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Fot EV, Smetkin AA, Volkov DA, Semenkova TN, Paromov KV, Kuzkov VV, Kirov MY. The Validation of Cardiac Index and Stroke-Volume Variation Measured by the Pulse-Wave Transit Time-Analysis Versus Conventional Pulse-Contour Analysis After Off-Pump Coronary Artery Bypass Grafting: Observational Study. J Cardiothorac Vasc Anesth 2023; 37:919-926. [PMID: 36878818 DOI: 10.1053/j.jvca.2023.02.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 02/06/2023] [Indexed: 02/13/2023]
Abstract
OBJECTIVE To compare the reliability of cardiac index (CI) and stroke-volume variation (SVV) measured by the pulse-wave transit-time (PWTT) method using estimated continuous cardiac output (esCCO) technique with conventional pulse-contour analysis after off-pump coronary artery bypass grafting (OPCAB). DESIGN A single-center, prospective, observational study. SETTING At a 1,000-bed university hospital. PARTICIPANTS A total of 21 patients were enrolled after elective OPCAB. INTERVENTIONS The study authors performed a method comparison study with simultaneous measurement of CI and SVV based on the esCCO technique (CIesCCO and esSVV, correspondingly) and pulse-contour analysis (CIPCA and SVVPCA, correspondingly). As a secondary analysis, they also assessed the trending ability of CIesCCO versus CIPCA. MEASUREMENTS AND MAIN RESULTS: The authors analyzed 178 measurement pairs for CI, and 174 pairs for SVV during the 10 study stages. The mean bias between CIesCCO and CIPCA was 0.06 L min/m2, with limits of agreement of ± 0.92 L min/m2 and a percentage error (PE) of 35.3%. The analysis of the trending ability of CI measured by PWTT revealed a concordance rate of 70%. The mean bias between esSVV and SVVPCA was -6.1%, with limits of agreement of ± 15.5% and a PE of 137%. CONCLUSIONS The overall performance of CIesCCO and esSVV versus CIPCA and SVVPCA is not clinically acceptable. A further improvement of the PWTT algorithm may be required for an accurate and precise assessment of CI and SVV.
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Affiliation(s)
- Evgeniia V Fot
- Department of Anesthesiology and Intensive Care Medicine, Northern State Medical University, Arkhangelsk, Russia; Department of Anesthesiology and Intensive Care Medicine, City Hospital #1 n.a. E.E. Volosevich, Arkhangelsk, Russia.
| | - Alexey A Smetkin
- Department of Anesthesiology and Intensive Care Medicine, Northern State Medical University, Arkhangelsk, Russia; Department of Anesthesiology and Intensive Care Medicine, City Hospital #1 n.a. E.E. Volosevich, Arkhangelsk, Russia
| | - Dmitriy A Volkov
- Department of Anesthesiology and Intensive Care Medicine, Northern State Medical University, Arkhangelsk, Russia; Department of Anesthesiology and Intensive Care Medicine, City Hospital #1 n.a. E.E. Volosevich, Arkhangelsk, Russia
| | - Tatyana N Semenkova
- Department of Anesthesiology and Intensive Care Medicine, Northern State Medical University, Arkhangelsk, Russia; Department of Anesthesiology and Intensive Care Medicine, City Hospital #1 n.a. E.E. Volosevich, Arkhangelsk, Russia
| | - Konstantin V Paromov
- Department of Anesthesiology and Intensive Care Medicine, Northern State Medical University, Arkhangelsk, Russia
| | - Vsevolod V Kuzkov
- Department of Anesthesiology and Intensive Care Medicine, Northern State Medical University, Arkhangelsk, Russia; Department of Anesthesiology and Intensive Care Medicine, City Hospital #1 n.a. E.E. Volosevich, Arkhangelsk, Russia
| | - Mikhail Y Kirov
- Department of Anesthesiology and Intensive Care Medicine, Northern State Medical University, Arkhangelsk, Russia; Department of Anesthesiology and Intensive Care Medicine, City Hospital #1 n.a. E.E. Volosevich, Arkhangelsk, Russia
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Hamad S, Maw J, Wright AJ. Ultrasonography assessment of gastric emptying for different emulsion microstructures was superior to acetaminophen marker method. FOOD STRUCTURE 2022. [DOI: 10.1016/j.foostr.2022.100299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Pilarczyk K, Haneya A, Panholzer B. Hämodynamisches Monitoring nach herzchirurgischem Eingriff. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2022. [DOI: 10.1007/s00398-022-00517-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bein B, Bachmann M, Huggett S, Wegermann P. SARS-CoV-2/COVID-19 – aktualisierte Empfehlungen zu Diagnostik und Therapie. Anasthesiol Intensivmed Notfallmed Schmerzther 2021; 56:277-287. [PMID: 33890259 DOI: 10.1055/a-1417-7074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Quintana-Villamandos B, Barranco M, Fernández I, Ruiz M, Del Cañizo JF. New Advances in Monitoring Cardiac Output in Circulatory Mechanical Assistance Devices. A Validation Study in a Porcine Model. Front Physiol 2021; 12:634779. [PMID: 33746776 PMCID: PMC7969803 DOI: 10.3389/fphys.2021.634779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 02/11/2021] [Indexed: 01/04/2023] Open
Abstract
Cardiac output (CO) measurement by continuous pulmonary artery thermodilution (COCTD) has been studied in patients with pulsatile-flow LVADs (left ventricular assist devices), confirming the clinical utility. However, it has not been validated in patients with continuous-flow LVADs. Therefore, the aim of this study was to assess the validity of COCTD in continuous-flow LVADs. Continuous-flow LVADs were implanted in six miniature pigs for partial assistance of the left ventricle. Both methods of measuring CO—measurement by COCTD and intermittent pulmonary artery thermodilution, standard technique (COITD)—were used in four consecutive moments of the study: before starting the LVAD (basal moment), and with the LVAD started in normovolemia, hypervolemia (fluid overloading), and hypovolemia (shock hemorrhage). At the basal moment, COCTD and COITD were closely correlated (r2 = 0.97), with a mean bias of −0.13 ± 0.16 L/min and percentage error of 11%. After 15 min of partial support LVAD, COCTD and COITD were closely correlated (r2 = 0.91), with a mean bias of 0.31 ± 0.35 L/min and percentage error of 20%. After inducing hypervolemia, COCTD and COITD were closely correlated (r2 = 0.99), with a mean bias of 0.04 ± 0.07 L/min and percentage error of 5%. After inducing hypovolemia, COCTD and COITD were closely correlated (r2 = 0.74), with a mean bias of 0.08 ± 0.22 L/min and percentage error of 19%. This study shows that continuous pulmonary thermodilution could be an alternative method of monitoring CO in a porcine model with a continuous-flow LVAD.
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Affiliation(s)
- Begoña Quintana-Villamandos
- Department of Anesthesiology and Intensive Care, Gregorio Marañón Hospital, Madrid, Spain.,Department of Pharmacology and Toxicology, Faculty of Medicine, Universidad Complutense, Madrid, Spain
| | - Mónica Barranco
- Department of Anesthesiology and Intensive Care, Gregorio Marañón Hospital, Madrid, Spain
| | - Ignacio Fernández
- Department of Anesthesiology and Intensive Care, Gregorio Marañón Hospital, Madrid, Spain
| | - Manuel Ruiz
- Department of Cardiovascular Surgery, Gregorio Marañón Hospital, Madrid, Spain.,Department of Surgery, Faculty of Medicine, Universidad Complutense, Madrid, Spain
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Lorenzen U, Pohlmann M, Hansen J, Klose P, Gruenewald M, Renner J, Elke G. Perioperative non-invasive versus semi-invasive cardiac index monitoring in patients with bariatric surgery - a prospective observational study. BMC Anesthesiol 2020; 20:196. [PMID: 32778047 PMCID: PMC7419223 DOI: 10.1186/s12871-020-01110-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 07/27/2020] [Indexed: 12/29/2022] Open
Abstract
Background In morbidly obese patients undergoing laparoscopic bariatric surgery, the combination of obesity-related comorbidities, pneumoperitoneum and extreme posture changes constitutes a high risk of perioperative hemodynamic complications. Thus, an advanced hemodynamic monitoring including continuous cardiac index (CI) assessment is desirable. While invasive catheterization may bear technical difficulties, transesophageal echocardiography is contraindicated due to the surgical procedure. Evidence on the clinical reliability of alternative semi- or non-invasive cardiac monitoring devices is limited. The aim was to compare the non-invasive vascular unloading to a semi-invasive pulse contour analysis reference technique for continuous CI measurements in bariatric surgical patients. Methods This prospective observational study included adult patients scheduled for elective, laparoscopic bariatric surgery after obtained institutional ethics approval and written informed consent. CI measurements were performed using the vascular unloading technique (Nexfin®) and semi-invasive reference method (FloTrac™). At 10 defined measurement time points, the influence of clinically indicated body posture changes, passive leg raising, fluid bolus administration and pneumoperitoneum was evaluated pre- and intraoperatively. Correlation, Bland-Altman and concordance analyses were performed. Results Sixty patients (mean BMI 49.2 kg/m2) were enrolled into the study and data from 54 patients could be entered in the final analysis. Baseline CI was 3.2 ± 0.9 and 3.3 ± 0.8 l/min/m2, respectively. Pooled absolute CI values showed a positive correlation (rs = 0.76, P < 0.001) and mean bias of of − 0.16 l/min/m2 (limits of agreement: − 1.48 to 1.15 l/min/m2) between the two methods. Pooled percentage error was 56.51%, missing the criteria of interchangeability (< 30%). Preoperatively, bias ranged from − 0.33 to 0.08 l/min/m2 with wide limits of agreement. Correlation of CI was best (rs = 0.82, P < 0.001) and percentage error lowest (46.34%) during anesthesia and after fluid bolus administration. Intraoperatively, bias ranged from − 0.34 to − 0.03 l/min/m2 with wide limits of agreement. CI measurements correlated best during pneumoperitoneum and after fluid bolus administration (rs = 0.77, P < 0.001; percentage error 35.95%). Trending ability for all 10 measurement points showed a concordance rate of 85.12%, not reaching the predefined Critchley criterion (> 92%). Conclusion Non-invasive as compared to semi-invasive CI measurements did not reach criteria of interchangeability for monitoring absolute and trending values of CI in morbidly obese patients undergoing bariatric surgery. Trial registration The study was registered retrospectively on June 12, 2017 with the registration number NCT03184272.
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Affiliation(s)
- Ulf Lorenzen
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 Haus R3, 24105, Kiel, Germany
| | - Markus Pohlmann
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 Haus R3, 24105, Kiel, Germany
| | - Jonathan Hansen
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 Haus R3, 24105, Kiel, Germany
| | - Phil Klose
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 Haus R3, 24105, Kiel, Germany
| | - Matthias Gruenewald
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 Haus R3, 24105, Kiel, Germany
| | - Jochen Renner
- Department of Anesthesiology, Helios Kliniken Schwerin, 19055, Schwerin, Germany
| | - Gunnar Elke
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 Haus R3, 24105, Kiel, Germany.
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Bein B, Bachmann M, Huggett S, Wegermann P. SARS-CoV-2/COVID-19: Evidence-Based Recommendations on Diagnosis and Therapy. Geburtshilfe Frauenheilkd 2020; 80:491-498. [PMID: 32435065 PMCID: PMC7234827 DOI: 10.1055/a-1156-3991] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
COVID-19, a new viral disease affecting primarily the respiratory system and the lung, has caused a pandemic posing serious challenges to healthcare systems around the world. In about 20% of patients, severe symptoms occur after a mean incubation period of 5 - 6 days; 5% of patients need intensive care therapy. Mortality is about 1 - 2%. Protecting healthcare workers is of paramount importance in order to prevent hospital-acquired infections. Therefore, during all procedures associated with aerosol production, personal protective equipment consisting of a FFP2/FFP3 (N95) respiratory mask, gloves, safety glasses and a waterproof overall should be used. Therapy is based on established recommendations issued for patients with acute lung injury (ARDS). Lung protective ventilation, prone position, restrictive fluid management and adequate management of organ failure are the mainstays of therapy. In case of fulminant lung failure, veno-venous extracorporeal membrane oxygenation may be used as a rescue in experienced centres. New, experimental therapies are evolving with ever increasing frequency; currently, however, no evidence-based recommendation is possible. If off-label and compassionate use of these drugs is considered, an individual benefit-risk assessment is necessary, since serious side effects have been reported.
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Affiliation(s)
- Berthold Bein
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie der Asklepios Klinik St. Georg, Hamburg, Germany
| | - Martin Bachmann
- Klinik für Intensivmedizin und Beatmungsmedizin, Asklepios Klinikum Harburg, Harburg, Germany
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Bein B, Bachmann M, Huggett S, Wegermann P. [SARS CoV-2/COVID-19: Evidence-Based Recommendation on Diagnosis and Therapy]. Anasthesiol Intensivmed Notfallmed Schmerzther 2020; 55:257-265. [PMID: 32274773 PMCID: PMC7295266 DOI: 10.1055/a-1146-8674] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Der Übersichtsartikel ist als praktische Handreichung für alle gedacht, die COVID-19-Patienten behandeln bzw. in nächster Zeit behandeln werden, und fasst das derzeit verfügbare Wissen zu Diagnostik und Therapie zusammen. Zusätzlich werden auch neue und experimentelle Therapien bewertet, soweit dazu zumindest Einzelfallberichte vorliegen.
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