scholarly journals Improving echographic monitoring of hemodynamics in critically ill patients: validation of right cardiac output measurements through the modified subcostal window

2020 ◽  
Author(s):  
Laura Colinas Fernández ◽  
Gonzalo Hernández Martínez ◽  
María B. Serna Gandía ◽  
Gaspar Tuero León ◽  
Pablo Cuesta-Montero ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Intraclass Correlation ◽  
Correlation Coefficients ◽  
Outflow Tract ◽  
Mechanically Ventilated ◽  
Severe Aortic Regurgitation ◽  
Time Integral ◽  
The Right

Abstract Background: The gold standard for echocardiographic monitoring of cardiac output in critically ill patients is measurements of the velocity-time integral (VTI) along the left ventricle outflow tract (LVOT). However, clinical circumstances such as severe aortic regurgitation or dynamic LVOT obstruction limit the use of LVOT VTI as a surrogate for stroke volume, and the transthoracic window is often unfeasible in mechanically ventilated patients. We aimed to assess the usefulness of using the right ventricle outflow tract (RVOT) VTI for echocardiographic monitoring of cardiac output. Methods: This prospective observational study included 100 consecutive patients admitted to a tertiary intensive care unit. We used intraclass correlation coefficients (ICC) to compare echocardiographic measurements of LVOT VTI through apical window with RVOT VTI through the parasternal and modified subcostal windows and to assess interobserver reproducibility. Preplanned post hoc analyses compared the ICC between ventilated and nonventilated patients. Results: At the time of echocardiography, 44 (44%) patients were mechanically ventilated and 28 (28%) were receiving vasoactive drugs. Good-quality measurements were obtained through the parasternal short-axis and/or apical views in 81 (81%) patients and in 100 (100%) patients through the subcostal window. Consistency with LVOT VTI was moderate for RVOT VTI measured from the modified subcostal view (ICC 0.727; 95%CI: 0.62–0.808) and for RVOT VTI measured from the transthoracic view (0.715; 95%CI: 0.59–0.807). Conclusions: Measurements of RVOT VTI are moderately consistent with measurements of LVOT VTI. Adding the modified subcostal window allows cardiac output to be monitored echocardiographically in practically all critically ill patients, even those under mechanical ventilation.

scholarly journals Reduction of Intra-abdominal Hypertension Is Associated with Increase of Cardiac Output in Critically Ill Patients Undergoing Mechanical Ventilation

2018 ◽  
Vol 3 (2) ◽  
pp. 90-97
Author(s):  
Claudiu Puiac ◽  
Theodora Benedek ◽  
Lucian Puscasiu ◽  
Nora Rat ◽  
Emoke Almasy ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Abdominal Pressure ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Abdominal Hypertension ◽  
Group 2 ◽  
Ventilated Patients ◽  
Group 1

Abstract Objective: To demonstrate the relationship between intra-abdominal hypertension (IAH) and cardiac output (CO) in mechanically ventilated (MV), critically ill patients. Material and methods: This was a single-center, prospective study performed between January and April 2016, on 30 mechanically ventilated patients (mean age 67.3 ± 11.9 years), admitted in the Intensive Care Unit (ICU) of the Emergency County Hospital of Tîrgu Mureș, Romania, who underwent measurements of intra-abdominal pressure (IAP). Patients were divided into two groups: group 1 – IAP <12 mmHg (n = 21) and group 2 – IAP >12 mmHg (n = 9). In 23 patients who survived at least 3 days post inclusion, the variation of CO and IAP between baseline and day 3 was calculated, in order to assess the variation of IAP in relation to the hemodynamic status. Results: IAP was 8.52 ± 1.59 mmHg in group 1 and 19.88 ± 8.05 mmHg in group 2 (p <0.0001). CO was significantly higher in group 1 than in the group with IAH: 6.96 ± 2.07 mmHg (95% CI 6.01–7.9) vs. 4.57 ± 1.23 mmHg (95% CI 3.62–5.52) (p = 0.003). Linear regression demonstrated an inverse correlation between CO and IAP (r = 0.48, p = 0.007). Serial measurements of CO and IAP proved that whenever accomplished, the decrease of IAP was associated with a significant increase in CO (p = 0.02). Conclusions: CO is significantly correlated with IAP in mechanically ventilated patients, and IAH reduction is associated with increase of CO in these critically ill cases.

scholarly journals Normal pressures and reliability of the Gaitview® system in healthy adults

2012 ◽  
Vol 36 (2) ◽  
pp. 159-164 ◽  
Author(s):  
Yoon Tae Kim ◽  
Jung Soo Lee
Keyword(s):  
Plantar Pressure ◽  
Repeated Measures ◽  
Normal Values ◽  
Center Of Pressure ◽  
Intraclass Correlation ◽  
Correlation Coefficients ◽  
Independent Study ◽  
Intraclass Correlation Coefficients ◽  
Time Integral ◽  
The Right

Background: Each plantar pressure measurement system has a different accuracy and reliability, which is required to establish a range of normal values and determine the reliability. Objectives: To determine normal pressures with the Gaitview® system and assess its reliability. Study Design: Single-group repeated measures. Methods: Dynamic barefoot plantar pressure data were obtained in 30 healthy young participants. In each session, three trials were recorded by one examiner for each foot using the two-step gait initiation method, which was repeated by another examiner the same day. One week later, all of the procedures were repeated. Time-integral mean pressures were measured for each of eight anatomical foot regions. The foot contact time (CT) and the time-integral mean angle of the center of pressure (COP) were also measured. Results: The greatest time-integral mean pressures were seen under the medial and lateral heel. The mean CT was 0.9 sec for both feet, and the time-integral mean angle of the COP was 9.3° for the right foot and 6.6° for the left. The intraclass correlation coefficients (ICCs) ranged from 0.69 to 0.97, and the coefficient of variation (CoV) from 9.9 to 59.97% for all parameters. Conclusions: These findings indicate that the Gaitview® system demonstrates good to moderate reliability. Clinical relevance The Gaitview® AFA-50 system (alFOOTs, Seoul, Republic of Korea) has been used by clinicians in Korea, but has not been investigated in an independent study. Therefore, this study established a range of normal values and determined the reliability of the Gaitview® AFA-50 system.

scholarly journals The Incidence of Radial Artery Occlusion in Critically Ill Patients after Cannulation with a Long Catheter

2021 ◽  
Vol 10 (14) ◽  
pp. 3172
Author(s):  
Magdalena Wujtewicz ◽  
Bartosz Regent ◽  
Rozalia Marszałek-Ratnicka ◽  
Aneta Smugała ◽  
Edyta Szurowska ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Critically Ill ◽  
Radial Artery ◽  
Critically Ill Patients ◽  
Artery Occlusion ◽  
Cardiac Output Monitoring ◽  
Artery Cannulation ◽  
Radial Artery Occlusion ◽  
Output Monitoring ◽  
The Right

Cardiac output monitoring is a common practice in critically ill patients. The PiCCO (pulse index continuous cardiac output) method requires artery cannulation. According to the manufacturer, the cannula in the radial artery should be removed after three days. However, longer monitoring is sometimes necessary. The aim of this study was to assess the incidence of radial artery occlusion (RAO) after three days of cannulation and to check whether five-day cannulation is related to a higher occlusion rate. An additional assessment was made to verify the presence of occlusion three, fourteen and thirty days after decannulation. The PiCCO cannula was inserted into the radial artery after the Barbeau test and Doppler assessment of blood flow. It was left for three or five days. Doppler was performed immediately after its removal and at three, fourteen and thirty days following decannulation. Thirty-seven patients were randomly assigned for three or five days of cannulation, and twenty-three of them were eligible for further analysis. RAO was found in thirteen (56.5%) patients. No statistical difference was found between the RAO rate for three and five day cannulations (p = 0.402). The incidence of RAO was lower when the right radial artery was cannulated (p = 0.022; OR 0.129). Radial artery cannulation with a PiCCO catheter poses a risk of RAO. However, the incidence of prolonged cannulation appeared to not increase the risk of artery occlusion. ClinicalTrials.gov ID NCT02695407.

scholarly journals Etiology, incidence, and outcomes of patient–ventilator asynchrony in critically-ill patients undergoing invasive mechanical ventilation

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yongfang Zhou ◽  
Steven R. Holets ◽  
Man Li ◽  
Gustavo A. Cortes-Puentes ◽  
Todd J. Meyer ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Invasive Mechanical Ventilation ◽  
Surgical Intensive Care ◽  
Mechanically Ventilated ◽  
History Of ◽  
Training Background ◽  
The Relationship

AbstractPatient–ventilator asynchrony (PVA) is commonly encountered during mechanical ventilation of critically ill patients. Estimates of PVA incidence vary widely. Type, risk factors, and consequences of PVA remain unclear. We aimed to measure the incidence and identify types of PVA, characterize risk factors for development, and explore the relationship between PVA and outcome among critically ill, mechanically ventilated adult patients admitted to medical, surgical, and medical-surgical intensive care units in a large academic institution staffed with varying provider training background. A single center, retrospective cohort study of all adult critically ill patients undergoing invasive mechanical ventilation for ≥ 12 h. A total of 676 patients who underwent 696 episodes of mechanical ventilation were included. Overall PVA occurred in 170 (24%) episodes. Double triggering 92(13%) was most common, followed by flow starvation 73(10%). A history of smoking, and pneumonia, sepsis, or ARDS were risk factors for overall PVA and double triggering (all P < 0.05). Compared with volume targeted ventilation, pressure targeted ventilation decreased the occurrence of events (all P < 0.01). During volume controlled synchronized intermittent mandatory ventilation and pressure targeted ventilation, ventilator settings were associated with the incidence of overall PVA. The number of overall PVA, as well as double triggering and flow starvation specifically, were associated with worse outcomes and fewer hospital-free days (all P < 0.01). Double triggering and flow starvation are the most common PVA among critically ill, mechanically ventilated patients. Overall incidence as well as double triggering and flow starvation PVA specifically, portend worse outcome.

scholarly journals Selection strategy for sedation depth in critically ill patients on mechanical ventilation

2021 ◽  
Vol 21 (S2) ◽  
Author(s):  
Longxiang Su ◽  
Chun Liu ◽  
Fengxiang Chang ◽  
Bo Tang ◽  
Lin Han ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Dimensionality Reduction ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Latent Profile Analysis ◽  
Profile Analysis ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Sedation And Analgesia ◽  
Ventilated Patients

Abstract Background Analgesia and sedation therapy are commonly used for critically ill patients, especially mechanically ventilated patients. From the initial nonsedation programs to deep sedation and then to on-demand sedation, the understanding of sedation therapy continues to deepen. However, according to different patient’s condition, understanding the individual patient’s depth of sedation needs remains unclear. Methods The public open source critical illness database Medical Information Mart for Intensive Care III was used in this study. Latent profile analysis was used as a clustering method to classify mechanically ventilated patients based on 36 variables. Principal component analysis dimensionality reduction was used to select the most influential variables. The ROC curve was used to evaluate the classification accuracy of the model. Results Based on 36 characteristic variables, we divided patients undergoing mechanical ventilation and sedation and analgesia into two categories with different mortality rates, then further reduced the dimensionality of the data and obtained the 9 variables that had the greatest impact on classification, most of which were ventilator parameters. According to the Richmond-ASS scores, the two phenotypes of patients had different degrees of sedation and analgesia, and the corresponding ventilator parameters were also significantly different. We divided the validation cohort into three different levels of sedation, revealing that patients with high ventilator conditions needed a deeper level of sedation, while patients with low ventilator conditions required reduction in the depth of sedation as soon as possible to promote recovery and avoid reinjury. Conclusion Through latent profile analysis and dimensionality reduction, we divided patients treated with mechanical ventilation and sedation and analgesia into two categories with different mortalities and obtained 9 variables that had the greatest impact on classification, which revealed that the depth of sedation was limited by the condition of the respiratory system.

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