5,986 results on '"*HEMODYNAMIC monitoring"'
Search Results
2. Can Currently Available Non-invasive Continuous Blood Pressure Monitors Replace Invasive Measurement With an Arterial Catheter?
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Gore, Payton, Liu, Hong, and Bohringer, Christian
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Biomedical and Clinical Sciences ,Cardiovascular ,Bioengineering ,Clinical Research ,4.2 Evaluation of markers and technologies ,Detection ,screening and diagnosis ,arterial line ,blood pressure ,continuous non-invasive blood pressure ,hemodynamic monitoring ,non-invasive cardiac output ,Medical and Health Sciences ,Biomedical and clinical sciences ,Health sciences - Abstract
Deviations from normal blood pressure (BP) during general anesthesia have been clearly linked to several adverse outcomes. Measuring BP accurately is therefore critically important for producing excellent outcomes in health care. Normal BP does not necessarily guarantee adequate organ perfusion however and adverse events have occurred even when BP seemed adequate. Invasive blood pressure monitoring has recently evolved beyond merely measuring BP. Arterial line-derived pulse contour analysis is used now to assess both cardiac output and stroke volume variation as indices of adequate intravascular volume. Confirmation of acceptable cardiac output with data derived from invasive intra-arterial catheters has become very important when managing high-risk patients. Newer devices that measure BP continuously and non-invasively in the digital arteries via a finger cuff have also become available. Many clinicians contemplate now if these new devices are ready to replace invasive monitoring with an arterial catheter. Unlike non-invasive devices, intra-arterial catheters allow frequent blood sampling. This makes it possible to assess vital parameters like pH, hemoglobin concentration, ionized calcium, potassium, glucose, and arterial partial pressure of oxygen and carbon dioxide frequently. Non-invasive continuous BP measurement has been found to be unreliable in critically ill patients, the elderly, and patients with calcified arteries. Pulse contour-derived estimates of cardiac output and stroke volume variation have been validated better with data derived from arterial lines than that from the newer finger cuff monitors. Significant advances have been recently made with non-invasive continuous BP monitors. Invasive monitoring with an arterial line however remains the gold standard for measuring BP and assessing pulse contour analysis-derived hemodynamic variables in critically ill patients. In the future, non-invasive continuous BP monitors will likely replace intermittent oscillometers in the operating room and the postoperative period. They will however not eliminate the need for arterial catheterization in critically ill patients. more...
- Published
- 2024
Catalog
3. Central venoplasty followed by 'double guidewire railroad technique' as a bailout strategy in difficult tunnelled dialysis catheter insertion.
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Sulaiman, Shabna and Razik, Abdul
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DIALYSIS catheters , *VENAE cavae , *RAILROAD tunnels , *JUGULAR vein , *HEMODYNAMIC monitoring - Abstract
End‐stage renal disease (ESRD) patients frequently encounter challenges at the time of dialysis catheter insertion from concomitantly associated with thoracic central venous obstruction (TCVO). TCVO complicates the placement of tunnelled dialysis catheters (TDCs). In cases where TCVO is unexpectedly encountered and TDC insertion becomes difficult, central venoplasty followed by catheter reinsertion is required. This report details a novel technique to salvage a TDC that was trapped at the TCVO site after removal of the peel‐away sheath. We describe the case of a 67‐year‐old diabetic male ESRD patient on haemodialysis since 2017, with history of multiple prior accesses, who presented with acute thrombosis of his arteriovenous fistula. TDC placement was attempted via the left internal jugular vein (IJV). Angiography revealed severe stenosis at the left brachiocephalic vein‐superior vena cava confluence, necessitating venoplasty. Post‐venoplasty, the TDC could not be advanced past the IJV venous entry site due to unfavourable catheter tip profile. Utilising a double guidewire railroad technique, the TDC was successfully reinserted, ensuring functional dialysis. The technique carries potential risks, which mandates careful hemodynamic monitoring and prophylactic measures. In conclusion, percutaneous placement of a TDC following a central venoplasty is at times life‐saving in patients with exhausted peripheral vascular access and concomitant TCVO. In the absence of a peel‐away sheath, TDC reinsertion using a double guidewire railroad technique is a helpful technique for salvaging the catheter, especially in financially‐constrained settings. [ABSTRACT FROM AUTHOR] more...
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- 2024
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4. Noninvasive Hemodynamic Monitors, What Is New and Old.
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Siemer, Christopher P., Siemer, Lauren C., Friedman, Amy L., and Alvis, Bret D.
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PLETHYSMOGRAPHY ,MEDICAL technology ,PATIENT safety ,ARTIFICIAL intelligence ,HEMODYNAMICS ,PATIENT monitoring - Abstract
This article reviews the evolution of noninvasive hemodynamic monitoring technologies, highlighting their importance in perioperative and critical care settings. Initially dominated by invasive methods, the field has shifted toward noninvasive techniques to reduce risks and improve patient safety. These advancements encompass various technologies, including bioimpedance/bioreactance, pulse contour analysis, and photoplethysmography, offering anesthesiologists dynamic tools for patient management. The article explores historical developments, traditional and advanced noninvasive monitors, and future trends, emphasizing the potential of integrating artificial intelligence and wearable technology in patient care. [ABSTRACT FROM AUTHOR] more...
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- 2024
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5. Post-anesthesia care unit hypotension in low-risk patients recovering from non-cardiac surgery: a prospective observational study.
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Flick, Moritz, Lohr, Anneke, Weidemann, Friederike, Naebian, Ashkan, Hoppe, Phillip, Thomsen, Kristen K., Krause, Linda, Kouz, Karim, and Saugel, Bernd
- Abstract
Intraoperative hypotension is common and associated with organ injury. Hypotension can not only occur during surgery, but also thereafter. After surgery, most patients are treated in post-anesthesia care units (PACU). The incidence of PACU hypotension is largely unknown – presumably in part because arterial pressure is usually monitored intermittently in PACU patients. We therefore aimed to evaluate the incidence, duration, and severity of PACU hypotension in low-risk patients recovering from non-cardiac surgery. In this observational study, we performed blinded continuous non-invasive arterial pressure monitoring with finger-cuffs (ClearSight system; Edwards Lifesciences, Irvine, CA, USA) in 100 patients recovering from non-cardiac surgery in the PACU. We defined PACU hypotension as a mean arterial pressure (MAP) < 65 mmHg. Patients had continuous finger-cuff monitoring for a median (25th percentile, 75th percentile) of 64 (44 to 91) minutes. Only three patients (3%) had PACU hypotension for at least one consecutive minute. These three patients had 4, 4, and 2 cumulative minutes of PACU hypotension; areas under a MAP of 65 mmHg of 17, 9, and 9 mmHg x minute; and time-weighted averages MAP less than 65 mmHg of 0.5, 0.3, and 0.2 mmHg. The median volume of crystalloid fluid patients were given during PACU treatment was 200 (100 to 400) ml. None was given colloids or a vasopressor during PACU treatment. In low-risk patients recovering from non-cardiac surgery, the incidence of PACU hypotension was very low and the few episodes of PACU hypotension were short and of modest severity. [ABSTRACT FROM AUTHOR] more...
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- 2024
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6. Integrated Piezoelectric Vascular Graft for Continuous Real‐Time Hemodynamics Monitoring.
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Ma, Zhiqiang, Jia, Weibin, Zhang, Jing, He, Xingdao, Liu, Shiyuan, Hilal, Mohamed Elhousseini, Zhou, Xiang, Yang, Zhengbao, Chen, Zonggang, Shi, Peng, and Khoo, Bee Luan
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VASCULAR grafts , *PIEZOELECTRIC detectors , *POLYVINYLIDENE fluoride , *SURGICAL complications , *HEMODYNAMIC monitoring - Abstract
Vascular grafts, widely utilized in managing cardiovascular diseases (CVD), are susceptible to postoperative complications. Recent strides in intelligent vascular grafts leveraging flexible bioelectronics enable hemodynamic and vascular health monitoring. However, their practical application faces challenges, notably biomechanical compatibility and endothelialization. Here, an all‐in‐one piezoelectric vascular graft (PVG) constructed by encapsulating a polyvinylidene fluoride (PVDF) nanofiber mat with patterned silver nanowire (AgNW) electrodes between two layers of polycaprolactone (PCL) nanofiber mats is presented. The meticulously optimized PVG, featuring PVDF and PCL nanofibers with average diameters of ≈950 and 250 nm, respectively, showcases remarkable endothelialization and mechanical performance akin to native blood vessels. The exquisite piezoelectric properties of PVDF nanofibers imbue PVG with outstanding mechanical sensing capabilities, boasting a sensitivity of 11 mV kPa−1 and stability exceeding 50 000 cycles, facilitating precise hemodynamic monitoring. Notably, artificial artery model tests demonstrate PVG's ability to diagnose vascular health status accurately based on detected hemodynamic data. Furthermore, the developed PVG exhibits nontoxicity, good hemocompatibility (hemolytic ratio < 1%), and histocompatibility. This pioneering technology, validated through ex vivo and in vivo experiments, represents a significant stride in precise vascular health management, unlocking diverse potential applications. [ABSTRACT FROM AUTHOR] more...
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- 2024
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7. Fast Multi-Distance Time-Domain NIRS and DCS System for Clinical Applications.
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Nabacino, Marco, Amendola, Caterina, Contini, Davide, Re, Rebecca, Spinelli, Lorenzo, and Torricelli, Alessandro
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ORIGINAL equipment manufacturers , *NEAR infrared spectroscopy , *TISSUES , *HEMODYNAMIC monitoring , *ACQUISITION of data - Abstract
We have designed and built an improved system for combined Time-Domain Near-Infrared Spectroscopy (TD NIRS) and Diffuse Correlation Spectroscopy (DCS) measurements. The system features two independent channels, enabling TD NIRS and DCS acquisition at short and long source-detector distances to enhance depth sensitivity in layered tissues. Moreover, the device can operate at fast acquisition rates (up to 50 Hz) to monitor hemodynamic oscillations in biological tissues. An OEM (Original Equipment Manufacturer) TD NIRS device enables stable and robust acquisition of photon distribution of time-of-flight. For the DCS signals, the use of a time tagger and a software correlator allows us flexibility in post-processing. A user-friendly GUI controls TD NIRS data acquisition and online data analysis. We present results for the system characterization on calibrated tissue phantoms according to standardized protocols for performance assessment of TD NIRS and DCS devices. In-vivo measurements during rest and during vascular occlusions are also reported to validate the system in real settings. [ABSTRACT FROM AUTHOR] more...
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- 2024
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8. Capnodynamic assessment of mixed venous oxygen saturation in a porcine experimental endotoxemic model.
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Svedmyr, Anders, Hedov, Joakim, Lipcsey, Miklos, Wallin, Mats, Hallbäck, Magnus, Lönnqvist, Per-Arne, and Karlsson, Jacob
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PULMONARY artery catheters , *CRITICALLY ill patient care , *SEPTIC shock , *OXYGEN saturation , *MEDICAL personnel , *SEPSIS - Abstract
Sepsis continues to be a major cause of death and illness globally, posing significant challenges for healthcare professionals. In the pursuit of more accurate and timely monitoring tools, the concept of capnodynamically derived mixed venous oxygen saturation (Capno-SvO2) has emerged as a promising method. Capno-SvO2 provides a non-invasive way to assess and track SvO2 and could serve as an additional tool alongside more invasive methods like the pulmonary artery catheter. This could potentially be of great value in the care of critically ill patients with sepsis, where alternative minimal invasive monitoring methods may vary in reliability. The aim of the current study was to compare capno-SvO2 against values obtained through pulmonary artery blood sample CO-oximetry and continuous fiberoptic SvO2 monitoring, using a well-established porcine experimental sepsis model. Anesthetized pigs were exposed to a standardized endotoxin infusion sepsis protocol, followed by a series of maneuvers typically applied in sepsis care. Simultaneous recordings were done throughout the experiment for all three monitoring methods. Bland–Altman analysis corrected for repeated measurements was used to assess the agreement of absolute values between the paired recording of CO-oximetry and Capno-SvO2 as well as between CO-oximetry and fiberoptic SvO2. The ability of Capno-SvO2 and fiberoptic SvO2 to track changes was assessed by concordance rate. A total of 10 animals and 275 paired datapoints were included in the study. The majority of the animals displayed pronounced hemodynamical instability in response to endotoxin exposure and subsequent treatment interventions. Analysis of all paired data points showed a bias between Capno-SvO2 and CO-oximetry SvO2 of + 1% with 95% limits of agreement of -14% to + 17%. The corresponding numbers for fiberoptic SvO2 and CO-oximetry SvO2 were -4% and -15% to + 8%. The concordance rate as compared to CO-oximetry, were 97% and 93% for Capno-SvO2 and fiberoptic SvO2, respectively. In this experimental sepsis model, continuous, non-invasive Capno-SvO2 generates average absolute values comparable to the gold standard CO-oximetry albeit with relatively wide limits of agreement. Capno-SvO2 displayed a concordance rate of 97% against CO-oximetry and exhibits better trending ability compared to invasive fiberoptic SvO2. [ABSTRACT FROM AUTHOR] more...
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- 2024
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9. Monitoring cardiac output.
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De Backer, Daniel, Hajjar, Ludhmila, and Monnet, Xavier
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PULMONARY artery catheters , *PULSE wave analysis , *HEMODYNAMIC monitoring , *ADULT respiratory distress syndrome , *RIGHT ventricular dysfunction , *MEASUREMENT errors , *BOLUS radiotherapy , *CRITICALLY ill patient care - Abstract
The document discusses the importance of monitoring cardiac output (CO) in critically ill patients to differentiate shock mechanisms, trigger therapeutic interventions, and evaluate their effects. Various techniques for measuring CO at the bedside are compared, including echocardiography, bioimpedance, bioreactance, esophageal Doppler, end-tidal CO2, and pulse wave analysis. The selection of a CO monitoring tool should consider invasiveness, patient condition, and the potential value of additional variables. CO measurements are crucial for diagnosing shock types, triggering therapies, and evaluating the effects of interventions or physiological changes in critically ill patients. [Extracted from the article] more...
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- 2024
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10. The accuracy of radial artery applanation tonometry and intra‐arterial blood pressure monitoring in critically ill patients: An evidence‐based review.
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Borg, Amber Leigh and Trapani, Josef
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INFECTION risk factors , *CRITICALLY ill , *PATIENTS , *RADIAL artery , *HEMODYNAMICS , *OPERATIVE surgery , *TONOMETRY , *DIASTOLIC blood pressure , *BLOOD pressure testing machines , *SYSTOLIC blood pressure , *PATIENT monitoring , *BLOOD pressure measurement - Abstract
The invasive intra‐arterial approach is the gold standard for measuring blood pressure in intensive care units where accuracy is crucial. However, invasive procedures increase the risk of infections and mortality. This evidence‐based review aimed to determine whether continuous non‐invasive blood pressure (CNIBP) monitoring, using Radial Artery Applanation Tonometry (RAAT) devices, is as accurate as invasive methods. Six papers were included: three prospective cohort studies and three comparative studies. Most studies showed that mean arterial pressure is accurately recorded through RAAT monitoring; however, more research is needed to assess the accuracy of non‐invasive readings of systolic and diastolic blood pressures, as data are not always concordant. [ABSTRACT FROM AUTHOR] more...
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- 2024
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11. Initiale Diagnostik und Therapie des Schocks.
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Riessen, Reimer, Bulla, Peter, Mengel, Annerose, and Kumle, Bernhard
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CRITICALLY ill patient care ,INTENSIVE care units ,CLINICAL medicine ,CRITICALLY ill ,EMERGENCY medicine - Abstract
Copyright of Medizinische Klinik: Intensivmedizin & Notfallmedizin is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.) more...
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- 2024
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12. Comparison of the ClearSight™ finger cuff monitor versus invasive arterial blood pressure measurement in elective cardiac surgery patients: a prospective observational study.
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Goncin, Una, Liu, Kaixuan K., Rawlyk, Brooklyn, Dalkilic, Sara, Walker, Mary Ellen J., Norton, Jonathan, and Hedlin, Peter
- Abstract
Copyright of Canadian Journal of Anaesthesia / Journal Canadien d'Anesthésie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.) more...
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- 2024
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13. Measured Oxygen Consumption During Pediatric Cardiac Catheterization is More Accurate than Assumed Oxygen Consumption.
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Ralston, Bradford H., Waberski, Andrew T., Kanter, Joshua P., Schick, Jacob W., and Downing, Tacy E.
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CONGENITAL heart disease , *OXYGEN consumption , *CARDIAC magnetic resonance imaging , *OLDER patients , *CARDIAC catheterization - Abstract
When calculating cardiac index (C.I.) by the Fick method, oxygen consumption (VO2) is often unknown, so assumed values are typically used. This practice introduces a known source of inaccuracy into the calculation. Using a measured VO2 (mVO2) from the CARESCAPE E-sCAiOVX module provides an alternative that may improve accuracy of C.I. calculations. Our aim is to validate this measurement in a general pediatric catheterization population and compare its accuracy with assumed VO2 (aVO2). mVO2 was recorded for all patients undergoing cardiac catheterization with general anesthesia and controlled ventilation during the study period. mVO2 was compared to the reference VO2 (refVO2) determined by the reverse Fick method using cardiac MRI (cMRI) or thermodilution (TD) as a reference standard for measurement of C.I. when available. 193 VO2 measurements were obtained, including 71 with a corresponding cMRI or TD measure of cardiac index for validation. mVO2 demonstrated satisfactory concordance and correlation with the TD- or cMRI-derived refVO2 (ρc = 0.73, r2 = 0.63) with a mean bias of − 3.2% (SD ± 17.3%). Assumed VO2 demonstrated much weaker concordance and correlation with refVO2 (ρc = 0.28, r2 = 0.31) with a mean bias of + 27.5% (SD ± 30.0%). Subgroup analysis of patients < 36 months of age demonstrated that error in mVO2 was not significantly different from that observed in older patients. Many previously reported prediction models for assuming VO2 performed poorly in this younger age range. Measured oxygen consumption using the E-sCAiOVX module is significantly more accurate than assumed VO2 when compared to TD- or cMRI-derived VO2 in a pediatric catheterization lab. [ABSTRACT FROM AUTHOR] more...
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- 2024
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14. Reanimación hídrica: predicción de la respuesta a volumen. Parte 1.
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Garduño-López, Jessica, Sánchez-Parada, Nora M., López-Rodríguez, Karen H., Amezcua-Gutiérrez, Marcos A., Gorordo-Delsol, Luis A., and Gasca-Aldama, José C.
- Subjects
FLUID therapy ,HEMODYNAMICS ,DECISION making in clinical medicine ,INTRAVENOUS therapy ,CENTRAL venous pressure ,SHOCK (Pathology) ,PATIENT monitoring - Abstract
Copyright of Revista de Educación e Investigación en Emergencias is the property of Publicidad Permanyer SLU and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.) more...
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- 2024
- Full Text
- View/download PDF
15. Capnodynamic assessment of mixed venous oxygen saturation in a porcine experimental endotoxemic model
- Author
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Anders Svedmyr, Joakim Hedov, Miklos Lipcsey, Mats Wallin, Magnus Hallbäck, Per-Arne Lönnqvist, and Jacob Karlsson
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SvO2 ,Mixed venous saturation ,Sepsis ,Septic shock ,Hemodynamic monitoring ,Non-invasive ,Medicine ,Science - Abstract
Abstract Sepsis continues to be a major cause of death and illness globally, posing significant challenges for healthcare professionals. In the pursuit of more accurate and timely monitoring tools, the concept of capnodynamically derived mixed venous oxygen saturation (Capno-SvO2) has emerged as a promising method. Capno-SvO2 provides a non-invasive way to assess and track SvO2 and could serve as an additional tool alongside more invasive methods like the pulmonary artery catheter. This could potentially be of great value in the care of critically ill patients with sepsis, where alternative minimal invasive monitoring methods may vary in reliability. The aim of the current study was to compare capno-SvO2 against values obtained through pulmonary artery blood sample CO-oximetry and continuous fiberoptic SvO2 monitoring, using a well-established porcine experimental sepsis model. Anesthetized pigs were exposed to a standardized endotoxin infusion sepsis protocol, followed by a series of maneuvers typically applied in sepsis care. Simultaneous recordings were done throughout the experiment for all three monitoring methods. Bland–Altman analysis corrected for repeated measurements was used to assess the agreement of absolute values between the paired recording of CO-oximetry and Capno-SvO2 as well as between CO-oximetry and fiberoptic SvO2. The ability of Capno-SvO2 and fiberoptic SvO2 to track changes was assessed by concordance rate. A total of 10 animals and 275 paired datapoints were included in the study. The majority of the animals displayed pronounced hemodynamical instability in response to endotoxin exposure and subsequent treatment interventions. Analysis of all paired data points showed a bias between Capno-SvO2 and CO-oximetry SvO2 of + 1% with 95% limits of agreement of -14% to + 17%. The corresponding numbers for fiberoptic SvO2 and CO-oximetry SvO2 were -4% and -15% to + 8%. The concordance rate as compared to CO-oximetry, were 97% and 93% for Capno-SvO2 and fiberoptic SvO2, respectively. In this experimental sepsis model, continuous, non-invasive Capno-SvO2 generates average absolute values comparable to the gold standard CO-oximetry albeit with relatively wide limits of agreement. Capno-SvO2 displayed a concordance rate of 97% against CO-oximetry and exhibits better trending ability compared to invasive fiberoptic SvO2. more...
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- 2024
- Full Text
- View/download PDF
16. Assessment of fluid responsiveness as a component of hemodynamic monitoring in the operating room and intensive care unit
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N.V. Matolinets and I.I. Yakymenko
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fluid therapy ,hemodynamic monitoring ,fluid responsiveness ,dynamic methods ,Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
Fluid therapy is a critical, and often primary treatment modality in the management of various critical conditions. Like any therapeutic intervention, intravenous fluids require precise indications, contraindications, and dosing, all determined through the assessment of a patient’s volume status. Hemodynamic assessment plays a pivotal role in the treatment of critically ill patients, enabling clinicians to administer appropriate fluid therapy and cardiovascular support to optimize tissue perfusion and oxygenation. Traditional methods of assessing fluid responsiveness, which are predominantly static such as central venous pressure and pulmonary artery occlusion pressure, often fall short in their predictive accuracy under dynamic clinical conditions. Consequently, there is a growing interest in dynamic methods of fluid responsiveness assessment, which analyze cardiovascular response to specific preload changes. This literature review aims to explore various dynamic methods of hemodynamic assessment, discussing their advantages and limitations based on sources from databases like PubMed and MEDLINE. more...
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- 2024
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17. Midline Catheters as an Alternative for Central Venous Catheters in Venous Oxygen Saturation Monitoring: A Single Center Experience.
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Kim, Justin S., Ivanovic, Sasa, Davison, Danielle, Bheem, Rishika, Wu, Maria, Sweeney, Brendan, Shaykhinurov, Eduard, and Yamane, David
- Abstract
Background: Central venous oxygen saturation (ScvO2) obtained from a central venous catheter (CVC) is often used to approximate oxygen delivery in critically ill patients. Despite their importance in administering medications and monitoring oxygen delivery, the use of CVCs can be associated with significant complications. Midline catheters are inserted via a peripheral vein above the antecubital fossa and provide a safe alternative to CVCs. This study aimed to determine the equivalence of ScvO2 and midline catheter oxygen saturation (SmO2) in critically ill patients. Methods: This was a single-center observational study of critically ill adult patients who had concurrently placed CVCs (internal jugular and subclavian) and midline catheters as part of standard ICU care. Venous oxygen saturation and lactate levels were measured from both catheters using the Abbott point-of-care i-STAT analyzer. Demographic and ICU admission data were collected. Continuous variables were compared using the paired t-test. Pearson's correlation was used to evaluate the linear correlation between ScvO2 and SmO2. The systematic error (bias) was calculated using Bland-Altman analysis. Receiver operating characteristic curves were constructed to evaluate the sensitivities and specificities for different values of SmO2 to predict ScvO2. Results: Forty-eight patients (n = 48) were enrolled in the study. The mean ScvO2 and SmO2 were 65.5% +/- 11.2% and 62.7% +/- 17.6% respectively (p = 0.1197). In the Bland-Altman analysis, the mean bias between ScvO2 and SmO2 was 2.8% +/- 12.3% with 95% limits of agreement of −21.3% to 26.9%. More than 60% of the ScvO2 and SmO2 values diverged by ≥ 5%. Conclusions: The difference between the mean SmO2 and ScvO2 was not statistically significant and the mean bias between SmO2 and ScvO2 is low. Despite this, the substantially large standard deviation and limits of agreement preclude the use of SmO2 as a direct surrogate of ScvO2. [ABSTRACT FROM AUTHOR] more...
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- 2025
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18. Impact of staged goal-directed fluid therapy on postoperative pulmonary complications in patients undergoing McKeown esophagectomy: a randomized controlled trial
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Chao Yang, Yujie Shi, Min Zhang, Yang Yang, and Yanhu Xie
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Goal-directed therapy ,Hemodynamic monitoring ,Pulmonary complications ,Postoperative ,McKeown esophagectomy ,Stroke volume variation ,Anesthesiology ,RD78.3-87.3 - Abstract
Abstract Background Our aim was to evaluate the influence of staged goal directed therapy (GDT) on postoperative pulmonary complications (PPCs), intraoperative hemodynamics and oxygenation in patients undergoing Mckeown esophagectomy. Methods Patients were randomly divided into three groups, staged GDT group (group A, n = 56): stroke volume variation (SVV) was set at 8–10% during the one lung ventilation (OLV) stage and 8–12% during the two lung ventilation (TLV) stage, GDT group (group B, n = 56): received GDT with a target SVV of 8–12% During the entire surgical procedure, and control group (group C, n = 56): conventional fluid therapy was administered by mean arterial pressure (MAP), central venous pressure (CVP), and urine volume. The primary outcome was the incidence of postoperative pulmonary complications within Postoperative days (POD) 7. The secondary outcomes were postoperative lung ultrasound (LUS) B-lines artefacts (BLA) scoring, incidence of other complications, the length of hospital stay, intraoperative hemodynamic and oxygenation indicators included mean arterial pressure (MAP), heart rate (HR), cardiac index (CI), cardiac output (CO), oxygenation index (OI), respiratory indices (RI), alveolar-arterial oxygen difference (Aa-DO2). Results Patients in group A and group B had a lower incidence of PPCs (7/56 vs. 17/56 and 9/56 vs. 17/56, p more...
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- 2024
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19. Predicting intradialytic hypotension in critically ill patients undergoing intermittent hemodialysis: a prospective observational study
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Rogério da Hora Passos, Fernanda Oliveira Coelho, Juliana Ribeiro Caldas, Erica Batista dosde Santos GalvãoMelo, Augusto Manoel de Carvalho Farias, Octávio Henrique Coelho Messeder, and Etienne Macedo more...
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Acute kidney injury ,Dynamic arterial elastance ,Hemodynamic monitoring ,Intradialytic hypotension ,Kidney replacement therapy ,Passive leg raising test ,Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
Abstract Background Hypotension during dialysis arises from vasomotor tone alterations and hypovolemia, with disrupted counterregulatory mechanisms in acute kidney injury (AKI) patients. This study investigated the predictive value of preload dependency, assessed by the passive leg raising (PLR) test, and arterial tone, measured by dynamic elastance (Eadyn), for intradialytic hypotension (IDH). Methods In this prospective observational study conducted in a tertiary hospital ICU, hemodynamic parameters were collected from critically ill AKI patients undergoing intermittent hemodialysis using the FloTrac/Vigileo system. Baseline measurements were recorded before KRT initiation, including the PLR test and Eadyn calculation. IDH was defined as mean arterial pressure (MAP) more...
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- 2024
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20. Is time to first CT scan in patients with isolated severe traumatic brain injury prolonged when prehospital arterial cannulation is performed? A retrospective non-inferiority study
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Michael Eichlseder, Sebastian Labenbacher, Alexander Pichler, Michael Eichinger, Thomas Kuenzer, Philipp Zoidl, Barbara Hallmann, Felix Stelzl, Nikolaus Schreiber, and Paul Zajic
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Brain Injuries ,Traumatic ,Emergency medical services ,Blood pressure ,Arterial pressure ,Hemodynamic monitoring ,Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
Abstract Background Invasive blood pressure measurement is the in-hospital gold standard to guide hemodynamic management and consecutively cerebral perfusion pressure in patients with traumatic brain injury (TBI). Its prehospital use is controversial since it may delay further care. The primary aim of this study was to test the hypothesis that patients with severe traumatic brain injury who receive prehospital arterial cannulation, compared to those with in-hospital cannulation, do not have a prolonged time between on-scene arrival and first computed tomography (CT) of the head by more than ten minutes. Methods This retrospective study included patients 18 years and older with isolated severe TBI and prehospital induction of emergency anaesthesia who received treatment in the resuscitation room of the University Hospital of Graz between January 1st, 2015, and December 31st, 2022. A Wilcoxon rank-sum test was used to test for non-inferiority (margin = ten minutes) of the time interval between on-scene arrival and first head CT. Results We included data of 181 patients in the final analysis. Prehospital arterial line insertion was performed in 87 patients (48%). Median (25–75th percentile) durations between on-scene arrival and first head CT were 73 (61–92) min for prehospital arterial cannulation and 75 (60–93) min for arterial cannulation in the resuscitation room. Prehospital arterial line insertion was significantly non-inferior within a margin of ten minutes with a median difference of 1 min (95% CI − 6 to 7, p = 0.003). Conclusion Time-interval between on-scene arrival and first head CT in patients with isolated severe traumatic brain injury who received prehospital arterial cannulation was not prolonged compared to those with in-hospital cannulation. This supports early out-of-hospital arterial cannulation performed by experienced providers. more...
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- 2024
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21. Comparison between Handheld Echocardiography and Cardiac Magnetic Resonance for Stroke Volume and Left Ventricular Ejection Fraction Quantification
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Frederique Maria de Raat, Sjoerd Bouwmeester, R. Arthur Bouwman, and Patrick Houthuizen
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handheld echocardiography ,hemodynamic monitoring ,left ventricle ejection fraction ,point-of-care ultrasound ,stroke volume ,Medical technology ,R855-855.5 - Abstract
Background: Reliable quantification of stroke volume (SV) and left ventricular ejection fraction (LVEF) is essential for point-of-care assessment in hemodynamically compromised patients. Handheld echocardiography (HHE) equipment has entered the market a few years ago and is now available for clinical use. However, the performance of HHE for SV and LVEF quantification in comparison to cardiac magnetic resonance (CMR) imaging as golden standard is yet unknown. Methods: Twenty volunteers were scanned with HHE, standard echocardiography (SE), and CMR. LVEF and SV were measured with each modality, and their accuracy and precision were evaluated. Results: Bias and limits of agreement (LOA) between HHE and CMR were −0.21% (−2.89: 2.48) and 11.24% (−15.79: 15.59) for LVEF and 29.85 ml (22.13: 37.57) and 32.34 ml (−15.01: 44.86) for SV, respectively. Bias and LOA between SE and CMR were −0.60% (−3.74:2.55) and 13.16% (−18.85:18.26) for LVEF and 32.08 ml (24.61:39.54) and 31.34 ml (−11.29:43.37) for SV, respectively. Conclusion: HHE versus CMR showed comparable accuracy and precision compared to SE versus CMR. more...
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- 2024
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22. Non-invasive hemodynamic monitoring during initiation of positive airway pressure treatment in patients with obstructive sleep apnea: a feasibility study
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Christoph Müller, Jens Kerl, and Dominic Dellweg
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Obstructive sleep apnea ,Positive airway pressure ,Hemodynamic monitoring ,Impedance cardiography ,Medicine - Abstract
Abstract Background The association of obstructive sleep apnea (OSA) with cardiovascular morbidity has been repeatedly reported in numerous studies and argues for treatment initiation even in the absence of significant day time sleepiness. While the long-term consequences of positive airway pressure (PAP) treatment on OSA related comorbidities like secondary hypertension are based on substantial clinical evidence, less is known about the immediate hemodynamic effects. Methods This study tried to investigate the impact of PAP treatment on different hemodynamic parameters in 48 patients with OSA by extending the standard polysomnographic assessment with non-invasive hemodynamic monitoring using impedance cardiography (ICG). On two consecutive nights under diagnostic and therapeutic conditions, polysomnographic and hemodynamic data were acquired. In addition, we subdivided the participants according to their treatment related change in stroke volume (SV) and assigned the hemodynamic measurements to the corresponding sleep stage. Results Comparing both conditions, a non-statistically significant decrease in SV and cardiac output (CO) was observed for all participants. Treatment initiation was associated with a statistically significant prolongation of the pre-ejection period (PEP) for the entire study population (p = 0.001) and the subgroup with decreasing SV (p = 0.008). In addition, systolic blood pressure (SBP) (p = 0.026) and pulse pressure (PP) (p = 0.041) were lowered significantly for patients with a therapeutically reduced SV under treatment conditions. A higher BMI (p = 0.020) and a more pronounced reduction of the respiratory distress index (RDI) (p = 0.030) and the arousal-index (p = 0.021) were observed for patients with decreasing SV. Correlational analysis revealed a negative relationship between the diagnostic values for both SBP (r=-0.324, p = 0.025) and PP (r=-0.407, p = 0.004) with the change in SV and a positive correlation with the change of the SBP (r = 0.317, p = 0.028) for all participants. Conclusions To conclude, our results indicate that treatment with a PAP device in patients with OSA can lead to a decrease in SV which is associated with a lowering of the SBP. This may be caused by a reduced sympathetic tone due to less respiratory events and an improved sleep profile. more...
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- 2024
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23. Correlation and concordance of carotid Doppler ultrasound and echocardiography with invasive cardiac output measurement in critically ill patients
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María Camila Arango-Granados, Jaime Andrés Quintero-Ramírez, Felipe Mejía-Herrera, Lina Mayerly Henao-Cardona, Valentina Muñoz-Patiño, and Luis Alfonso Bustamante-Cristancho
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Cardiac output ,Carotid Doppler ,Invasive hemodynamic monitoring ,Ultrasound ,Intensive care ,Echocardiography ,Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
Abstract Background Critical care management heavily relies on accurate cardiac output (CO) measurement. Echocardiography has been a mainstay in non-invasive cardiac monitoring; however, its comparability to invasive methods warrants further exploration. Recent studies have suggested the potential of carotid Doppler measurements as a promising approach to estimate CO. Despite this potential, the literature presents mixed outcomes regarding its reliability and accuracy. This study aims to evaluate the correlation and concordance between carotid Doppler ultrasonography and invasive hemodynamic monitoring in estimating CO in critically ill patients. Furthermore, it assesses the concordance and correlation between echocardiography CO and the standard invasive CO measurements. Methods This concordance study involved critically ill adults requiring invasive CO measurement. Patients with arrhythmias, severe valvulopathy, pregnancy, and poor acoustic window were excluded. Statistical analyses comprised univariate analysis, Wilcoxon signed-rank test, Spearman correlation, and intraclass correlation coefficient. Ethical approval was granted by the institution’s ethics committee. Results A total of 49 critically ill patients were included, predominantly male (63.27%), with a median age of 57 years. Diagnoses included subarachnoid hemorrhage (53.06%) and heart failure (8.16%). Mean cardiac index was 3.36 ± 0.81 L/min/m2 and mean cardiac output was 5.98 ± 1.47 L/min. Spearman correlation coefficient between echocardiography and invasive CO measurements was 0.58 (p-value = p more...
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- 2024
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24. Fluid boluses and infusions in the early phase of resuscitation from septic shock and sepsis-induced hypotension: a retrospective report and outcome analysis from a tertiary hospital
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Antonio Messina, Marco Albini, Nicolò Samuelli, Andrea Brunati, Elena Costantini, Giulia Lionetti, Marta Lubian, Massimiliano Greco, Guia Margherita Matronola, Fabio Piccirillo, Daniel De Backer, Jean Louis Teboul, and Maurizio Cecconi more...
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Fluid therapy ,Fluid bolus ,Fluids ,Electronic health records system ,Fluid responsiveness ,Hemodynamic monitoring ,Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
Abstract Background Fluid administration is the first line treatment in intensive care unit (ICU) patients with sepsis and septic shock. While fluid boluses administration can be titrated by predicting preload dependency, the amount of other forms of fluids may be more complex to be evaluated. We conducted a retrospective analysis in a tertiary hospital, to assess the ratio between fluids given as boluses and total administered fluid intake during early phases of ICU stay, and to evaluate the impact of fluid strategy on ICU mortality. Data related to fluid administration during the first four days of ICU stay were exported from an electronic health records system (ICCA®, Philips Healthcare). Demographic data, severity score, norepinephrine dose at ICU admission, overall fluid balance and the percentage of different fluid components of the overall volume administered were included in a multivariable logistic regression model, evaluating the association with ICU survival. Results We analyzed 220 patients admitted with septic shock and sepsis-induced hypotension from 1st July 2021 to 31st December 2023. Fluid boluses and maintenance represented 49.3% ± 22.8 of the overall fluid intake, being balanced solution the most represented (40.4% ± 22.0). The fluid volume for drug infusion represented 34.0% ± 2.9 of the total fluid intake, while oral or via nasogastric tube fluid intake represented 18.0% ± 15.7 of the total fluid intake. Fluid volume given as boluses represented 8.6% of the total fluid intake over the four days, with a reduction from 25.1% ± 24.0 on Day 1 to 4.8% ± 8.7 on Day 4. A positive fluid balance [OR 1.167 (1.029–1.341); p = 0.021] was the most important factor associated with ICU mortality. Non-survivors (n = 66; 30%) received a higher amount of overall inputs than survivors only on Day 1 [2493 mL vs. 1855 mL; p = 0.022]. Conclusions This retrospective analysis of fluids given over the early phases of septic shock and sepsis-induced hypotension showed that the overall volume given by boluses ranges from about 25% on Day 1 to about 5% on Day 4 from ICU admission. Our data confirms that a positive fluid balance over the first 4 days of ICU is associated with mortality. more...
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- 2024
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25. Evaluating tissue hypoxia and the response to fluid administration in septic shock patients: a metabolic cluster analysis
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Cristina Espinal, Edgar Cortés, Anna Pérez-Madrigal, Paula Saludes, Aurora Gil, Alba Caballer, Sara Nogales, Guillem Gruartmoner, and Jaume Mesquida
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Lactate ,Venous oxygen saturation ,Venous-to-arterial carbon dioxide difference ,Fluid responsiveness ,Circulatory shock ,Hemodynamic monitoring ,Anesthesiology ,RD78.3-87.3 - Abstract
Abstract Background The selection of adequate indicators of tissue hypoxia for guiding the resuscitation process of septic patients is a highly relevant issue. Current guidelines advocate for the use of lactate as sole metabolic marker, which may be markedly limited, and the integration of different variables seems more adequate. In this study, we explored the metabolic profile and its implications in the response to the administration of a fluid challenge in early septic shock patients. Methods Observational study including septic shock patients within 24 h of ICU admission, monitored with a cardiac output estimation system, with ongoing resuscitation. Hemodynamic and metabolic variables were measured before and after a fluid challenge (FC). A two-step cluster analysis was used to define the baseline metabolic profile, including lactate, central venous oxygen saturation (ScvO2), central venous-to-arterial carbon dioxide difference (PcvaCO2), and PcvaCO2 corrected by the difference in arterial-to-venous oxygen content (PcvaCO2/CavO2). Results Seventy-seven fluid challenges were analyzed. Cluster analysis revealed two distinct metabolic profiles at baseline. Cluster A exhibited lower ScvO2, higher PcvaCO2, and lower PcvaCO2/CavO2. Increases in cardiac output (CO) were associated with increases in VO2 exclusively in cluster A. Baseline isolated metabolic variables did not correlate with VO2 response, and changes in ScvO2 and PcvaCO2 were associated to VO2 increase only in cluster A. Conclusions In a population of early septic shock patients, two distinct metabolic profiles were identified, suggesting tissue hypoxia or dysoxia. Integrating metabolic variables enhances the ability to detect those patients whose VO2 might increase as results of fluid administration. more...
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- 2024
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26. Continuous non-invasive vs. invasive arterial blood pressure monitoring during neuroradiological procedure: a comparative, prospective, monocentric, observational study
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Xavier Chapalain, Thomas Morvan, Jean-Christophe Gentric, Aurélie Subileau, Christophe Jacob, Anna Cadic, Anaïs Caillard, and Olivier Huet
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Blood pressure ,Hemodynamic monitoring ,Intraoperative ,Neuroradiology ,Surgery ,RD1-811 - Abstract
Abstract Background In the perioperative setting, the most accurate way to continuously measure arterial blood pressure (ABP) is using an arterial catheter. Surrogate methods such as finger cuff have been developed to allow non-invasive measurements and are increasingly used, but need further evaluation. The aim of this study is to evaluate the accuracy and clinical concordance between two devices for the measurement of ABP during neuroradiological procedure. Methods This is a prospective, monocentric, observational study. All consecutive patients undergoing a neuroradiological procedure were eligible. Patients who needed arterial catheter for blood pressure measurement were included. During neuroradiological procedure, ABP (systolic, mean and diatolic blood pressure) was measured with two different technologies: radial artery catheter and Nexfin. Bland-Altman and error grid analyses were performed to evaluate the accuracy and clinical concordance between devices. Results From March 2022 to November 2022, we included 50 patients, mostly ASA 3 (60%) and required a cerebral embolization (94%) under general anaesthesia (96%). Error grid analysis showed that 99% of non-invasive ABP measures obtained with the Nexfin were located in the risk zone A or B. However, 65.7% of hypertension events and 41% of hypotensive events were respectively not detected by Nexfin. Compared to the artery catheter, a significant relationship was found for SAP (r 2 = 0.78) and MAP (r 2 = 0.80) with the Nexfin (p more...
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- 2024
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27. CardioMEMS monitoring device migration: A rare complication
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Maan Awad, MBBS, Mark Colantonio, MD, Marcelino Mederos Liriano, MD, Matthew Santer, DO, Katherine Shepherd, MD, and Affan Haleem, MD
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CarrdioMEMS ,Heart failure ,Ambulatory hemodynamic monitoring ,CHF exacerbation ,Medical physics. Medical radiology. Nuclear medicine ,R895-920 - Abstract
We present a rare case of CardioMEMS device migration six years post-implantation. Much is still being learned about endothelization of pulmonary vasculature and this case highlights the importance of device surveillance and device-related complications. more...
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- 2024
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28. Impact of staged goal-directed fluid therapy on postoperative pulmonary complications in patients undergoing McKeown esophagectomy: a randomized controlled trial.
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Yang, Chao, Shi, Yujie, Zhang, Min, Yang, Yang, and Xie, Yanhu
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ESOPHAGEAL surgery , *RESEARCH funding , *FLUID therapy , *STATISTICAL sampling , *HEMODYNAMICS , *RANDOMIZED controlled trials , *DESCRIPTIVE statistics , *LUNGS , *INTRAOPERATIVE monitoring , *REACTIVE oxygen species , *OXYGEN in the body , *ARTERIAL pressure , *HEART beat , *CARDIAC output , *INTRAOPERATIVE care , *CENTRAL venous pressure , *CONVALESCENCE , *STROKE volume (Cardiac output) , *POSTOPERATIVE period , *LENGTH of stay in hospitals , *COMPARATIVE studies , *MECHANICAL ventilators ,PREVENTION of surgical complications ,DIGESTIVE organ surgery - Abstract
Background: Our aim was to evaluate the influence of staged goal directed therapy (GDT) on postoperative pulmonary complications (PPCs), intraoperative hemodynamics and oxygenation in patients undergoing Mckeown esophagectomy. Methods: Patients were randomly divided into three groups, staged GDT group (group A, n = 56): stroke volume variation (SVV) was set at 8–10% during the one lung ventilation (OLV) stage and 8–12% during the two lung ventilation (TLV) stage, GDT group (group B, n = 56): received GDT with a target SVV of 8–12% During the entire surgical procedure, and control group (group C, n = 56): conventional fluid therapy was administered by mean arterial pressure (MAP), central venous pressure (CVP), and urine volume. The primary outcome was the incidence of postoperative pulmonary complications within Postoperative days (POD) 7. The secondary outcomes were postoperative lung ultrasound (LUS) B-lines artefacts (BLA) scoring, incidence of other complications, the length of hospital stay, intraoperative hemodynamic and oxygenation indicators included mean arterial pressure (MAP), heart rate (HR), cardiac index (CI), cardiac output (CO), oxygenation index (OI), respiratory indices (RI), alveolar-arterial oxygen difference (Aa-DO2). Results: Patients in group A and group B had a lower incidence of PPCs (7/56 vs. 17/56 and 9/56 vs. 17/56, p < 0.05), and a fewer B-lines score on postoperative ultrasound (4.61 ± 0.51 vs. 6.15 ± 0.74 and 4.75 ± 0.62 vs. 6.15 ± 0.74, p < 0.05) compared to group C. The CI, CO, MAP, and OI were higher in group A compared to group B and group C in the stage of thoracic operation. During the abdominal operation stage, patients in group A and group B had a better hemodynamic and oxygenation indicators than group C. Conclusions: In comparison to conventional fluid therapy, intraoperative staged GDT can significantly reduce the incidence of postoperative pulmonary complications in patients undergoing McKeown esophagectomy, facilitating patient recovery. Compared to GDT, it can improve intraoperative oxygenation and stabilize intraoperative hemodynamics in patients. Trial registration: This study was registered in the Chinese Clinical Trial Registry on 24/11/2021 (ChiCTR2100053598). [ABSTRACT FROM AUTHOR] more...
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- 2024
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29. Critical Care Ultrasound in Shock: A Comprehensive Review of Ultrasound Protocol for Hemodynamic Assessment in the Intensive Care Unit.
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Pérez, Camilo, Diaz-Caicedo, Diana, Almanza Hernández, David Fernando, Moreno-Araque, Lorena, Yepes, Andrés Felipe, and Carrizosa Gonzalez, Jorge Armando
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INTENSIVE care units , *CARDIAC output , *HEMODYNAMIC monitoring , *CRITICAL care medicine , *ULTRASONIC imaging - Abstract
Shock is a life-threatening condition that requires prompt recognition and treatment to prevent organ failure. In the intensive care unit, shock is a common presentation, and its management is challenging. Critical care ultrasound has emerged as a reliable and reproducible tool in diagnosing and classifying shock. This comprehensive review proposes an ultrasound-based protocol for the hemodynamic assessment of shock to guide its management in the ICU. The protocol classifies shock as either low or high cardiac index and differentiates obstructive, hypovolemic, cardiogenic, and distributive etiologies. In distributive shock, the protocol proposes a hemodynamic-based approach that considers the presence of dynamic obstruction, fluid responsiveness, fluid tolerance, and ventriculo-arterial coupling. The protocol gives value to quantitative measures based on critical care ultrasound to guide hemodynamic management. Using critical care ultrasound for a comprehensive hemodynamic assessment can help clinicians diagnose the etiology of shock and define the appropriate treatment while monitoring the response. The protocol's use in the ICU can facilitate prompt recognition, diagnosis, and management of shock, ultimately improving patient outcomes. [ABSTRACT FROM AUTHOR] more...
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- 2024
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30. Artifact Management for Cerebral Near-Infrared Spectroscopy Signals: A Systematic Scoping Review.
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Bergmann, Tobias, Vakitbilir, Nuray, Gomez, Alwyn, Islam, Abrar, Stein, Kevin Y., Sainbhi, Amanjyot Singh, Froese, Logan, and Zeiler, Frederick A.
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NEAR infrared spectroscopy , *HEMODYNAMIC monitoring , *PATIENT monitoring , *DATABASE searching , *DATA quality - Abstract
Artifacts induced during patient monitoring are a main limitation for near-infrared spectroscopy (NIRS) as a non-invasive method of cerebral hemodynamic monitoring. There currently does not exist a robust "gold-standard" method for artifact management for these signals. The objective of this review is to comprehensively examine the literature on existing artifact management methods for cerebral NIRS signals recorded in animals and humans. A search of five databases was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The search yielded 806 unique results. There were 19 articles from these results that were included in this review based on the inclusion/exclusion criteria. There were an additional 36 articles identified in the references of select articles that were also included. The methods outlined in these articles were grouped under two major categories: (1) motion and other disconnection artifact removal methods; (2) data quality improvement and physiological/other noise artifact filtering methods. These were sub-categorized by method type. It proved difficult to quantitatively compare the methods due to the heterogeneity of the effectiveness metrics and definitions of artifacts. The limitations evident in the existing literature justify the need for more comprehensive comparisons of artifact management. This review provides insights into the available methods for artifact management in cerebral NIRS and justification for a homogenous method to quantify the effectiveness of artifact management methods. This builds upon the work of two existing reviews that have been conducted on this topic; however, the scope is extended to all artifact types and all NIRS recording types. Future work by our lab in cerebral NIRS artifact management will lie in a layered artifact management method that will employ different techniques covered in this review (including dynamic thresholding, autoregressive-based methods, and wavelet-based methods) amongst others to remove varying artifact types. [ABSTRACT FROM AUTHOR] more...
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- 2024
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31. Ultrasound-guided Axillary Artery Catheter Placement and Associated Complications in Critically Ill Patients.
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Cardona, Stephanie, Gross, Aliza S., Yu, Allen T., Bassily-Marcus, Adel, Oropello, John, and Manasia, Anthony
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ARTERIAL catheters , *CRITICALLY ill patient care , *HEMODYNAMICS , *TERTIARY care , *BODY mass index - Abstract
Background: Arterial catheter placement for hemodynamic monitoring is commonly performed in critically ill patients. The radial and femoral arteries are the two sites most frequently used; there is limited data on the use of the axillary artery for this purpose. The aim of this study was to investigate the rate of complications from ultrasound-guided axillary artery catheter placement in critically ill patients. Methods: A retrospective study at a tertiary care center of patients admitted to an intensive care unit who had ultrasound-guided axillary artery catheter placement during admission. Primary outcome of interest was catheter related complications, including bleeding, vascular complications, compartment syndrome, stroke or air embolism, catheter malfunction, and need for surgical intervention. Results: This study identified 88 patients who had an ultrasound-guided axillary artery catheter placed during their admission. Of these 88, nine patients required multiple catheters placed, for a total of 99 axillary artery catheter placement events. The median age was 64 [IQR 48, 71], 41 (47%) were female, and median body mass index (BMI) was 26 [IQR 22, 30]. The most common complication was minor bleeding (11%), followed by catheter malfunction (2%), and vascular complications (2%). Univariate analyses did not show any association between demographics and clinical variables, and complications related to axillary arterial catheter. Conclusion: The most common complication found with ultrasound-guided axillary artery catheter placement was minor bleeding, followed by catheter malfunction, and vascular complications. Ultrasound-guided axillary arterial catheters are an alternative in patients in whom radial or femoral arterial access is difficult or not possible to achieve. [ABSTRACT FROM AUTHOR] more...
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- 2024
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32. Reliability of Continuous Noninvasive Hemoglobin Monitoring in Healthy Participants During En Route Care Training.
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Davis, William T, Valdez-Delgado, Krystal K, Bennett, Christopher, Mann-Salinas, Elizabeth, Burnett, Gregory M, Bedford, Theresa, Albright-Trainer, Brooke, Savell, Shelia C, and Sorensen, Derek
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DRUG administration routes , *INTENSIVE care patients , *AIR travel , *PULSE oximetry , *HEMODYNAMIC monitoring - Abstract
Introduction Current standards for hemoglobin monitoring during air transports of U.S. combat wounded are invasive and intermittent. Fielded pulse co-oximeters can noninvasively measure total hemoglobin, but this parameter is not currently utilized. The primary objective of this study was to assess the percentage of vital sign measurements with successful capture of total noninvasive hemoglobin measurement using spectrophotometry-based technology for Hb (SpHb) measurements in healthy participants during training flights. Secondary objectives were to assess the feasibility of a novel electronic data capture mechanism from usual patient movement items and perform a pilot analysis of SpHb changes in healthy participants during transitions from ground to air transport. Methods We conducted a feasibility study enrolling healthy participants who had hemodynamic monitoring during usual U.S. Air Force Critical Care Air Transport (CCAT) flight training exercises from 2022 to 2023. Usual CCAT monitoring equipment and currently used Masimo Rainbow® pulse co-oximeters had the capability to measure SpHb. After each training exercise, the study team wirelessly downloaded case files from patient monitors utilizing the Battlefield Assisted Trauma Distributed Observation Kit (BATDOKTM) Case Downloader application. We then calculated point and precision estimates for the percentage of time for successful SpHb capture during the exercise and compared this to pulse oximetry (SpO2) capture. An a priori precision analysis for percentage of flight-time with successful SpHb data capture and descriptive statistics were performed. This study received Exempt Determination by the 59th Medical Wing IRB. Results We analyzed 26 records with mean monitoring durations of 94.5 [59.3-119.9] minutes during ground phases and 78.0 [59.9-106.5] minutes during flight phases. SpHb measures were successfully captured for 97.7% (n = 4,620) of possible ground measurements and 97.2% (n = 3,973) of possible in-flight measurements compared to 99.5% ground and 98.2% in-flight capture for SpO2. Mean intervals of missing SpHb data were 2 ± 5 minutes on the ground and 4 ± 6 minutes in-flight. Mean SpHb increased by 0.93 ± 0.96 g/dL during the ground phase, but had minimal changes during ascent, cruising altitude or descent. The BATDOKTM Case downloader completed transfer for all files. Conclusion Masimo Rainbow® SpHb pulse co-oximeters reliably captured continuous, noninvasive hemoglobin measurements using usual CCAT patient movement items in healthy participants during both ground and flight training. The BATDOKTM Case Downloader successfully imported case files from CCAT patient monitors. Mean SpHb measures had a small increase during the ground phase of monitoring followed by minimal changes when transitioning to flight altitude. [ABSTRACT FROM AUTHOR] more...
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- 2024
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33. The Use of Pulmonary Artery Catheters and Echocardiography in the Cardiac Surgery Setting: A Nationwide Italian Survey.
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Sanfilippo, Filippo, Noto, Alberto, Ajello, Valentina, Martinez Lopez de Arroyabe, Blanca, Aloisio, Tommaso, Bertini, Pietro, Mondino, Michele, Silvetti, Simona, Putaggio, Antonio, Continella, Carlotta, Ranucci, Marco, Sangalli, Fabio, Scolletta, Sabino, and Paternoster, Gianluca more...
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Wide variations exist in the use of pulmonary artery catheters (PACs) and echocardiography in the field of cardiac surgery. A national survey promoted by the Italian Association of Cardio-Thoracic Anesthesiologists and Intensive Care was conducted. The study occurred in Italian cardiac surgery centers (n = 71). Anesthesiologists-intensivists were enrolled. Anonymous questionnaires were used to investigate the use of PACs and echocardiography in the operating room (OR) and intensive care unit (ICU). A total of 257 respondents (32.2% response rate) from 59 centers (83.1% response rate) participated. Use of PACs seems less common in ORs (median insertion in 20% [5-70] of patients), with slightly higher use in ICUs; in about half of cases, it was the continuous cardiac output monitoring system of choice. Almost two-thirds of respondents recently inserted at least one PAC within a few hours of ICU admission, despite its need being largely preoperatively predictable. Protocols regulating PAC insertion were reported by 25.3% and 28% of respondents (OR and ICU, respectively). Transesophageal echocardiography (TEE) was performed intraoperatively in >75% of patients by 86.4% of respondents; only 23.7% stated that intraoperative TEE relied on anesthesiologists. Tissue Doppler and/or 3D imaging were widely available (87.4% and 82%, respectively), but only 37.8% and 24.3% of respondents self-declared skills in these modalities, respectively; 77.1% of respondents had no echocardiography certification, nor were pursuing certification (various reasons); 40.9% had not attended recent echocardiography courses. Lower PAC use was associated with university hospitals (OR: p = 0.014, ICU: p = 0.032) and with lower interventions/year (OR: p = 0.023). Higher independence in performing TEE was reported in university hospitals (OR: p < 0.001; ICU: p = 0.006), centers with higher interventions/year (OR: p = 0.019), and by respondents with less experience in cardiology (ICU: p = 0.046). Variability in the use of PACs and echocardiography was found. Protocols regulating the use of PACs seem infrequent. University centers use PACs less and have greater skills in TEE. Training and certifications in echocardiography should be encouraged. [ABSTRACT FROM AUTHOR] more...
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- 2024
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34. Is time to first CT scan in patients with isolated severe traumatic brain injury prolonged when prehospital arterial cannulation is performed? A retrospective non-inferiority study.
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Eichlseder, Michael, Labenbacher, Sebastian, Pichler, Alexander, Eichinger, Michael, Kuenzer, Thomas, Zoidl, Philipp, Hallmann, Barbara, Stelzl, Felix, Schreiber, Nikolaus, and Zajic, Paul
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Background: Invasive blood pressure measurement is the in-hospital gold standard to guide hemodynamic management and consecutively cerebral perfusion pressure in patients with traumatic brain injury (TBI). Its prehospital use is controversial since it may delay further care. The primary aim of this study was to test the hypothesis that patients with severe traumatic brain injury who receive prehospital arterial cannulation, compared to those with in-hospital cannulation, do not have a prolonged time between on-scene arrival and first computed tomography (CT) of the head by more than ten minutes. Methods: This retrospective study included patients 18 years and older with isolated severe TBI and prehospital induction of emergency anaesthesia who received treatment in the resuscitation room of the University Hospital of Graz between January 1st, 2015, and December 31st, 2022. A Wilcoxon rank-sum test was used to test for non-inferiority (margin = ten minutes) of the time interval between on-scene arrival and first head CT. Results: We included data of 181 patients in the final analysis. Prehospital arterial line insertion was performed in 87 patients (48%). Median (25–75th percentile) durations between on-scene arrival and first head CT were 73 (61–92) min for prehospital arterial cannulation and 75 (60–93) min for arterial cannulation in the resuscitation room. Prehospital arterial line insertion was significantly non-inferior within a margin of ten minutes with a median difference of 1 min (95% CI − 6 to 7, p = 0.003). Conclusion: Time-interval between on-scene arrival and first head CT in patients with isolated severe traumatic brain injury who received prehospital arterial cannulation was not prolonged compared to those with in-hospital cannulation. This supports early out-of-hospital arterial cannulation performed by experienced providers. [ABSTRACT FROM AUTHOR] more...
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- 2024
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35. PPG and Bioimpedance-Based Wearable Applications in Heart Rate Monitoring—A Comprehensive Review.
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Lapsa, Didzis, Janeliukstis, Rims, Metshein, Margus, and Selavo, Leo
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HEART rate monitoring ,HEMODYNAMIC monitoring ,HEART beat ,BLOOD pressure ,WEARABLE technology ,HEART rate monitors - Abstract
The monitoring of hemodynamic parameters, such as heart rate and blood pressure, provides valuable indications of overall cardiovascular health. It is preferable that such monitoring is non-invasive and in real time via an affordable, compact and small-scale device for maximum convenience. Numerous literature sources have exploited derivations of these parameters from photoplethysmogram (PPG) and electrical bioimpedance (EBI) signal measurements through the use of calculation algorithms of varying complexity. Compared to electrocardiogram (ECG), these measurement techniques have a merit of well-established practices of designing a wearable device that could conveniently be put on a wrist. The current paper provides a comprehensive review on the use of PPG and EBI measurement techniques in the context of hemodynamic parameter monitoring using a wearable device. A special emphasis is placed on the most basic hemodynamic parameter—heart rate—describing different algorithms of heart rate detection and monitoring. The last section provides an overview of commercially available and in-home wearable device technologies based on PPG and EBI measurements, their design challenges, and future prospects. [ABSTRACT FROM AUTHOR] more...
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- 2024
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36. Fluid boluses and infusions in the early phase of resuscitation from septic shock and sepsis-induced hypotension: a retrospective report and outcome analysis from a tertiary hospital.
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Messina, Antonio, Albini, Marco, Samuelli, Nicolò, Brunati, Andrea, Costantini, Elena, Lionetti, Giulia, Lubian, Marta, Greco, Massimiliano, Matronola, Guia Margherita, Piccirillo, Fabio, De Backer, Daniel, Teboul, Jean Louis, and Cecconi, Maurizio more...
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SEPTIC shock treatment , *RISK assessment , *BLOOD gases analysis , *CRITICALLY ill , *PATIENTS , *PHYSIOLOGIC salines , *RESEARCH funding , *PARENTERAL feeding , *T-test (Statistics) , *FLUID therapy , *LOGISTIC regression analysis , *INDEPENDENT variables , *TREATMENT effectiveness , *TERTIARY care , *RETROSPECTIVE studies , *HOSPITAL mortality , *MANN Whitney U Test , *MULTIVARIATE analysis , *CHI-squared test , *DESCRIPTIVE statistics , *SEPTIC shock , *INTRAVENOUS therapy , *INTENSIVE care units , *MEDICAL records , *ACQUISITION of data , *ELECTRONIC health records , *NORADRENALINE , *LACTATES , *ALBUMINS , *COMPARATIVE studies , *DATA analysis software , *HYPOTENSION , *DISEASE risk factors - Abstract
Background: Fluid administration is the first line treatment in intensive care unit (ICU) patients with sepsis and septic shock. While fluid boluses administration can be titrated by predicting preload dependency, the amount of other forms of fluids may be more complex to be evaluated. We conducted a retrospective analysis in a tertiary hospital, to assess the ratio between fluids given as boluses and total administered fluid intake during early phases of ICU stay, and to evaluate the impact of fluid strategy on ICU mortality. Data related to fluid administration during the first four days of ICU stay were exported from an electronic health records system (ICCA®, Philips Healthcare). Demographic data, severity score, norepinephrine dose at ICU admission, overall fluid balance and the percentage of different fluid components of the overall volume administered were included in a multivariable logistic regression model, evaluating the association with ICU survival. Results: We analyzed 220 patients admitted with septic shock and sepsis-induced hypotension from 1st July 2021 to 31st December 2023. Fluid boluses and maintenance represented 49.3% ± 22.8 of the overall fluid intake, being balanced solution the most represented (40.4% ± 22.0). The fluid volume for drug infusion represented 34.0% ± 2.9 of the total fluid intake, while oral or via nasogastric tube fluid intake represented 18.0% ± 15.7 of the total fluid intake. Fluid volume given as boluses represented 8.6% of the total fluid intake over the four days, with a reduction from 25.1% ± 24.0 on Day 1 to 4.8% ± 8.7 on Day 4. A positive fluid balance [OR 1.167 (1.029–1.341); p = 0.021] was the most important factor associated with ICU mortality. Non-survivors (n = 66; 30%) received a higher amount of overall inputs than survivors only on Day 1 [2493 mL vs. 1855 mL; p = 0.022]. Conclusions: This retrospective analysis of fluids given over the early phases of septic shock and sepsis-induced hypotension showed that the overall volume given by boluses ranges from about 25% on Day 1 to about 5% on Day 4 from ICU admission. Our data confirms that a positive fluid balance over the first 4 days of ICU is associated with mortality. [ABSTRACT FROM AUTHOR] more...
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- 2024
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37. Correlation and concordance of carotid Doppler ultrasound and echocardiography with invasive cardiac output measurement in critically ill patients.
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Arango-Granados, María Camila, Quintero-Ramírez, Jaime Andrés, Mejía-Herrera, Felipe, Henao-Cardona, Lina Mayerly, Muñoz-Patiño, Valentina, and Bustamante-Cristancho, Luis Alfonso
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CAROTID artery ultrasonography , *DOPPLER echocardiography , *DOPPLER ultrasonography , *INTRACLASS correlation , *WILCOXON signed-rank test - Abstract
Background: Critical care management heavily relies on accurate cardiac output (CO) measurement. Echocardiography has been a mainstay in non-invasive cardiac monitoring; however, its comparability to invasive methods warrants further exploration. Recent studies have suggested the potential of carotid Doppler measurements as a promising approach to estimate CO. Despite this potential, the literature presents mixed outcomes regarding its reliability and accuracy. This study aims to evaluate the correlation and concordance between carotid Doppler ultrasonography and invasive hemodynamic monitoring in estimating CO in critically ill patients. Furthermore, it assesses the concordance and correlation between echocardiography CO and the standard invasive CO measurements. Methods: This concordance study involved critically ill adults requiring invasive CO measurement. Patients with arrhythmias, severe valvulopathy, pregnancy, and poor acoustic window were excluded. Statistical analyses comprised univariate analysis, Wilcoxon signed-rank test, Spearman correlation, and intraclass correlation coefficient. Ethical approval was granted by the institution's ethics committee. Results: A total of 49 critically ill patients were included, predominantly male (63.27%), with a median age of 57 years. Diagnoses included subarachnoid hemorrhage (53.06%) and heart failure (8.16%). Mean cardiac index was 3.36 ± 0.81 L/min/m2 and mean cardiac output was 5.98 ± 1.47 L/min. Spearman correlation coefficient between echocardiography and invasive CO measurements was 0.58 (p-value = p < 0.001), with an ICC of 0.59 for CO and 0.52 for cardiac index. Carotid measurements displayed no significant correlation with invasive CO. Conclusion: There is a moderate correlation and concordance between echocardiography and invasive CO measurements. There is no significant correlation between carotid variables and invasive CO, underscoring the necessity for cautious interpretation and application, particularly in patients with distinctive cerebral blood flow dynamics. [ABSTRACT FROM AUTHOR] more...
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- 2024
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38. Association between the mean perfusion pressure and the risk of acute kidney injury in critically ill patients with sepsis: a retrospective cohort study.
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Li, Ling, Qin, Shuangwen, Lu, Xiuhong, Huang, Liuyun, Xie, Mingjie, and Huang, Debin
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ACUTE kidney failure , *LOGISTIC regression analysis , *HEMODYNAMIC monitoring , *HOSPITAL mortality , *LOG-rank test - Abstract
Background: Mean perfusion pressure (MPP) has recently emerged as a potential biomarker for personalized management of tissue perfusion in critically ill patients. However, its association with the occurrence of acute kidney injury (AKI) in septic patients and the optimal MPP range remain uncertain. Therefore, this study aims to investigate the relationship between MPP and AKI in critically ill patients with sepsis. Methods: We identified 5867 patients with sepsis from the MIMIC-IV database who met the inclusion and exclusion criteria. The exposure variable was the first set of MPP measured within 24 h after ICU admission with invasive hemodynamic monitoring. The primary outcome was the incidence of AKI at 7 days following ICU admission according to the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. Secondary outcomes included in-hospital mortality, lengths of ICU, and hospital stay. Optimal cut-off point for MPP were determined using the Youden index, and multivariable logistic regression was employed to examine the association between MPP and AKI. Subgroup analyses were conducted to enhance result robustness. Kaplan-Meier survival analysis was utilized to evaluate in-hospital mortality rates categorized by MPP. Results: A total of 5,867 patients with sepsis were included in this study, and the overall incidence of AKI was 82.3%(4828/5867). Patients were categorized into low MPP (< 63 mmHg) and high MPP (≥ 63 mmHg) groups using the optimal ROC curve-derived cut-off point. The incidence of AKI in the low MPP group was higher than that in the high MPP group (87.6% vs. 78.3%, P < 0.001). Multivariable logistic regression analysis adjusted for confounding factors revealed that each 1 mmHg increase in MPP as a continuous variable was associated with a 2% decrease in AKI incidence within 7 days of ICU admission (OR:0.98, 95%CI:0.97–0.99, P < 0.001). When MPP was used as a categorical variable, patients in the high MPP group had a lower risk of AKI than those in the low MPP group (OR:0.71, 95%CI:0.61–0.83, P = 0.001). Subgroup analyses demonstrated a consistent association between MPP and AKI risk across all variables assessed (P for interaction all > 0.05). Kaplan-Meier curve analysis demonstrated a higher survival rate during hospitalization in the high MPP group compared to the low MPP group (Log-rank test, P < 0.0001). Conclusions: Lower levels of MPP are associated with an increased incidence of AKI at 7 days in critically ill patients with sepsis. [ABSTRACT FROM AUTHOR] more...
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- 2024
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39. Evaluating tissue hypoxia and the response to fluid administration in septic shock patients: a metabolic cluster analysis.
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Espinal, Cristina, Cortés, Edgar, Pérez-Madrigal, Anna, Saludes, Paula, Gil, Aurora, Caballer, Alba, Nogales, Sara, Gruartmoner, Guillem, and Mesquida, Jaume
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SEPTIC shock treatment , *OXYGEN saturation , *CLUSTER analysis (Statistics) , *CRITICALLY ill , *PATIENTS , *RESEARCH funding , *FLUID therapy , *SCIENTIFIC observation , *HEMODYNAMICS , *DESCRIPTIVE statistics , *CARDIAC output , *LACTATES , *INTENSIVE care units , *CARBON dioxide , *HYPOXEMIA , *BIOMARKERS - Abstract
Background: The selection of adequate indicators of tissue hypoxia for guiding the resuscitation process of septic patients is a highly relevant issue. Current guidelines advocate for the use of lactate as sole metabolic marker, which may be markedly limited, and the integration of different variables seems more adequate. In this study, we explored the metabolic profile and its implications in the response to the administration of a fluid challenge in early septic shock patients. Methods: Observational study including septic shock patients within 24 h of ICU admission, monitored with a cardiac output estimation system, with ongoing resuscitation. Hemodynamic and metabolic variables were measured before and after a fluid challenge (FC). A two-step cluster analysis was used to define the baseline metabolic profile, including lactate, central venous oxygen saturation (ScvO2), central venous-to-arterial carbon dioxide difference (PcvaCO2), and PcvaCO2 corrected by the difference in arterial-to-venous oxygen content (PcvaCO2/CavO2). Results: Seventy-seven fluid challenges were analyzed. Cluster analysis revealed two distinct metabolic profiles at baseline. Cluster A exhibited lower ScvO2, higher PcvaCO2, and lower PcvaCO2/CavO2. Increases in cardiac output (CO) were associated with increases in VO2 exclusively in cluster A. Baseline isolated metabolic variables did not correlate with VO2 response, and changes in ScvO2 and PcvaCO2 were associated to VO2 increase only in cluster A. Conclusions: In a population of early septic shock patients, two distinct metabolic profiles were identified, suggesting tissue hypoxia or dysoxia. Integrating metabolic variables enhances the ability to detect those patients whose VO2 might increase as results of fluid administration. [ABSTRACT FROM AUTHOR] more...
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- 2024
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40. Is it safe to give birth with an activated implantable cardioverter–defibrillator: A multicentre observational study.
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van der Stuijt, Willeke, Kooiman, Kirsten M., de Veld, Jolien A., Pepplinkhuizen, Shari, Olde Nordkamp, Louise R. A., Oudijk, Martijn A., Wilde, Arthur A. M., Smeding, Lonneke, and Knops, Reinoud E. more...
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IMPLANTABLE cardioverter-defibrillators , *INDUCED labor (Obstetrics) , *VENTRICULAR arrhythmia , *FISHER exact test , *SCIENTIFIC observation , *HEMODYNAMIC monitoring - Abstract
Objective: Data and guidelines are lacking, so implantable cardioverter–defibrillators (ICDs) are often deactivated during labour to prevent inappropriate shocks. This study aimed to ascertain the safety of an activated ICD during labour. Design: An observational study was performed. Setting: Dutch hospitals. Population or Sample: A total of 41 childbirths were included of 26 patients who gave birth between February 2009 and November 2018 after receiving an ICD in our tertiary hospital. Five of these childbirths were attended by the research team between December 2018 and August 2020, during which the ICD remained active. Methods: Groups were made based on ICD status during labour. Patients who gave birth with an activated ICD at least once were stratified to the activated ICD group. Patients' files were checked and patients received a questionnaire about childbirth perceptions and treatment preferences. The differences in ordinal data resulting from the questionnaire were calculated using a chi‐square or Fisher's exact test. Main outcome measures: Primary outcome was inappropriate ICD therapy and occurrence of ventricular arrhythmias requiring treatment. Results: During the 41 childbirths, no inappropriate shocks or ventricular arrhythmias occurred during labour. All patients in the activated ICD group (n = 13) preferred this setting, while 8 of the 13 patients in the deactivated ICD group preferred activation (p = 0.002). Reasons included avoiding hemodynamic monitoring, magnet placement, or labour induction to facilitate technician availability. Conclusions: This study shows no evidence that labour and birth in women with an activated ICD are unsafe, as there were no ventricular arrhythmias or inappropriate therapy. In addition, most patients prefer an activated ICD during labour. [ABSTRACT FROM AUTHOR] more...
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- 2024
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41. Pilot Study to Optimize Goal-directed Hemodynamic Management During Pancreatectomy.
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Galouzis, Nicholas, Khawam, Maria, Alexander, Evelyn V., Khreiss, Mohammad R., Luu, Carrie, Mesropyan, Lusine, Riall, Taylor S., Kwass, William K., and Dull, Randal O.
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PANCREATECTOMY , *GOAL (Psychology) , *HEMODYNAMICS , *INTRAOPERATIVE monitoring , *HEMODYNAMIC monitoring - Abstract
Intraoperative goal-directed hemodynamic therapy (GDHT) is a cornerstone of enhanced recovery protocols. We hypothesized that use of an advanced noninvasive intraoperative hemodynamic monitoring system to guide GDHT may decrease intraoperative hypotension (IOH) and improve perfusion during pancreatic resection. The monitor uses machine learning to produce the Hypotension Prediction Index to predict hypotensive episodes. A clinical decision-making algorithm uses the Hypotension Prediction Index and hemodynamic data to guide intraoperative fluid versus pressor management. Pre-implementation (PRE), patients were placed on the monitor and managed per usual. Post-implementation (POST), anesthesia teams were educated on the algorithm and asked to use the GDHT guidelines. Hemodynamic data points were collected every 20 s (8942 PRE and 26,638 POST measurements). We compared IOH (mean arterial pressure <65 mmHg), cardiac index >2, and stroke volume variation <12 between the two groups. 10 patients were in the PRE and 24 in the POST groups. In the POST group, there were fewer minimally invasive resections (4.2% versus 30.0%, P = 0.07), more pancreaticoduodenectomies (75.0% versus 20.0%, P < 0.01), and longer operative times (329.0 + 108.2 min versus 225.1 + 92.8 min, P = 0.01). After implementation, hemodynamic parameters improved. There was a 33.3% reduction in IOH (5.2% ± 0.1% versus 7.8% ± 0.3%, P < 0.01, a 31.6% increase in cardiac index >2.0 (83.7% + 0.2% versus 63.6% + 0.5%, P < 0.01), and a 37.6% increase in stroke volume variation <12 (73.2% + 0.3% versus 53.2% + 0.5%, P < 0.01). Advanced intraoperative hemodynamic monitoring to predict IOH combined with a clinical decision-making tree for GDHT may improve intraoperative hemodynamic parameters during pancreatectomy. This warrants further investigation in larger studies. [ABSTRACT FROM AUTHOR] more...
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- 2024
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42. Accuracy of Respiratory Variation in Inferior Vena Cava Diameter to Predict Fluid Responsiveness in Children Under Mechanical Ventilation.
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Campos, Nathalia Barros, de Lima, Lícia Bertanha, Ferraz, Isabel de Siqueira, Nogueira, Roberto J. N., Brandão, Marcelo B., and de Souza, Tiago H.
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VENA cava inferior , *ARTIFICIAL respiration , *HYPERVOLEMIA , *FLUIDS , *FLOW velocity - Abstract
Proper assessment of fluid responsiveness using accurate predictors is crucial to guide fluid therapy and avoid the serious adverse effects of fluid overload. The main objective of this study was to investigate the accuracy of respiratory variations in inferior vena cava diameter (∆IVC) to predict fluid responsiveness in mechanically ventilated children. This prospective single-center study included 32 children (median age and weight of 17 months and 10 kg, respectively) who received a fluid infusion of 10 ml kg–1 of crystalloid solutions over 10 min. ∆IVC and respiratory variation in aortic blood flow peak velocity (∆Vpeak) were determined over one controlled respiratory cycle before and after fluid loading. Thirteen (41%) participants were fluid-responders. ∆IVC, ∆Vpeak, stroke volume index, and cardiac index were found to be predictors of fluid responsiveness. However, the area under the ROC curve of ∆IVC was smaller when compared to ∆Vpeak (0.709 vs. 0.935, p < 0.012). The best cut-off values were 7.7% for ∆IVC (sensitivity, 69.2%; specificity 78.9%, positive predictive value, 69.2%; and negative predictive value, 78.9%) and 18.2% for ∆Vpeak (sensitivity, 84.6%; specificity, 89.5%; positive predictive value, 84.6%; negative predictive value, 89.5%). Changes in stroke volume were positively correlated with ∆IVC (ρ = 0.566, p < 0.001) and ∆Vpeak (ρ = 0.603, p < 0.001). A significant correlation was also found between changes in MAP and ∆Vpeak (ρ = 0.382; p = 0.031), but the same was not observed with ∆IVC (ρ = 0.011; p = 0.951). In conclusion, ∆IVC was found to have a moderate accuracy in predicting fluid responsiveness in mechanically ventilated children and is an inferior predictor when compared to ∆Vpeak. [ABSTRACT FROM AUTHOR] more...
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- 2024
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43. Continuous Right Ventricular Pressure Monitoring in Cardiac Surgery.
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Denault, André, Couture, Etienne J., Perry, Tjorvi, Saade, Elena, Calderone, Alexander, Zeng, Yu Hao, Scherb, Daniel, Moses, Kevin, Potes, Cristhian, Hammoud, Ali, Beaubien-Souligny, William, Elmi-Sarabi, Mahsa, Grønlykke, Lars, Lamarche, Yoan, Lebon, Jean-Sébastien, Rousseau-Saine, Nicolas, Desjardins, Georges, and Rochon, Antoine more...
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Right ventricular (RV) dysfunction in cardiac surgery can lead to RV failure, which is associated with increased morbidity and mortality. Abnormal RV function can be identified using RV pressure monitoring. The primary objective of the study is to determine the proportion of patients with abnormal RV early to end-diastole diastolic pressure gradient (RVDPG) and abnormal RV end-diastolic pressure (RVEDP) before initiation and after cardiopulmonary bypass (CPB) separation. The secondary objective is to evaluate if RVDPG before CPB initiation is associated with difficult and complex separation from CPB, RV dysfunction, and failure at the end of cardiac surgery. Prospective study. Tertiary care cardiac institute. Cardiac surgical patients. Cardiac surgery. Automated electronic quantification of RVDPG and RVEDP were obtained. Hemodynamic measurements were correlated with cardiac and extracardiac parameters from transesophageal echocardiography and postoperative complications. Abnormal RVDPG was present in 80% of the patients (n = 105) at baseline, with a mean RVEDP of 14.2 ± 3.9 mmHg. Patients experienced an RVDPG > 4 mmHg for a median duration of 50.2% of the intraoperative period before CPB initiation and 60.6% after CPB separation. A total of 46 (43.8%) patients had difficult/complex separation from CPB, 18 (38.3%) patients had RV dysfunction, and 8 (17%) had RV failure. Abnormal RVDPG before CPB was not associated with postoperative outcome. Elevated RVDPG and RVEDP are common in cardiac surgery. RVDPG and RVEDP before CPB initiation are not associated with RV dysfunction and failure but can be used to diagnose them. [ABSTRACT FROM AUTHOR] more...
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- 2024
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44. Leveraging Hypotension Prediction Index to Forecast LPS-Induced Acute Lung Injury and Inflammation in a Porcine Model: Exploring the Role of Hypoxia-Inducible Factor in Circulatory Shock.
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Tsai, Yuan-Ming, Lin, Yu-Chieh, Chen, Chih-Yuan, Chien, Hung-Che, Chang, Hung, and Chiang, Ming-Hsien
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ADULT respiratory distress syndrome ,CARDIOGENIC shock ,HYPOXIA-inducible factors ,OXYGEN saturation ,ENZYME-linked immunosorbent assay - Abstract
Acute respiratory distress syndrome (ARDS) is a critical illness in critically unwell patients, characterized by refractory hypoxemia and shock. This study evaluates an early detection tool and investigates the relationship between hypoxia and circulatory shock in ARDS, to improve diagnostic precision and therapy customization. We used a porcine model, inducing ARDS with mechanical ventilation and intratracheal plus intravenous lipopolysaccharide (LPS) injection. Hemodynamic changes were monitored using an Acumen IQ sensor and a ForeSight Elite sensor connected to the HemoSphere platform. We evaluated tissue damage, inflammatory response, and hypoxia-inducible factor (HIF) alterations using enzyme-linked immunosorbent assay and immunohistochemistry. The results showed severe hypotension and increased heart rates post-LPS exposure, with a notable rise in the hypotension prediction index (HPI) during acute lung injury (p = 0.024). Tissue oxygen saturation dropped considerably in the right brain region. Interestingly, post-injury HIF-2α levels were lower at the end of the experiment. Our findings imply that the HPI can effectively predict ARDS-related hypotension. HIF expression levels may serve as possible markers of rapid ARDS progression. Further research should be conducted on the clinical value of this novel approach in critical care, as well as the relationship between the HIF pathway and ARDS-associated hypotension. [ABSTRACT FROM AUTHOR] more...
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- 2024
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45. Flexible adaptive sensing tonometry for medical-grade multi-parametric hemodynamic monitoring.
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Deng, Mengkang, Du, Chentao, Fang, Jiayuan, Xu, Changshun, Guo, Chenhui, Huang, Jiantao, Li, Kang, Chen, Lei, Zhang, Yuan-Ting, Chang, Yu, and Pan, Tingrui
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HEMODYNAMIC monitoring ,TONOMETRY ,BLOOD pressure ,CLOSED loop systems ,SPATIAL resolution ,ONLINE monitoring systems - Abstract
Continuous hemodynamic monitoring in a wearable means can play a crucial role in managing hypertension and preventing catastrophic cardiovascular events. In this study, we have described the fully wearable tonometric device, referred to as flexible adaptive sensing tonometry (FAST), which is capable of continuous and accurate monitoring of hemodynamic parameters within the medical-grade precision. In particular, the FAST system integrates a 1 × 8 unit array of highly sensitive and highly flexible iontronic sensing (FITS) with 1 mm spatial resolution and a closed-loop motion system. The flexible tonometric architecture has been used to determine the radial arterial position with high sensitivity and high conformability, which simplifies the biaxial searching process of the traditional applanation tonometry into a highly efficient uniaxial applanation while keeping the medical-precision assessments. Importantly, a self-calibration algorithm can be automatically implemented during the applanation process, from which the intra-arterial blood pressure wave can be continuously predicted within the medical-grade precision, and subsequently, multi-parametric hemodynamic analysis can be performed in real-time. Experimental validations on health volunteers have demonstrated that the FAST measurements are all within the required accuracy of the clinical standards for continuous pulse wave assessments, blood pressure monitoring as well as other key hemodynamic parameter evaluations. Therefore, the FAST system, by integrating the flexible iontronic sensing array, provides a real-time, medical-grade hemodynamic monitoring solution in a continuously wearable manner, from which remote patient-centered monitoring can be delivered with both medical precision and convenience. [ABSTRACT FROM AUTHOR] more...
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- 2024
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46. Continuous non-invasive vs. invasive arterial blood pressure monitoring during neuroradiological procedure: a comparative, prospective, monocentric, observational study.
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Chapalain, Xavier, Morvan, Thomas, Gentric, Jean-Christophe, Subileau, Aurélie, Jacob, Christophe, Cadic, Anna, Caillard, Anaïs, and Huet, Olivier
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BLOOD pressure , *RADIAL artery , *ARTERIAL catheters , *BLOOD pressure measurement , *SCIENTIFIC observation - Abstract
Background: In the perioperative setting, the most accurate way to continuously measure arterial blood pressure (ABP) is using an arterial catheter. Surrogate methods such as finger cuff have been developed to allow non-invasive measurements and are increasingly used, but need further evaluation. The aim of this study is to evaluate the accuracy and clinical concordance between two devices for the measurement of ABP during neuroradiological procedure. Methods: This is a prospective, monocentric, observational study. All consecutive patients undergoing a neuroradiological procedure were eligible. Patients who needed arterial catheter for blood pressure measurement were included. During neuroradiological procedure, ABP (systolic, mean and diatolic blood pressure) was measured with two different technologies: radial artery catheter and Nexfin. Bland-Altman and error grid analyses were performed to evaluate the accuracy and clinical concordance between devices. Results: From March 2022 to November 2022, we included 50 patients, mostly ASA 3 (60%) and required a cerebral embolization (94%) under general anaesthesia (96%). Error grid analysis showed that 99% of non-invasive ABP measures obtained with the Nexfin were located in the risk zone A or B. However, 65.7% of hypertension events and 41% of hypotensive events were respectively not detected by Nexfin. Compared to the artery catheter, a significant relationship was found for SAP (r2 = 0.78) and MAP (r2 = 0.80) with the Nexfin (p < 0.001). Bias and limits of agreement (LOA) were respectively 9.6 mmHg (− 15.6 to 34.8 mmHg) and − 0.8 mmHg (− 17.2 to 15.6 mmHg), for SAP and MAP. Conclusions: Nexfin is not strictly interchangeable with artery catheter for ABP measuring. Further studies are needed to define its clinical use during neuroradiological procedure. Trial registration: Clinicaltrials.gov, registration number: NCT05283824. [ABSTRACT FROM AUTHOR] more...
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- 2024
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47. Analysis of hemodynamics and impedance using bioelectrical impedance analysis in hypovolemic shock-induced swine model.
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Park, Hoonsung, Lee, Hanyoung, Baik, Seungmin, and Lee, Jae-Myeong
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BIOELECTRIC impedance , *HYPOVOLEMIA , *HYPOVOLEMIC anemia , *SWINE , *HEMODYNAMIC monitoring , *HEMODYNAMICS - Abstract
To treat hypovolemic shock, fluid infusion or blood transfusion is essential to address insufficient volume. Much controversy surrounds resuscitation in hypovolemic shock. We aimed to identify the ideal fluid combination for treating hypovolemic shock-induced swine model, analyzing bioelectrical impedance and hemodynamics. Fifteen female three-way crossbred pigs were divided into three different groups. The three resuscitation fluids were (1) balanced crystalloid, (2) balanced crystalloid + 5% dextrose water, and (3) balanced crystalloid + 20% albumin. The experiment was divided into three phases and conducted sequentially: (1) controlled hemorrhage (1 L bleeding, 60 min), (2) resuscitation phase 1 (1 L fluid infusion, 60 min), and (3) resuscitation phase 2 (1 L fluid infusion, 60 min). Bioelectrical impedance analysis was implemented with a segmental multifrequency bioelectrical impedance analyzer. A total of 61 impedance measurements were assessed for each pig at six different frequencies in five segments of the pig. Pulse rate (PR), mean arterial pressure (MAP), stroke volume (SV), and stroke volume variation (SVV) were measured using a minimally invasive hemodynamic monitoring device. The three-dimensional graph showed a curved pattern when infused with 1 L of balanced crystalloid + 1 L of 5% dextrose water and 1.6 L of balanced crystalloid + 400 ml of 20% albumin. The 1M impedance increased in all groups during the controlled hemorrhage, and continuously decreased from fluid infusion to the end of the experiment. Only balanced crystalloid + 20% albumin significantly restored MAP and SV to the same level as the start of the experiment after the end of fluid infusion. There were no significant differences in MAP and SV from the time of recovery to the initial value of 1M impedance to the end of fluid infusion in all groups. The change and the recovery of hemodynamic indices such as MAP and SV coincide with the change and the recovery of 1M impedance. Using balanced crystalloid mixed with 20% albumin in hypovolemic shock-induced swine model may be helpful in securing hemodynamic stability, compared with balanced crystalloid single administration. [ABSTRACT FROM AUTHOR] more...
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- 2024
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48. 低血压预测指数在机器人辅助腹腔镜膀胱切除术患者血流动力 学管理中应用 1 例报告及文献复习.
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阮文青, 付泽润, 黄 逸, 李龙云, 孙 耀, and 李 凯
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POSITRON emission tomography , *COMPUTED tomography , *TROPONIN I , *TRACHEA intubation , *SURGICAL robots , *HEMODYNAMIC monitoring , *INTRAOPERATIVE monitoring - Abstract
Objective: To analyze the intraoperative hemodynamic management by hypotension prediction index (HPI) in one patient underwent robot-assisted laparoscopic cystectomy, and to provide the reference for anesthesia monitoring and hemodynamic management in the similar major surgery. Methods: The clinical data, intraoperative hemodynamic data, usage and dosage of vasoactive drugs, and clinical outcomes of one patient underwent robot-assisted laparoscopic cystectomy with HPI-guided intraoperative hemodynamic management were retrospectively analyzed, and the relevant literatures were reviewed. Results: The patient, a 72-year-old female, was admitted due to macroscopic hematuria for 5 months accompanied by dysuria for 3 months. The cystoscope results showed a 7 cm×7 cm×5 cm mass on the right side of the bladder trigone and a 4 cm×3 cm×3 cm mass near the bladder neck. The positron emission tomography/computed tomography (PET/CT) results showed thickening of the right posterior bladder wall with high metabolism, and the preliminary diagnosis was bladder malignancy. After preoperative anesthesia evaluation, the robot-assisted laparoscopic cystectomy was planned. After entering the operating room, the routine monitoring was conducted, and the monitor equipped with HPI software was used to guide intraoperative hemodynamic management. After routine anesthesia induction, the tracheal intubation was performed by video laryngoscope. The patient experienced intraoperative hypotension (IOH) for six times, the cumulative time of mean arterial pressure (MAP)<65 mmHg was 13. 7 min, accounting for 4. 40% of the anesthesia duration, and the time-weighted average of MAP< 65 mmHg was 0. 28 mmHg. The time range with HPI≥85 roughly overlapped with and included the period of MAP<65 mmHg. At 146 time points with HPI≥85, the MAP remained greater than 65 mmHg at 68. 5% (100/146) of the points. At 47 time points with MAP<65 mmHg, HPI≥85 occurred at 97. 9% (46/47) of the points. On the first postoperative day, the patient’s hypersensitive cardiac troponin I was <0. 01 μg·L-1, and no perioperative adverse events occurred. The patient was discharged on the eighth day. Conclusion: HPI can promptly and accurately predict the occurrence of IOH in the patients undergoing robot-assisted laparoscopic cystectomy. The use of HPI-based hypotension correction strategies during surgery can maintain the time-weighted average of MAP<65 mmHg at a lower level. [ABSTRACT FROM AUTHOR] more...
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- 2024
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49. Accuracy of Noninvasive Blood Pressure Monitoring in Critically Ill Adults.
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Haber, Erin N., Sonti, Rajiv, Simkovich, Suzanne M., Pike, C. William, Boxley, Christian L., Fong, Allan, Weintraub, William S., and Cobb, Nathan K.
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BLOOD pressure measurement , *INTENSIVE care units , *CATHETERS , *TERTIARY care , *MECHANICAL ventilators - Abstract
Background: Blood pressure (BP) is routinely invasively monitored by an arterial catheter in the intensive care unit (ICU). However, the available data comparing the accuracy of noninvasive methods to arterial catheters for measuring BP in the ICU are limited by small numbers and diverse methodologies. Purpose: To determine agreement between invasive arterial blood pressure monitoring (IABP) and noninvasive blood pressure (NIBP) in critically ill patients. Methods: This was a single center, observational study of critical ill adults in a tertiary care facility evaluating agreement (≤10% difference) between simultaneously measured IABP and NIBP. We measured clinical features at time of BP measurement inclusive of patient demographics, laboratory data, severity of illness, specific interventions (mechanical ventilation and dialysis), and vasopressor dose to identify particular clinical scenarios in which measurement agreement is more or less likely. Results: Of the 1852 critically ill adults with simultaneous IABP and NIBP readings, there was a median difference of 6 mm Hg in mean arterial pressure (MAP), interquartile range (1-12), P <.01. A logistic regression analysis identified 5 independent predictors of measurement discrepancy: increasing doses of norepinephrine (adjusted odds ratio [aOR] 1.10 [95% confidence interval, CI 1.08-1.12] P =.03 for every change in 5 µg/min), lower MAP value (aOR 0.98 [0.98-0.99] P <.01 for every change in 1 mm Hg), higher body mass index (aOR 1.04 [1.01-1.09] P =.01 for an increase in 1), increased patient age (aOR 1.31 [1.30-1.37] P <.01 for every 10 years), and radial arterial line location (aOR 1.74 [1.16-2.47] P =.04). Conclusions: There was broad agreement between IABP and NIBP in critically ill patients over a range of BPs and severity of illness. Several variables are associated with measurement discrepancy; however, their predictive capacity is modest. This may guide future study into which patients may specifically benefit from an arterial catheter. [ABSTRACT FROM AUTHOR] more...
- Published
- 2024
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50. Simultaneous Venous-Arterial Doppler Ultrasound During Early Fluid Resuscitation to Characterize a Novel Doppler Starling Curve: A Prospective Observational Pilot Study.
- Author
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Kenny, Jon-Émile S., Prager, Ross, Rola, Philippe, Haycock, Korbin, Gibbs, Stanley O., Johnston, Delaney H., Horner, Christine, Eibl, Joseph K., Lau, Vivian C., and Kemp, Benjamin O.
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DOPPLER ultrasonography , *RESUSCITATION , *CAROTID artery , *STROKE treatment , *HEMODYNAMICS - Abstract
Background: The likelihood of a patient being preload responsive—a state where the cardiac output or stroke volume (SV) increases significantly in response to preload—depends on both cardiac filling and function. This relationship is described by the canonical Frank-Starling curve. Research Question : We hypothesize that a novel method for phenotyping hypoperfused patients (ie, the "Doppler Starling curve") using synchronously measured jugular venous Doppler as a marker of central venous pressure (CVP) and corrected flow time of the carotid artery (ccFT) as a surrogate for SV will refine the pretest probability of preload responsiveness/unresponsiveness. Study Design and Methods: We retrospectively analyzed a prospectively collected convenience sample of hypoperfused adult emergency department (ED) patients. Doppler measurements were obtained before and during a preload challenge using a wireless, wearable Doppler ultrasound system. Based on internal jugular and carotid artery Doppler surrogates of CVP and SV, respectively, we placed hemodynamic assessments into quadrants (Qx) prior to preload augmentation: low CVP with normal SV (Q1), high CVP and normal SV (Q2), low CVP and low SV (Q3) and high CVP and low SV (Q4). The proportion of preload responsive and unresponsive assessments in each quadrant was calculated based on the maximal change in ccFT (ccFTΔ) during either a passive leg raise or rapid fluid challenge. Results: We analyzed 41 patients (68 hemodynamic assessments) between February and April 2021. The prevalence of each phenotype was: 15 (22%) in Q1, 8 (12%) in Q2, 39 (57%) in Q3, and 6 (9%) in Q4. Preload unresponsiveness rates were: Q1, 20%; Q2, 50%; Q3, 33%, and Q4, 67%. Interpretation: Even fluid naïve ED patients with sonographic estimates of low CVP have high rates of fluid unresponsiveness, making dynamic testing valuable to prevent ineffective IVF administration. [ABSTRACT FROM AUTHOR] more...
- Published
- 2024
- Full Text
- View/download PDF
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