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Webb KL, Pruter WW, Poole RJ, Techentin RW, Johnson CP, Regimbal RJ, Berndt KJ, Holmes DR, Haider CR, Joyner MJ, Convertino VA, Wiggins CC, Curry TB. Comparing the compensatory reserve metric obtained from invasive arterial measurements and photoplethysmographic volume-clamp during simulated hemorrhage. J Clin Monit Comput 2024:10.1007/s10877-024-01166-x. [PMID: 38733507 DOI: 10.1007/s10877-024-01166-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 04/16/2024] [Indexed: 05/13/2024]
Abstract
PURPOSE The compensatory reserve metric (CRM) is a novel tool to predict cardiovascular decompensation during hemorrhage. The CRM is traditionally computed using waveforms obtained from photoplethysmographic volume-clamp (PPGVC), yet invasive arterial pressures may be uniquely available. We aimed to examine the level of agreement of CRM values computed from invasive arterial-derived waveforms and values computed from PPGVC-derived waveforms. METHODS Sixty-nine participants underwent graded lower body negative pressure to simulate hemorrhage. Waveform measurements from a brachial arterial catheter and PPGVC finger-cuff were collected. A PPGVC brachial waveform was reconstructed from the PPGVC finger waveform. Thereafter, CRM values were computed using a deep one-dimensional convolutional neural network for each of the following source waveforms; (1) invasive arterial, (2) PPGVC brachial, and (3) PPGVC finger. Bland-Altman analyses were used to determine the level of agreement between invasive arterial CRM values and PPGVC CRM values, with results presented as the Mean Bias [95% Limits of Agreement]. RESULTS The mean bias between invasive arterial- and PPGVC brachial CRM values at rest, an applied pressure of -45mmHg, and at tolerance was 6% [-17%, 29%], 1% [-28%, 30%], and 0% [-25%, 25%], respectively. Additionally, the mean bias between invasive arterial- and PPGVC finger CRM values at rest, applied pressure of -45mmHg, and tolerance was 2% [-22%, 26%], 8% [-19%, 35%], and 5% [-15%, 25%], respectively. CONCLUSION There is generally good agreement between CRM values obtained from invasive arterial waveforms and values obtained from PPGVC waveforms. Invasive arterial waveforms may serve as an alternative for computation of the CRM.
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Affiliation(s)
- Kevin L Webb
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First St. SW, 55905, Rochester, Minnesota, MN, USA
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Wyatt W Pruter
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First St. SW, 55905, Rochester, Minnesota, MN, USA
| | - Ruth J Poole
- Special Purpose Processor Development Group, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Robert W Techentin
- Special Purpose Processor Development Group, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Christopher P Johnson
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First St. SW, 55905, Rochester, Minnesota, MN, USA
| | - Riley J Regimbal
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First St. SW, 55905, Rochester, Minnesota, MN, USA
| | - Kaylah J Berndt
- Special Purpose Processor Development Group, Mayo Clinic, Rochester, Minnesota, United States of America
| | - David R Holmes
- Biomedical Analytics and Computational Engineering Laboratory, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Clifton R Haider
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Michael J Joyner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First St. SW, 55905, Rochester, Minnesota, MN, USA
| | - Victor A Convertino
- Battlefield Health & Trauma Center for Human Integrative Physiology, Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, TX, United States of America
| | - Chad C Wiggins
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First St. SW, 55905, Rochester, Minnesota, MN, USA
- Department of Kinesiology, Michigan State University, East Lansing, Michigan, United States of America
| | - Timothy B Curry
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First St. SW, 55905, Rochester, Minnesota, MN, USA.
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Abel B, Gerling KA, Mares JA, Hutzler J, Pierskalla I, Hays J, Propper B, White JM, Burmeister DM. Real-Time Measurements of Oral Mucosal Carbon Dioxide (POMCO2) Reveals an Inverse Correlation With Blood Pressure in a Porcine Model of Coagulopathic Junctional Hemorrhage. Mil Med 2024; 189:e612-e619. [PMID: 37632757 DOI: 10.1093/milmed/usad336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/28/2023] [Accepted: 08/11/2023] [Indexed: 08/28/2023] Open
Abstract
INTRODUCTION Shock states that occur during, for example, profound hemorrhage can cause global tissue hypoperfusion leading to organ failure. There is an unmet need for a reliable marker of tissue perfusion during hemorrhage that can be followed longitudinally. Herein, we investigated whether longitudinal POMCO2 tracks changes in hemodynamics in a swine model of coagulopathic uncontrolled junctional hemorrhage. MATERIALS AND METHODS Female Yorkshire-crossbreed swine (n = 7, 68.1 ± 0.7 kg) were anesthetized and instrumented for continuous measurement of mean arterial pressure (MAP). Coagulopathy was induced by the exchange of 50 to 60% of blood volume with 6% Hetastarch over 30 minutes to target a hematocrit of <15%. A 4.5-mm arteriotomy was made in the right common femoral artery with 30 seconds of free bleeding. POMCO2 was continuously measured from baseline through hemodilution, hemorrhage, and a subsequent 3-h intensive care unit period. Rotational thromboelastometry and blood gases were measured. RESULTS POMCO2 and MAP showed no significant changes during the hemodilution phase of the experiment, which produced coagulopathy evidenced by prolonged clot formation times. However, POMCO2 increased because of the uncontrolled hemorrhage by 11.3 ± 3.1 mmHg and was inversely correlated with the drop (17.9 ± 5.9 mmHg) in MAP (Y = -0.4122*X + 2.649, P = .02, r2 = 0.686). In contrast, lactate did not significantly correlate with the changes in MAP (P = .35) or POMCO2 (P = .37). CONCLUSIONS Despite the logical appeal of measuring noninvasive tissue CO2 measurement as a surrogate for gastrointestinal perfusion, prior studies have only reported snapshots of this readout. The present investigation shows real-time longitudinal measurement of POMCO2 to confirm that MAP inversely correlates to POMCO2 in the face of coagulopathy. The simplicity of measuring POMCO2 in real time can provide an additional practical option for military or civilian medics to monitor trends in hypoperfusion during hemorrhagic shock.
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Affiliation(s)
- Biebele Abel
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA
- Department of Surgery, Uniformed Services University of the Health Science, Bethesda, MD 20814, USA
| | | | - John A Mares
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA
- Department of Surgery, Uniformed Services University of the Health Science, Bethesda, MD 20814, USA
| | - Justin Hutzler
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA
- Department of Surgery, Uniformed Services University of the Health Science, Bethesda, MD 20814, USA
| | | | - Jim Hays
- ExoStat Medical, Inc., Prior Lake, MN 55372, USA
| | - Brandon Propper
- Department of Surgery, Uniformed Services University of the Health Science, Bethesda, MD 20814, USA
- Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
| | - Joseph M White
- Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
| | - David M Burmeister
- Department of Surgery, Uniformed Services University of the Health Science, Bethesda, MD 20814, USA
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
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Späth M, Rohde M, Ni D, Knieling F, Stelzle F, Schmidt M, Klämpfl F, Hohmann M. The influence of the optical properties on the determination of capillary diameters. Sci Rep 2022; 12:270. [PMID: 34997168 PMCID: PMC8742127 DOI: 10.1038/s41598-021-04359-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 12/21/2021] [Indexed: 11/09/2022] Open
Abstract
Various clinically applicable scores and indices are available to help identify the state of a microcirculatory disorder in a patient. Several of these methods, however, leave room for interpretation and only provide clues for diagnosis. Thus, a measurement method that allows a reliable detection of impending or manifest circulatory malfunctions would be of great value. In this context, the optical and non-invasive method of shifted position-diffuse reflectance imaging (SP-DRI) was developed. It allows to determine the capillary diameter and thus to assess the state of the microcirculation. The aim of the present study is to investigate how the quantification of capillary diameters by SP-DRI behaves in different individuals, i.e. for a wide range of optical properties. For this, within Monte-Carlo simulations all optical properties (seven skin layers, hemoglobin) were randomly varied following a Gaussian distribution. An important finding from the present investigation is that SP-DRI works when the optical properties are chosen randomly. Furthermore, it is shown that appropriate data analysis allows calibration-free absolute quantification of the capillary diameter across individuals using SP-DRI. This underpins the potential of SP-DRI to serve as an early alert system for the onset of microcirculatory associated diseases.
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Affiliation(s)
- Moritz Späth
- Institute of Photonic Technologies, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91052, Erlangen, Germany. .,Erlangen Graduate School in Advanced Optical Technologies, 91052, Erlangen, Germany.
| | - Maximilian Rohde
- grid.411668.c0000 0000 9935 6525Department of Oral and Maxillofacial Surgery, University Hospital Erlangen, 91054 Erlangen, Germany ,grid.5330.50000 0001 2107 3311Erlangen Graduate School in Advanced Optical Technologies, 91052 Erlangen, Germany
| | - Dongqin Ni
- grid.5330.50000 0001 2107 3311Institute of Photonic Technologies, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91052 Erlangen, Germany ,grid.5330.50000 0001 2107 3311Erlangen Graduate School in Advanced Optical Technologies, 91052 Erlangen, Germany
| | - Ferdinand Knieling
- grid.411668.c0000 0000 9935 6525Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, 91054 Erlangen, Germany
| | - Florian Stelzle
- grid.5330.50000 0001 2107 3311Institute of Photonic Technologies, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91052 Erlangen, Germany ,grid.411668.c0000 0000 9935 6525Department of Oral and Maxillofacial Surgery, University Hospital Erlangen, 91054 Erlangen, Germany ,grid.5330.50000 0001 2107 3311Erlangen Graduate School in Advanced Optical Technologies, 91052 Erlangen, Germany
| | - Michael Schmidt
- grid.5330.50000 0001 2107 3311Institute of Photonic Technologies, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91052 Erlangen, Germany ,grid.5330.50000 0001 2107 3311Erlangen Graduate School in Advanced Optical Technologies, 91052 Erlangen, Germany
| | - Florian Klämpfl
- grid.5330.50000 0001 2107 3311Institute of Photonic Technologies, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91052 Erlangen, Germany ,grid.5330.50000 0001 2107 3311Erlangen Graduate School in Advanced Optical Technologies, 91052 Erlangen, Germany
| | - Martin Hohmann
- grid.5330.50000 0001 2107 3311Institute of Photonic Technologies, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91052 Erlangen, Germany ,grid.5330.50000 0001 2107 3311Erlangen Graduate School in Advanced Optical Technologies, 91052 Erlangen, Germany
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Klemcke HG, Calderon ML, Crimmins SL, Ryan KL, Xiang L, Hinojosa-Laborde C. Effects of ketamine analgesia on cardiorespiratory responses and survival to trauma and hemorrhage in rats. J Appl Physiol (1985) 2021; 130:1583-1593. [PMID: 33830812 DOI: 10.1152/japplphysiol.00476.2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Ketamine is the recommended analgesic on the battlefield for soldiers with hemorrhage, despite a lack of supportive evidence from laboratory or clinical studies. Hence, this study determined the effects of ketamine analgesia on cardiorespiratory responses and survival to moderate (37% blood volume; n = 8/group) or severe hemorrhage (50% blood volume; n = 10/group) after trauma in rats. We used a conscious hemorrhage model with extremity trauma (fibular fracture + soft tissue injury) while measuring mean arterial pressure (MAP), heart rate (HR), and body temperature (Tb) by telemetry, and respiration rate (RR), minute volume (MV), and tidal volume (TV) via whole body plethysmography. Male rats received saline (S) or 5.0 mg/kg ketamine (K) (100 µL/100 g body wt) intra-arterially after trauma and hemorrhage. All rats survived 37% hemorrhage. For 50% hemorrhage, neither survival times [180 min (SD 78) vs. 209 min (SD 66)] nor percent survival (60% vs. 80%) differed between S- and K-treated rats. After 37% hemorrhage, K (compared with S) increased MAP and decreased Tb and MV. After 50% hemorrhage, K (compared with S) increased MAP but decreased HR and MV. K effects on cardiorespiratory function were time dependent, significant but modest, and transient at the analgesic dose given. K effects on Tb were also significant but modest and more prolonged. With the use of this rat model, our data support the use of K as an analgesic in injured, hypovolemic patients.NEW & NOTEWORTHY Ketamine administration at a dose shown to alleviate pain in nonhemorrhaged rats with extremity trauma had only modest and transient effects on multiple aspects of cardiorespiratory function after both moderate (37%) and severe (50%) traumatic hemorrhages. Such effects did not alter survival.
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Affiliation(s)
- Harold G Klemcke
- United States Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas
| | - Mariam L Calderon
- United States Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas
| | - Stephen L Crimmins
- United States Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas
| | - Kathy L Ryan
- United States Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas
| | - Lusha Xiang
- United States Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas
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Späth M, Hohmann M, Rohde M, Lengenfelder B, Stelzle F, Klämpfl F. Determination of the diameter of simulated human capillaries using shifted position-diffuse reflectance imaging. JOURNAL OF BIOPHOTONICS 2021; 14:e202000465. [PMID: 33432711 DOI: 10.1002/jbio.202000465] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 01/05/2021] [Accepted: 01/06/2021] [Indexed: 06/12/2023]
Abstract
Multiple diseases are associated with a wide spectrum of microvascular dysfunctions, microangiopathies and microcirculation disorders. Monitoring the microcirculation could thus be useful to diagnose many local and systemic circulatory disorders and to supervise critically ill patients. Many of the scores currently available to help identify the condition of a microcirculation disorder are invasive or leave scope for interpretation. Thus, the present study aims to investigate with Monte-Carlo simulations (as numerical solutions of the radiative transfer equation) whether shifted position-diffuse reflectance imaging (SP-DRI), a non-invasive diagnostic technique, reveals information on the capillary diameter to assess the state of the microcirculation. To quantify the SP-DRI signal, the modulation parameter K is introduced. It proves to correlate almost perfectly with the capillary diameter ( R¯2≈1 ), making it a valid parameter for reliably assessing microcirculation. SP-DRI is emerging as an important milestone on the way to early and conveniently diagnosing microcirculation associated diseases.
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Affiliation(s)
- Moritz Späth
- Institute of Photonic Technologies, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Erlangen Graduate School in Advanced Optical Technologies, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Martin Hohmann
- Institute of Photonic Technologies, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Erlangen Graduate School in Advanced Optical Technologies, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Maximilian Rohde
- Erlangen Graduate School in Advanced Optical Technologies, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Department of Oral and Maxillofacial Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Benjamin Lengenfelder
- Institute of Photonic Technologies, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Erlangen Graduate School in Advanced Optical Technologies, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Florian Stelzle
- Institute of Photonic Technologies, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Erlangen Graduate School in Advanced Optical Technologies, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Department of Oral and Maxillofacial Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Florian Klämpfl
- Institute of Photonic Technologies, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Erlangen Graduate School in Advanced Optical Technologies, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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6
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Nazir S, Pateau V, Bert J, Clement JF, Fayad H, l'Her E, Visvikis D. Surface imaging for real-time patient respiratory function assessment in intensive care. Med Phys 2020; 48:142-155. [PMID: 33118190 DOI: 10.1002/mp.14557] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 10/08/2020] [Accepted: 10/20/2020] [Indexed: 11/11/2022] Open
Abstract
PURPOSE Monitoring of physiological parameters is a major concern in Intensive Care Units (ICU) given their role in the assessment of vital organ function. Within this context, one issue is the lack of efficient noncontact techniques for respiratory monitoring. In this paper, we present a novel noncontact solution for real-time respiratory monitoring and function assessment of ICU patients. METHODS The proposed system uses a Time-of-Flight depth sensor to analyze the patient's chest wall morphological changes in order to estimate multiple respiratory function parameters. The automatic detection of the patient's torso is also proposed using a deep neural network model trained on the COCO dataset. The evaluation of the proposed system was performed on a mannequin and on 16 mechanically ventilated patients (a total of 216 recordings) admitted in the ICU of the Brest University Hospital. RESULTS The estimation of respiratory parameters (respiratory rate and tidal volume) showed high correlation with the reference method (r = 0.99; P < 0.001 and r = 0.99; P < 0.001) in the mannequin recordings and (r = 0.95, P < 0.001 and r = 0.90, P < 0.001) for patients. CONCLUSION This study describes and evaluates a novel noncontact monitoring system suitable for continuous monitoring of key respiratory parameters for disease assessment of critically ill patients.
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Affiliation(s)
- Souha Nazir
- INSERM, UMR1101, LaTIM, University of Brest, Brest, 29200, France
| | | | - Julien Bert
- INSERM, UMR1101, LaTIM, University of Brest, Brest, 29200, France
| | | | - Hadi Fayad
- INSERM, UMR1101, LaTIM, University of Brest, Brest, 29200, France.,Hamad Medical Corporation OHS, PET/CT center Doha, Doha, Qatar
| | - Erwan l'Her
- INSERM, UMR1101, LaTIM, University of Brest, Brest, 29200, France.,CHRU, Brest, 29200, France
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Akrami K, Sweeney DA, Malhotra A. Antibiotic stewardship in the intensive care unit: tools for de-escalation from the American Thoracic Society Meeting 2016. J Thorac Dis 2016; 8:S533-5. [PMID: 27606085 PMCID: PMC4990674 DOI: 10.21037/jtd.2016.07.28] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 06/28/2016] [Indexed: 01/24/2023]
Affiliation(s)
- Kevan Akrami
- Department of Infectious Disease, University of California, San Diego, USA
- Critical Care Medicine, National Institute of Health, Bethesda, MD, USA
| | - Daniel A. Sweeney
- Department of Pulmonary, Critical Care and Sleep Medicine, University of California, San Diego, USA
| | - Atul Malhotra
- Department of Pulmonary, Critical Care and Sleep Medicine, University of California, San Diego, USA
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8
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Farkas DL, Kolodziejski NJ, Stapels CJ, McAdams DR, Fernandez DE, Podolsky MJ, Christian JF, Ward BB, Vartarian M, Feinberg SE, Lee SY, Parikh U, Mycek MA, Joyner MJ, Johnson CP, Paradis NA. A disposable, flexible skin patch for clinical optical perfusion monitoring at multiple depths. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2016; 9715:97151H. [PMID: 29056813 PMCID: PMC5647776 DOI: 10.1117/12.2230988] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Stable, relative localization of source and detection fibers is necessary for clinical implementation of quantitative optical perfusion monitoring methods such as diffuse correlation spectroscopy (DCS) and diffuse reflectance spectroscopy (DRS). A flexible and compact device design is presented as a platform for simultaneous monitoring of perfusion at a range of depths, enabled by precise location of optical fibers in a robust and secure adhesive patch. We will discuss preliminary data collected on human subjects in a lower body negative pressure model for hypovolemic shock. These data indicate that this method facilitates simple and stable simultaneous monitoring of perfusion at multiple depths and within multiple physiological compartments.
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Affiliation(s)
- Dana L Farkas
- Northeastern University, Boston, MA 02115
- Radiation Monitoring Devices, 44 Hunt Street, Watertown, MA, USA 02472
| | | | | | - Daniel R McAdams
- Radiation Monitoring Devices, 44 Hunt Street, Watertown, MA, USA 02472
| | | | | | - James F Christian
- Radiation Monitoring Devices, 44 Hunt Street, Watertown, MA, USA 02472
| | - Brent B Ward
- Dept. of Oral and Maxillofacial Surgery, University of Michigan, Ann Arbor, MI 48109
| | - Mark Vartarian
- Dept. of Oral and Maxillofacial Surgery, University of Michigan, Ann Arbor, MI 48109
| | - Stephen E Feinberg
- Dept. of Oral and Maxillofacial Surgery, University of Michigan, Ann Arbor, MI 48109
| | - Seung Yup Lee
- Dept. of Oral and Maxillofacial Surgery, University of Michigan, Ann Arbor, MI 48109
| | - Urmi Parikh
- Dept. of Oral and Maxillofacial Surgery, University of Michigan, Ann Arbor, MI 48109
| | - Mary-Ann Mycek
- Dept. of Oral and Maxillofacial Surgery, University of Michigan, Ann Arbor, MI 48109
| | | | | | - Norman A Paradis
- Department of Emergency Medicine, Dartmouth-Hitchcock Medical, Lebanon, NH 03766
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9
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Diagnostic value of procalcitonin in burn septic patients. Burns 2014; 40:1240-1. [DOI: 10.1016/j.burns.2014.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 04/11/2014] [Indexed: 11/18/2022]
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10
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Bumbasirević V, Jovanović B, Palibrk I, Karamarković A, Radenković D, Gregorić P, Djukić V, Stevanović R, Simić D, Ivancević N. [Hemorrhagic shock]. ACTA CHIRURGICA IUGOSLAVICA 2007; 54:63-70. [PMID: 17633864 DOI: 10.2298/aci0701063b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Hemorrhagic shock is a condition produced by rapid and significant loss of blood which lead to hemodynamic instability, decreases in oxygen delivery, decreased tissue perfusion, cellular hypoxia, organ damage and can be rapidly fatal. Despite improved understanding of the pathophysiology and significant advances in technology, it remains a serious problem associated with high morbidity and mortality. Early treatment is essential but is hampered by the fact that signs and symptoms of shock appear only after the state of shock is well establish and the compensatory mechanisms have started to fail. The primary goal is to stop the bleeding and restore the intravascular volume. This review addresses the pathophysiology and treatment of haemorrhagic shock.
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Affiliation(s)
- V Bumbasirević
- Institut za anesteziju i reanimatologiju,Urgentni centar KCS, Beograd
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