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Cho HY, Lee HJ, Hwang IE, Lee HC, Kim WH, Yang SM. Comparison of invasive and non-invasive measurements of cardiac index and systemic vascular resistance in living-donor liver transplantation: a prospective, observational study. BMC Anesthesiol 2023; 23:359. [PMID: 37924013 PMCID: PMC10625262 DOI: 10.1186/s12871-023-02302-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 09/28/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Based on the controversy surrounding pulmonary artery catheterization (PAC) in surgical patients, we investigated the interchangeability of cardiac index (CI) and systemic vascular resistance (SVR) measurements between ClearSight™ and PAC during living-donor liver transplantation (LDLT). METHODS This prospective study included consecutively selected LDLT patients. ClearSight™-based CI and SVR measurements were compared with those from PAC at seven LDLT-stage time points. ClearSight™-based systolic (SAP), mean (MAP), and diastolic (DAP) arterial pressures were also compared with those from femoral arterial catheterization (FAC). For the comparison and analysis of ClearSight™ and the reference method, Bland-Altman analysis was used to analyze accuracy while polar and four-quadrant plots were used to analyze the trending ability. RESULTS From 27 patients, 189 pairs of ClearSight™ and reference values were analyzed. The CI and SVR performance errors (PEs) exhibited poor accuracy between the two methods (51.52 and 51.73%, respectively) in the Bland-Altman analysis. CI and SVR also exhibited unacceptable trending abilities in both the polar and four-quadrant plot analyses. SAP, MAP, and DAP PEs between the two methods displayed favorable accuracy (24.28, 21.18, and 26.26%, respectively). SAP and MAP exhibited acceptable trending ability in the four-quadrant plot between the two methods, but not in the polar plot analyses. CONCLUSIONS During LDLT, CI and SVR demonstrated poor interchangeability, while SAP and MAP exhibited acceptable interchangeability between ClearSight™ and FAC.
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Affiliation(s)
- Hye-Yeon Cho
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Anesthesiology and Pain Medicine, Nowon Eulji Medical Center, Eulji University, Seoul, Republic of Korea
| | - Ho-Jin Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - In Eob Hwang
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyung-Chul Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Won Ho Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seong-Mi Yang
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
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Non-invasive continuous blood pressure monitoring using the ClearSight system for pregnant women at high risks of post-partum hemorrhage: comparison with invasive blood pressure monitoring during cesarean section. Obstet Gynecol Sci 2022; 65:325-334. [PMID: 35754365 PMCID: PMC9304436 DOI: 10.5468/ogs.22063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 05/31/2022] [Indexed: 11/08/2022] Open
Abstract
Objective This study aimed to investigate the accuracy and precision of continuous, non-invasive blood pressure obtained using the ClearSight system by comparing it with invasive arterial blood pressure, and to assess the hemodynamic changes using the ClearSight system in patients undergoing cesarean section. Methods Arterial pressure was measured invasively with an intra-arterial catheter and non-invasively using the ClearSight system during cesarean section in patients with placenta previa or placenta accreta. Blood pressure measurements obtained using these two means were then compared. Results Total 1,277 blood pressure measurement pairs were collected from 21 patients. Under Bland-Altman analysis, the ClearSight system demonstrated an acceptable accuracy with a bias and standard deviation of 8.8±13.4 mmHg for systolic blood pressure, -6.3±7.1 mmHg for diastolic blood pressure, and -2.7±8.0 mmHg for median blood pressure. Cardiac index levels were significantly elevated during fetal delivery and 5 minutes after placental removal, and systemic vascular resistance index levels were significantly decreased during fetal delivery and 40 minutes after placental removal. Conclusion In patients undergoing cesarean section, the ClearSight system showed excellent accuracy and precision compared to that of the currently used invasive monitoring system.
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Wang Y, Huang W, Han J, Tian Y, Wang C, Li L. A comparison of ClearSight noninvasive cardiac output and pulmonary artery bolus thermodilution cardiac output in cardiac surgery patients. Perioper Med (Lond) 2022; 11:24. [PMID: 35676705 PMCID: PMC9178897 DOI: 10.1186/s13741-022-00248-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 02/17/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The ClearSight system measures blood pressure non-invasively and determines cardiac output by analyzing the continuous pressure waveform. We performed a multi-center clinical study in China to test the equivalence of cardiac output measured with the ClearSight system (CSCO) and cardiac output measured with the pulmonary artery catheter bolus thermodilution (TDCO) method. METHODS We included adult patients undergoing cardiac surgery in three Chinese hospitals and measured TDCO and CSCO simultaneously after induction of anesthesia. Hemodynamic stability was required during measurement of TDCO and CSCO. At least four TDCO determinations were performed. The corresponding CSCO was determined as the average over a 30-s period following the injection of each bolus. A data pair for the comparison included the average of three or four accepted TDCO values and the average of the matching CSCO values. Main outcomes included Bland-Altman analysis of bias and standard deviation (SD) and the percentage error (PE). RESULTS One hundred twenty-five subjects were enrolled, and 122 TDCO and CSCO data pairs were available for analysis. Ninety-five (75.4%) data pairs were collected in hemodynamically stable conditions, mean (SD) CSCO was 4.21 (0.78) l/min, and mean TDCO was 3.90 (0.67) l/min. Bias was 0.32 (0.51) l/min, and PE was 25.2%. Analyzing all 122 data pairs resulted in a mean CSCO of 4.19 (0.82) l/min and a mean TDCO of 3.83 (0.71) l/min. Resulting bias was 0.36 (0.53) l/min, and PE was 26.4%. CONCLUSIONS CSCO and TDCO agreed with a low systematic bias. Besides, mean PE was well below the pre-defined 30%. Hemodynamic stability only had a small impact on the analysis. We conclude that CSCO is equivalent to TDCO in cardiac surgery patients. The trial was retrospectively registered in ClinicalTrials.gov, identifier NCT03807622 ; January 17, 2019.
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Affiliation(s)
- Yuefu Wang
- Department of Anesthesiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Department of Anaesthesiology and Surgical Critical Care Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Weiqin Huang
- Department of Anesthesiology, Asian Heart Hospital, Wuhan, Wuhan, China
| | - Jiange Han
- Department of Anesthesiology, Chest Hospital, Tianjin, Tianjin, China
| | - Yu Tian
- Department of Anaesthesiology and Surgical Critical Care Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Chunrong Wang
- Department of Anaesthesiology and Surgical Critical Care Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Lihuan Li
- Department of Anaesthesiology and Surgical Critical Care Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
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Juri T, Suehiro K, Kanematsu R, Takahashi K, Fujimoto Y, Tanaka K, Mori T. Validation of Continuous Noninvasive Blood Pressure Monitoring Using Error Grid Analysis. Anesth Analg 2022; 134:773-780. [PMID: 35051952 DOI: 10.1213/ane.0000000000005882] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Error grid analysis was recently proposed to compare blood pressure obtained by 2 measurement methods. This study aimed to compare continuous noninvasive blood pressure (CNBP) with invasive blood pressure (IBP) using the error grid analysis and investigate the confounding risk factors attributable to the differences between CNBP and IBP. METHODS Sixty adult patients undergoing general anesthesia were prospectively enrolled. Simultaneous comparative data regarding CNBP and IBP were collected. The Bland-Altman analysis was conducted to compare CNBP and IBP for systolic blood pressure (SBP) and mean blood pressure (MBP; acceptable accuracy: mean bias <5 mm Hg; standard deviation <8 mm Hg). The clinical relevance of the discrepancies between CNBP and IBP was evaluated by the error grid analysis, which classifies the differences into 5 zones from "no risk" (A) to "dangerous risk" (E). Additionally, an ordinal logistic regression analysis was performed to evaluate the relationship between the risk zones for MBP, classified by the error grid analysis and covariates of interest. RESULTS A total of 10,663 pairs of CNBP/IBP were finally analyzed. The Bland-Altman analysis showed an acceptable accuracy with a bias of -3.3 ± 5.6 mm Hg for MBP but a poor accuracy with a bias of 5.4 ± 10.5 mm Hg for SBP. The error grid analysis showed the proportions of zones A to E as 96.7%, 3.2%, 0.1%, 0%, and 0% for SBP, respectively, and 72.0%, 27.9%, 0.1%, 0%, and 0% for MBP, respectively. The finger cuff missed 23.9% of epochs when SBP <90 mm Hg and 55.3% of epochs when MBP <65 mm Hg. The ordinal logistic regression analysis revealed that older age (adjusted odds ratio for decade: 1.54, 95% confidence interval [CI], 1.15-2.08; P = .004) and length of time from the initiation of finger cuff inflation (adjusted odds ratio for 60 minutes: 1.40, 95% CI, 1.13-1.73; P = .002) were significant factors of being in a more dangerous zone of the error grid. CONCLUSIONS The error grid analysis revealed the larger clinical discrepancy between CNBP and IBP in MBP compared with that in SBP. Old age and longer finger cuff inflation time were significant factors of being in a more dangerous zone of the error grid, which could affect the hemodynamic management during surgery.
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Affiliation(s)
- Takashi Juri
- From the Department of Anesthesiology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Koichi Suehiro
- From the Department of Anesthesiology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Rieko Kanematsu
- From the Department of Anesthesiology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kanae Takahashi
- Department of Biostatistics, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Yohei Fujimoto
- From the Department of Anesthesiology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Katsuaki Tanaka
- From the Department of Anesthesiology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Takashi Mori
- From the Department of Anesthesiology, Osaka City University Graduate School of Medicine, Osaka, Japan
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Bodys-Pełka A, Kusztal M, Boszko M, Główczyńska R, Grabowski M. Non-Invasive Continuous Measurement of Haemodynamic Parameters-Clinical Utility. J Clin Med 2021; 10:jcm10214929. [PMID: 34768449 PMCID: PMC8584279 DOI: 10.3390/jcm10214929] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 10/15/2021] [Accepted: 10/20/2021] [Indexed: 11/16/2022] Open
Abstract
The evaluation and monitoring of patients’ haemodynamic parameters are essential in everyday clinical practice. The application of continuous, non-invasive measurement methods is a relatively recent solution. CNAP, ClearSight and many other technologies have been introduced to the market. The use of these techniques for assessing patient eligibility before cardiac procedures, as well as for intraoperative monitoring is currently being widely investigated. Their numerous advantages, including the simplicity of application, time- and cost-effectiveness, and the limited risk of infection, could enforce their further development and potential utility. However, some limitations and contradictions should also be discussed. The aim of this paper is to briefly describe the new findings, give practical examples of the clinical utility of these methods, compare them with invasive techniques, and review the literature on this subject.
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Affiliation(s)
- Aleksandra Bodys-Pełka
- 1st Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland; (A.B.-P.); (M.K.); (M.B.); (M.G.)
- Doctoral School, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Maciej Kusztal
- 1st Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland; (A.B.-P.); (M.K.); (M.B.); (M.G.)
| | - Maria Boszko
- 1st Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland; (A.B.-P.); (M.K.); (M.B.); (M.G.)
| | - Renata Główczyńska
- 1st Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland; (A.B.-P.); (M.K.); (M.B.); (M.G.)
- Correspondence: ; Tel.: +48-5992-616
| | - Marcin Grabowski
- 1st Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland; (A.B.-P.); (M.K.); (M.B.); (M.G.)
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Lee SW, Lee S, Kim H, Kim YJ, Kim M, Choi JH. Accuracy of noninvasive continuous arterial pressure monitoring using ClearSight during one-lung ventilation. Medicine (Baltimore) 2021; 100:e25152. [PMID: 33726000 PMCID: PMC7982160 DOI: 10.1097/md.0000000000025152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 02/23/2021] [Indexed: 01/05/2023] Open
Abstract
Noninvasive continuous arterial pressure monitoring may be clinically useful in patients who require continuous blood pressure monitoring in situations where arterial catheter placement is limited. Many previous studies on the accuracy of the noninvasive continuous blood pressure monitoring method reported various results. However, there is no research on the effectiveness of noninvasive arterial pressure monitoring during one-lung ventilation. The purpose of this study was to compare arterial blood pressure obtained through invasive method and noninvasive method by using ClearSight during one-lung ventilation.In this retrospective observational study, a total of 26 patients undergoing one-lung ventilation for thoracic surgery at a single institution between March and July 2019 were recruited. All patients in this study were cannulated on their radial artery to measure continuously invasive blood pressures and applied ClearSight on the ipsilateral side of the cannulated arm. We compared and analyzed the agreement and trendability of blood pressure recorded with invasive and noninvasive methods during one-lung ventilation.Blood pressure and pulse rate showed a narrower limit of agreement with a percentage error value of around 30%. In addition, the tracking ability of each measurement could be determined by the concordance rate, all of which were below acceptable limits (92%).In noninvasive arterial blood pressure monitoring using ClearSight, mean blood pressure and pulse rate show acceptable agreement with the invasive method.
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Affiliation(s)
- Sang-Wook Lee
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, Seoul
| | - Sangho Lee
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, Seoul
| | - Hyungtae Kim
- Department of Medicine, Graduate School, Kyung Hee University
| | - Yun-Jong Kim
- Department of Anesthesiology and Pain Medicine, Kyung Hee University Hospital
| | - Mihyeon Kim
- Department of Anesthesiology and Pain Medicine, Kyung Hee University Hospital
| | - Jeong-Hyun Choi
- Department of Anesthesiology and Pain Medicine, College of Medicine, Kyung Hee University, Seoul, Korea
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Use of pulse contour technology for continuous blood pressure monitoring in pediatric patients. Blood Press Monit 2021; 25:278-284. [PMID: 32701567 DOI: 10.1097/mbp.0000000000000458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study evaluates the accuracy of continuous blood pressure monitoring using pulse contour technology with the ClearSight monitoring device, a noninvasive alternative to placing an invasive arterial line, in pediatric patients. METHODS Children younger than 18 years admitted to a pediatric ICU, who required an arterial line, and fit into the ClearSight finger cuff were included. Blood pressure measurement for systolic, diastolic, and mean arterial pressures (MAP) obtained by the ClearSight device were compared with those obtained with the intra-arterial catheter as well as automated cuff measurements using the mixed-effects model. Analysis was conducted for entire cohort, and measurements obtained with and without vasopressor use. RESULTS There were 213 measurements from 10 patients. There was a statistically significant difference in systolic blood pressure when comparing arterial line and ClearSight systolic and diastolic measurements between the two methods (P < 0.001). There was no statistical difference between arterial MAP and ClearSight MAP (P = 0.957). Results were similar when ClearSight measurements were compared with automated cuff measurements. Both the vasopressor use and nonvasopressor use groups showed a statistically significant difference between arterial and ClearSight measurements for systolic and diastolic pressures, but not for the MAP. CONCLUSIONS Measurements of MAP obtained by the ClearSight device were almost identical to those obtained by the intra-arterial catheter. Although there was a difference in systolic blood pressures between the two methods, in those patients receiving inotropic support, the difference was within the range of what is considered acceptable in validating blood pressure devices.
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Chen YYK, Desai SP, Fox JA. Literature and new innovations leading to the rise and fall of the Swan-Ganz catheter. J Anesth Hist 2020; 6:21-25. [PMID: 33674026 DOI: 10.1016/j.janh.2020.12.008] [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] [Received: 07/25/2019] [Revised: 02/24/2020] [Accepted: 12/26/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND In 1970, Harold James Charles Swan and William Ganz published their work on the pulmonary artery catheter (PAC or Swan-Ganz catheter). They described the successful bedside use of a flow-directed catheter to continuously evaluate the heart, and it was used extensively in the years following to care for critically ill patients. In recent decades, clinicians have reevaluated the risks and benefits of the PAC. AIM We acknowledge the contributions of Swan and Ganz and discuss literature, including randomized controlled trials, and new technology surrounding the rise and fall in use of the PAC. METHODS We performed a literature search of retrospective and prospective studies, including randomized controlled trials, and editorials to understand the history and clinical outcomes of the PAC. RESULTS In the 1980s, clinicians began to question the benefits of the PAC. In 1996 and 2003, a large observational study and randomized controlled trial, respectively, showed no clear benefits in outcome. Thereafter, use of PACs began to drop precipitously. New less and noninvasive technology can estimate cardiac output and blood pressure continuously. CONCLUSIONS Swan and Ganz contributed to the bedside understanding of the pathophysiology of the heart. The history of the rise and fall in use of the PAC parallels the literature and invention of less-invasive technology. Although the PAC has not been shown to improve clinical outcomes in large randomized controlled trials, it may still be useful in select patients. New less-invasive and noninvasive technology may ultimately replace it if literature supports it.
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Affiliation(s)
- Yun-Yun K Chen
- Department of Anaesthesia - Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA.
| | - Sukumar P Desai
- Department of Anaesthesia - Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA; Department of Anaesthesia - Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - John A Fox
- Department of Anaesthesia - Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
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Klose P, Lorenzen U, Berndt R, Borzikowsky C, Hill M, Gruenewald M, Elke G, Renner J. Continuous noninvasive monitoring of arterial pressure using the vascular unloading technique in comparison to the invasive gold standard in elderly comorbid patients: A prospective observational study. Health Sci Rep 2020; 3:e204. [PMID: 33204849 PMCID: PMC7654630 DOI: 10.1002/hsr2.204] [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: 07/07/2020] [Revised: 09/09/2020] [Accepted: 10/13/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND AND AIMS Elderly patients aged ≥65 years represent a growing population in the perioperative field, particularly orthopedic and vascular surgery. The higher degree of age-related or comorbid-dependent vascular alterations renders these patients at risk for hemodynamic complications and likely denote a possible limitation for modern, non-invasive arterial pressure monitoring devices. The aim was to compare vascular unloading technique-derived to invasive measurements of systolic (SAP), diastolic (DAP), and mean arterial pressure (MAP) in elderly perioperative patients. METHODS This prospective observational study included patients aged ≥65 years scheduled for orthopedic and patients ≥50 years with peripheral artery disease Fontaine stage ≥ II scheduled for vascular surgery, respectively. Invasive radial artery and non-invasive finger-cuff (Nexfin system) arterial pressures were recorded before and after induction of general anesthesia and during surgery. Correlation, Bland-Altman, and concordance analyses were performed. Measurements of arterial pressure were also compared during intraoperative hypotension (MAP <70 mm Hg) and hypertension (MAP >105 mm Hg). RESULTS Sixty patients with orthopedic (N = 25, mean (SD) age 77 (5) years) and vascular surgery (N = 35, age 69 [10] years) were enrolled. Seven hundred data pairs of all patients were analysed and pooled bias and percentage error were: SAP: 14.43 mm Hg, 43.79%; DAP: -2.40 mm Hg, 53.78% and MAP: 1.73 mm Hg, 45.05%. Concordance rates were 84.01% for SAP, 77.87% for DAP, and 86.47% for MAP. Predefined criteria for interchangeability of absolute and trending values could neither be reached in the overall nor in the subgroup analyses orthopedic vs vascular surgery. During hypertension, percentage error was found to be lowest for all pressure values, still not reaching predefined criteria. CONCLUSION Arterial pressure monitoring with the vascular unloading technique did not reach criteria of interchangeability for absolute and trending values. Nevertheless, the putatively beneficial use of noninvasive arterial pressure measurements should be further evaluated in the elderly perioperative patient.
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Affiliation(s)
- Phil Klose
- Department of Anaesthesiology and Intensive Care MedicineUniversity Medical Center Schleswig‐Holstein, Campus KielKielGermany
| | - Ulf Lorenzen
- Department of Anaesthesiology and Intensive Care MedicineUniversity Medical Center Schleswig‐Holstein, Campus KielKielGermany
| | - Rouven Berndt
- Department of Cardiovascular SurgeryUniversity Medical Center Schleswig‐Holstein, Campus KielKielGermany
| | - Christoph Borzikowsky
- Institute of Medical Informatics and StatisticsChristian‐Albrechts‐University Kiel, University Medical Center Schleswig‐Holstein, Campus KielKielGermany
| | - Moritz Hill
- Department of Anaesthesiology and Intensive Care MedicineUniversity Medical Center Schleswig‐Holstein, Campus KielKielGermany
| | - Matthias Gruenewald
- Department of Anaesthesiology and Intensive Care MedicineUniversity Medical Center Schleswig‐Holstein, Campus KielKielGermany
| | - Gunnar Elke
- Department of Anaesthesiology and Intensive Care MedicineUniversity Medical Center Schleswig‐Holstein, Campus KielKielGermany
| | - Jochen Renner
- Department of AnesthesiologyHelios Kliniken SchwerinSchwerinGermany
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Heijne A, Krijtenburg P, Bremers A, Scheffer GJ, Malagon I, Slagt C. Four different methods of measuring cardiac index during cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Korean J Anesthesiol 2020; 74:120-133. [PMID: 32819047 PMCID: PMC8024204 DOI: 10.4097/kja.20202] [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: 04/28/2020] [Accepted: 08/14/2020] [Indexed: 01/21/2023] Open
Abstract
Background Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are high-risk extensive abdominal surgery. During high-risk surgery, less invasive methods for cardiac index (CI) measurement have been widely used in operating theater. We investigated the accuracy of CI derived from different methods (FroTrac, ProAQT, ClearSight, and arterial pressure waveform analysis [APWA], from PICCO) and compared them to transpulmonary thermodilution (TPTD) during CRS and HIPEC in the operative room and intensive care unit (ICU). Methods Twenty-five patients scheduled for CRS-HIPEC were enrolled. During nine predefined time-points, simultaneous hemodynamic measurements were performed in the operating room and ICU. Absolute and relative changes of CI were analyzed using a Bland-Altman plot, four-quadrant plot, and interchangeability. Results The mean bias was −0.1 L/min/m2 for ClearSight, ProAQT, and APWA and was −0.2 L/min/m2 for FloTrac compared with TPTD. All devices had large limits of agreement (LoA). The percentage of errors and interchangeabilities for ClearSight, FloTrac, ProAQT, and APWA were 50%, 50%, 54%, 36% and 36%, 47%, 40%, 72%, respectively. Trending capabilities expressed as concordance using clinically significant CI changes were −7º ± 39º, −19º ± 38º, −13º ± 41º, and −15º ± 39º. Interchangeability in trending showed low percentages of interchangeable and gray zone data pairs for all devices. Conclusions During CRS-HIPEC, ClearSight, FloTrac and ProAQT systems were not able to reliably measure CI compared to TPTD. Reproducibility of changes over time using concordance, angular bias, radial LoA, and interchangeability in trending of all devices was unsatisfactory.
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Affiliation(s)
- Amon Heijne
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Piet Krijtenburg
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Andre Bremers
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Gert Jan Scheffer
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ignacio Malagon
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Cornelis Slagt
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
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Pestel G, Fukui K, Higashi M, Schmidtmann I, Werner C. [Meta-analyses on measurement precision of non-invasive hemodynamic monitoring technologies in adults]. Anaesthesist 2019; 67:409-425. [PMID: 29789877 DOI: 10.1007/s00101-018-0452-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
An ideal non-invasive monitoring system should provide accurate and reproducible measurements of clinically relevant variables that enables clinicians to guide therapy accordingly. The monitor should be rapid, easy to use, readily available at the bedside, operator-independent, cost-effective and should have a minimal risk and side effect profile for patients. An example is the introduction of pulse oximetry, which has become established for non-invasive monitoring of oxygenation worldwide. A corresponding non-invasive monitoring of hemodynamics and perfusion could optimize the anesthesiological treatment to the needs in individual cases. In recent years several non-invasive technologies to monitor hemodynamics in the perioperative setting have been introduced: suprasternal Doppler ultrasound, modified windkessel function, pulse wave transit time, radial artery tonometry, thoracic bioimpedance, endotracheal bioimpedance, bioreactance, and partial CO2 rebreathing have been tested for monitoring cardiac output or stroke volume. The photoelectric finger blood volume clamp technique and respiratory variation of the plethysmography curve have been assessed for monitoring fluid responsiveness. In this manuscript meta-analyses of non-invasive monitoring technologies were performed when non-invasive monitoring technology and reference technology were comparable. The primary evaluation criterion for all studies screened was a Bland-Altman analysis. Experimental and pediatric studies were excluded, as were all studies without a non-invasive monitoring technique or studies without evaluation of cardiac output/stroke volume or fluid responsiveness. Most studies found an acceptable bias with wide limits of agreement. Thus, most non-invasive hemodynamic monitoring technologies cannot be considered to be equivalent to the respective reference method. Studies testing the impact of non-invasive hemodynamic monitoring technologies as a trend evaluation on outcome, as well as studies evaluating alternatives to the finger for capturing the raw signals for hemodynamic assessment, and, finally, studies evaluating technologies based on a flow time measurement are current topics of clinical research.
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Affiliation(s)
- G Pestel
- Klinik für Anästhesiologie, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland.
| | - K Fukui
- Klinik für Anästhesiologie, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - M Higashi
- Klinik für Anästhesiologie, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - I Schmidtmann
- Institut für Medizinische Biometrie, Epidemiologie und Informatik (IMBEI), Universitätsmedizin Mainz, Mainz, Deutschland
| | - C Werner
- Klinik für Anästhesiologie, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
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Pour-Ghaz I, Manolukas T, Foray N, Raja J, Rawal A, Ibebuogu UN, Khouzam RN. Accuracy of non-invasive and minimally invasive hemodynamic monitoring: where do we stand? ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:421. [PMID: 31660320 DOI: 10.21037/atm.2019.07.06] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
One of the most important variables in assessing hemodynamic status in the intensive care unit (ICU) is the cardiac function and blood pressure. Invasive methods such as pulmonary artery catheter and arterial line allow monitoring of blood pressure and cardiac function accurately and reliably. However, their use is not without drawbacks, especially when the invasive nature of these procedures and complications associated with them are considered. There are several newer methods of noninvasive and minimally invasive hemodynamic monitoring available. In this manuscript, we will review these different methods of minimally invasive and non-invasive hemodynamic monitoring and will discuss their advantages, drawbacks and limitations.
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Affiliation(s)
- Issa Pour-Ghaz
- Department of Internal Medicine, Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Theodore Manolukas
- Department of Internal Medicine, Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Nathalie Foray
- Department of Medicine - Critical Care, Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Joel Raja
- Department of Internal Medicine, Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Aranyak Rawal
- Department of Internal Medicine, Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Uzoma N Ibebuogu
- Department of Internal Medicine, Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Rami N Khouzam
- Department of Internal Medicine, Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN, USA
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Abstract
During surgery, one of the primary functions of the anesthesiologist is to monitor the patient and ensure safe and effective conduct of anesthesia to provide the optimum operating conditions. Standard guidelines for perioperative monitoring have been firmly established by the American Society of Anesthesiologists. However, in recent years, new advances in technology has led to the development of many new monitoring modalities, especially involving the neurologic and cardiovascular systems. This article presents a targeted review to discuss the functions and limitations of these new monitors and how they are applied in the modern operating room setting.
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Affiliation(s)
- Yi Deng
- Department of Anesthesiology and Critical Care Medicine, Baylor College of Medicine, 1 Baylor Plaza, MSC 120, Houston, TX 77030, USA.
| | - Jovany Cruz Navarro
- Department of Anesthesiology, Baylor College of Medicine, 1 Baylor Plaza, MSC 120, Houston, TX 77030, USA; Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Sandeep Markan
- Department of Anesthesiology and Critical Care Medicine, Baylor College of Medicine, 1 Baylor Plaza, MSC 120, Houston, TX 77030, USA
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Yokose M, Mihara T, Takaya M, Yamamoto T, Saigusa Y, Takaki S, Goto T. The perfusion index measured by the pulse oximeter affects the agreement between ClearSight and the arterial catheter-based blood pressures: A prospective observational study. PLoS One 2019; 14:e0219511. [PMID: 31291340 PMCID: PMC6619788 DOI: 10.1371/journal.pone.0219511] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 06/25/2019] [Indexed: 11/19/2022] Open
Abstract
Background ClearSight is a noninvasive arterial blood pressure monitor, but it remains unknown whether it is affected by the state of perfusion to the fingers. We investigated whether the lower perfusion index (PI) measured with a pulse oximeter, which reflects finger perfusion, would affect the agreement between arterial pressures measured with ClearSight versus those obtained with an arterial catheter. Methods Paired arterial pressure data (ClearSight and arterial catheter-based pressures) and PI values were prospectively obtained from 30 patients undergoing major abdominal surgery. The primary outcome was standard deviation (SD) of the bias (precision) of blood pressure between ClearSight and arterial catheter. The ratio of the adjusted SD of the bias between PI≤1 and PI>1 was calculated using the linear mixed-effects model. The secondary outcomes were the bias and the limits of agreement (LOA) between the two devices (repeated measures Bland-Altman analysis). Results We analyzed 6312 paired data points. The adjusted SD of bias in PI ≤1 compared with those in PI >1 was 1.4-fold (95% confidence interval: 1.3- to 1.4-fold) for systolic arterial pressure, 1.5-fold (95% confidence interval: 1.3- to 1.6-fold) for diastolic arterial pressure, and 1.3-fold (95% confidence interval: 1.2- to 1.5-fold) for mean arterial pressure. The bias (LOA) were as follows: systolic arterial pressure in the PI ≤1 and PI >1 groups, -3.5 (-35.4 to 28.4) mmHg and 2.2 (-19.9 to 24.3) mmHg, respectively; diastolic arterial pressure in the PI ≤1 and PI >1 groups, 13.1 (-5.1 to 31.3) mmHg and 9.0, (-2.6 to 20.6) mmHg, respectively; and mean arterial pressure in the PI ≤1 and PI >1 groups, 8.7 (-11.3 to 28.7) mmHg and 7.6 (-6.2 to 21.3) mmHg, respectively. Conclusions PI ≤1 was associated with a large SD of the bias between the devices. The PI value could be a real-time indicator of ClearSight precision.
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Affiliation(s)
- Masashi Yokose
- Department of Anesthesiology and Critical Care Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
- * E-mail:
| | - Takahiro Mihara
- Department of Anesthesiology and Critical Care Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
- Education and Training Department, Yokohama City University Hospital, YCU Centre for Novel and Exploratory Clinical Trials, Yokohama, Japan
| | - Masahiro Takaya
- Department of Anesthesiology, Fujisawa City Hospital, Fujisawa, Kanagawa, Japan
| | - Takumi Yamamoto
- Department of Anesthesiology and Critical Care Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yusuke Saigusa
- Department of Biostatistics, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Shunsuke Takaki
- Department of Anesthesiology and Critical Care Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Takahisa Goto
- Department of Anesthesiology and Critical Care Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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Noninvasive continuous arterial pressure monitoring with Clearsight during awake carotid endarterectomy: A prospective observational study. Eur J Anaesthesiol 2019; 36:144-152. [PMID: 30562226 DOI: 10.1097/eja.0000000000000938] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Continuous noninvasive blood pressure (CNBP) measurement using the volume-clamp method is a less invasive alternative compared with invasive intra-arterial monitoring for awake patients during carotid endarterectomy (CEA) under regional anaesthesia. OBJECTIVE We investigated the agreement of blood pressure (BP) recorded with invasive and CNBP methods during awake CEA. DESIGN A prospective observational study for assessing agreement with Bland-Altman plots, agreement-tolerability indices (ATI), concordance and interchangeability. SETTING Azienda Ospedaliera Universitaria G. Martino, Messina, a University tertiary referral centre in Italy. PATIENTS In 30 consecutive patients, we recorded continuously ipsilateral invasive and noninvasive BPs, from 3 min before carotid cross-clamping to 5 min after unclamping. MAIN OUTCOME MEASURES Primary outcome was bias, 95% limits of agreement, ATI, concordance and interchangeability for mean arterial pressure (MAP). Secondary outcomes were agreements for systolic arterial pressure and diastolic arterial pressure. Tracking of changes was assessed with four-quadrant polar plots and the trend interchangeability method. Optimal bias was defined as 5 mmHg or less. RESULTS A total of 2672 invasive and CNBP paired measurements (93% of overall data) were analysed, with a median of 92 readings per patient [IQR 76 to 100]. Mean (SD) bias for MAP, systolic arterial pressure and DAP were -6.8 (6.7), -3.0 (9.7) and -9.0 (5.4) mmHg, respectively. The ATIs were 0.88, 0.95 and 0.71, respectively, where ATI of 1.0 or less and at least 2.0 defined acceptable, marginal and unacceptable agreements. The four-quadrant plot analysis for beat-to-beat differences showed concordance rates of 97.3%, 99.98% and 96.4%, respectively. Polar plot analysis showed 95% limits of agreement of -3 to 3, -2 to 2 and -2 to 2 mmHg respectively. Trend interchangeability method showed an interchangeability rate of 95% for MAP. CONCLUSION During CEA performed under regional anaesthesia, CNBP offers a less invasive approach for BP monitoring. We found acceptable agreement for MAP defined by an ATI of 0.88 and an excellent 95% global interchangeability rate. A suboptimal bias of 7 mmHg was found with CNBP for MAP.
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Olesen ND, Jørgensen TB, Eiberg J, Helgstrand UJV, Sillesen HH, Cedergreen P, Secher NH, Nielsen HB. Elevated Renal Oxygen Extraction During Open Abdominal Aortic Aneurysm Repair Is Related to Postoperative Renal Dysfunction. Semin Cardiothorac Vasc Anesth 2018; 22:369-375. [PMID: 30047299 DOI: 10.1177/1089253218790270] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Open abdominal aortic aneurysm repair is often followed by elevated plasma creatinine, likely due to impaired renal blood flow. We evaluated whether postoperative elevation in creatinine relates to renal oxygen extraction during surgery as an index of renal blood flow and also monitored frontal lobe oxygenation. METHODS For 19 patients (66 ± 10 years; mean ± SD) undergoing open infrarenal abdominal aortic aneurysm repair, renal oxygen extraction was determined by arterial and renal vein catheterization. Near-infrared spectroscopy determined frontal lobe oxygenation. RESULTS During surgery mean arterial pressure (from 102 ± 14 to 65 ± 11 mm Hg; P < .0001), arterial hemoglobin (from 7.7 ± 0.7 to 6.6 ± 0.8 mmol/L; P < 0.0001), and frontal lobe oxygenation (from 74 ± 6% to 70 ± 6%; P = .0414) decreased, while renal oxygen extraction increased (from 5.3% [4.3-8.1]; median [interquartile range] to 10.8% [5.8-17.5]; P = .0405). Plasma creatinine became significantly elevated on the second day after the operation (from 83 [73-101] to 105 µmol/L [79-143]; P = .0062) with a peak increase observed after 2 days (1-2). The peak increase in creatinine correlated to intraoperative renal oxygen extraction ( r = 0.51; P = .026). CONCLUSION Kidney function was affected after open abdominal aortic aneurysm repair likely related to limited renal blood flow. We take the increase in renal oxygen extraction and reduction in frontal lobe oxygenation to suggest that mean arterial pressure and hemoglobin were too low to maintain renal and cerebral circulation in vascular surgical patients.
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Burtman DT, Stolze A, genaamd Dengler SEK, Vonk AB, Boer C. Minimally Invasive Determinations of Oxygen Delivery and Consumption in Cardiac Surgery: An Observational Study. J Cardiothorac Vasc Anesth 2018; 32:1266-1272. [DOI: 10.1053/j.jvca.2017.06.042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Indexed: 11/11/2022]
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Delaney LJ, Bellomo R, van Haren F. Responsiveness of Noninvasive Continuous Cardiac Output Monitoring During the Valsalva Maneuver. Clin Nurs Res 2018. [PMID: 29514518 DOI: 10.1177/1054773818762878] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To describe the baseline hemodynamic variables and response time of hemodynamic changes associated with the Valsalva maneuver using noninvasive continuous cardiac output monitoring (Nexfin). Hemodynamic monitoring provides an integral component of advanced clinical care and the ability to monitor response to treatment interventions. The emergence of noninvasive hemodynamic monitoring provides clinicians with an opportunity to monitor and assess patients rapidly with ease of implementation. However, the responsiveness of this method in tracking dynamic changes that occur has not been fully elucidated. A prospective observational study was conducted involving 44 healthy volunteers (age = 38 ±12 years). Participants performed a Valsalva maneuvers to illicit dynamic changes in blood pressure, cardiac output, cardiac index, systemic vascular resistance index (SVRI), and stroke volume. Changes in these hemodynamic parameters were monitored while performing repeated standardized Valsalva maneuvers. Baseline hemodynamic values were obtained in all 44 participants, and showed an interaction with age, accompanying a significant decline in cardiac index (r = -.66, p < .05) and stroke volume (r = -.68,p < .05), and an increase in SVRI (r = .67, p < .05) with increasing age. The Valsalva maneuver, performed in 20 participants, resulted in a change of 10% from baseline blood pressure and cardiac index, which was detected within 4.53 s (SD = 4.36) and 3.31 s (SD = 2.21), respectively. Noninvasive continuous cardiac monitoring demonstrated the ability to rapidly detect logical and predictable hemodynamic changes. These observations suggest that such Nexfin technology may have useful clinical applications.
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Affiliation(s)
- L J Delaney
- University of Canberra, Australian Capital Territory, Australia.,Australian National University, Canberra, Australian Capital Territory, Australia
| | - R Bellomo
- Melbourne University, Victoria, Australia.,Austin Hospital, Heidelberg, Victoria, Australia
| | - F van Haren
- Australian National University, Canberra, Australian Capital Territory, Australia.,Canberra Hospital, Australian Capital Territory, Australia
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Sakai Y, Yasuo M. T, Oyama T, Murakami C, Kakuta N, Tanaka K. Noninvasive continuous blood pressure monitoring by the ClearSight system during robot‐assisted laparoscopic radical prostatectomy. THE JOURNAL OF MEDICAL INVESTIGATION 2018; 65:69-73. [DOI: 10.2152/jmi.65.69] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Yoko Sakai
- Department of Anesthesiology, Institute of Biomedical Sciences, Tokushima University Graduate School
| | - Tsutsumi Yasuo M.
- Department of Anesthesiology, Institute of Biomedical Sciences, Tokushima University Graduate School
| | - Takuro Oyama
- Department of Anesthesiology, Institute of Biomedical Sciences, Tokushima University Graduate School
| | - Chiaki Murakami
- Department of Anesthesiology, Institute of Biomedical Sciences, Tokushima University Graduate School
| | - Nami Kakuta
- Department of Anesthesiology, Institute of Biomedical Sciences, Tokushima University Graduate School
| | - Katsuya Tanaka
- Department of Anesthesiology, Institute of Biomedical Sciences, Tokushima University Graduate School
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Noninvasive BP Monitoring in the Critically Ill: Time to Abandon the Arterial Catheter? Chest 2017; 153:1023-1039. [PMID: 29108815 DOI: 10.1016/j.chest.2017.10.030] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 10/11/2017] [Accepted: 10/26/2017] [Indexed: 12/17/2022] Open
Abstract
Although its reliability is often questioned, noninvasive BP (NIBP)-monitoring with an oscillometric arm cuff is widely used, even in critically ill patients in shock. When correctly implemented, modern arm NIBP devices can provide accurate and precise measurements of mean BP, as well as clinically meaningful information such as identification of hypotension and hypertension and monitoring of patient response to therapy. Even in specific circumstances such as arrhythmia, hypotension, vasopressor infusion, and possibly in obese patients, arm NIBP may be useful, contrary to widespread belief. Hence, postponing the arterial catheter insertion pending the initiation of more urgent diagnostic and therapeutic measures could be a suitable strategy. Given the arterial catheter-related burden, fully managing critically ill patients without any arterial catheter may also be an option. Indeed, the benefit that patients may experience from an arterial catheter has been questioned in studies failing to show that its use reduces mortality. However, randomized controlled trials to confirm that NIBP can safely fully replace the arterial catheter have yet to be performed. In addition to intermittent measurements, continuous NIBP monitoring is a booming field, as illustrated by the release onto the market of user-friendly devices, based on digital volume clamp and applanation tonometry. Although the imperfect accuracy and precision of these devices would probably benefit from technical refinements, their good ability to track, in real time, the direction of changes in BP is an undeniable asset. Their drawbacks and advantages and whether these devices are currently ready to use in the critically ill patient are discussed in this review.
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Ukor IF, Hilton AK, Bailey MJ, Bellomo R. The haemodynamic effects of bolus versus slower infusion of intravenous crystalloid in healthy volunteers. J Crit Care 2017; 41:254-259. [PMID: 28599199 DOI: 10.1016/j.jcrc.2017.05.036] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 05/19/2017] [Accepted: 05/30/2017] [Indexed: 01/12/2023]
Abstract
PURPOSE This pilot study aimed to characterise the haemodynamic effect of 1L of IV normal saline (NS) administered as a rapid versus slow infusion on cardiac output (CO), heart rate (HR), systemic blood pressures, and carotid blood flow in six healthy volunteers. MATERIALS AND METHODS Six healthy male volunteers aged 18-65years were randomized to receive 1L NS given over 30min or 120min. On a subsequent study session the alternate fluid regimen was administered. Haemodynamic data was gathered using a non-invasive finger arterial pressure monitor (Nexfin®), echocardiography and carotid duplex sonography. Time to micturition and urine volume was also assessed. RESULTS Compared to baseline, rapid infusion of 1L of saline over 30min produced a fall in Nexfin®-measured CO by 0.62L/min (p<0.001), whereas there was a marginal but significant increase during infusion of 1L NS over 120min of 0.02L/min (p<0.001). This effect was mirrored by changes in HR and blood pressure (BP) (p<0.001). There were no significant changes in carotid blood flow, time to micturition, or urine volume produced. CONCLUSIONS Slower infusion of 1L NS in healthy male volunteers produced a greater increase in CO, HR and BP than rapid infusion.
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Affiliation(s)
- Ida F Ukor
- Department of Intensive Care, Austin Hospital, Heidelberg 3081, Melbourne, VIC, Australia; Department of Anaesthesia and Perioperative Medicine, Monash Medical Centre, Clayton 3168, Melbourne, VIC, Australia.
| | - Andrew K Hilton
- Department of Intensive Care, Austin Hospital, Heidelberg 3081, Melbourne, VIC, Australia
| | - Michael J Bailey
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Alfred Centre, Prahran 3181, Melbourne, VIC, Australia
| | - Rinaldo Bellomo
- Department of Intensive Care, Austin Hospital, Heidelberg 3081, Melbourne, VIC, Australia; Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Alfred Centre, Prahran 3181, Melbourne, VIC, Australia
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Raggi EP, Sakai T. Update on Finger-Application-Type Noninvasive Continuous Hemodynamic Monitors (CNAP and ccNexfin): Physical Principles, Validation, and Clinical Use. Semin Cardiothorac Vasc Anesth 2017; 21:321-329. [DOI: 10.1177/1089253217708620] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The CNAP HD Monitor (CNSystems, Graz, Austria) and the ccNexfin (The ClearSight System: Edwards Lifesciences Corporation, Irvine, CA) are continuous, noninvasive blood pressure monitors using a finger-application device. These devices show a promising ability to allow for rapid detection of hemodynamic derangement when compared with oscillometry. The accuracy and precision of these devices as blood pressure monitors has been evaluated when compared with intra-arterial catheters. Additionally, they can be used to measure beat-to-beat cardiac output (CO). As CO monitors, they are capable of trending changes in CO when compared with a transpulmonary thermodilution monitor. Difficulty with use in critically ill and awake patients has been encountered because of altered microvascular physiology and patient movement. The principles of operation and clinical validation of these devices are presented. The clinicians who are interested in using these devices in their clinical setting should be aware of the relatively large bias and CIs in the hemodynamic measurements.
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Affiliation(s)
- Eugene P. Raggi
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Tetsuro Sakai
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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McLean B. Comparing blood pressure measures: does one measurement equal another? Crit Care Nurse 2016; 35:75-81. [PMID: 25639580 DOI: 10.4037/ccn2015557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Barbara McLean
- Barbara McLean is a critical care clinical nurse specialist at Grady Health Systems in Atlanta, Georgia.
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Nowak RM, Reed BP, Nanayakkara P, DiSomma S, Moyer ML, Millis S, Levy P. Presenting hemodynamic phenotypes in ED patients with confirmed sepsis. Am J Emerg Med 2016; 34:2291-2297. [DOI: 10.1016/j.ajem.2016.08.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 08/09/2016] [Accepted: 08/13/2016] [Indexed: 01/08/2023] Open
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Lazkani A, Lebuffe G. Post-operative consequences of hemodynamic optimization. J Visc Surg 2016; 153:S5-S9. [PMID: 28340895 DOI: 10.1016/j.jviscsurg.2016.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Hemodynamic optimization begins with a medical assessment to identify the high-risk patients. This stratification is needed to customize the choice of hemodynamic support that is best adapted to the patient's level of risk, integrating the use of the least invasive procedures. The macro-circulatory hemodynamic approach aims to maintain a balance between oxygen supply (DO2) and oxygen demand (VO2). Volume replacement plays a crucial role based on the titration of fluid boluses according to their effect on measured stroke volume or indices of preload dependency. Good function of the microcirculatory system is the best guarantee to achieve this goal. An assessment of the DO2/VO2 ratio is needed for guidance in critical situations where tissue hypoxia may occur. Overall, all of these strategies are based on objective criteria to guide vascular replacement and/or tissue oxygenation in order to improve the patient's post-operative course by decreasing morbidity and hospital stay.
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Affiliation(s)
- A Lazkani
- Univ.Lille, CHU Lille, Pôle d'Anesthésie Réanimation, 59000 Lille, France
| | - G Lebuffe
- Univ.Lille, CHU Lille, EA7365 - GRITA - Groupe de Recherche sur les Formes Injectables et technologies Associées, Pôle d'Anesthésie Réanimation, 59000 Lille, France.
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Heusdens J, Lof S, Pennekamp C, Specken-Welleweerd J, de Borst G, van Klei W, van Wolfswinkel L, Immink R. Validation of non-invasive arterial pressure monitoring during carotid endarterectomy. Br J Anaesth 2016; 117:316-23. [DOI: 10.1093/bja/aew268] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2016] [Indexed: 11/14/2022] Open
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de Wilde RBP, de Wit F, Geerts BF, van Vliet AL, Aarts LPHJ, Vuyk J, Jansen JRC. Non-invasive continuous arterial pressure and pulse pressure variation measured with Nexfin®in patients following major upper abdominal surgery: a comparative study. Anaesthesia 2016; 71:788-97. [DOI: 10.1111/anae.13503] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2016] [Indexed: 11/28/2022]
Affiliation(s)
- R. B. P. de Wilde
- Department of Intensive Care; Leiden University Medical Centre; Leiden the Netherlands
| | - F. de Wit
- Department of Anaesthesiology; Leiden University Medical Centre; Leiden the Netherlands
| | - B. F. Geerts
- Department of Anaesthesiology; Leiden University Medical Centre; Leiden the Netherlands
| | - A. L. van Vliet
- Department of Anaesthesiology; Leiden University Medical Centre; Leiden the Netherlands
| | - L. P. H. J. Aarts
- Department of Anaesthesiology; Leiden University Medical Centre; Leiden the Netherlands
| | - J. Vuyk
- Department of Anaesthesiology; Leiden University Medical Centre; Leiden the Netherlands
| | - J. R. C. Jansen
- Department of Intensive Care; Leiden University Medical Centre; Leiden the Netherlands
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Bartels K, Esper SA, Thiele RH. Blood Pressure Monitoring for the Anesthesiologist. Anesth Analg 2016; 122:1866-79. [DOI: 10.1213/ane.0000000000001340] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Balzer F, Habicher M, Sander M, Sterr J, Scholz S, Feldheiser A, Müller M, Perka C, Treskatsch S. Comparison of the non-invasive Nexfin® monitor with conventional methods for the measurement of arterial blood pressure in moderate risk orthopaedic surgery patients. J Int Med Res 2016; 44:832-43. [PMID: 27142436 PMCID: PMC5536626 DOI: 10.1177/0300060516635383] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 02/03/2016] [Indexed: 11/15/2022] Open
Abstract
Objective Continuous invasive arterial blood pressure (IBP) monitoring remains the gold standard for BP measurement, but traditional oscillometric non-invasive intermittent pressure (NIBP) measurement is used in most low-to-moderate risk procedures. This study compared non-invasive continuous arterial BP measurement using a Nexfin® monitor with NIBP and IBP monitors. Methods This was a single-centre, prospective, pilot study in patients scheduled for elective orthopaedic surgery. Systolic BP, diastolic BP and mean arterial blood pressure (MAP) were measured by Nexfin®, IBP and NIBP at five intraoperative time-points. Pearson correlation coefficients, Bland–Altman plots and trending ability of Nexfin® measurements were used as criteria for success in the investigation of measurement reliability. Results A total of 20 patients were enrolled in the study. For MAP, there was a sufficient correlation between IBP/Nexfin® (Pearson = 0.75), which was better than the correlation between IBP/NIBP (Pearson = 0.70). Bland–Altman analysis of the data showed that compared with IBP, there was a higher percentage error for MAPNIBP (30%) compared with MAPNexfin® (27%). Nexfin® and NIBP underestimated systolic BP; NIBP also underestimated diastolic BP and MAP. Trending ability for MAPNexfin® and MAPNIBP were comparable to IBP. Conclusion Non-invasive BP measurement with Nexfin® was comparable with IBP and tended to be more precise than NIBP.
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Affiliation(s)
- Felix Balzer
- Department of Anaesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Charitéplatz, Berlin, Germany
| | - Marit Habicher
- Department of Anaesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Charitéplatz, Berlin, Germany
| | - Michael Sander
- Department of Anaesthesiology and Intensive Care Medicine, Universitätsklinikum Giessen und Marburg GmbH, Rudolf-Buchheim-Straße, Giessen, Germany
| | - Julian Sterr
- Department of Internal Medicine, Klinikum Starnberg, Oßwaldstraße, Starnberg, Germany
| | - Stephanie Scholz
- Department of Anaesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Charitéplatz, Berlin, Germany
| | - Aarne Feldheiser
- Department of Anaesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Charitéplatz, Berlin, Germany
| | - Michael Müller
- Centre for Musculoskeletal Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité- Universitätsmedizin Berlin, Charitéplatz, Berlin, Germany
| | - Carsten Perka
- Centre for Musculoskeletal Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité- Universitätsmedizin Berlin, Charitéplatz, Berlin, Germany
| | - Sascha Treskatsch
- Department of Anaesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Charitéplatz, Berlin, Germany
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Do Cardiovascular Responses to Active and Passive Coping Tasks predict Future Blood Pressure over a 10-Month Later? SPANISH JOURNAL OF PSYCHOLOGY 2016; 19:E10. [DOI: 10.1017/sjp.2016.5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractThe study examined whether cardiovascular responses to active or passive coping tasks and single or multiple tasks predicted changes in resting blood pressure (BP) over a ten-month period. Heart rate (HR), BP, cardiac output (CO), and total peripheral resistance (TPR) were measured at rest, and during mental stress tests (mental arithmetic, speech, and cold pressor tasks). A total of 104 eligible participants participated in the initial study, and 77 (74.04%) normotensive adult participants’ resting BP were re-evaluated at ten-month follow-up. Regression analyses indicated that after adjustment for baseline BP, initial age, gender, body mass index, family history of cardiovascular disease, and current cigarette smoking, heighted systolic blood pressure (SBP) and HR responses to an active coping task (mental arithmetic) were associated with increased future SBP (ΔR2 = .060, ΔR2 = .045, respectively). Further, aggregated SBP responsivity (over the three tasks) to the predictor models resulted in significant, but smaller increases in ΔR2 accounting for .040 of the variance of follow-up SBP. These findings suggest that cardiovascular responses to active coping tasks predict future SBP. Further, compared with single tasks, the findings revealed that SBP responses to three tasks were less predictive compared to an individual task (i.e., mental arithmetic). Of importance, hemodynamic reactivity (namely CO and TPR) did not predict future BP suggesting that more general psychophysiological processes (e.g., inflammation, platelet aggregation) may be implicated, or that BP, but not hemodynamic reactivity may be a marker of hypertension.
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Minimally invasive or noninvasive cardiac output measurement: an update. J Anesth 2016; 30:461-80. [DOI: 10.1007/s00540-016-2154-9] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 02/17/2016] [Indexed: 12/15/2022]
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Aritürk C, Açil M, Ulugöl H, Ustalar Özgen ZS, Ökten EM, Dağdelen S, Karabulut EH, Alhan HC, Toraman F. Is the Nexfin finger cuff method for cardiac output measurement reliableduring coronary artery bypass grafting? A prospective comparison with the echocardiography and FloTrac/Vigileo methods. Turk J Med Sci 2016; 46:291-5. [PMID: 27511487 DOI: 10.3906/sag-1406-32] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 06/22/2015] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND/AIM The aim of the current study was to assess the accuracy of cardiac output (CO) measurements obtained by the Nexfin finger cuff method as compared with the FloTrac/Vigileo and echocardiography methods in coronary artery bypass grafting (CABG) patients. MATERIALS AND METHODS First-time elective CABG patients were prospectively enrolled in this study and divided into three groups according to CO measurement method. CO measurements were performed simultaneously by three different contributors and were collected by the fourth one 24 h postoperative in the intensive care unit (ICU). Data were statistically analyzed. RESULTS Seventeen female and 13 male patients between 42 and 78 years of age (with a mean of 56 ± 4) were the subjects of this study. The mean CO measurements were 5.9 ± 1.4 L/min, 5.8 ± 1.1 L/min, and 6.0 ± 1.1 L/min for the Nexfin, FloTrac/Vigileo, and echocardiography methods, respectively (P > 0.05). The correlation values between Nexfin and FloTrac/Vigileo, Nexfin and echocardiography, and FloTrac/Vigileo and echocardiography were r = 0.445, r = 0.377, and r = 0.384, respectively (P < 0.05). CONCLUSION Nexfin yielded results comparable to those obtained with FloTrac/Vigileo and echocardiography for the postoperative CO assessment of CABG patients. Nexfin may be used in uncomplicated, hemodynamically stable patients in ICU as a reliable and totally noninvasive method of CO measurement.
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Affiliation(s)
- Cem Aritürk
- Department of Cardiovascular Surgery, Faculty of Medicine, Acıbadem University, İstanbul, Turkey
| | - Meltem Açil
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Acıbadem University, İstanbul, Turkey
| | - Halim Ulugöl
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Acıbadem University, İstanbul, Turkey
| | - Zehra Serpil Ustalar Özgen
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Acıbadem University, İstanbul, Turkey
| | - Eyüp Murat Ökten
- Department of Cardiovascular Surgery, Faculty of Medicine, Acıbadem University, İstanbul, Turkey
| | - Sinan Dağdelen
- Department of Cardiology, Faculty of Medicine, Acıbadem University, İstanbul, Turkey
| | - Eşref Hasan Karabulut
- Department of Cardiovascular Surgery, Faculty of Medicine, Acıbadem University, İstanbul, Turkey
| | - Hüseyin Cem Alhan
- Department of Cardiovascular Surgery, Faculty of Medicine, Acıbadem University, İstanbul, Turkey
| | - Fevzi Toraman
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Acıbadem University, İstanbul, Turkey
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Blanié A, Soued M, Benhamou D, Mazoit JX, Duranteau J. A Comparison of Photoplethysmography Versus Esophageal Doppler for the Assessment of Cardiac Index During Major Noncardiac Surgery. Anesth Analg 2016; 122:430-6. [DOI: 10.1213/ane.0000000000001113] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Miller J, Ho CX, Tang J, Thompson R, Goldberg J, Amer A, Nahab B. Assessing Fluid Responsiveness in Spontaneously Breathing Patients. Acad Emerg Med 2016; 23:186-90. [PMID: 26764894 DOI: 10.1111/acem.12864] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Revised: 10/05/2015] [Accepted: 10/06/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The primary objective of this study was to test if fasting volunteers exhibit fluid responsiveness using noninvasive hemodynamic measurements. The secondary objective was to test a passive leg raise (PLR) maneuver as a diagnostic predictor of fluid responsiveness. METHODS This was a quasi-experimental design involving healthy volunteers. Subjects were excluded for pregnancy and congestive heart failure. Following a 12-hour fast, subjects had baseline hemodynamic monitoring recorded using noninvasive, continuous pulse contour analysis. Subjects then had a PLR maneuver performed, followed by an intravenous bolus of crystalloid. A rise in stroke volume ≥ 10% from baseline with the bolus was considered consistent with fluid responsiveness, and the same rise with a PLR was consistent with a positive PLR maneuver. The primary outcome was the change in stroke volume with a fluid bolus. Univariate analysis assessed changes in hemodynamic parameters. Logistic regression analysis determined the test characteristics of the PLR in predicting subjects who were ultimately fluid responsive. RESULTS Forty subjects completed the study. The mean change in stroke volume with a crystalloid bolus was 19% (95% confidence interval [CI] = 16% to 21%). Thirty-six (90%) subjects were fluid responsive. The mean PLR response for the overall cohort was 16% (95% CI = 12% to 19%), and 26 (65%) subjects had a positive PLR maneuver. The PLR was 72% sensitive (95% CI = 55% to 85%) and 100% specific (95% CI = 40% to 100%) for predicting the presence of fluid responsiveness. CONCLUSIONS Noninvasive assessment of fluid responsiveness in healthy volunteers and prediction of this response with a PLR maneuver is achievable. Further work is indicated to test these methods in acutely ill patients.
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Affiliation(s)
- Joseph Miller
- Department of Emergency Medicine; Henry Ford Hospital; Detroit MI
- Wayne State University School of Medicine; Detroit MI
| | - Chuan-Xing Ho
- Wayne State University School of Medicine; Detroit MI
| | - Joy Tang
- Wayne State University School of Medicine; Detroit MI
| | | | - Jared Goldberg
- Department of Emergency Medicine; Henry Ford Hospital; Detroit MI
| | - Ahmed Amer
- Department of Emergency Medicine; Henry Ford Hospital; Detroit MI
| | - Bashar Nahab
- Lincoln Medical and Mental Health Center; Weill Cornell Medical College; New York NY
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Smolle KH, Schmid M, Prettenthaler H, Weger C. The Accuracy of the CNAP®Device Compared with Invasive Radial Artery Measurements for Providing Continuous Noninvasive Arterial Blood Pressure Readings at a Medical Intensive Care Unit. Anesth Analg 2015; 121:1508-16. [DOI: 10.1213/ane.0000000000000965] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Vos JJ, Poterman M, Salm PP, Van Amsterdam K, Struys MMRF, Scheeren TWL, Kalmar AF. Noninvasive pulse pressure variation and stroke volume variation to predict fluid responsiveness at multiple thresholds: a prospective observational study. Can J Anaesth 2015; 62:1153-60. [PMID: 26335905 PMCID: PMC4595532 DOI: 10.1007/s12630-015-0464-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 08/16/2015] [Indexed: 11/30/2022] Open
Abstract
Background Pulse pressure variation (PPV) and stroke volume variation (SVV) are dynamic preload variables that can be measured noninvasively to assess fluid responsiveness (FR) in anesthetized patients with mechanical ventilation. Few studies have examined the effectiveness of predicting FR according to the definition of FR, and assessment of inconclusive values of PPV and SVV around the cut-off value (the “grey zone”) might improve individual FR prediction. We explored the ability of noninvasive volume clamp derived measurements of PPV and SVV to predict FR using the grey zone approach, and we assessed the influence of multiple thresholds on the predictive ability of the numerical definition of FR. Methods Ninety patients undergoing general surgery were included in this prospective observational study and received a 500 mL fluid bolus as deemed clinically required by the attending anesthesiologist. A minimal relative increase in stroke volume index (↑SVI) was used to define FR with different thresholds from 10-25%. The PPV, SVV, and SVI were measured using the Nexfin® device that employs noninvasive volume clamp plethysmography. Results The area under the receiver operator characteristic curve gradually increased for PPV / SVV with higher threshold values (from 0.818 / 0.760 at 10% ↑SVI to 0.928 / 0.944 at 25% ↑SVI). The grey zone limits of both PPV and SVV changed from 9–16% (PPV) and 5–13% (SVV) at the 10% ↑SVI threshold to 18–21% (PPV) and 14–16% (SVV) at the 25% ↑SVI threshold. Conclusion Noninvasive PPV and SVV measurements allow an acceptable FR prediction, although the reliability of both variables is dependent on the intended increase in SVI, which improves substantially with concomitant smaller grey zones at higher ↑SVI thresholds. Electronic supplementary material The online version of this article (doi:10.1007/s12630-015-0464-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jaap Jan Vos
- Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO BOX 30 001, 9700 RB, Groningen, The Netherlands.
| | - Marieke Poterman
- Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO BOX 30 001, 9700 RB, Groningen, The Netherlands
| | - Pieternel Papineau Salm
- Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO BOX 30 001, 9700 RB, Groningen, The Netherlands
| | - Kai Van Amsterdam
- Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO BOX 30 001, 9700 RB, Groningen, The Netherlands
| | - Michel M R F Struys
- Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO BOX 30 001, 9700 RB, Groningen, The Netherlands
| | - Thomas W L Scheeren
- Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO BOX 30 001, 9700 RB, Groningen, The Netherlands
| | - Alain F Kalmar
- Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO BOX 30 001, 9700 RB, Groningen, The Netherlands.,Department of Anesthesiology and Intensive Care Medicine, Maria Middelares Hospital, Ghent, Belgium
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Scully CG, Gomatam S, Forrest S, Strauss DG. Importance of re-calibration time on pulse contour analysis agreement with thermodilution measurements of cardiac output: a retrospective analysis of intensive care unit patients. J Clin Monit Comput 2015; 30:577-86. [PMID: 26285740 DOI: 10.1007/s10877-015-9749-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 08/10/2015] [Indexed: 10/23/2022]
Abstract
We assessed the effect of re-calibration time on cardiac output estimation and trending performance in a retrospective analysis of an intensive care unit patient population using error grid analyses. Paired thermodilution and arterial blood pressure waveform measurements (N = 2141) from 222 patient records were extracted from the Multiparameter Intelligent Monitoring in Intensive Care II database. Pulse contour analysis was performed by implementing a previously reported algorithm at calibration times of 1, 2, 8 and 24 h. Cardiac output estimation agreement was assessed using Bland-Altman and error grid analyses. Trending was assessed by concordance and a 4-Quadrant error grid analysis. Error between pulse contour and thermodilution increased with longer calibration times. Limits of agreement were -1.85 to 1.66 L/min for 1 h maximum calibration time compared to -2.70 to 2.41 L/min for 24 h. Error grid analysis resulted in 74.2 % of points bounded by 20 % error limits of thermodilution measurements for 1 h calibration time compared to 65 % for 24 h. 4-Quadrant error grid analysis showed <75 % of changes in pulse contour estimates to be within ±80 % of the change in the thermodilution measurement at any calibration time. Shorter calibration times improved the agreement of cardiac output pulse contour estimates with thermodilution. Use of minimally invasive pulse contour methods in intensive care monitoring could benefit from prospective studies evaluating calibration protocols. The applied pulse contour analysis method and thermodilution showed poor agreement to monitor changes in cardiac output.
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Affiliation(s)
- Christopher G Scully
- Office of Science and Engineering Laboratories, Division of Biomedical Physics, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, MD, USA.
| | - Shanti Gomatam
- Office of Surveillance and Biometrics, Division of Biostatistics, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Shawn Forrest
- Office of Device Evaluation, Division of Cardiovascular Devices, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - David G Strauss
- Office of Science and Engineering Laboratories, Division of Biomedical Physics, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, MD, USA
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Bartels K, Thiele RH. Advances in photoplethysmography: beyond arterial oxygen saturation. Can J Anaesth 2015; 62:1313-28. [PMID: 26286382 DOI: 10.1007/s12630-015-0458-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 07/03/2015] [Accepted: 08/11/2015] [Indexed: 01/19/2023] Open
Abstract
PURPOSE Photoplethysmography permits continuous measurement of heart rate and peripheral oxygen saturation and has been widely used to inform clinical decisions. Recently, a myriad of noninvasive hemodynamic monitoring devices using this same technology have been increasingly available. This narrative review aims to summarize the principles that form the basis for the function of these devices as well as to comment on trials evaluating their accuracy and clinical application. PRINCIPAL FINDINGS Advanced monitoring devices extend photoplethysmography technology beyond measuring oxygen concentration and heart rate. Quantification of respiratory variation of the photoplethysmographic waveform reflects respiratory variation of the arterial pressure waveform and can be used to gauge volume responsiveness. Both the volume-clamp and physiocal techniques are extensions of conventional photoplethysmography and permit continuous measurement of finger arterial blood pressure. Finger arterial pressure waveforms can subsequently inform estimations of cardiac output. CONCLUSIONS Although respiratory variations of the plethysmographic waveform correlate only modestly with the arterial blood pressure waveform, fluid responsiveness can be relatively consistently assessed using both approaches. Continuous blood pressure measurements obtained using the volume-clamp technique may be as accurate as conventional brachial noninvasive blood pressure measurements. Most importantly, clinical comparative effectiveness studies are still needed in order to determine if these technologies can be translated into improvement of relevant patient outcomes.
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Affiliation(s)
- Karsten Bartels
- Departments of Anesthesiology and Surgery, University of Colorado Denver, Aurora, CO, USA
| | - Robert H Thiele
- Divisions of Cardiac, Thoracic, and Critical Care Anesthesiology, Departments of Anesthesiology and Biomedical Engineering, University of Virginia School of Medicine, Charlottesville, VA, USA.
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Abstract
Although use of the classic pulmonary artery catheter has declined, several techniques have emerged to estimate cardiac output. Arterial pressure waveform analysis computes cardiac output from the arterial pressure curve. The method of estimating cardiac output for these devices depends on whether they need to be calibrated by an independent measure of cardiac output. Some newer devices have been developed to estimate cardiac output from an arterial curve obtained noninvasively with photoplethysmography, allowing a noninvasive beat-by-beat estimation of cardiac output. This article describes the different devices that perform pressure waveform analysis.
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Affiliation(s)
- Xavier Monnet
- Medical Intensive Care Unit, Bicêtre Hospital, Paris-Sud University Hospitals, 78, rue du Général Leclerc, F-94270 Le Kremlin-Bicêtre, France; EA4533, Paris-Sud University, 63 rue Gabriel Péri, F-94270 Le Kremlin-Bicêtre, France.
| | - Jean-Louis Teboul
- Medical Intensive Care Unit, Bicêtre Hospital, Paris-Sud University Hospitals, 78, rue du Général Leclerc, F-94270 Le Kremlin-Bicêtre, France; EA4533, Paris-Sud University, 63 rue Gabriel Péri, F-94270 Le Kremlin-Bicêtre, France
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40
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The accuracy of noninvasive cardiac output and pressure measurements with finger cuff. Curr Opin Crit Care 2015; 21:232-9. [DOI: 10.1097/mcc.0000000000000198] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Vincent JL, Pelosi P, Pearse R, Payen D, Perel A, Hoeft A, Romagnoli S, Ranieri VM, Ichai C, Forget P, Della Rocca G, Rhodes A. Perioperative cardiovascular monitoring of high-risk patients: a consensus of 12. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2015; 19:224. [PMID: 25953531 PMCID: PMC4424585 DOI: 10.1186/s13054-015-0932-7] [Citation(s) in RCA: 126] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
A significant number of surgical patients are at risk of intra- or post-operative complications or both, which are associated with increased lengths of stay, costs, and mortality. Reducing these risks is important for the individual patient but also for health-care planners and managers. Insufficient tissue perfusion and cellular oxygenation due to hypovolemia, heart dysfunction or both is one of the leading causes of perioperative complications. Adequate perioperative management guided by effective and timely hemodynamic monitoring can help reduce the risk of complications and thus potentially improve outcomes. In this review, we describe the various available hemodynamic monitoring systems and how they can best be used to guide cardiovascular and fluid management in the perioperative period in high-risk surgical patients.
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Affiliation(s)
- Jean-Louis Vincent
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, 808 route de Lennik, 1070, Brussels, Belgium.
| | - Paolo Pelosi
- AOU IRCCS San Martino-IST, Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Largo Rosanna Benzi 8, 16132, Genoa, Italy.
| | - Rupert Pearse
- Adult Critical Care Unit, Royal London Hospital, Whitechapel Road, London, E1 1BB, UK.
| | - Didier Payen
- Department of Anesthesiology and Critical Care, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris 7 Denis Diderot, 75475, Paris, Cedex 10, France.
| | - Azriel Perel
- Department of Anesthesiology and Intensive Care, Sheba Medical Center, Tel Aviv University, Tel Aviv, 52621, Israel.
| | - Andreas Hoeft
- Department of Anesthesiology and Intensive Care Medicine, University of Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany.
| | - Stefano Romagnoli
- Department of Human Health Sciences, Section of Anesthesiology and Intensive Care, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Largo Giovanni Alessandro Brambilla 3, 50139, Florence, Italy.
| | - V Marco Ranieri
- Department of Anesthesia and Intensive Care Medicine, University of Turin, S.Giovanni Battista Molinette Hospital, 10126, Turin, Italy.
| | - Carole Ichai
- Medico-Surgical Intensive Care Unit, Saint-Roch University Hospital, University of Nice, 5 Rue Pierre Dévoluy, 06006, Nice, France.
| | - Patrice Forget
- Service d'Anesthésiologie, Cliniques Universitaires Saint-Luc, Institute of Neuroscience (IoNS), Université catholique de Louvain, Avenue Hippocrate 10, 1200, Brussels, Belgium.
| | - Giorgio Della Rocca
- Department of Anesthesia and Intensive Care Medicine, University Hospital, Medical School, University of Udine, P. le S. Maria della Misericordia 15, 33100, Udine, Italy.
| | - Andrew Rhodes
- Department of Intensive Care Medicine, St George's Healthcare NHS Trust, Blackshaw Road, London, SW17 0QT, UK.
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Noninvasive assessment of hemodynamics: a comparative analysis of fingertip pulse contour analysis and impedance cardiography. Blood Press Monit 2015; 20:209-14. [PMID: 25815738 DOI: 10.1097/mbp.0000000000000118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Systemic hemodynamic assessment is useful for characterizing the underlying physiology of hypertension, selecting individualized treatment approaches, and understanding the underlying mechanisms of action of interventions. Invasive methods are not suitable for routine clinic or research use, and noninvasive methods such as impedance cardiography have technical and practical limitations. Fingertip pulse contour analysis using the Nexfin device is a novel alternative to noninvasive assessment of blood pressure and hemodynamics. Although both impedance cardiography and the Nexfin have been validated against invasive methods, the extent to which they are correlated with each other is unknown. This study is a comparative analysis of data simultaneously obtained by impedance cardiography and using the Nexfin device. METHODS As part of a larger clinical trial, 13 adults with type 2 diabetes completed cardiovascular reactivity testing on three occasions: at study baseline and after two 4-week dietary treatment periods. Blood pressure, hemodynamics, and heart rate variability were assessed at rest and during acute mental stress. RESULTS Blood pressure, heart rate, and heart rate variability data were significantly correlated between the two devices, but hemodynamic data (stroke volume, cardiac output, total peripheral resistance) were not significantly correlated. Both techniques detected treatment-related changes in blood pressure and total peripheral resistance, but significantly differed in the magnitude and/or direction of treatment effects. CONCLUSION We conclude that Nexfin is not an appropriate alternative to impedance cardiography for measurement of underlying hemodynamics in psychophysiological research, but may be useful for beat-to-beat monitoring of blood pressure and heart rate variability.
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Cardiovascular changes occurring with occlusion of a mature arteriovenous fistula. J Vasc Access 2015; 16:459-66. [DOI: 10.5301/jva.5000336] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2014] [Indexed: 11/20/2022] Open
Abstract
Background The aim of this study was to evaluate the relationship between Qa, cardiovascular parameters and symptomatic cardiac disease. Methods A prospective cohort study of 100 patients dialysing via an arteriovenous fistula (AVF) was performed. Qa was measured using pulsed Doppler ultrasound. Cardiovascular parameters were measured using thoracic bioimpedance technique (Medis, GmbH). Measurement of cardiovascular parameters was undertaken pre- and post-occlusion of the AVF. Results Mean age was 57.1 years (range: 19-83); 51% male. Mean values pre-occlusion: mean arterial blood pressure (MABP) 89.6 ± 16.9 mmHg; stroke volume index (SVI) 39.3 ± 4.6 mL; cardiac index (CI) 3.7 ± 0.8 L/min/m2; systemic vascular resistance index (SVRI) 585.5 ± 67.8 dyn/sec/cm−5/m2; oxygen delivery (DO2I) 607.1 ± 116.8 mL/min/m2. A total of 12% of patients had CI>4.5 L/min/m2 pre-occlusion. There was no difference in heart rate (HR), MABP and SVI following occlusion of AVF. Mean CI reduced post-AVF occlusion (∆CI: -0.42 L/min/m2; p<0.001), as did DO2I (∆ DO2I: 45.5 mL/min/m2; p<0.001). SVRI increased (∆SVRI: 170.1 dyn/sec/cm−5/m2; p<0.001). The drop in CI which occurred post-AVF occlusion was greater in patients with Qa >2000 mL/min (-2.79 ± 0.34 vs. -0.24 ± 0.48 L/min/m2; p<0.001). There was a non-significant trend towards symptomatic heart failure in those patients with a greater ∆CI following AVF occlusion (NYHA 1: -0.1 ± 0.1 L/min/m2; NHYA 2: -0.3 ± 0.7 L/min/m2; NYHA 3: -0.7 ± 1.0 L/min/m2; p = 0.06). Conclusions The relationship between AVF blood flow, cardiac output and symptomatic cardiac disease is complex. Occlusion of an AVF leads to reduced cardiac output and improved oxygen delivery, even in asymptomatic patients. This difference is most marked in patients with high-flow AVF (>2000 mL/min). High-flow AVF with large ∆CI may lead to high cardiac output state, which is reversible on occlusion of the AVF.
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Bova JF, da Cunha AF, Stout RW, Bhumiratana S, Alfi DM, Eisig SB, Vunjak-Novakovic G, Lopez MJ. Bupivacaine mandibular nerve block affects intraoperative blood pressure and heart rate in a Yucatan miniature swine mandibular condylectomy model: a pilot study. J INVEST SURG 2014; 28:32-9. [PMID: 25394295 DOI: 10.3109/08941939.2014.971207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE/AIM The primary objective was to evaluate the effect of a bupivacaine mandibular nerve block on intraoperative blood pressure (BP) and heart rate (HR) in response to surgical stimulation and the need for systemic analgesics postoperatively. We hypothesized that a mandibular nerve block would decrease the need for systemic analgesics both intraoperatively and postoperatively. MATERIALS AND METHODS Fourteen adult male Yucatan pigs were purchased. Pigs were chemically restrained with ketamine, midazolam, and dexmedetomidine and anesthesia was maintained with isoflurane inhalant anesthesia. Pigs were randomized to receive a mandibular block with either bupivacaine (bupivacaine group) or saline (control group). A nerve stimulator was used for administration of the block with observation of masseter muscle twitch to indicate the injection site. Invasive BP and HR were measured with the aid of an arterial catheter in eight pigs. A rescue analgesic protocol consisting of fentanyl and lidocaine was administered if HR or BP values increased 20% from baseline. Postoperative pain was quantified with a customized ethogram. HR and BP were evaluated at base line, pre-rescue, 10 and 20 min post-rescue. RESULTS Pre-rescue mean BP was significantly increased (p = .001) for the bupivacaine group. Mean intraoperative HR was significantly lower (p = .044) in the bupivacaine versus saline group. All other parameters were not significant. CONCLUSION Addition of a mandibular nerve block to the anesthetic regimen in the miniature pig condylectomy model may improve variations in intraoperative BP and HR. This study establishes the foundation for future studies with larger animal numbers to confirm these preliminary findings.
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Affiliation(s)
- Jonathan F Bova
- 1Department of Pathobiological Sciences, Louisiana State University School of Veterinary Medicine , Baton Rouge, Louisiana , USA
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Esper SA, Pinsky MR. Arterial waveform analysis. Best Pract Res Clin Anaesthesiol 2014; 28:363-80. [PMID: 25480767 DOI: 10.1016/j.bpa.2014.08.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 08/19/2014] [Accepted: 08/27/2014] [Indexed: 01/20/2023]
Abstract
The bedside measurement of continuous arterial pressure values from waveform analysis has been routinely available via indwelling arterial catheterization for >50 years. Invasive blood pressure monitoring has been utilized in critically ill patients, in both the operating room and critical care units, to facilitate rapid diagnoses of cardiovascular insufficiency and monitor response to treatments aimed at correcting abnormalities before the consequences of either hypo- or hypertension are seen. Minimally invasive techniques to estimate cardiac output (CO) have gained increased appeal. This has led to the increased interest in arterial waveform analysis to provide this important information, as it is measured continuously in many operating rooms and intensive care units. Arterial waveform analysis also allows for the calculation of many so-called derived parameters intrinsically created by this pulse pressure profile. These include estimates of left ventricular stroke volume (SV), CO, vascular resistance, and during positive-pressure breathing, SV variation, and pulse pressure variation. This article focuses on the principles of arterial waveform analysis and their determinants, components of the arterial system, and arterial pulse contour. It will also address the advantage of measuring real-time CO by the arterial waveform and the benefits to measuring SV variation. Arterial waveform analysis has gained a large interest in the overall assessment and management of the critically ill and those at a risk of hemodynamic deterioration.
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Affiliation(s)
- Stephen A Esper
- Department of Anesthesiology, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Michael R Pinsky
- Department of Anesthesiology, University of Pittsburgh, Pittsburgh, PA, USA; Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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Greenfield N, Balk RA. Evaluating the adequacy of fluid resuscitation in patients with septic shock: controversies and future directions. Hosp Pract (1995) 2014; 40:147-57. [PMID: 22615089 DOI: 10.3810/hp.2012.04.980] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Fluid resuscitation is a cornerstone in the treatment of severe sepsis and septic shock. However, there is little evidence to guide clinicians in its administration. Current guidelines recommend targeting fluid therapy based on measurements of cardiac filling pressures, such as central venous pressure. Static pressures are poor predictors of a patient's response to fluid. Such response can be better predicted by measuring changes in hemodynamic parameters caused by positive pressure ventilation or maneuvers designed to simulate increased preload. These changes can be measured by analysis of arterial waveforms, echocardiography or Doppler, or with emerging noninvasive technologies. This article reviews the current role of fluid replacement strategies and the use of monitoring systems in the overall resuscitation of patients with severe sepsis and septic shock.
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Affiliation(s)
- Neal Greenfield
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Rush Medical College, Chicago, IL
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Vos J, Poterman M, Mooyaart E, Weening M, Struys M, Scheeren T, Kalmar A. Comparison of continuous non-invasive finger arterial pressure monitoring with conventional intermittent automated arm arterial pressure measurement in patients under general anaesthesia. Br J Anaesth 2014; 113:67-74. [DOI: 10.1093/bja/aeu091] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Accuracy and Precision of Continuous Noninvasive Arterial Pressure Monitoring Compared with Invasive Arterial Pressure. Anesthesiology 2014; 120:1080-97. [DOI: 10.1097/aln.0000000000000226] [Citation(s) in RCA: 137] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Abstract
Background:
Continuous noninvasive arterial pressure monitoring devices are available for bedside use, but the accuracy and precision of these devices have not been evaluated in a systematic review and meta-analysis.
Methods:
The authors performed a systematic review and meta-analysis of studies comparing continuous noninvasive arterial pressure monitoring with invasive arterial pressure monitoring. Random-effects pooled bias and SD of bias for systolic arterial pressure, diastolic arterial pressure, and mean arterial pressure were calculated. Continuous noninvasive arterial pressure monitoring was considered acceptable if pooled estimates of bias and SD were not greater than 5 and 8 mmHg, respectively, as recommended by the Association for the Advancement of Medical Instrumentation.
Results:
Twenty-eight studies (919 patients) were included. The overall random-effect pooled bias and SD were −1.6 ± 12.2 mmHg (95% limits of agreement −25.5 to 22.2 mmHg) for systolic arterial pressure, 5.3 ± 8.3 mmHg (−11.0 to 21.6 mmHg) for diastolic arterial pressure, and 3.2 ± 8.4 mmHg (−13.4 to 19.7 mmHg) for mean arterial pressure. In 14 studies focusing on currently commercially available devices, bias and SD were −1.8 ± 12.4 mmHg (−26.2 to 22.5 mmHg) for systolic arterial pressure, 6.0 ± 8.6 mmHg (−10.9 to 22.9 mmHg) for diastolic arterial pressure, and 3.9 ± 8.7 mmHg (−13.1 to 21.0 mmHg) for mean arterial pressure.
Conclusions:
The results from this meta-analysis found that inaccuracy and imprecision of continuous noninvasive arterial pressure monitoring devices are larger than what was defined as acceptable. This may have implications for clinical situations where continuous noninvasive arterial pressure is being used for patient care decisions.
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Siebenmann C, Rasmussen P, Sørensen H, Zaar M, Hvidtfeldt M, Pichon A, Secher NH, Lundby C. Cardiac output during exercise: A comparison of four methods. Scand J Med Sci Sports 2014; 25:e20-7. [DOI: 10.1111/sms.12201] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2014] [Indexed: 12/21/2022]
Affiliation(s)
- C. Siebenmann
- Center for Integrative Human Physiology; Institute of Physiology; University of Zürich; Zürich Switzerland
| | - P. Rasmussen
- Center for Integrative Human Physiology; Institute of Physiology; University of Zürich; Zürich Switzerland
| | - H. Sørensen
- Department of Anesthesia; The Copenhagen Muscle Research Center; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - M. Zaar
- Department of Anesthesia; The Copenhagen Muscle Research Center; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - M. Hvidtfeldt
- Department of Anesthesia; The Copenhagen Muscle Research Center; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - A. Pichon
- Laboratoire Réponses Cellulaires et Fonctionnelles à l'Hypoxie; Université Paris 13; Bobigny France
| | - N. H. Secher
- Department of Anesthesia; The Copenhagen Muscle Research Center; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - C. Lundby
- Center for Integrative Human Physiology; Institute of Physiology; University of Zürich; Zürich Switzerland
- Food & Nutrition & Sport Science; Gothenburg University; Gothenburg Sweden
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Semi-invasive measurement of cardiac output based on pulse contour: a review and analysis. Can J Anaesth 2014; 61:452-79. [PMID: 24643474 DOI: 10.1007/s12630-014-0135-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 02/18/2014] [Indexed: 12/21/2022] Open
Abstract
PURPOSE The aim of this review was to provide a meta-analysis of all five of the most popular systems for arterial pulse contour analysis compared with pulmonary artery thermodilution, the established reference method for measuring cardiac output (CO). The five investigated systems are FloTrac/Vigileo(®), PiCCO(®), LiDCO/PulseCO(®), PRAM/MostCare(®), and Modelflow. SOURCE In a comprehensive literature search through MEDLINE(®), Web of Knowledge (v.5.11), and Google Scholar, we identified prospective studies and reviews that compared the pulse contour approach with the reference method (n = 316). Data extracted from the 93 selected studies included range and mean cardiac output, bias, percentage error, software versions, and study population. We performed a pooled weighted analysis of their precision in determining CO in various patient groups and clinical settings. PRINCIPAL FINDINGS Results of the majority of studies indicate that the five investigated systems show acceptable accuracy during hemodynamically stable conditions. Forty-three studies provided adequate data for a pooled weighted analysis and resulted in a mean (SD) total pooled bias of -0.28 (1.25) L·min(-1), percentage error of 40%, and a correlation coefficient of r = 0.71. In hemodynamically unstable patients (n = 8), we found a higher percentage error (45%) and bias of -0.54 (1.64) L·min(-1). CONCLUSION During hemodynamic instability, CO measurement based on continuous arterial pulse contour analysis shows only limited agreement with intermittent bolus thermodilution. The calibrated systems seem to deliver more accurate measurements than the auto-calibrated or the non-calibrated systems. For reliable use of these semi-invasive systems, especially for critical therapeutic decisions during hemodynamic disorders, both a strategy for hemodynamic optimization and further technological improvements are necessary.
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