Journal of clinical monitoring and computing
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J Clin Monit Comput · Feb 2018
Comparative Study Observational StudyDoes obesity affect the non-invasive measurement of cardiac output performed by electrical cardiometry in children and adolescents?
Electrical cardiometry (EC) is a non-invasive and inexpensive method for hemodynamic assessment and monitoring. However, its feasibility for widespread clinical use, especially for the obese population, has yet to be determined. In this study, we evaluated the agreement and reliability of EC compared to transthoracic Doppler echocardiography (TTE) in normal, overweight, and obese children and adolescents. ⋯ Indexed values for SV were lower in the OW+OB group than in the normal weight group when measured by EC (p < 0.0001) but no differences were seen when measured by TTE (p = 0.096). In all weight groups, there were strong correlations and good agreement between EC and TTE. However, EC may underestimate hemodynamic measurements in obese participants due to fat tissue.
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J Clin Monit Comput · Feb 2018
Comparative Study Clinical Trial Observational StudyComparison of non-invasive blood pressure monitoring using modified arterial applanation tonometry with intra-arterial measurement.
Intermittent non-invasive blood pressure measurement with tourniquets is slow, can cause nerve and skin damage, and interferes with other measurements. Invasive measurement cannot be safely used in all conditions. Modified arterial tonometry may be an alternative for fast and continuous measurement. ⋯ The readings for diastolic pressures were inside the limits recommended by AAMI. Movement increased the failure rate significantly (p < 0.001). Thus, arterial tonometry is not an appropriate replacement for invasive blood pressure measurement in these patients.
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J Clin Monit Comput · Feb 2018
Randomized Controlled TrialThe effect of fluid resuscitation on the effective circulating volume in patients undergoing liver surgery: a post-hoc analysis of a randomized controlled trial.
To assess the significance of an analogue of the mean systemic filling pressure (Pmsa) and its derived variables, in providing a physiology based discrimination between responders and non-responders to fluid resuscitation during liver surgery. A post-hoc analysis of data from 30 patients undergoing major hepatic surgery was performed. Patients received 15 ml kg-1 fluid in 30 min. ⋯ The area under the receiver operating characteristics curve of Pvr, PPV and SVV for predicting FR was 0.75, 0.73 and 0.72, respectively. Changes in Pmsa, Pvr and EH reflect changes in effective circulating volume and heart performance following fluid resuscitation, providing a physiologic discrimination between responders and non-responders. Also, Pvr predicts FR equivalently compared to PPV and SVV, and might therefore aid in predicting FR in case dynamic preload variables cannot be used.
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J Clin Monit Comput · Feb 2018
Influence of the marvelous™ three-way stopcock on the natural frequency and damping coefficient in blood pressure transducer kits.
Two types of Planecta™ ports are commonly used as sampling ports in blood pressure transducer kits: a flat-type port (FTP) and a port with a three-way stopcock (PTS). Recently, a new type of three-way stopcock (Marvelous™) has been released as a Planecta™ counterpart, but its effects on the frequency characteristics and reliability of blood pressure monitoring have not been investigated. We assessed the influence of the Marvelous™ stopcock on the frequency characteristics of the pressure transducer kit. ⋯ Plotting the data on a Gardner chart revealed that the changes fell within the adequate dynamic response region, indicating they were within the allowable range. Insertion of Marvelous™ stopcocks slightly affects the natural frequency of the pressure transducer kit, similar to inserting a PTS. The results indicate that the Marvelous™ stopcock is useful for accurate monitoring of arterial blood pressure, and may be recommended when insertion of two or more closed-loop blood sampling systems is necessary.
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J Clin Monit Comput · Feb 2018
Cross-comparisons of trending accuracies of continuous cardiac-output measurements: pulse contour analysis, bioreactance, and pulmonary-artery catheter.
We compared the similarity of cardiac-output (CO) estimates between available bolus thermodilution pulmonary-artery catheters (PAC), arterial pulse-contour analysis (LiDCOplus™, FloTrac™ and PiCCOplus™), and bioreactance (NICOM™). Repetitive simultaneous estimates of CO obtained from the above devices were compared in 21 cardiac-surgery patients during the first 2 h post-surgery. Mean and absolute values for CO across the devices were compared by ANOVA, Bland-Altman, Pearson moment, and linear-regression analyses. ⋯ From Pearson moment analysis, dynamic changes in CO, estimated by each device, showed good cross-correlations. Although all devices studied recorded similar mean CO values, which dynamically changed in similar directions, they have markedly different bias and precision values relative to each other. Thus, results from prior studies that have used one device to estimate CO cannot be used to validate others devices.