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The predictive value of lung ultrasound combined with central venous oxygen saturation variations in the outcome of ventilator weaning in patients after thoracic surgery. Am J Transl Res 2022; 14:8621-8631. [PMID: 36628206 PMCID: PMC9827289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 11/02/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To evaluate the predictive value of lung ultrasound score (LUS) combined with central venous oxygen saturation variations (ΔScvO2) in the outcome of ventilator weaning in patients after thoracic surgery. METHODS The clinical data of 60 patients who received tracheal intubation ventilator-assisted breathing after thoracic surgery were retrospectively analyzed, and they were divided into successful (n = 35) and failed (n = 25) groups according to the postoperative weaning outcomes. The factors influencing the failure of weaning in patients after thoracic surgery were compared and analyzed, and the values of LUS, ΔScvO2 as well as the combination of both were calculated to predict the failure of weaning in patients after thoracic surgery. RESULTS The results of logistic regression analysis showed that LUS, ΔScvO2, and partial pressure of carbon dioxide (PaCO2) may be risk factors influencing weaning failure in patients after thoracic surgery (OR = 1.844, 4.006, 1.271, P < 0.001 for all), while diaphragm thickening fraction (DTF) and partial pressure of oxygen (PaO2) may be protective factors (OR = 0.852, 0.674, P = 0.002 for all). Receiver operator characteristic (ROC) curve showed that area under the curves (AUCs) of LUS, ΔScvO2, and the combination of the two was 0.865 (95% CI: 0.766-0.964), 0.874 (95% CI: 0.781-0.967), and 0.925 (95% CI: 0.860-0.990), respectively, in predicting failure of weaning in patients after thoracic surgery. CONCLUSION LUS and ΔScvO2 were closely related to chest ultrasound index and arterial blood gas index in patients after thoracic surgery, both of which may be risk factors for weaning failure in patients after thoracic surgery, and their combination can effectively predict the occurrence of weaning failure.
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Svedmyr A, Konrad M, Wallin M, Hallbäck M, Lönnqvist PA, Karlsson J. Non-invasive capnodynamic mixed venous oxygen saturation during major changes in oxygen delivery. J Clin Monit Comput 2021; 36:1315-1324. [PMID: 34609659 PMCID: PMC8490846 DOI: 10.1007/s10877-021-00762-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 09/27/2021] [Indexed: 02/07/2023]
Abstract
Mixed venous oxygen saturation (SvO2) is an important variable in anesthesia and intensive care but currently requires pulmonary artery catheterization. Recently, non-invasive determination of SvO2 (Capno-SvO2) using capnodynamics has shown good agreement against CO-oximetry in an animal model of modest hemodynamic changes. The purpose of the current study was to validate Capno-SvO2 against CO-oximetry during major alterations in oxygen delivery. Furthermore, evaluating fiberoptic SvO2 for its response to the same challenges. Eleven mechanically ventilated pigs were exposed to oxygen delivery changes: increased inhaled oxygen concentration, hemorrhage, crystalloid and blood transfusion, preload reduction and dobutamine infusion. Capno-SvO2 and fiberoptic SvO2 recordings were made in parallel with CO-oximetry. Respiratory quotient, needed for capnodynamic SvO2, was measured by analysis of mixed expired gases. Agreement of absolute values between CO-oximetry and Capno-SvO2 and fiberoptic SvO2 respectively, was assessed using Bland–Altman plots. Ability of Capno- SvO2 and fiberoptic SvO2 to detect change compared to CO-oximetry was assessed using concordance analysis.
The interventions caused significant hemodynamic variations. Bias between Capno-SvO2 and CO-oximetry was + 3% points (95% limits of agreements – 7 to + 13). Bias between fiberoptic SvO2 and CO-oximetry was + 1% point, (95% limits of agreements − 7 to + 9). Concordance rate for Capno-SvO2 and fiberoptic SvO2 vs. CO-oximetry was 98% and 93%, respectively. Capno-SvO2 generates absolute values close to CO-oximetry. The performance of Capno-SvO2 vs. CO-oximetry was comparable to the performance of fiberoptic SvO2 vs. CO-oximetry. Capno-SvO2 appears to be a promising tool for non-invasive SvO2 monitoring.
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Affiliation(s)
- Anders Svedmyr
- Karolinska Institute Department of Physiology and Pharmacology (FYFA), C3, Per-Arne Lönnqvist Group - Section of Anesthesiology and Intensive Care, Anestesi- och Intensivvårdsavdelningen, 171 76, Stockholm, PA, Sweden
- Pediatric Perioperative Medicine and Intensive Care, Karolinska University Hospital, Eugenivägen 23, 171 64, Stockholm, Sweden
| | - Mark Konrad
- Maquet Critical Care AB, Röntgenvägen 2, 171 06, Solna, Sweden
| | - Mats Wallin
- Karolinska Institute Department of Physiology and Pharmacology (FYFA), C3, Per-Arne Lönnqvist Group - Section of Anesthesiology and Intensive Care, Anestesi- och Intensivvårdsavdelningen, 171 76, Stockholm, PA, Sweden
- Maquet Critical Care AB, Röntgenvägen 2, 171 06, Solna, Sweden
| | - Magnus Hallbäck
- Maquet Critical Care AB, Röntgenvägen 2, 171 06, Solna, Sweden
| | - Per-Arne Lönnqvist
- Karolinska Institute Department of Physiology and Pharmacology (FYFA), C3, Per-Arne Lönnqvist Group - Section of Anesthesiology and Intensive Care, Anestesi- och Intensivvårdsavdelningen, 171 76, Stockholm, PA, Sweden
- Pediatric Perioperative Medicine and Intensive Care, Karolinska University Hospital, Eugenivägen 23, 171 64, Stockholm, Sweden
| | - Jacob Karlsson
- Karolinska Institute Department of Physiology and Pharmacology (FYFA), C3, Per-Arne Lönnqvist Group - Section of Anesthesiology and Intensive Care, Anestesi- och Intensivvårdsavdelningen, 171 76, Stockholm, PA, Sweden.
- Pediatric Perioperative Medicine and Intensive Care, Karolinska University Hospital, Eugenivägen 23, 171 64, Stockholm, Sweden.
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Giraud R, Vujovic B, Assouline B, Neto Silva I, Bendjelid K. Do ScvO 2 variations induced by passive leg raising predict fluid responsiveness? A prospective study. Physiol Rep 2021; 9:e15012. [PMID: 34491003 PMCID: PMC8422598 DOI: 10.14814/phy2.15012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/28/2021] [Accepted: 07/30/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The present study investigates whether ScvO2 variations induced by passive leg raising (PLR) are able to predict fluid responsiveness (FR) in mechanically ventilated patients. DESIGN A monocentric prospective clinical study. SETTING An intensive care division in a tertiary hospital. PATIENTS The inclusion criteria were elective postoperative cardiac surgery patients who were over 18 years old, deeply sedated, mechanically ventilated and needed volume expansion (VE). Fluid responders (R) were defined as patients who increased their left ventricular outflow tract velocity time integral (VTI) ≥15% after VE. INTERVENTION In patients included in this study, continuous ScvO2 monitoring (CeVOX device, Pulsion Medical Systems) and VTI (transthoracic echocardiography) were measured simultaneously before and during a PLR test and before and after VE (with 500 ml of saline). MEASUREMENTS AND MAIN RESULTS Thirty-three consecutive patients were included in this study. In 15 patients with a positive PLR test (increase in VTI ≥15%), ScvO2 increased during PLR by 9 ± 4%. In the 18 patients with a negative PLR test, ScvO2 did not significantly change during PLR. VE increased ScvO2 by 9 ± 6% and 2 ± 4% in responders and nonresponders, respectively. If ScvO2 increased by >4% during the PLR test, then a positive VTI response (≥15%) was diagnosed with a sensitivity of 93% (68-99%) and a specificity of 94% (63-99%) (Area under the receiver operating characteristic curve 0.92 ± 0.58, p < 0.05). Moreover, ScvO2 variations were able to distinguish responders to VE from nonresponders to VE with a sensitivity of 87% (68-99%) and a specificity of 89% (63-99%) (Area under the receiver operating characteristic curve 0.89 ± 0.07, p < 0.05). CONCLUSIONS ScvO2 variation induced by PLR is a reliable, minimally invasive parameter for predicting FR at the postoperative cardiac surgery bedside of mechanically ventilated, critically ill patients.
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Affiliation(s)
- Raphaël Giraud
- Intensive Care UnitGeneva University HospitalsGenevaSwitzerland
- Faculty of MedicineUniversity of GenevaGenevaSwitzerland
- Geneva Hemodynamic Research GroupUniversity of GenevaGenevaSwitzerland
| | - Bojana Vujovic
- Intensive Care UnitGeneva University HospitalsGenevaSwitzerland
| | - Benjamin Assouline
- Intensive Care UnitGeneva University HospitalsGenevaSwitzerland
- Faculty of MedicineUniversity of GenevaGenevaSwitzerland
- Geneva Hemodynamic Research GroupUniversity of GenevaGenevaSwitzerland
| | - Ivo Neto Silva
- Intensive Care UnitGeneva University HospitalsGenevaSwitzerland
- Faculty of MedicineUniversity of GenevaGenevaSwitzerland
- Geneva Hemodynamic Research GroupUniversity of GenevaGenevaSwitzerland
| | - Karim Bendjelid
- Intensive Care UnitGeneva University HospitalsGenevaSwitzerland
- Faculty of MedicineUniversity of GenevaGenevaSwitzerland
- Geneva Hemodynamic Research GroupUniversity of GenevaGenevaSwitzerland
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Karlsson J, Lönnqvist PA, Wallin M, Hallbäck M. A Continuous Noninvasive Method to Assess Mixed Venous Oxygen Saturation: A Proof-of-Concept Study in Pigs. Anesth Analg 2021; 132:1768-1776. [PMID: 33009138 DOI: 10.1213/ane.0000000000005188] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Mixed venous oxygen saturation (Svo2) is important when evaluating the balance between oxygen delivery and whole-body oxygen consumption. Monitoring Svo2 has so far required blood samples from a pulmonary artery catheter. By combining volumetric capnography, for measurement of effective pulmonary blood flow, with the Fick principle for oxygen consumption, we have developed a continuous noninvasive method, capnodynamic Svo2, for assessment of Svo2. The objective of this study was to validate this new technique against the gold standard cardiac output (CO)-oximetry Svo2 measurement of blood samples obtained from a pulmonary artery catheter and to assess the potential influence of intrapulmonary shunting. METHODS Eight anesthetized mechanically ventilated domestic-breed piglets of both sexes (median weight 23.9 kg) were exposed to a series of interventions intended to reduce as well as increase Svo2. Simultaneous recordings of capnodynamic and CO-oximetry Svo2 as well as shunt fraction, using the Berggren formula, were performed throughout the protocol. Agreement of absolute values for capnodynamic and CO-oximetry Svo2 and the ability for capnodynamic Svo2 to detect change were assessed using Bland-Altman plot and concordance analysis. RESULTS Overall bias for capnodynamic versus CO-oximetry Svo2 was -1 percentage point (limits of agreement -13 to +11 percentage points), a mean percentage error of 22%, and a concordance rate of 100%. Shunt fraction varied between 13% at baseline and 22% at the end of the study and was associated with only minor alterations in agreement between the tested methods. CONCLUSIONS In the current experimental setting, capnodynamic assessment of Svo2 generates absolute values very close to the reference method CO-oximetry and is associated with 100% trending ability.
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Affiliation(s)
- Jacob Karlsson
- From the Department of Physiology and Pharmacology (Fysiologi och Farmakologi [FYFA]), Karolinska Institute, Stockholm, Sweden.,Department of Pediatric Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Per-Arne Lönnqvist
- From the Department of Physiology and Pharmacology (Fysiologi och Farmakologi [FYFA]), Karolinska Institute, Stockholm, Sweden.,Department of Pediatric Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Mats Wallin
- From the Department of Physiology and Pharmacology (Fysiologi och Farmakologi [FYFA]), Karolinska Institute, Stockholm, Sweden.,Maquet Critical Care Aktiebolag (AB), Solna, Sweden
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Syrkina AG, Ryabov VV. Central hemodynamic monitoring in patients with cardiogenic shock. TERAPEVT ARKH 2021; 93:502-508. [DOI: 10.26442/00403660.2021.04.200688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 06/03/2021] [Indexed: 11/22/2022]
Abstract
Cardiogenic shock is the pathology most commonly encountered by intensive care physicians. Its frequency averages 410% in STEMI (ST-elevation myocardial infarction) patients and 24% in NONSTEMI (non-ST-elevation myocardial infarction) patients. Effective shock therapy is impossible without understanding the hemodynamic mechanisms of its occurrence. Many authors emphasize that cardiac output is the most important indicator of cardiac function, which necessitates its monitoring. Meanwhile, the cardiac output monitoring is associated with a number of difficulties, including those related to the technology of recording this function. In this article, the authors emphasize the importance of measuring central hemodynamic parameters in patients with predominantly cardiogenic shock. We have tried to structure the knowledge about different techniques of central hemodynamics monitoring, considered advantages and disadvantages of each of them. We believe that the data obtained by hemodynamic monitoring should be closely studied and used, because sometimes multidirectional mechanisms may be involved in the genesis of shock; therefore, therapy should be based on the data obtained in a particular patient.
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Nitzan M, Nitzan I, Arieli Y. The Various Oximetric Techniques Used for the Evaluation of Blood Oxygenation. SENSORS 2020; 20:s20174844. [PMID: 32867184 PMCID: PMC7506757 DOI: 10.3390/s20174844] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 08/24/2020] [Accepted: 08/25/2020] [Indexed: 12/12/2022]
Abstract
Adequate oxygen delivery to a tissue depends on sufficient oxygen content in arterial blood and blood flow to the tissue. Oximetry is a technique for the assessment of blood oxygenation by measurements of light transmission through the blood, which is based on the different absorption spectra of oxygenated and deoxygenated hemoglobin. Oxygen saturation in arterial blood provides information on the adequacy of respiration and is routinely measured in clinical settings, utilizing pulse oximetry. Oxygen saturation, in venous blood (SvO2) and in the entire blood in a tissue (StO2), is related to the blood supply to the tissue, and several oximetric techniques have been developed for their assessment. SvO2 can be measured non-invasively in the fingers, making use of modified pulse oximetry, and in the retina, using the modified Beer–Lambert Law. StO2 is measured in peripheral muscle and cerebral tissue by means of various modes of near infrared spectroscopy (NIRS), utilizing the relative transparency of infrared light in muscle and cerebral tissue. The primary problem of oximetry is the discrimination between absorption by hemoglobin and scattering by tissue elements in the attenuation measurement, and the various techniques developed for isolating the absorption effect are presented in the current review, with their limitations.
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Affiliation(s)
- Meir Nitzan
- Department of Physics/Electro-Optics Engineering, Jerusalem College of Technology, 21 Havaad Haleumi St., Jerusalem 91160, Israel;
- Correspondence:
| | - Itamar Nitzan
- Monash Newborn, Monash Children’s Hospital, Melbourne 3168, Australia;
- Department of Neonatology, Shaare Zedek Medical Center, Shmuel Bait St 12, Jerusalem 9103102, Israel
| | - Yoel Arieli
- Department of Physics/Electro-Optics Engineering, Jerusalem College of Technology, 21 Havaad Haleumi St., Jerusalem 91160, Israel;
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Huber W, Zanner R, Schneider G, Schmid R, Lahmer T. Assessment of Regional Perfusion and Organ Function: Less and Non-invasive Techniques. Front Med (Lausanne) 2019; 6:50. [PMID: 30968023 PMCID: PMC6438879 DOI: 10.3389/fmed.2019.00050] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 02/25/2019] [Indexed: 12/13/2022] Open
Abstract
Sufficient organ perfusion essentially depends on preserved macro- and micro-circulation. The last two decades brought substantial progress in the development of less and non-invasive monitoring of macro-hemodynamics. However, several recent studies suggest a frequent incoherence of macro- and micro-circulation. Therefore, this review reports on interactions of macro- and micro-circulation as well as on specific regional and micro-circulation. Regarding global micro-circulation the last two decades brought advances in a more systematic approach of clinical examination including capillary refill time, a graded assessment of mottling of the skin and accurate measurement of body surface temperatures. As a kind of link between macro- and microcirculation, a number of biochemical markers can easily be obtained. Among those are central-venous oxygen saturation (ScvO2), plasma lactate and the difference between central-venous and arterial CO2 (cv-a-pCO2-gap). These inexpensive markers have become part of clinical routine and guideline recommendations. While their potential to replace parameters of macro-circulation such as cardiac output (CO) is limited, they facilitate the interpretation of the adequacy of CO and other macro-circulatory markers. Furthermore, they give additional hints on micro-circulatory impairment. In addition, a number of more sophisticated technical approaches to quantify and visualize micro-circulation including video-microscopy, laser flowmetry, near-infrared spectroscopy (NIRS), and partial oxygen pressure measurement have been introduced within the last 20 years. These technologies have been extensively used for scientific purposes. Moreover, they have been successfully used for educational purposes and to visualize micro-circulatory disturbances during sepsis and other causes of shock. Despite several studies demonstrating the association of these techniques and parameters with outcome, their practical application still is limited. However, future improvements in automated and “online” diagnosis will help to make these technologies more applicable in clinical routine. This approach is promising with regard to several studies which demonstrated the potential to guide therapy in different types of shock. Finally several organs have specific patterns of circulation related to their special anatomy (liver) or their auto-regulatory capacities (brain, kidney). Therefore, this review also discusses specific issues of monitoring liver, brain, and kidney circulation and function.
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Affiliation(s)
- Wolfgang Huber
- Medizinische Klinik und Poliklinik II, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Robert Zanner
- Klinik für Anästhesiologie, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Gerhard Schneider
- Klinik für Anästhesiologie, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Roland Schmid
- Medizinische Klinik und Poliklinik II, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Tobias Lahmer
- Medizinische Klinik und Poliklinik II, Klinikum rechts der Isar, Technische Universität München, München, Germany
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