Journal of clinical monitoring and computing
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J Clin Monit Comput · Dec 2016
Comparative Study Clinical Trial Observational StudyComparison of cardiac output measures by transpulmonary thermodilution, pulse contour analysis, and pulmonary artery thermodilution during off-pump coronary artery bypass surgery: a subgroup analysis of the cardiovascular anaesthesia registry at a single tertiary centre.
Cardiac output measurement has a long history in haemodynamic management and many devices are now available with varying levels of accuracy. The purpose of the study was to compare the agreement and trending abilities of cardiac output, as measured by transpulmonary thermodilution and calibrated pulse contour analysis, using the VolumeView™ system, continuous thermodilution via a pulmonary artery catheter, and uncalibrated pulse contour analysis, using FloTrac™ with pulmonary artery bolus thermodilution. Twenty patients undergoing off-pump coronary artery bypass surgery using a pulmonary artery catheter and the VolumeView™ and FloTrac™ systems were included in this subgroup analysis of the cardiovascular anaesthesia registry at a single tertiary centre. ⋯ All pairs of measurements showed significant correlations (p < 0.001), whereas only transpulmonary thermodilution revealed trending ability (concordance rate of 95.1 %, angular bias of 1.33°, and radial limits of agreement of 28.71°) compared with pulmonary artery bolus thermodilution. Transpulmonary thermodilution using the VolumeView™ system provides reliable data on cardiac output measurement and tracking the changes thereof when compared with pulmonary artery bolus thermodilution in patients with preserved cardiac function during off-pump coronary artery bypass surgery. Trial registration NCT01713192 (ClinicalTrials.gov).
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J Clin Monit Comput · Dec 2016
ReviewCerebral near-infrared spectroscopy in the care of patients during cardiological procedures: a summary of the clinical evidence.
Patients undergoing cardiological procedures generally have significant cardiovascular morbidity, and therefore these patients might be at risk for major periprocedural complications. The ability to closely monitor the hemodynamic status would present a major advantage to optimize patient care in this setting. The aim of this review is to assess the available evidence for the use of near-infrared spectroscopy (NIRS) in the care of patients during cardiological procedures. ⋯ Six studies evaluated NIRS during supraventricular and ventricular arrhythmias, one during transcatheter aortic valve implantations, and four studies assessed the use of NIRS in pediatric catheterization procedures. Overall, the studies demonstrated that NIRS provides a very quick representation of cerebral oxygen saturation and that it might identify changes that could not be predicted from standard hemodynamic monitoring. However, the evidence is currently too low to conclude that NIRS can optimize patient care during cardiological procedures.
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J Clin Monit Comput · Dec 2016
Observational StudyHigh veno-arterial carbon dioxide gradient is not predictive of worst outcome after an elective cardiac surgery: a retrospective cohort study.
Alteration of tissue perfusion is a main contributor of organ dysfunction. In cardiac surgery, the importance of organ dysfunction is associated with worse outcome. Central venous-arterial difference in CO2 tension (ΔCO2) has been proposed as a global marker of the adequacy of tissue perfusion in shock states. ⋯ The SOFA score, the hospital and 6 months mortality rate were higher in patients with low ΔCO2. Surprisingly, we did not find results previously published in other surgical settings. In cardiac surgery, ΔCO2 has a low predictive value of outcome.
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J Clin Monit Comput · Dec 2016
Randomized Controlled TrialChanges in intraocular pressure during surgery in the lateral decubitus position under sevoflurane and propofol anesthesia.
Intraocular pressure (IOP) has been shown to change with body position. Several studies have shown that the lateral decubitus position (LDP) is associated with a significant increase in IOP in the dependent eye. However, whether anesthetic agents alter IOP in the LDP remains unclear. ⋯ The number of patients in whom IOP increased to ≥28 mmHg was greater in the sevoflurane group than in the propofol group. Propofol may be better than sevoflurane for the maintenance of anesthesia in the LDP. Monitoring of IOP in the LDP might help avoid ophthalmic complications.
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J Clin Monit Comput · Dec 2016
Wireless non-invasive continuous respiratory monitoring with FMCW radar: a clinical validation study.
Altered respiratory rate is one of the first symptoms of medical conditions that require timely intervention, e.g., sepsis or opioid-induced respiratory depression. To facilitate continuous respiratory rate monitoring on general hospital wards a contactless, non-invasive, prototype monitor was developed using frequency modulated continuous wave radar. We aimed to study whether radar can reliably measure respiratory rate in postoperative patients. ⋯ Eight patients were included; yielding 796 min of observation time during mechanical ventilation and 521 min during spontaneous breathing. After elimination of movement artifacts the bias and 95 % limits of agreement for mechanical ventilation and spontaneous breathing were -0.12 (-1.76 to 1.51) and -0.59 (-5.82 to 4.63) breaths per minute respectively. The radar was able to accurately measure respiratory rate in mechanically ventilated patients, but the accuracy decreased during spontaneous breathing.