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Wu NH, Hsieh TH, Chang CY, Lin HY. Impact of the intra-aortic balloon pump on the reliability of the fourth-generation FloTrac/EV1000 system in patients undergoing robotic-assisted off-pump coronary artery bypass surgery. Heart Vessels 2024; 39:275-276. [PMID: 38085332 DOI: 10.1007/s00380-023-02347-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 11/29/2023] [Indexed: 02/10/2024]
Affiliation(s)
- Nien-Hsun Wu
- Department of Anesthesiology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Tsung-Han Hsieh
- Department of Research, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Chun-Yu Chang
- Department of Anesthesiology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Han-Yu Lin
- Department of Anesthesiology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.
- School of Medicine, Tzu Chi University, Hualien, Taiwan.
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Kandil S, Sedra A. Hemodynamic monitoring in liver transplantation 'the hemodynamic system'. Curr Opin Organ Transplant 2024; 29:72-81. [PMID: 38032246 DOI: 10.1097/mot.0000000000001125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
PURPOSE OF REVIEW The purpose of this article is to provide a comprehensive review of hemodynamic monitoring in liver transplantation. RECENT FINDINGS Radial arterial blood pressure monitoring underestimates the aortic root arterial blood pressure and causes excessive vasopressor and worse outcomes. Brachial and femoral artery monitoring is well tolerated and should be considered in critically ill patients expected to be on high dose pressors. The pulmonary artery catheter is the gold standard of hemodynamic monitoring and is still widely used in liver transplantation; however, it is a highly invasive monitor with potential for serious complications and most of its data can be obtained by other less invasive monitors. Rescue transesophageal echocardiography relies on few simple views and should be available as a standby to manage sudden hemodynamic instability. Risk of esophageal bleeding from transesophageal echocardiography in liver transplantation is the same as in other patient populations. The arterial pulse waveform analysis based cardiac output devices are minimally invasive and have the advantage of real-time beat to beat monitoring of cardiac output. No hemodynamic monitor can improve clinical outcomes unless integrated into a goal-directed hemodynamic therapy. The hemodynamic monitoring technique should be tailored to the patient's medical status, surgical technique, and the anesthesiologist's level of expertise. SUMMARY The current article provides a review of the current hemodynamic monitoring systems and their integration in goal-directed hemodynamic therapy.
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Affiliation(s)
- Sherif Kandil
- Department of Anesthesiology, Keck Medical School of USC, Los Angeles, California, USA
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Bourdillon N, Subudhi AW, Fan JL, Evero O, Elliott JE, Lovering AT, Roach RC, Kayser B. AltitudeOmics: effects of 16 days acclimatization to hypobaric hypoxia on muscle oxygen extraction during incremental exercise. J Appl Physiol (1985) 2023; 135:823-832. [PMID: 37589059 PMCID: PMC10642515 DOI: 10.1152/japplphysiol.00100.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 07/11/2023] [Accepted: 08/03/2023] [Indexed: 08/18/2023] Open
Abstract
Acute altitude exposure lowers arterial oxygen content ([Formula: see text]) and cardiac output ([Formula: see text]) at peak exercise, whereas O2 extraction from blood to working muscles remains similar. Acclimatization normalizes [Formula: see text] but not peak [Formula: see text] nor peak oxygen consumption (V̇o2peak). To what extent acclimatization impacts muscle O2 extraction remains unresolved. Twenty-one sea-level residents performed an incremental cycling exercise to exhaustion near sea level (SL), in acute (ALT1) and chronic (ALT16) hypoxia (5,260 m). Arterial blood gases, gas exchange at the mouth and oxy- (O2Hb) and deoxyhemoglobin (HHb) of the vastus lateralis were recorded to assess arterial O2 content ([Formula: see text]), [Formula: see text], and V̇o2. The HHb-V̇o2 slope was taken as a surrogate for muscle O2 extraction. During moderate-intensity exercise, HHb-V̇o2 slope increased to a comparable extent at ALT1 (2.13 ± 0.94) and ALT16 (2.03 ± 0.88) compared with SL (1.27 ± 0.12), indicating increased O2 extraction. However, the HHb/[Formula: see text] ratio increased from SL to ALT1 and then tended to go back to SL values at ALT16. During high-intensity exercise, HHb-V̇o2 slope reached a break point beyond which it decreased at SL and ALT1, but not at ALT16. Increased muscle O2 extraction during submaximal exercise was associated with decreased [Formula: see text] in acute hypoxia. The significantly greater muscle O2 extraction during maximal exercise in chronic hypoxia is suggestive of an O2 reserve.NEW & NOTEWORTHY During incremental exercise muscle deoxyhemoglobin (HHb) and oxygen consumption (V̇o2) both increase linearly, and the slope of their relationship is an indirect index of local muscle O2 extraction. The latter was assessed at sea level, in acute and during chronic exposure to 5,260 m. The demonstrated presence of a muscle O2 extraction reserve during chronic exposure is coherent with previous studies indicating both limited muscle oxidative capacity and decrease in motor drive.
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Affiliation(s)
- Nicolas Bourdillon
- Institute of Sports Sciences, University of Lausanne, Lausanne, Switzerland
| | - Andrew W Subudhi
- Hybl Sports Medicine and Performance Center, Department of Human Physiology and Nutrition, University of Colorado, Colorado Springs, Colorado, United States
| | - Jui-Lin Fan
- Department of Physiology, Faculty of Medical & Health Sciences, Manaaki Manawa-The Centre for Heart Research, University of Auckland, Auckland, New Zealand
| | - Oghenero Evero
- Altitude Research Center, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Jonathan E Elliott
- Department of Human Physiology, University of Oregon, Eugene, Oregon, United States
| | - Andrew T Lovering
- Department of Human Physiology, University of Oregon, Eugene, Oregon, United States
| | - Robert C Roach
- Altitude Research Center, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Bengt Kayser
- Institute of Sports Sciences, University of Lausanne, Lausanne, Switzerland
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Tupprasoot R, Blaise BJ. Continuous cerebral blood flow monitoring: What should we do with these extra numbers? BJA Open 2023; 7:100148. [PMID: 37638084 PMCID: PMC10457465 DOI: 10.1016/j.bjao.2023.100148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 05/24/2023] [Indexed: 08/29/2023]
Abstract
NeoDoppler is a noninvasive monitoring device that can be attached to a patient's head to provide real-time continuous cerebral Doppler evaluation. A feasibility study shows that it can be used in operating theatres during anaesthesia to potentially guide haemodynamic management. We discuss the impact of this new device and which further research would be necessary to find its role in clinical practice.
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Affiliation(s)
- Raksa Tupprasoot
- Department of Paediatric Anaesthetics, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Benjamin J. Blaise
- Department of Paediatric Anaesthetics, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Center for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas' Hospital, London, UK
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Farahmand M, Bodwell E, D'Souza GA, Herbertson LH, Scully CG. Mock circulatory loop generated database for dynamic characterization of pressure-based cardiac output monitoring systems. Comput Biol Med 2023; 160:106979. [PMID: 37167657 DOI: 10.1016/j.compbiomed.2023.106979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 03/30/2023] [Accepted: 04/23/2023] [Indexed: 05/13/2023]
Abstract
Pulse contour cardiac output monitoring systems allow real-time and continuous estimation of hemodynamic variables such as cardiac output (CO) and stroke volume variation (SVV) by analysis of arterial blood pressure waveforms. However, evaluating the performance of CO monitoring systems to measure the small variations in these variables sometimes used to guide fluid therapy is a challenge due to limitations in clinical reference methods. We developed a non-clinical database as a tool for assessing the dynamic attributes of pressure-based CO monitoring systems, including CO response time and CO and SVV resolutions. We developed a mock circulation loop (MCL) that can simulate rapid changes in different parameters, such as CO and SVV. The MCL was configured to simulate three different states (normovolemic, cardiogenic shock, and hyperdynamic) representing a range of flow and pressure conditions. For each state, we simulated stepwise changes in the MCL flow and collected datasets for characterizing pressure-based CO systems. Nine datasets were generated that contain hours of peripheral pressure, central flow and pressure waveforms. The MCL-generated database is provided open access as a tool for evaluating dynamic characteristics of pressure-based CO algorithms and systems in detecting variations in CO and SVV indices. In an example application of the database, a CO response time of 10 s, CO and SVV resolutions with lower and upper limits of (-9.1%, 8.4%) and (-5.0%, 3.8%), respectively, were determined for a pressure-based CO benchtop system. This tool will support a more comprehensive assessment of pressure-based CO monitoring systems and algorithms.
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Affiliation(s)
- Masoud Farahmand
- Center for Devices and Radiological Health, Office of Science and Engineering Laboratories, U.S. Food and Drug Administration, Silver Spring, MD, USA.
| | | | - Gavin A D'Souza
- Center for Devices and Radiological Health, Office of Science and Engineering Laboratories, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Luke H Herbertson
- Center for Devices and Radiological Health, Office of Science and Engineering Laboratories, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Christopher G Scully
- Center for Devices and Radiological Health, Office of Science and Engineering Laboratories, U.S. Food and Drug Administration, Silver Spring, MD, USA
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Wu HT, Chen JJ. Calculation of an Improved Stiffness Index Using Decomposed Radial Pulse and Digital Volume Pulse Signals. J Pers Med 2022; 12. [PMID: 36579481 DOI: 10.3390/jpm12111768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/14/2022] [Accepted: 10/24/2022] [Indexed: 01/01/2023] Open
Abstract
The stiffness index (SI) is used to estimate cardiovascular risk in humans. In this study, we developed a refined SI for determining arterial stiffness based on the decomposed radial pulse and digital volume pulse (DVP) waveforms. In total, 40 mature asymptomatic subjects (20 male and 20 female, 42 to 76 years of age) and 40 subjects with type 2 diabetes mellitus (T2DM) (23 male and 17 female, 35 to 78 years of age) were enrolled in this study. We measured subjects' radial pulse at the wrist and their DVP at the fingertip, and then implemented ensemble empirical mode decomposition (EEMD) to derive the orthogonal intrinsic mode functions (IMFs). An improved SI (SInew) was calculated by dividing the body height by the mean transit time between the first IMF5 peak and the IMF6 trough. Another traditional index, pulse wave velocity (PWVfinger), was also included for comparison. For the PWVfinger index, the subjects with T2DM presented significantly higher SInew values measured according to the radial pulse (SInew-RP) and DVP signals (SInew-DVP). Using a one-way analysis of variance, we found no statistically significant difference between SInew-RP and PWVfinger when applied to the same test subjects. Binary logistic regression analysis showed that a high SInew-RP value was the most significant risk factor for developing T2DM (SInew-RP odds ratio 3.17, 95% CI 1.53-6.57; SInew-DVP odds ratio 2.85, 95% CI 1.27-6.40). Our refined stiffness index could provide significant information regarding the decomposed radial pulse and digital volume pulse signals in assessments of arterial stiffness.
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Jasińska-Gniadzik K, Szwed P, Gasecka A, Zawadka M, Grabowski M, Pietrasik A. Haemodynamic monitoring in acute heart failure - what you need to know. Adv Cardiol 2022; 18:90-100. [PMID: 36051835 DOI: 10.5114/aic.2022.118524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 06/05/2022] [Indexed: 12/03/2022]
Abstract
Acute heart failure (AHF) is a sudden, life-threatening condition, defined as a gradual or rapid onset of symptoms and/or signs of HF. AHF requires urgent medical attention, being the most frequent cause of unplanned hospital admission in patients above 65 years of age. AHF is associated with a 4–12% in-hospital mortality rate and a 21–35% 1-year mortality rate post-discharge. Considering the serious prognosis in AHF patients, it is very important to understand the mechanisms and haemodynamic status in an individual AHF patient, thus preventing end-organ failure and death. Haemodynamic monitoring is a serial assessment of cardiovascular function, intended to detect physiologic abnormalities at the earliest stages, determine which interventions could be most effective, and provide the basis for initiating the most appropriate therapy and evaluate its effects. Over the past decades, haemodynamic monitoring techniques have evolved greatly. Nowadays, they range from very invasive to non-invasive, from intermittent to continuous, and in terms of the provided parameters. Invasive techniques contain pulmonary artery catheterization and transpulmonary thermodilution. Minimally invasive techniques include oesophageal Doppler and noncalibrated pulse wave analysis. Non-invasive techniques contain echocardiography, bioimpedance, and bioreactance techniques as well as non-invasive pulse contour methods. Each of these techniques has specific indications and limitations. In this article, we aimed to provide a pathophysiological explanation of the physical terms and parameters used for haemodynamic monitoring in AHF and to summarize the working principles, advantages, and disadvantages of the currently used methods of haemodynamic monitoring.
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Devasahayam S, Gangadharan N, Surekha C, Baskaran B, Mukadam FA, Subramani S. Intra-arterial blood pressure measurement: sources of error and solutions. Med Biol Eng Comput 2022; 60:1123-1138. [DOI: 10.1007/s11517-022-02509-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 01/17/2022] [Indexed: 11/26/2022]
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Brahmbhatt DH, Daly AL, Luk AC, Fan E, Billia F. Response by Brahmbhatt et al to Letter Regarding Article, "Liberation From Venoarterial Extracorporeal Membrane Oxygenation: A Review". Circ Heart Fail 2022; 15:e009260. [PMID: 35026962 DOI: 10.1161/circheartfailure.121.009260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Darshan H Brahmbhatt
- Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada (D.H.B., A.L.D., A.C.L., F.B.)
- Department of Medicine (D.H.B., A.C.L., F.B.), University of Toronto, ON, Canada
- National Heart & Lung Institute, Imperial College London, United Kingdom (D.H.B.)
- Ted Rogers Centre for Heart Research, Toronto, ON, Canada (D.H.B., A.C.L., F.B.)
| | - Andrea L Daly
- Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada (D.H.B., A.L.D., A.C.L., F.B.)
| | - Adriana C Luk
- Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada (D.H.B., A.L.D., A.C.L., F.B.)
- Department of Medicine (D.H.B., A.C.L., F.B.), University of Toronto, ON, Canada
- Ted Rogers Centre for Heart Research, Toronto, ON, Canada (D.H.B., A.C.L., F.B.)
| | - Eddy Fan
- Interdepartmental Division of Critical Care Medicine (E.F.), University of Toronto, ON, Canada
- Toronto General Hospital Research Institute, University Health Network, ON, Canada (E.F., F.B.)
| | - Filio Billia
- Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada (D.H.B., A.L.D., A.C.L., F.B.)
- Department of Medicine (D.H.B., A.C.L., F.B.), University of Toronto, ON, Canada
- Ted Rogers Centre for Heart Research, Toronto, ON, Canada (D.H.B., A.C.L., F.B.)
- Toronto General Hospital Research Institute, University Health Network, ON, Canada (E.F., F.B.)
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Senoner T, Velik-salchner C, Tauber H. The Pulmonary Artery Catheter in the Perioperative Setting: Should It Still Be Used? Diagnostics (Basel) 2022; 12:177. [PMID: 35054343 PMCID: PMC8774775 DOI: 10.3390/diagnostics12010177] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 12/29/2021] [Accepted: 01/10/2022] [Indexed: 12/13/2022] Open
Abstract
The pulmonary artery catheter (PAC) was introduced into clinical practice in the 1970s and was initially used to monitor patients with acute myocardial infarctions. The indications for using the PAC quickly expanded to critically ill patients in the intensive care unit as well as in the perioperative setting in patients undergoing major cardiac and noncardiac surgery. The utilization of the PAC is surrounded by multiple controversies, with literature claiming its benefits in the perioperative setting, and other publications showing no benefit. The right interpretation of the hemodynamic parameters measured by the PAC and its clinical implications are of the utmost essence in order to guide a specific therapy. Even though clinical trials have not shown a reduction in mortality with the use of the PAC, it still remains a valuable tool in a wide variety of clinical settings. In general, the right selection of the patient population (high-risk patients with or without hemodynamic instability undergoing high-risk procedures) as well as the right clinical setting (centers with experience and expertise) are essential in order for the patient to benefit most from PAC use.
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Berisha G, Solberg R, Klingenberg C, Solevåg AL. Neonatal Impedance Cardiography in Asphyxiated Piglets-A Feasibility Study. Front Pediatr 2022; 10:804353. [PMID: 35281226 PMCID: PMC8913887 DOI: 10.3389/fped.2022.804353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 01/26/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Impedance cardiography (ICG) is a non-invasive method for continuous cardiac output measurement and has the potential to improve monitoring and treatment of sick neonates. PhysioFlow® is a signal-morphology ICG-system showing promising results in adults with low and high cardiac output, but no data from neonates or neonatal models exist. The aim of this study was to investigate PhysioFlow® feasibility in asphyxiated newborn piglets. METHODS Fifteen piglets, under continuous arterial heart rate (HR) and blood pressure (BP) monitoring, were asphyxiated until asystole. Cardiopulmonary resuscitation was performed and the piglets monitored after return of spontaneous circulation (ROSC). Arterial lactate was measured at baseline, every 5 min throughout asphyxiation, at asystole, and at 10 min and later every 30 min after ROSC. PhysioFlow® measured cardiac stroke volume (SV) and HR, and calculated cardiac index (CI) (L/m2/min). Registrations with a signal quality < 75% were excluded, and registrations recorded for 30 min from start of asphyxia analyzed. Pearson correlations were calculated for CI; and HR, mean BP and blood lactate. RESULTS The piglets were asphyxiated for median (interquartile range) 30 (20-35) min and had a lactate at asystole of 15.0 (9.1-17.0) mmol/L. Out of a total of 20.991 registrations in all animals combined, there were 10.148 (48.3%) registrations with a signal quality ≥ 75%. Signal quality ≥ 75% varied in individual piglets from 7 to 82% of registrations. We analyzed 1.254 registrations recorded 30 min from initiation of asphyxia, i.e., in piglets with brief asphyxia times, this included cardiopulmonary resuscitation and post-ROSC observation. There was a positive correlation between CI and SVI (r = 0.90, p < 0.001), and between CI and HR (r = 0.446, p < 0.001). There was no correlation between CI, or mean BP or lactate (p = 0.98 and 0.51, respectively). CONCLUSION About half of ICG-registrations in asphyxiated piglets were of good quality. However, signal quality was highly variable between piglets. In total, there was a higher proportion of reliable ICG-registrations than reported from clinical delivery room studies using electrical velocimetry. Our data are physiologically plausible and supports further research evaluating PhysioFlow® for cardiac output monitoring in perinatal asphyxia. In particular, factors influencing inter-individual variations in signal quality should be explored.
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Affiliation(s)
- Gazmend Berisha
- Department of Paediatric and Adolescent Medicine, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Rønnaug Solberg
- Department of Pediatric Research, Institute of Surgical Research, Oslo University Hospital Rikshospitalet, University of Oslo, Oslo, Norway.,Department of Pediatrics, Vestfold Hospital Trust, Tønsberg, Norway
| | - Claus Klingenberg
- Department of Paediatrics, University Hospital of North Norway, Tromsø, Norway.,Paediatric Research Group, Department of Clinical Medicine, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Anne Lee Solevåg
- Department of Paediatric and Adolescent Medicine, Oslo University Hospital, Nydalen, Norway
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Fiorelli S, Capua G, Menna C, Andreetti C, Giorni E, Riva E, Agostini E, D'Andrea F, Massullo E, Peritore V, Rocco M, Massullo D. Intraoperative cardiac function assessment by transesophageal echocardiography versus FloTrac/Vigileo™ system during pectus excavatum surgical repair. J Anesth Analg Crit Care 2021; 1:21. [PMID: 37386660 DOI: 10.1186/s44158-021-00025-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 11/23/2021] [Indexed: 07/01/2023]
Abstract
BACKGROUND Pectus excavatum (PE), a congenital deformity of the chest wall, can lead to cardiac compression and related symptoms. PE surgical repair can improve cardiac function. Intraoperative transesophageal echocardiography (TEE) has been successfully employed to assess intraoperative hemodynamic variations in patients undergoing PE repair. FloTrac/Vigileo™ system (Edwards Life-sciences Irvine, CA) (FT/V) is a minimally invasive cardiac output monitoring system. This retrospective study aimed to assess hemodynamic changes in surgical repair of PE using FT/V and concordance with parameters measured by TEE. RESULTS N=19 patients submitted to PE repair via Ravitch or Nuss technique were enrolled. Intraoperative cardiac assessments simultaneously obtained via TEE and FT/V system were investigated. The agreement between TEE-derived cardiac output (CO-TEE) and FT/V system parameter (COAP) was evaluated. The relationship between COTEE and COAP was analyzed for all data using linear regression analysis. A significant correlation between COAP and COTEE values (R = 0.65, p < 0.001) was found. Bland-Altman analysis of COAP and COTEE showed a bias of 0.13 L/min and a limit of agreement of - 2.33 to 2.58 L/min, with a percentage error of 48%. Intraoperative measurements by TEE and FT/V both showed a significant increase in CO after surgical correction of PE (p < 0.005). CONCLUSIONS FT/V system compared to TEE in hemodynamic monitoring during PE surgery yielded clinically unacceptable results due to a high percentage error. After surgical correction of PE, CO, measured by TEE and FT/V, significantly improved.
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Affiliation(s)
- Silvia Fiorelli
- Anesthesia and Intensive Care Medicine, Department of Clinical and Surgical Translational Medicine, Sapienza University of Rome, Via di Grottarossa, 1035 00189, Roma, Italy.
| | - Gelsomina Capua
- Anesthesia and Intensive Care Medicine, Department of Clinical and Surgical Translational Medicine, Sapienza University of Rome, Via di Grottarossa, 1035 00189, Roma, Italy
| | - Cecilia Menna
- Thoracic Surgery, Department of Clinical and Surgical Translational Medicine, Sapienza University of Rome, Via di Grottarossa, 1035 00189, Rome, Italy
| | - Claudio Andreetti
- Thoracic Surgery, Department of Clinical and Surgical Translational Medicine, Sapienza University of Rome, Via di Grottarossa, 1035 00189, Rome, Italy
| | - Elisabetta Giorni
- Anesthesia and Intensive Care Medicine, Department of Clinical and Surgical Translational Medicine, Sapienza University of Rome, Via di Grottarossa, 1035 00189, Roma, Italy
| | - Ettore Riva
- Anesthesia and Intensive Care Medicine, Department of Clinical and Surgical Translational Medicine, Sapienza University of Rome, Via di Grottarossa, 1035 00189, Roma, Italy
| | - Elisabetta Agostini
- Anesthesia and Intensive Care Medicine, Department of Clinical and Surgical Translational Medicine, Sapienza University of Rome, Via di Grottarossa, 1035 00189, Roma, Italy
| | - Fabrizio D'Andrea
- Division of Cardiology, Department of Clinical and Molecular Medicine, University of Rome, Via di Grottarossa, 1035 00189, Rome, Italy
| | - Elisa Massullo
- Thoracic Surgery, Department of Clinical and Surgical Translational Medicine, Sapienza University of Rome, Via di Grottarossa, 1035 00189, Rome, Italy
| | - Valentina Peritore
- Thoracic Surgery, Department of Clinical and Surgical Translational Medicine, Sapienza University of Rome, Via di Grottarossa, 1035 00189, Rome, Italy
| | - Monica Rocco
- Anesthesia and Intensive Care Medicine, Department of Clinical and Surgical Translational Medicine, Sapienza University of Rome, Via di Grottarossa, 1035 00189, Roma, Italy
| | - Domenico Massullo
- Anesthesia and Intensive Care Medicine, Department of Clinical and Surgical Translational Medicine, Sapienza University of Rome, Via di Grottarossa, 1035 00189, Roma, Italy
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Álvarez-Montoya D, Madrid-Muñoz C, Escobar-Robledo L, Gallo-Villegas J, Aristizábal-Ocampo D. A novel method for the noninvasive estimation of cardiac output with brachial oscillometric blood pressure measurements through an assessment of arterial compliance. Blood Press Monit 2021; 26:426-434. [PMID: 34128491 DOI: 10.1097/mbp.0000000000000553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To propose and validate a new method for estimating cardiac output based on the total arterial compliance (Ct) formula that does not need an arterial waveform and to apply it to brachial oscillometric blood pressure measurements (OBPMs). METHODS One hundred subjects with normal heart anatomy and function were included. Reference values for cardiac output were measured with echocardiography, and Ct was calculated with a two-element Windkessel model. Then, a statistical model of arterial compliance (Ce) was used to estimate cardiac output. Finally, the measured and estimated cardiac output values were compared for accuracy and reproducibility. RESULTS The model was derived from the data of 70 subjects and prospectively tested with the data from the remaining 30 individuals. The mean age of the whole group was 43.4 ± 12.8 years, with 46% women. The average blood pressure (BP) was 107.1/65.0 ± 15.0/9.6 mmHg and the average heart rate was 67.7 ± 11.4 beats/min. The average Ct was 1.39 ± 0.27 mL/mmHg and the average cardiac output was 5.5 ± 1.0 L/min. The mean difference in the cardiac output estimated by the proposed methodology vs. that measured by Doppler echocardiography was 0.022 L/min with an SD of 0.626 L/min. The intraclass correlation coefficient was 0.93, and the percentage error was 19%. CONCLUSION Cardiac output could be reliably and noninvasively obtained with brachial OBPMs through a novel method for estimating Ct without the need for an arterial waveform. The new method could identify hemodynamic factors that explain BP values in an ambulatory care setting.
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Affiliation(s)
- Diego Álvarez-Montoya
- Centro Clínico y de Investigación SICOR (Soluciones Integrales en Riesgo Cardiovascular)
| | - Camilo Madrid-Muñoz
- Centro Clínico y de Investigación SICOR (Soluciones Integrales en Riesgo Cardiovascular)
| | - Luis Escobar-Robledo
- Centro Clínico y de Investigación SICOR (Soluciones Integrales en Riesgo Cardiovascular)
| | - Jaime Gallo-Villegas
- Centro Clínico y de Investigación SICOR (Soluciones Integrales en Riesgo Cardiovascular)
- Facultad de Medicina, Universidad de Antioquia
| | - Dagnovar Aristizábal-Ocampo
- Centro Clínico y de Investigación SICOR (Soluciones Integrales en Riesgo Cardiovascular)
- Cellular and Molecular Biology Unit, Corporación para Investigaciones Biológicas, Medellín, Colombia
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14
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Whittle RS, Stapleton LM, Petersen LG, Diaz-Artiles A. Indirect measurement of absolute cardiac output during exercise in simulated altered gravity is highly dependent on the method. J Clin Monit Comput 2021; 36:1355-1366. [PMID: 34677821 DOI: 10.1007/s10877-021-00769-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 10/13/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Altered gravity environments introduce cardiovascular changes that may require continuous hemodynamic monitoring in both spaceflight and terrestrial analogs. Conditions in such environments are often prohibitive to direct/invasive methods and therefore, indirect measurement techniques must be used. This study compares two common cardiac measurement techniques used in the human spaceflight domain, pulse contour analysis (PCA-Nexfin) and inert gas rebreathing (IGR-Innocor), in subjects completing ergometer exercise under altered gravity conditions simulated using a tilt paradigm. METHODS Seven subjects were tilted to three different angles representing Martian, Lunar, and microgravity conditions in the rostrocaudal direction. They completed a 36-min submaximal cardiovascular exercise protocol in each condition. Hemodynamics were continuously monitored using Nexfin and Innocor. RESULTS Linear mixed-effects models revealed a significant bias of [Formula: see text] ml ([Formula: see text]) in stroke volume and [Formula: see text] l/min ([Formula: see text]) in cardiac output, with Nexfin measuring greater than Innocor in both variables. These values are in agreement with a Bland-Altman analysis. The correlation of stroke volume and cardiac output measurements between Nexfin and Innocor were [Formula: see text] ([Formula: see text]) and [Formula: see text] ([Formula: see text]) respectively. CONCLUSION There is a poor agreement in absolute stroke volume and cardiac output values between measurement via PCA (Nexfin) and IGR (Innocor) in subjects who are exercising in simulated altered gravity environments. These results suggest that the chosen measurement method and device greatly impacts absolute measurements of cardiac output. However, there is a good level of agreement between the two devices when measuring relative changes. Either of these devices seem adequate to capture cardiac changes, but should not be solely relied upon for accurate measurement of absolute cardiac output.
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Affiliation(s)
- Richard S Whittle
- Department of Aerospace Engineering, Texas A&M University, 3141 TAMU, College Station, TX, 77843, USA
| | - Lindsay M Stapleton
- Department of Aerospace Engineering, Texas A&M University, 3141 TAMU, College Station, TX, 77843, USA
| | - Lonnie G Petersen
- Department of Radiology, University of California San Diego, 8929 University Center Lane, La Jolla, CA, 92122, USA
| | - Ana Diaz-Artiles
- Department of Aerospace Engineering, Texas A&M University, 3141 TAMU, College Station, TX, 77843, USA. .,Department of Health and Kinesiology, Texas A&M University, 4243 TAMU, College Station, TX, 77843, USA.
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15
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Lou X, Liu Y, Cui Y, Li J, Li L, Ma L, Zou M, Chen X, Li J. Contemporary Trends and Risk Factors of Hemodynamic and Myocardial Mechanics Derived by the Pressure Recording Analytical Method After Pediatric Cardiopulmonary Bypass. Front Cardiovasc Med 2021; 8:687150. [PMID: 34355027 PMCID: PMC8330813 DOI: 10.3389/fcvm.2021.687150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/25/2021] [Indexed: 01/14/2023] Open
Abstract
Objective: Adverse factors of postoperative hemodynamic and myocardial performance remain largely unexplored in children with congenital heart disease following cardiopulmonary bypass due to technical limitations. Pressure recording analytical method (PRAM) is a continuous hemodynamic and myocardial performance monitoring technique based on beat-to-beat arterial pressure waveform. Using PRAM, we examined the temporal trends and adverse factors, in clinical management, of these performances. Methods: We monitored blood pressure, cardiac index, cardiac cycle efficiency (CCE), dP/dTmax, and systematic vascular resistance index in 91 children (aged 186 ± 256 days) during their first 48 h after cardiopulmonary bypass. Above parameters, inotropic and vasoactive drug dosages, and serum lactate were recorded 3-hourly. NT-proBNP was measured daily. Results: CCE and dP/dTmax gradually increased (Ps < 0.0001), while systematic vascular resistance index, diastolic blood pressure and inotrope dosages decreased (Ps < 0.0001) over time. Cardiac index, systolic blood pressure, and heart rate did not change significantly (Ps ≥ 0.231). Patients undergoing deep hypothermic circulatory arrest had significantly higher heart rate and lower CCE (Ps ≤ 0.006) over time. Multivariate analyses indicated that epinephrine dose significantly correlated with systolic blood pressure, cardiac index, CCE, and dP/dTmax after polynomial transformation, with the peak ranging from 0.075 to 0.097. Conclusions: Systemic hemodynamic and myocardial performance gradually improved in the first 48 h after cardiopulmonary bypass without the “classic” nadir at 9–12 h. Deep hypothermic circulatory arrest and higher epinephrine doses were adversely associated with these performances. CCE, rather than cardiac index or other common-used parameters, was the most sensitive and consistent indicator.
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Affiliation(s)
- Xiaobin Lou
- Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.,Clinical Physiology Laboratory, Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yingying Liu
- Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.,Clinical Physiology Laboratory, Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yanqin Cui
- Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.,Cardiac Intensive Care Unit, Heart Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Jianbin Li
- Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.,Cardiac Intensive Care Unit, Heart Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Lijuan Li
- Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.,Cardiac Intensive Care Unit, Heart Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Li Ma
- Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.,Cardiovascular Surgery, Heart Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Minghui Zou
- Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.,Cardiovascular Surgery, Heart Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Xinxin Chen
- Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.,Cardiovascular Surgery, Heart Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Jia Li
- Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.,Clinical Physiology Laboratory, Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
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16
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Mukkamala R, Kohl BA, Mahajan A. Comparison of accuracy of two uncalibrated pulse contour cardiac output monitors in off-pump coronary artery bypass surgery patients using pulmonary artery catheter-thermodilution as a reference. BMC Anesthesiol 2021; 21:189. [PMID: 34246222 PMCID: PMC8272317 DOI: 10.1186/s12871-021-01415-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 06/17/2021] [Indexed: 12/02/2022] Open
Abstract
Background Cardiac output (CO) is a key measure of adequacy of organ and tissue perfusion, especially in critically ill or complex surgical patients. CO monitoring technology continues to evolve. Recently developed CO monitors rely on unique algorithms based on pulse contour analysis of an arterial blood pressure (ABP) waveform. The objective of this investigation was to compare the accuracy of two monitors using different methods of pulse contour analysis – the Retia Argos device and the Edwards Vigileo-FloTrac device – with pulmonary artery catheter (PAC)-thermodilution as a reference. Methods Fifty-eight patients undergoing off-pump coronary artery bypass surgery formed the study cohort. A total of 572 triplets of CO measurements from each device – Argos, Vigileo-FloTrac (third generation), and thermodilution – were available before and after interventions (e.g., vasopressors, fluids, and inotropes). Bland–Altman analysis accounting for repeated measurements per subject and concordance analysis were applied to assess the accuracy of the CO values and intervention-induced CO changes of each pulse contour device against thermodilution. Cluster bootstrapping was employed to statistically compare the root-mean-squared-errors (RMSE = √(μ2 + σ2), where μ and σ are the Bland–Altman bias and precision errors) and concordance rates of the two devices. Results The RMSE (mean (95% confidence intervals)) for CO values was 1.16 (1.00–1.32) L/min for the Argos device and 1.54 (1.33–1.77) L/min for the Vigileo-FloTrac device; the concordance rate for intervention-induced CO changes was 87 (82–92)% for the Argos device and 72 (65–78)% for the Vigileo-FloTrac device; and the RMSE for the CO changes was 17 (15–19)% for the Argos device and 21 (19–23)% for the Vigileo-FloTrac device (p < 0.0167 for all comparisons). Conclusions In comparison with CO measured by the PAC, the Argos device proved to be more accurate than the Vigileo-FloTrac device in CO trending and absolute CO measurement in patients undergoing off-pump coronary artery bypass surgery. Supplementary Information The online version contains supplementary material available at 10.1186/s12871-021-01415-5.
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Affiliation(s)
- Ramakrishna Mukkamala
- Department of Anesthesiology and Perioperative Medicine and Department of Bioengineering, University of Pittsburgh, 408 Benedum Hall, 3700 O'Hara Street, Pittsburgh, PA, 15261, USA. .,Retia Medical, Valhalla, NY, USA.
| | - Benjamin A Kohl
- Department of Anesthesiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Aman Mahajan
- Department of Anesthesiology and Perioperative Medicine and Department of Bioengineering, University of Pittsburgh, A-1305 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA, 15261, USA
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17
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Smith R, Murphy L, Pretty CG, Desaive T, Shaw GM, Chase JG. Tube-load model: A clinically applicable pulse contour analysis method for estimation of cardiac stroke volume. Comput Methods Programs Biomed 2021; 204:106062. [PMID: 33813060 DOI: 10.1016/j.cmpb.2021.106062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 03/17/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND AND OBJECTIVES Accurate, reproducible, and reliable real-time clinical measurement of stroke volume (SV) is challenging. To accurately estimate arterial mechanics and SV by pulse contour analysis, accounting for wave reflection, such as by a tube-load model, is potentially important. This study tests for the first time whether a dynamically identified tube-load model, given a single peripheral arterial input signal and pulse transit time (PTT), provides accurate SV estimates during hemodynamic instability. METHODS The model is tested for 5 pigs during hemodynamic interventions, using either an aortic flow probe or admittance catheter for a validation SV measure. Performance is assessed using Bland-Altman and polar plot analysis for a series of long-term state-change and short-term dynamic events. RESULTS The overall median bias and limits of agreement (2.5th, 97.5th percentile) from Bland-Altman analysis were -10% [-49, 36], and -1% [-28,20] for state-change and dynamic events, respectively. The angular limit of agreement (maximum of 2.5th, 97.5th percentile) from polar-plot analysis for state-change and dynamic interventions was 35.6∘, and 35.2∘, respectively. CONCLUSION SV estimation agreement and trending performance was reasonable given the severity of the interventions. This simple yet robust method has potential to track SV within acceptable limits during hemodynamic instability in critically ill patients, provided a sufficiently accurate PTT measure.
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Affiliation(s)
- Rachel Smith
- Department of Mechanical Engineering, University of Canterbury, New Zealand.
| | - Liam Murphy
- Department of Mechanical Engineering, University of Canterbury, New Zealand
| | | | - Thomas Desaive
- IGA Cardiovascular Science, University of Liége, Liége, Belgium
| | | | - J Geoffrey Chase
- Department of Mechanical Engineering, University of Canterbury, New Zealand
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18
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Møller A, Wetterslev J, Shahidi S, Hellemann D, Secher NH, Pedersen OB, Marcussen KV, Ramsing BGU, Mortensen A, Nielsen HB. Effect of low vs high haemoglobin transfusion trigger on cardiac output in patients undergoing elective vascular surgery: Post-hoc analysis of a randomized trial. Acta Anaesthesiol Scand 2021; 65:302-312. [PMID: 33141936 DOI: 10.1111/aas.13733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 10/06/2020] [Accepted: 10/07/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND During vascular surgery, restricted red-cell transfusion reduces frontal lobe oxygen (ScO2 ) saturation as determined by near-infrared spectroscopy. We evaluated whether inadequate increase in cardiac output (CO) following haemodilution explains reduction in ScO2 . METHODS This is a post-hoc analysis of data from the Transfusion in Vascular surgery (TV) Trial where patients were randomized on haemoglobin drop below 9.7 g/dL to red-cell transfusion at haemoglobin below 8.0 (low-trigger) vs 9.7 g/dL (high-trigger). Fluid administration was guided by optimizing stroke volume. We compared mean intraoperative levels of CO, haemoglobin, oxygen delivery, and CO at nadir ScO2 with linear regression adjusted for age, operation type and baseline. Data for 46 patients randomized before end of surgery were included for analysis. RESULTS The low-trigger resulted in a 7.1% lower mean intraoperative haemoglobin level (mean difference, -0.74 g/dL; P < .001) and reduced volume of red-cell transfused (median [inter-quartile range], 0 [0-300] vs 450 mL [300-675]; P < .001) compared with the high-trigger group. Mean CO during surgery was numerically 7.3% higher in the low-trigger compared with the high-trigger group (mean difference, 0.36 L/min; 95% confidence interval (CI.95), -0.05 to 0.78; P = .092; n = 42). At the nadir ScO2 -level, CO was 11.9% higher in the low-trigger group (mean difference, 0.58 L/min; CI.95, 0.10-1.07; P = .024). No difference in oxygen delivery was detected between trial groups (MD, 1.39 dLO2 /min; CI.95, -6.16 to 8.93; P = .721). CONCLUSION Vascular surgical patients exposed to restrictive RBC transfusion elicit the expected increase in CO making it unlikely that their potentially limited cardiac capacity explains the associated ScO2 decrease.
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Affiliation(s)
- Anders Møller
- Department of Anaesthesia and Intensive care Næstved‐Slagelse‐Ringsted Slagelse Hospital Slagelse Denmark
| | - Jørn Wetterslev
- Copenhagen Trial Unit Centre for Clinical Intervention Research, Rigshospitalet Copenhagen Denmark
| | - Saeid Shahidi
- Department of Cardiology and Vascular Surgery Zealand University Hospital Roskilde Roskilde Denmark
| | - Dorthe Hellemann
- Department of Anaesthesia and Intensive care Næstved‐Slagelse‐Ringsted Slagelse Hospital Slagelse Denmark
| | - Niels H. Secher
- Department of Anaesthesia, Rigshospitalet University of Copenhagen Copenhagen Denmark
| | - Ole B. Pedersen
- Department of Clinical Immunology Næstved Hospital Nastved Denmark
| | - Klaus V. Marcussen
- Department of Anaesthesia and Intensive care Næstved‐Slagelse‐Ringsted Slagelse Hospital Slagelse Denmark
| | - Benedicte G. U. Ramsing
- Department of Anaesthesia and Intensive care Næstved‐Slagelse‐Ringsted Slagelse Hospital Slagelse Denmark
| | - Anette Mortensen
- Department of Anaesthesia and Intensive care Næstved‐Slagelse‐Ringsted Slagelse Hospital Slagelse Denmark
| | - Henning B. Nielsen
- Department of Anaesthesia Zealand University Hospital Roskilde Roskilde Denmark
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19
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Skouropoulou D, Lacitignola L, Di Bella C, Stabile M, Acquafredda C, Brienza N, Grasso S, Crovace A, Iarussi F, Staffieri F. Intraoperative Assessment of Fluid Responsiveness in Normotensive Dogs under Isoflurane Anaesthesia. Vet Sci 2021; 8:26. [PMID: 33670144 DOI: 10.3390/vetsci8020026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 01/31/2021] [Accepted: 02/07/2021] [Indexed: 12/17/2022] Open
Abstract
The aim of this study was to evaluate the incidence of fluid responsiveness (FR) to a fluid challenge (FC) in normotensive dogs under anaesthesia. The accuracy of pulse pressure variation (PPV), systolic pressure variation (SPV), stroke volume variation (SVV), and plethysmographic variability index (PVI) for predicting FR was also evaluated. Dogs were anaesthetised with methadone, propofol, and inhaled isoflurane in oxygen, under volume-controlled mechanical ventilation. FC was performed by the administration of 5 mL/kg of Ringer's lactate within 5 min. Cardiac index (CI; L/min/m2), PPV, (%), SVV (%), SPV (%), and PVI (%) were registered before and after FC. Data were analysed with ANOVA and ROC tests (p < 0.05). Fluid responsiveness was defined as 15% increase in CI. Eighty dogs completed the study. Fifty (62.5%) were responders and 30 (37.5%) were nonresponders. The PPV, PVI, SPV, and SVV cut-off values (AUC, p) for discriminating responders from nonresponders were PPV >13.8% (0.979, <0.001), PVI >14% (0.956, <0.001), SPV >4.1% (0.793, <0.001), and SVV >14.7% (0.729, <0.001), respectively. Up to 62.5% of normotensive dogs under inhalant anaesthesia may be fluid responders. PPV and PVI have better diagnostic accuracy to predict FR, compared to SPV and SVV.
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20
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Bhatia A, Maddox TM. Remote Patient Monitoring in Heart Failure: Factors for Clinical Efficacy. Int J Heart Fail 2021; 3:31. [PMID: 36263114 PMCID: PMC9536717 DOI: 10.36628/ijhf.2020.0023] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/19/2020] [Accepted: 11/06/2020] [Indexed: 12/11/2022]
Abstract
Despite clinical advances in its treatment, heart failure (HF) is associated with significant adverse clinical outcomes and is among the greatest drivers of healthcare utilization. Outpatient management of HF remains suboptimal, with gaps in the provision of evidence-based therapies, and difficulties in predicting and managing clinical decompensation. Remote patient monitoring (RPM) has the potential to address these issues, and thus has been of increasing interest to HF clinicians and health systems. Economic incentives, including increasing RPM reimbursement and HF readmission penalties, are also spurring increased interest in RPM. This review establishes a framework for evaluating RPM based on its various components: 1) patient data collection, 2) data transmission, analysis, and presentation, and 3) care team review and clinical action. The existing evidence regarding RPM in HF management is also reviewed. Based on the data, we identify RPM features associated with clinical efficacy and describe emerging digital tools that have the promise of addressing current needs.
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21
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Fernández SN, Santiago MJ, González R, López J, Solana MJ, Urbano J, López-Herce J. Changes in hemodynamics, renal blood flow and urine output during continuous renal replacement therapies. Sci Rep 2020; 10:20797. [PMID: 33247145 PMCID: PMC7695709 DOI: 10.1038/s41598-020-77435-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 11/09/2020] [Indexed: 11/09/2022] Open
Abstract
Continuous renal replacement therapies (CRRT) affect hemodynamics and urine output. Some theories suggest a reduced renal blood flow as the cause of the decreased urine output, but the exact mechanisms remain unclear. A prospective experimental study was carried out in 32 piglets (2–3 months old) in order to compare the impact of CRRT on hemodynamics, renal perfusion, urine output and renal function in healthy animals and in those with non-oliguric acute kidney injury (AKI). CRRT was started according to our clinical protocol, with an initial blood flow of 20 ml/min, with 10 ml/min increases every minute until a goal flow of 5 ml/kg/min. Heart rate, blood pressure, central venous pressure, cardiac output, renal blood flow and urine output were registered at baseline and during the first 6 h of CRRT. Blood and urine samples were drawn at baseline and after 2 and 6 h of therapy. Blood pressure, cardiac index and urine output significantly decreased after starting CRRT in all piglets. Renal blood flow, however, steadily increased throughout the study. Cisplatin piglets had lower cardiac index, higher vascular resistance, lower renal blood flow and lower urine output than control piglets. Plasma levels of ADH and urine levels of aquaporin-2 were lower, whereas kidney injury biomarkers were higher in the cisplatin group of piglets. According to our findings, a reduced renal blood flow doesn’t seem to be the cause of the decrease in urine output after starting CRRT.
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Affiliation(s)
- S N Fernández
- Pediatric Intensive Care Department, Gregorio Marañón General University Hospital, Madrid, Spain. .,Department of Pediatrics. School of Medicine, Complutense University of Madrid, Madrid, Spain. .,Health Research Institute of the Gregorio Marañón Hospital, Madrid, Spain.
| | - M J Santiago
- Pediatric Intensive Care Department, Gregorio Marañón General University Hospital, Madrid, Spain.,Department of Pediatrics. School of Medicine, Complutense University of Madrid, Madrid, Spain.,Health Research Institute of the Gregorio Marañón Hospital, Madrid, Spain
| | - R González
- Pediatric Intensive Care Department, Gregorio Marañón General University Hospital, Madrid, Spain.,Department of Pediatrics. School of Medicine, Complutense University of Madrid, Madrid, Spain.,Health Research Institute of the Gregorio Marañón Hospital, Madrid, Spain
| | - J López
- Pediatric Intensive Care Department, Gregorio Marañón General University Hospital, Madrid, Spain.,Department of Pediatrics. School of Medicine, Complutense University of Madrid, Madrid, Spain.,Health Research Institute of the Gregorio Marañón Hospital, Madrid, Spain
| | - M J Solana
- Pediatric Intensive Care Department, Gregorio Marañón General University Hospital, Madrid, Spain.,Department of Pediatrics. School of Medicine, Complutense University of Madrid, Madrid, Spain.,Health Research Institute of the Gregorio Marañón Hospital, Madrid, Spain
| | - J Urbano
- Pediatric Intensive Care Department, Gregorio Marañón General University Hospital, Madrid, Spain.,Department of Pediatrics. School of Medicine, Complutense University of Madrid, Madrid, Spain.,Health Research Institute of the Gregorio Marañón Hospital, Madrid, Spain
| | - J López-Herce
- Pediatric Intensive Care Department, Gregorio Marañón General University Hospital, Madrid, Spain.,Department of Pediatrics. School of Medicine, Complutense University of Madrid, Madrid, Spain.,Health Research Institute of the Gregorio Marañón Hospital, Madrid, Spain
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22
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Smith R, Balmer J, Pretty CG, Mehta-Wilson T, Desaive T, Shaw GM, Chase JG. Incorporating pulse wave velocity into model-based pulse contour analysis method for estimation of cardiac stroke volume. Comput Methods Programs Biomed 2020; 195:105553. [PMID: 32497771 DOI: 10.1016/j.cmpb.2020.105553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 04/30/2020] [Accepted: 05/15/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND AND OBJECTIVES Stroke volume (SV) and cardiac output (CO) are important metrics for hemodynamic management of critically ill patients. Clinically available devices to continuously monitor these metrics are invasive, and less invasive methods perform poorly during hemodynamic instability. Pulse wave velocity (PWV) could potentially improve estimation of SV and CO by providing information on changing vascular tone. This study investigates whether using PWV for parameter identification of a model-based pulse contour analysis method improves SV estimation accuracy. METHODS Three implementations of a 3-element windkessel pulse contour analysis model are compared: constant-Z, water hammer, and Bramwell-Hill methods. Each implementation identifies the characteristic impedance parameter (Z) differently. The first method identifies Z statically and does not use PWV, and the latter two methods use PWV to dynamically update Z. Accuracy of SV estimation is tested in an animal trial, where interventions induce severe hemodynamic changes in 5 pigs. Model-predicted SV is compared to SV measured using an aortic flow probe. RESULTS SV percentage error had median bias and [(IQR); (2.5th, 97.5th percentiles)] of -0.5% [(-6.1%, 4.7%); (-50.3%, +24.1%)] for the constant-Z method, 0.6% [(-4.9%, 6.2%); (-43.4%, +29.3%)] for the water hammer method, and 0.8% [(-6.5, 8.6); (-37.1%, +47.6%)] for the Bramwell-Hill method. CONCLUSION Incorporating PWV for dynamic Z parameter identification through either the Bramwell-Hill equation or the water hammer equation does not appreciably improve the 3-element windkessel pulse contour analysis model's prediction of SV during hemodynamic changes compared to the constant-Z method.
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Affiliation(s)
- Rachel Smith
- Department of Mechanical Engineering, University of Canterbury, New Zealand.
| | - Joel Balmer
- Department of Mechanical Engineering, University of Canterbury, New Zealand
| | | | | | - Thomas Desaive
- IGA Cardiovascular Science, University of Liége, Liége, Belgium
| | | | - J Geoffrey Chase
- Department of Mechanical Engineering, University of Canterbury, New Zealand
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Fischer MO, Joosten A, Desebbe O, Boutros M, Debroczi S, Broch O, Malbrain ML, Ameloot K, Hofer CK, Bubenek-Turconi ŞI, Monnet X, Diouf M, Lorne E. Interchangeability of cardiac output measurements between non-invasive photoplethysmography and bolus thermodilution: A systematic review and individual patient data meta-analysis. Anaesth Crit Care Pain Med 2020; 39:75-85. [DOI: 10.1016/j.accpm.2019.05.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 04/29/2019] [Accepted: 05/27/2019] [Indexed: 01/30/2023]
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Ajayan N, Hrishi AP, Sethuraman M. How Reliable Are the Functional Hemodynamic Tests in Predicting Fluid Responsiveness in Patients Undergoing Protective Ventilation During Prone Spine Surgeries? Anesth Analg 2020; 130:e150. [PMID: 31985495 DOI: 10.1213/ane.0000000000004670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Neeraja Ajayan
- Division of Neuroanesthesia, Department of Anesthesiology, Sree Chitra Tirunal Institute for Medical Sciences, Thiruvananthapuram, Kerala, India,
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Zócalo Y, Díaz A, Bia D. Cardiac Output Monitoring in Children, Adolescents and Adults Based on Pulse Contour Analysis: Comparison with Echocardiography-Derived Data and Identification of Factors Associated with Their Differences. Cardiovasc Eng Technol 2020; 11:67-83. [DOI: 10.1007/s13239-019-00439-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 10/18/2019] [Indexed: 01/24/2023]
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Aseni P, Orsenigo S, Storti E, Pulici M, Arlati S. Current concepts of perioperative monitoring in high-risk surgical patients: a review. Patient Saf Surg 2019; 13:32. [PMID: 31660064 PMCID: PMC6806509 DOI: 10.1186/s13037-019-0213-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 09/26/2019] [Indexed: 12/16/2022] Open
Abstract
A substantial number of patients are at high-risk of intra- or post-operative complications or both. Most perioperative deaths are represented by patients who present insufficient physiological reserve to meet the demands of major surgery. Recognition and management of critical high-risk surgical patients require dedicated and effective teams, capable of preventing, recognize, start treatment with adequate support in time to refer patients to the satisfactory ICU level provision. The main task for health-care planners and managers is to identify and reduce this severe risk and to encourage patient’s safety practices. Inadequate tissue perfusion and decreased cellular oxygenation due to hypovolemia, heart dysfunction, reduced cardiovascular reserve, and concomitant diseases are the most common causes of perioperative complications. Hemodynamic, respiratory and careful sequential monitoring have become essential aspects of the clinical practice both for surgeons and intensivists. New monitoring techniques have changed significantly over the past few years and are now able to rapidly identify shock states earlier, define the etiology, and monitor the response to different therapies. Many of these techniques are now minimally invasive or non-invasive. Advanced hemodynamic and respiratory monitoring combines invasive, non-invasive monitoring skills. Non-invasive ultrasound has emerged during the last years as an essential operative and perioperative evaluation tool, and its use is now rapidly growing. Perioperative management guided by appropriate sequential clinical evaluation combined with respiratory and hemodynamic monitoring is an established tool to help clinicians to identify those patients at higher risk in the attempt to reduce the complications rate and potentially improve patient outcomes. This review aims to provide an update of currently available standard concepts and evolving technologies of the various respiratory and hemodynamic monitoring systems for the high-risk surgical patients, highlighting their potential usefulness when integrated with careful clinical evaluation.
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Affiliation(s)
- Paolo Aseni
- Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
| | - Stefano Orsenigo
- Department of Anesthesia and Intensive Care, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Enrico Storti
- Dipartimento Emergenza Urgenza, UOC Anestesia e Rianimazione, ASST, Lodi, Italy
| | - Marco Pulici
- Department of Anesthesia and Intensive Care, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Sergio Arlati
- Department of Anesthesia and Intensive Care, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
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Parker T, Brealey D, Dyson A, Singer M. Optimising organ perfusion in the high-risk surgical and critical care patient: a narrative review. Br J Anaesth 2019; 123:170-176. [PMID: 31054772 DOI: 10.1016/j.bja.2019.03.027] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 02/18/2019] [Accepted: 03/12/2019] [Indexed: 12/18/2022] Open
Abstract
Maintenance or prompt restoration of an oxygen supply sufficient to facilitate adequate cellular metabolism is fundamental in maintaining organ function. This is particularly relevant when metabolic needs change markedly, for example in response to major surgery or critical illness. The consequences of inadequate tissue oxygenation include wound and anastomotic breakdown, organ dysfunction, and death. However, our ability to identify those at risk and to promptly recognise and correct tissue hypoperfusion is limited. Reliance is placed upon surrogate markers of tissue oxygenation such as arterial blood pressure and serum lactate that are insensitive to early organ compromise. Advances in oxygen sensing technology will facilitate monitoring in various organ beds and allow more precise titration of therapies to physiologically relevant endpoints. Clinical trials will be needed to evaluate any impact on outcomes, however accurate on-line monitoring of the adequacy of tissue oxygenation offers the promise of a paradigm shift in resuscitation and perioperative practice. This narrative review examines current evidence for goal-directed therapy in the optimisation of organ perfusion in high-risk surgical and critically ill patients, and offers arguments to support the potential utility of tissue oxygen monitoring.
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Affiliation(s)
- Thomas Parker
- Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, UK
| | - David Brealey
- Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, UK
| | - Alex Dyson
- Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, UK
| | - Mervyn Singer
- Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, UK.
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