Journal of clinical monitoring and computing
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J Clin Monit Comput · Oct 2012
ReviewBedside echocardiography in critically ill patients: a true hemodynamic monitoring tool.
Echocardiography is a versatile, accurate and noninvasive tool suited to examination of shocked patients. Since the 1980s, intensive care practitioners have used ultrasound widely for hemodynamic evaluation and for cardiac anatomy visualization. ⋯ We will also report the main indications of echocardiography and the corresponding parameters. Finally, we will indicate educational programs and define minimum training that enable self-sufficiency.
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J Clin Monit Comput · Oct 2012
ReviewHemodynamic management of cardiovascular failure by using PCO(2) venous-arterial difference.
The difference between mixed venous blood carbon dioxide tension (PvCO(2)) and arterial carbon dioxide tension (PaCO(2)), called ∆PCO(2) has been proposed to better characterize the hemodynamic status. It depends on the global carbon dioxide (CO(2)) production, on cardiac output and on the complex relation between CO(2) tension and CO(2) content. ⋯ The difference between central venous CO(2) tension and arterial CO(2) tension, which is easy to obtain can substitute for ∆PCO(2) to assess the adequacy of cardiac output. Differences between local tissue CO(2) tension and arterial CO(2) tension can also be obtained and provide data on the adequacy of local blood flow to the local metabolic conditions.
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J Clin Monit Comput · Aug 2012
ReviewMonitoring tissue oxygenation by near infrared spectroscopy (NIRS): background and current applications.
Conventional cardiovascular monitoring may not detect tissue hypoxia, and conventional cardiovascular support aiming at global hemodynamics may not restore tissue oxygenation. NIRS offers non-invasive online monitoring of tissue oxygenation in a wide range of clinical scenarios. NIRS monitoring is commonly used to measure cerebral oxygenation (rSO(2)), e.g. during cardiac surgery. ⋯ Therefore, measuring and obtaining adequate tissue oxygenation may prevent (postoperative) complications and may thus be cost-effective. NIRS monitoring may also be used to detect tissue hypoxia in (prehospital) emergency settings, where it has prognostic significance and enables monitoring of therapeutic interventions, particularly in patients with trauma. However, optimal therapeutic agents and strategies for augmenting tissue oxygenation have yet to be determined.
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Anesthesiology is a stressful medical profession. While anesthesia in particular has become safer for the patient in the last decades, anesthesiology as a profession represents a medical field in which the professionals are permanently tense. The various reasons for this situation include the fact that anesthesiology is a team profession that requires perfect cooperation with other specialists. ⋯ This reality created the need to look for remedies; some authors recommend a long list of measures to be taken in order to prevent or reduce the magnitude of professional stress. This list includes a continuous self-care attitude, consisting of having a balanced professional and personal life; adequate sleep; avoiding drugs, obesity, and "workaholic" behavior; as well as better use of leisure. Finally, more studies are needed to find out which preventive means may potentially reduce the risk of professional stress among anesthesiologists.
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Monitoring of continuous blood pressure and cardiac output is important to prevent hypoperfusion and to guide fluid administration, but only few patients receive such monitoring due to the invasive nature of most of the methods presently available. Noninvasive blood pressure can be determined continuously using finger cuff technology and cardiac output is easily obtained using a pulse contour method. In this way completely noninvasive continuous blood pressure and cardiac output are available for clinical use in all patients that would otherwise not be monitored. Developments and state of art in hemodynamic monitoring are reviewed here, with a focus on noninvasive continuous hemodynamic monitoring form the finger.