on average patients spent 91% (76 to 100%) of the surgery time in a preload independent state. Twelve of 12 patients met the criteria for compliance with intraoperative GDFT management. CONCLUSION Intraoperative GDFT delivered by closed-loop system under anaesthesiologist guidance allowed to obtain targeted objectives in 91% of surgery time. This approach may provide a way to ensure consistent high-quality delivery of fluid administration and compliance with perioperative goal directed therapy.
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Affiliation(s)
- J Rinehart
- Department of anesthesiology and perioperative care, university of California Irvine, 101 S City Drive, Orange, CA 92868 Irvine, CA, USA
| | - Y Le Manach
- Department of anesthesiology and critical Care medicine, CHU Pitié-Salpêtrière, Paris, France; Departments of anesthesia and clinical epidemiology and biostatistics, faculty of health sciences, McMaster university and population health research institute, perioperative medicine and surgical research Unit, Hamilton, ON, Canada
| | - H Douiri
- Department of anesthesiology and critical Care medicine, CHU Pitié-Salpêtrière, Paris, France
| | - C Lee
- Department of anesthesiology and perioperative care, university of California Irvine, 101 S City Drive, Orange, CA 92868 Irvine, CA, USA
| | - M Lilot
- Department of anesthesiology and perioperative care, university of California Irvine, 101 S City Drive, Orange, CA 92868 Irvine, CA, USA
| | - K Le
- Department of anesthesiology and perioperative care, university of California Irvine, 101 S City Drive, Orange, CA 92868 Irvine, CA, USA
| | - C Canales
- Department of anesthesiology and perioperative care, university of California Irvine, 101 S City Drive, Orange, CA 92868 Irvine, CA, USA
| | - M Cannesson
- Department of anesthesiology and perioperative care, university of California Irvine, 101 S City Drive, Orange, CA 92868 Irvine, CA, USA.
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Cannesson M. Colloids vs crystalloids for stroke volume optimization: The colloids are taking on water. Ann Fr Anesth Reanim 2013; 32:639-640. [PMID: 24119790 DOI: 10.1016/j.annfar.2013.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- M Cannesson
- Department of anesthesiology and perioperative care, university of California, Irvine, 333, City Boulevard West Side, Orange, CA 92868-3301.
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Souza Neto E, Cannesson M. Reply from the authors. Br J Anaesth 2011. [DOI: 10.1093/bja/aer313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Desgranges FP, Desebbe O, Ghazouani A, Gilbert K, Keller G, Chiari P, Robin J, Bastien O, Lehot JJ, Cannesson M. Influence of the site of measurement on the ability of plethysmographic variability index to predict fluid responsiveness. Br J Anaesth 2011; 107:329-35. [PMID: 21680600 DOI: 10.1093/bja/aer165] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Plethysmographic variability index (PVI) is an accurate predictor of fluid responsiveness in mechanically ventilated patients. However, the site of measurement of the plethysmographic waveform impacts its morphology and its respiratory variation. The goal of this study was to investigate the ability of PVI to predict fluid responsiveness at three sites of measurement (the forehead, ear, and finger) in mechanically ventilated patients under general anaesthesia. METHODS We studied 28 subjects after induction of general anaesthesia. Subjects were monitored with a pulmonary artery catheter and three pulse oximeter sensors (the finger, ear, and forehead). Pulse pressure variation, central venous pressure, cardiac index (CI), and PVI measured at the forehead, ear, and finger (PVI(forehead), PVI(ear), and PVI(finger)) were recorded before and after fluid loading (FL). Subjects were responders to volume expansion if CI increased >15% after FL. RESULTS Areas under the receiver-operating curves to predict fluid responsiveness were 0.906, 0.880, and 0.836 for PVI(forehead), PVI(ear), and PVI(finger), respectively (P<0.05). PVI(forehead), PVI(ear), and PVI(finger) had a threshold value to predict fluid responsiveness of 15%, 16%, and 12% with sensitivities of 89%, 74%, and 74% and specificities of 78%, 74%, and 67%, respectively. CONCLUSIONS PVI can predict fluid responsiveness in anaesthetized and ventilated subjects at all three sites of measurement. However, the threshold values for predicting fluid responsiveness differ with the site of measurement. These results support the use of this plethysmographic dynamic index in the cephalic region when the finger is inaccessible or during states of low peripheral perfusion.
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Affiliation(s)
- F-P Desgranges
- Hospices Civils de Lyon, Department of Anesthesiology and Intensive Care, Louis Pradel Hospital, Claude Bernard Lyon 1 University, INSERM ERI 22, Lyon, France
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Meng L, Cannesson M, Alexander BS, Yu Z, Kain ZN, Cerussi AE, Tromberg BJ, Mantulin WW. Effect of phenylephrine and ephedrine bolus treatment on cerebral oxygenation in anaesthetized patients. Br J Anaesth 2011; 107:209-17. [PMID: 21642644 DOI: 10.1093/bja/aer150] [Citation(s) in RCA: 155] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND How phenylephrine and ephedrine treatments affect global and regional haemodynamics is of major clinical relevance. Cerebral tissue oxygen saturation (Sct(O2) )-guided management may improve postoperative outcome. The physiological variables responsible for Sct(O2) changes induced by phenylephrine and ephedrine bolus treatment in anaesthetized patients need to be defined. METHODS A randomized two-treatment cross-over trial was conducted: one bolus dose of phenylephrine (100-200 µg) and one bolus dose of ephedrine (5-20 mg) were given to 29 ASA I-III patients anaesthetized with propofol and remifentanil. , mean arterial pressure (MAP), cardiac output (CO), and other physiological variables were recorded before and after treatments. The associations of changes were analysed using linear-mixed models. RESULTS The CO decreased significantly after phenylephrine treatment [▵CO = -2.1 (1.4) litre min(-1), P<0.001], but was preserved after ephedrine treatment [▵CO = 0.5 (1.4) litre min(-1), P>0.05]. The was significantly decreased after phenylephrine treatment [▵ = -3.2 (3.0)%, P<0.01] but preserved after ephedrine treatment [▵ = 0.04 (1.9)%, P>0.05]. CO was identified to have the most significant association with (P<0.001). After taking CO into consideration, the other physiological variables, including MAP, were not significantly associated with (P>0.05). CONCLUSIONS Associated with changes in CO, decreased after phenylephrine treatment, but remained unchanged after ephedrine treatment. The significant correlation between CO and implies a cause-effect relationship between global and regional haemodynamics.
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Affiliation(s)
- L Meng
- Department of Anesthesiology and Perioperative Care, University of California, Irvine Medical Center, 101 The City Drive South, Bldg. 53, Rm 227, Orange, CA 92868, USA.
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Pereira de Souza Neto E, Grousson S, Duflo F, Ducreux C, Joly H, Convert J, Mottolese C, Dailler F, Cannesson M. Predicting fluid responsiveness in mechanically ventilated children under general anaesthesia using dynamic parameters and transthoracic echocardiography. Br J Anaesth 2011; 106:856-64. [DOI: 10.1093/bja/aer090] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
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Vichova Z, Hénaine R, Basto Duarte M, Lehot JJ, Cannesson M. Impact of biventricular and left ventricular pacing on hemodynamics and left ventricular dyssynchrony compared with right ventricular pacing in the early postoperative period following cardiac surgery. ACTA ACUST UNITED AC 2011; 30:403-9. [DOI: 10.1016/j.annfar.2011.02.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2010] [Accepted: 02/09/2011] [Indexed: 11/27/2022]
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Rinehart J, Alexander B, Meng L, Cannesson M. Fluid resuscitation based on dynamic predictors of fluid responsiveness: closed loop algorithm versus anesthesiologists. Crit Care 2011. [PMCID: PMC3061681 DOI: 10.1186/cc9471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Cannesson M, Desebbe O, Piriou V, Lehot JJ. Monitorage continu et automatisé de la précharge dépendance en anesthésie et en réanimation : intérêts et limites. ACTA ACUST UNITED AC 2010; 29:452-63. [DOI: 10.1016/j.annfar.2010.03.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2009] [Accepted: 03/04/2010] [Indexed: 10/19/2022]
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Cannesson M, Vallet B, Michard F. Pulse pressure variation and stroke volume variation: from flying blind to flying right? Br J Anaesth 2009; 103:896-7; author reply 897-9. [DOI: 10.1093/bja/aep321] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Simon R, Desebbe O, Hénaine R, Bastien O, Lehot JJ, Cannesson M. Comparaison des valeurs de débit cardiaque obtenues à l’aide d’un nouveau système d’impédancemétrie thoracique avec les données du cathéter artériel pulmonaire en postopératoire de chirurgie cardiaque. ACTA ACUST UNITED AC 2009; 28:537-41. [DOI: 10.1016/j.annfar.2009.04.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2008] [Accepted: 04/21/2009] [Indexed: 10/20/2022]
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Lehot JJ, Collange V, Vichova Z, Cannesson M. Pratique de la circulation extracorporelle et médecine basée sur les preuves. Ing Rech Biomed 2008. [DOI: 10.1016/s1959-0318(08)74450-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Cannesson M, Hénaine R, Di Filippo S, Neidecker J, Bompard D, Védrinne C, Lehot JJ. Utilisation clinique d’un oxymètre de pouls de nouvelle génération dans le cadre de la chirurgie cardiaque pédiatrique. ACTA ACUST UNITED AC 2008; 27:808-12. [DOI: 10.1016/j.annfar.2008.06.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2008] [Accepted: 06/27/2008] [Indexed: 10/21/2022]
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Cannesson M, Desebbe O, Rosamel P, Delannoy B, Robin J, Bastien O, Lehot JJ. Pleth variability index to monitor the respiratory variations in the pulse oximeter plethysmographic waveform amplitude and predict fluid responsiveness in the operating theatre. Br J Anaesth 2008; 101:200-6. [DOI: 10.1093/bja/aen133] [Citation(s) in RCA: 252] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Cannesson M, Piriou V, Neidecker J, Lehot JJ. Anesthésie pour chirurgie non cardiaque chez le patient adulte porteur d'une cardiopathie congénitale. ACTA ACUST UNITED AC 2007; 26:931-42. [DOI: 10.1016/j.annfar.2007.07.082] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2007] [Accepted: 07/25/2007] [Indexed: 11/27/2022]
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Farhat F, Sassard T, Scalabre A, Greffe G, Cannesson M, Jegaden O. Canulations et circuits en chirurgie aortique : complications des canulations artérielles. Ing Rech Biomed 2007. [DOI: 10.1016/s1297-9562(07)78719-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Bastien O, Cannesson M. Microcirculation splanchnique et circulation extra-corporelle. Ing Rech Biomed 2007. [DOI: 10.1016/s1297-9562(07)78718-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Hachemi M, Cannesson M, Vu Thi Z, Cao D, Lehot JJ, Bastien O. Convulsions après chirurgie cardiaque : étude cas-témoins sur une année. Ing Rech Biomed 2007. [DOI: 10.1016/s1297-9562(07)78724-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Attof Y, Hachemi M, Cannesson M, Souza Neto EP, Rosamel P, Chambrier C, Bastien O, Lehot JJ. [From the creation to the appreciation of a personal digital assistant-based clinical decision-support system for the management of artificial nutrition]. ACTA ACUST UNITED AC 2007; 26:1031-6. [PMID: 17977688 DOI: 10.1016/j.annfar.2007.09.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2007] [Accepted: 09/25/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The aim of our study was to assess the effect of NutriPDA, a personal digital assistant (PDA)-based clinical decision-support system (CDSS) for the management of artificial nutrition. A CDSS was developed and implemented on a handheld computer for use in the ICU after cardiovascular and thoracic surgery. STUDY DESIGN System impact was assessed in a prospective "before/after" cohort trial. METHODS After informed consent we studied 61 patients in the postcardiovascular and thoracic surgery ICU (age > 17 years, duration of artificial nutrition > 3 days, length of stay > 8 days). Patients were divided into two groups (before and after the use of NutriPDA: Group A: 32 patients (4-month period in 2005); group B: 29 patients (4-month period in 2006). RESULTS There were no significant differences in anthropometric and clinical parameters between the 2 groups. Energetic intakes were < 80% of basal energetic expenditures in 21% and 1% of patients, respectively (P < 0.01). Caloric and nitrogen intakes were below international recommendation in Group A: 20+/-4 kcal/kg/d (mean+/-SD), 104+/-30 mg/kg/d, but not in Group B: 26+/-5 kcal/kg/d, 196+/-41 mg/kg/d (P < 0.01). CONCLUSION NutriPDA was found to be able to optimize artificial nutrition by improving caloric intake in ICU. This new software has potential clinical applications.
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Affiliation(s)
- Y Attof
- Service d'anesthésie-réanimation, hôpital cardiovasculaire et pneumologique Louis-Pradel, hospices civils de Lyon, BP Lyon-Monchat, 69394 Lyon cedex 03, France; ERI 22, université Claude-Bernard Lyon-I, France.
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Cannesson M, Attof Y, Rosamel P, Joseph P, Bastien O, Lehot JJ. Comparison of FloTrac™ cardiac output monitoring system in patients undergoing coronary artery bypass grafting with pulmonary artery cardiac output measurements. Eur J Anaesthesiol 2007; 24:832-9. [PMID: 17666154 DOI: 10.1017/s0265021507001056] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Arterial pulse waveform analysis has been proposed for cardiac output (CO) determination and monitoring without calibration or thermodilution (FloTrac/Vigileo; Edwards Lifesciences, Irvine, CA, USA). The accuracy and clinical applicability of this technology has not been fully evaluated. We designed this prospective study to compare the accuracy of the FloTrac system (CO(FT)) vs. pulmonary artery catheter standard bolus thermodilution (CO(PAC) ) in patients undergoing coronary artery bypass grafting. METHODS We studied 11 patients referred for coronary artery bypass grafting. CO(FT) and CO(PAC) were determined at six time points in the operating room including before and 5 min after volume expansion (500 mL 6% hetastarch). Measurements were performed on arrival in the intensive care unit and every 4 h afterwards. Bland-Altman analysis was used to assess the agreement between CO(FT) and CO(PAC). RESULTS CO(PAC) ranged from 2.0 to 7.6 L min-1 and CO(FT) ranged from 1.9 to 8.2 L min-1. There was a significant relationship between CO(PAC) and CO(FT) (r = 0.662; P < 0.001). Agreement between CO(PAC) and CO(FT) was -0.26 +/- 0.87 L min-1. Volume expansion induced a significant increase in both CO(PAC) and CO(FT) (from 3.4 +/- 0.8 to 4.4 +/- 1.0 L min-1; P < 0.001 and from 3.9 +/- 1.2 to 5.0 +/- 1.1 L min-1; P < 0.001, respectively) and there was a significant relationship between percent change in CO(PAC) and CO(FT) following volume expansion (r = 0.722; P = 0.01). CONCLUSION We found clinically acceptable agreement between CO(FT) and CO(PAC) in this setting. This new device has potential clinical applications.
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Affiliation(s)
- M Cannesson
- Hospives Civils de Lyon, Hôpital Louis Pradel, Department of Anesthesiology, Bron, France.
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Hachemi M, Attof Y, Cannesson M, Lehot JJ. [Central venous catheterization and cardiac tamponade: comment]. Ann Fr Anesth Reanim 2007; 26:711. [PMID: 17572047 DOI: 10.1016/j.annfar.2007.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
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Rosamel P, Flamens C, Paulus S, Cannesson M, Bastien O. Emergency cardiac mechanical assistance: place of mucosal gastric tonometry as prognostic indicator. Eur J Anaesthesiol 2007; 24:840-6. [PMID: 17582249 DOI: 10.1017/s0265021507000671] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND AND OBJECTIVES The death of patients treated by ventricular assist device is usually related to multiorgan failure for which a disorder of splanchnic circulation is blamed. Gastric tonometry (measurement of gastric intra-mucosal pressure of CO(2)) has already been studied in many fields and especially in cardiac surgery. The aim of this study was to investigate the prognostic value of gastric tonometry monitoring after implantation of a ventricular assist device. METHODS In this prospective study, all consecutive patients scheduled for a ventricular assist device were included. Gastric tonometry was added to standard monitoring. Data were collected (lactate, gastric CO(2) (PgCO(2)) during cardiopulmonary bypass, at admission to ICU, 24 and 48 h later and when norepinephrine was stopped. Preoperative biologic and haemodynamic data were also collected. The primary endpoint was death. RESULTS Fifty-six patients (50 men and 6 women) were included. In 91% of the cases, the mechanical assistance was biventricular. The objective of the assistance was a bridge to transplant in 93% (n = 27). Twenty-seven deaths (48%) occurred during the study, 59% (n = 16) of them took place before the cardiac transplantation (mean time = 18 +/- 16 days after assist device insertion). Many factors were found to be associated with death: weight (P = 0.018), red cells administration (P = 0.025), length of surgery (P = 0.016), PgCO(2) on admission to ICU (P = 0.040) and norepinephrine dose at 24 h. CONCLUSIONS Gastric tonometry has a prognostic value in the early postoperative hours after the implantation of a ventricular assist device.
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Affiliation(s)
- P Rosamel
- Service d'Anesthésie et Réanimation, Hôpital Cardiovasculaire et Pneumologique Louis Pradel, Lyon, France
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Cannesson M, Desebbe O, Hachemi M, Jacques D, Bastien O, Lehot JJ. Respiratory variations in pulse oximeter waveform amplitude are influenced by venous return in mechanically ventilated patients under general anaesthesia. Eur J Anaesthesiol 2007; 24:245-51. [PMID: 17054816 DOI: 10.1017/s026502150600161x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2006] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVES Respiratory variations in pulse oximetry plethysmographic waveform amplitude (DeltaPOP) are related to respiratory variations in arterial pulse pressure (DeltaPP) in the critical care setting. The aims of this study were to test the hypothesis that in mechanically ventilated patients undergoing general anaesthesia, DeltaPOP calculation is feasible and can detect changes in preload. METHODS Twenty-five mechanically ventilated patients were studied immediately after induction of general anaesthesia. Haemodynamic data (mean arterial pressure [MAP], central venous pressure [CVP], DeltaPP and DeltaPOP) were recorded at baseline, before and after tilting the patient from anti-Trendelenburg to Trendelenburg position in order to induce preload changes. RESULTS Change from anti-Trendelenburg to Trendelenburg position induced changes in MAP (58 +/- 9 to 67 +/- 10 mmHg, P < 0.05), CVP (4 +/- 4 to 13 +/- 5 mmHg, P < 0.05), DeltaPP (14 +/- 8 to 7 +/- 5%, P < 0.05) and DeltaPOP (17 +/- 12 to 9 +/- 5%, P < 0.05). There was a significant relationship between DeltaPOP in anti-Trendelenburg position and percent change in MAP after volume expansion (r = 0.82; P < 0.05). CONCLUSIONS DeltaPOP can be determined in the operating room and is influenced by changes in preload. This new index has potential clinical applications for the prediction of fluid responsiveness.
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Affiliation(s)
- M Cannesson
- Claude Bernard Lyon 1 University, Louis Pradel Hospital, Department of Anaesthesiology and Intensive Care, EA 1896, France.
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Cannesson M, Desebbe O, Lehot JJ. Fluid responsiveness using non-invasive predictors during major hepatic surgery. Br J Anaesth 2007; 98:272-3; author reply 273-4. [PMID: 17251218 DOI: 10.1093/bja/ael353] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Cannesson M, Burckard E, Lefèvre M, Bastien O, Lehot JJ. Facteurs de risque de mortalité après chirurgie pour dissection aortique de type A : impact des traitements antithrombotiques préopératoires. ACTA ACUST UNITED AC 2004; 23:568-74. [PMID: 15234721 DOI: 10.1016/j.annfar.2004.03.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2003] [Accepted: 03/10/2004] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The purpose of this investigation was to study the incidence and consequences of anticoagulant therapy in the surgical management of acute aortic dissections. STUDY DESIGN Retrospective study. PATIENTS AND METHODS We reviewed all acute type A aortic dissections that were surgically managed in our institution from 1 January 1990 to 31 December 2000. Survival outcome and characteristics potentially associated with survival were abstracted from patient records. We screened preoperative electrocardiograms (ECG) and anticoagulant therapy. RESULTS ST segment elevation incidence was 14% and preoperative anticoagulant therapy occurred in 63 (20%) cases as follow: aspirin 12%, aspirin + heparin 6%, thrombolysis 1%. Overall mortality was 22%. Time between pain and surgery was not statistically different between anticoagulant therapy and standard group. Administration of antithrombotic agents before admission in -hospital increased significantly mortality (Odds ratio (OR) = 2.02; IC [1.1-3.71]; p = 0.023). Other risk factors for death were preoperative circulatory failure (OR = 8.28 [4.23-16.24], p < 0.0001), preoperative cardiac arrest (OR = 21.92 [7.16-67.14], p < 0.0001), preoperative circulatory arrest (OR = 2.79 [1.60-4.88], p = 0.0003), preoperative cerebral perfusion (OR = 2.45 [1.18-5.05], p = 0.016), postoperative circulatory failure (OR = 3.37 [1.85-6.17], p < 0.0001), postoperative cardiac arrest (OR = 9.92 [3.49-28.21], p < 0.0001), postoperative serum creatinine >150 micromol/l (OR = 4.55 [2.43-8.50], p < 0.0001), postoperative dialysis (OR = 5.63 [2.44-13.20], p < 0.0001), more than 7 days of post-operative ventilation (OR = 23.44 [12.0-45.7], p < 0.0001). DISCUSSION In our experience, 20% of acute type A aortic dissections had received a preoperative anticoagulant therapy. This event is an independent risk factor of in-hospital death and is more frequent in case of ischaemic ECG abnormalities.
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Affiliation(s)
- M Cannesson
- Service d'anesthésie-réanimation, hôpital cardiovasculaire et pneumologique Louis-Pradel, 28, avenue du Doyen-Lépine, 69500 Bron, France.
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Cannesson M, Nargues N, Bryssine B, Debon R, Boselli E, Chassard D. Intrathecal morphine overdose during combined spinal-epidural block for Caesarean delivery. Br J Anaesth 2002; 89:925-7. [PMID: 12453940 DOI: 10.1093/bja/aef286] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
We describe a 25 mg intrathecal morphine overdose during a combined spinal-epidural block for a Caesarean delivery. Naloxone infusion (5.24 mg over 24 h) was started prior to the patient becoming symptomatic and almost immediately after the overdose. Invasive therapeutics such as mechanical ventilation were avoided.
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Affiliation(s)
- M Cannesson
- Service d'Anesthésie-Réanimation, Hôpital de l'Hôtel-Dieu, F-69002 Lyon, France
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