Iced vs Room-Temperature Injectates for Cardiac Index Measurement During Hypothermia and Normothermia

2010 ◽  
Vol 19 (4) ◽  
pp. 365-372 ◽  
Author(s):  
Elissa Walsh ◽  
Sheila Adams ◽  
Janine Chernipeski ◽  
Jenny Cloud ◽  
Elizabeth Gillies ◽  
...  
Keyword(s):  
Cardiac Index ◽  
Room Temperature ◽  
Surgical Patients ◽  
Body Temperatures ◽  
Convenience Sample ◽  
Recovery Unit ◽  
Bland Altman Method ◽  
Index Measurement ◽  
Few Data ◽  
Thermodilution Measurement

Background Few data are available on the accuracy of thermodilution measurements of cardiac index with room-temperature injectates and a closed delivery system in patients with low cardiac indexes and/or hypothermic body temperatures. Objective To compare iced and room-temperature injectates for thermodilution measurement of cardiac index in postoperative cardiac surgical patients during hypothermia and normothermia. Methods In a convenience sample of cardiac surgical patients in a cardiac recovery unit, cardiac index was measured with both room-temperature and iced injectates during hypothermia (≤36.0°C) and normothermia (≥36.1°C and ≤38.0°C). Device bias and precision were calculated and graphed by using the Bland-Altman method. A Student t test was used to determine differences between cardiac indexes by injectate temperature. Results A total of 38 patients were studied. Mean bias and precision for room-temperature and iced injectates in all patients were 0.11 (SD, 0.27) during hypothermia and −0.03 (SD, 0.21) during normothermia. In hypothermic patients, cardiac index differed significantly between room-temperature and iced injectates (t1,37 = 2.41, P = .02). Cardiac index measurements did not differ between room-temperature and iced injectates in normothermic patients (P = .33). Conclusions Although significant differences in thermodilution cardiac index were found between room-temperature and iced injectates during hypothermic body temperatures, these differences were small (mean, <0.11). These findings add to the results of the few studies on accuracy of room-temperature injectates for thermodilution measurement of cardiac index.

Cardiac Index Based on Measurements Obtained in a Bedside Chair and in Bed

2011 ◽  
Vol 20 (3) ◽  
pp. 210-216 ◽  
Author(s):  
Cheryl Rader ◽  
Melissa Nelson ◽  
Cindy Sobek ◽  
Michelle Smith ◽  
Rose Garcia ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Cardiac Index ◽  
Method Comparison ◽  
Surgical Patients ◽  
Thermodilution Technique ◽  
Convenience Sample ◽  
Output Measurement ◽  
Bland Altman Method ◽  
The Mean ◽  
Clinically Significant

Background Accurate measurements for determining cardiac index can be obtained while patients are supine in bed at various backrest elevations. It is not clear if these measurements are accurate when patients are in a bedside chair. Objective To determine if cardiac index based on measurements obtained with the patient in a chair is similar to cardiac index based on measurements obtained with the patient in bed. Methods A convenience sample of cardiac surgical patients and a method-comparison design were used to compare cardiac index values based on measurements obtained with patients in 2 different positions: in a chair and in the bed. A standard thermodilution technique was used to measure cardiac output. Measurement of cardiac output in the second position was obtained immediately after measurement in the first position. Positions were randomly assigned. Bias and precision were calculated and graphed with the Bland-Altman method. Differences in cardiac index of 0.50 or more were considered clinically significant. Analysis of variance was used to determine differences between cardiac index values for the 2 positions. Results A total of 27 postoperative cardiac surgical patients were studied. Cardiac index values based on measurements obtained with patients in the 2 different positions did not differ significantly (F1,50 = 0.446; P = .51). The mean difference score (bias) between the 2 positions was −0.07 (precision, 0.30) Conclusions The practice of putting cardiac surgical patients whose hemodynamic status is stable back to bed before obtaining measurements for calculation of cardiac index may not be required for accurate values.

Thermodilution measurement of cardiac output in patients with low output: room-temperature versus iced injectate

1998 ◽  
Vol 7 (6) ◽  
pp. 436-438 ◽  
Author(s):  
M Kiely ◽  
LA Byers ◽  
R Greenwood ◽  
E Carroll ◽  
D Carroll
Keyword(s):  
Cardiac Output ◽  
Cardiac Index ◽  
Room Temperature ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Thermodilution Technique ◽  
Convenience Sample ◽  
Low Cardiac Output ◽  
Significant Difference ◽  
Critically Ill Adults

BACKGROUND: Measurements of cardiac output with the thermodilution technique add to data for clinical decision making and therefore must be valid and reliable. However, the results of studies on the accuracy of values obtained with room-temperature and iced injectates, especially in patients with high or low cardiac output, have been conflicting. OBJECTIVE: To determine the effect of the temperature of the injectate (iced or room temperature) on cardiac output values obtained with the thermodilution technique in critically ill adults with known low cardiac output. METHODS: A convenience sample of 50 subjects (41 men and 9 women) who had a cardiac index of less than 2.5 (calculated as cardiac output in liters per minute divided by body surface area in square meters) before the study had cardiac output measured by using a closed system and manual injections of room-temperature and iced injectates. RESULTS: A paired t test indicated no significant difference between iced and room-temperature injectates for cardiac output (iced, 3.62 L/min; room temperature, 3.71 L/min; t = 0.99; P = .327) and cardiac index (iced, 1.95; room temperature, 1.99; t = 0.71; P = .482). CONCLUSION: The findings support the practice of using room-temperature injectate to measure cardiac output in patients with low cardiac output.

Deliberate Increase of Oxygen Delivery in the Perioperative Period

2018 ◽  
pp. 34-38
Keyword(s):  
Oxygen Consumption ◽  
High Risk ◽  
Cardiac Index ◽  
Oxygen Delivery ◽  
Myocardial Oxygen Consumption ◽  
Perioperative Period ◽  
Surgical Patients ◽  
Controlled Study ◽  
Surgical Patient ◽  
Mortality And Morbidity

This case focuses on increasing the amount of oxygen delivered to the surgical patient during the perioperative period by asking the question: Does the deliberate increase in oxygen delivery with the use of perioperative dopexamine reduce mortality and morbidity in high-risk surgical patients? Dopexamine is a dopamine analogue that produces peripheral vasodilation and an increase in cardiac index without significant increases in myocardial oxygen consumption. High-risk surgical patients were randomized to control or protocol limbs of the study. This randomized controlled study demonstrated a significant reduction in mortality and morbidity when dopexamine was used to increase oxygen delivery during the perioperative period in high-risk surgical patients.

Effects of cold exposure and dehydration on renal function in black-tailed prairie dogs

1977 ◽  
Vol 42 (2) ◽  
pp. 295-299 ◽  
Author(s):  
J. D. Hamilton ◽  
E. W. Pfeiffer
Keyword(s):  
Renal Function ◽  
Room Temperature ◽  
Sodium Concentration ◽  
Urine Concentration ◽  
Cynomys Ludovicianus ◽  
Prairie Dogs ◽  
Body Temperatures ◽  
Concentration Gradients ◽  
Plasma Urea ◽  
Cold Room

Black-tailed prairie dogs (Cynomys ludovicianus) were deprived of food and water for several weeks during the fall and winter in a cold-room hibernaculum (Ta 5–8 degrees C), and for several days at room temperature during the summer. Body temperatures (Tb) were determined periodically in nine animals by radiotransmitters implanted in the abdomen. Animals deprived of food and water in the summer were killed when maximum urine concentration was achieved. Eight animals in the winter were active when killed after 7–35 days in the hibernaculum with Tb between 18 and 36 degrees C. Five animals that became torpid periodically in the winter were killed after 19–42 days in the hibernaculum when their Tb indicated torpor (Tb less than 13 degrees C). Active animals in the summer and winter possessed pronounced renal corticomedullary urea and sodium concentration gradients. Torpid animals lacked these gradients and had lower urine and plasma osmotic concentrations than active animals. Plasma urea values and terminal osmolal U/P ratios were lowest in torpid prairie dogs.

scholarly journals Effect of Continuously Warmed Irrigating Solution during Transurethral Resection

1988 ◽  
Vol 16 (3) ◽  
pp. 324-328 ◽  
Author(s):  
T. Harioka ◽  
M. Murakawa ◽  
J. Noda ◽  
K. Mori
Keyword(s):  
Body Temperature ◽  
Operating Room ◽  
Spinal Anaesthesia ◽  
Transurethral Resection ◽  
Room Temperature ◽  
Bladder Tumour ◽  
Body Temperatures ◽  
Lower Abdomen ◽  
Deep Body ◽  
Bladder Tumours

The effects of a continuously warmed irrigating solution on body temperature during transurethral resection of the prostate and of bladder tumours were studied in forty patients. Anaesthesia was spinal and deep body temperatures of the forehead and lower abdomen were measured, using a deep body thermometry system. Both forehead and lower abdominal deep body temperatures decreased significantly in the patients who underwent transurethral resection of the prostate with an irrigating solution at operating room temperature, but did not decrease in the patients who received a continuously warmed irrigating solution. The same results were obtained for the patients who underwent transurethral resection of bladder tumour. Our results indicate that a continuously warmed irrigating solution could prevent the fall in body temperature during transurethral resection, especially prostate resection, under spinal anaesthesia.

Apparent Emissivity of Combustion Soot Aggregate Coating at High Temperature

2017 ◽  
Vol 139 (4) ◽  
Author(s):  
Tai Ran Fu ◽  
Ji Bin Tian ◽  
Hua Sheng Wang
Keyword(s):  
Heat Transfer ◽  
High Temperature ◽  
Room Temperature ◽  
Spectral Emissivity ◽  
Radiative Properties ◽  
Nickel Substrate ◽  
Soot Aggregate ◽  
Different Temperatures ◽  
Few Data ◽  
Total Hemispherical Emissivity

Soot aggregates frequently occur during combustion or pyrolysis of fuels. The radiative properties of soot aggregates at high temperature are important for understanding soot characteristics and evaluating heat transfer in combustion systems. However, few data for soot radiative properties at high temperature were available. This work experimentally investigated the apparent emissivity of the soot aggregate coating at high temperature using spectral and total hemispherical measurements. The soot aggregate coatings were formed on nickel substrates by a paraffin flame. The surface and inner morphology of the coatings were characterized by scanning electron microscope (SEM). The thickness of the coating was 30.16 μm so the contribution of the smooth nickel substrate to the apparent radiation from the coating could be neglected. The total hemispherical emissivity of the coating on the nickel substrate was measured using the steady-state calorimetric method at different temperatures. The spectral directional emissivity of the coating was measured for the wavelength of 0.38–16.0 μm at the room temperature. The measurements show that the total hemispherical emissivity decreases from 0.895 to 0.746 as the temperature increases from 438 K to 1052 K. The total hemispherical emissivity of the coating deposited on the nickel substrate is much larger than those of the nickel substrate and a nickel oxidization film. The measured spectral emissivity of the coating at the room temperature was used to theoretically calculate the total hemispherical emissivity at different temperatures by integration with respect to wavelength. The measured and calculated total hemispherical emissivities were similar, but their changes relative to temperature were completely opposite. This difference is due to the fact that the spectral emissivity of the coating is a function of temperature. The present results provide useful reference data for analyzing radiative heat transfer at high temperature of soot aggregates in combustion processes.

scholarly journals Reliability of the continuous cardiac index measurement using the pulse contour analysis of the PiCCO system

Critical Care ◽  
2007 ◽  
Vol 11 (Suppl 2) ◽  
pp. P292
Author(s):  
M Franzen ◽  
A Umgelter ◽  
S von Delius ◽  
A Weber ◽  
J Reichenberger ◽  
...  
Keyword(s):  
Cardiac Index ◽  
Pulse Contour Analysis ◽  
Pulse Contour ◽  
Contour Analysis ◽  
Index Measurement

Characterization and Subcellular Localization of Leucine Aminonaphthylamidase (LAN) in Rainbow Trout (Salmo gairdneri)

1975 ◽  
Vol 32 (8) ◽  
pp. 1289-1295 ◽  
Author(s):  
G. R. Bouck ◽  
P. W. Schneider Jr. ◽  
Janet Jacobson ◽  
R. C. Ball
Keyword(s):  
Enzyme Activity ◽  
Rainbow Trout ◽  
Reaction Time ◽  
Blood Plasma ◽  
Substrate Concentration ◽  
Room Temperature ◽  
Diagnostic Value ◽  
Inhibitory Effect ◽  
Salmo Gairdneri ◽  
Body Temperatures

LAN analyses appear to have diagnostic value in fish pathobiology and studies were undertaken to determine optima for substrate concentration, pH, reaction time, temperature, and buffer ions. Citrate ion did not inhibit LAN at anticoagulant levels, but cyanide, pyrophosphate, and EDTA had an inhibitory effect. Storage of samples at —10 and 1 C resulted in small but significant reductions of LAN activity, while at room temperature enzyme activity was rapidly lost. LAN activity was distributed among liver fractions as follows: microsomes, 12%; mitochondria, 9%; cellular sap, 37%; other, 50%. Three isozymes of LAN were found. Blood plasma contained significant amounts of LAN activity which was significantly higher in cold- than in warm-acclimated fish. However, these LAN levels were comparable when their activity was extrapolated to body temperatures.

Risk Factors for the Development of Clostridium difficile-Associated Diarrhea During a Hospital Outbreak

1991 ◽  
Vol 12 (6) ◽  
pp. 345-348 ◽  
Author(s):  
Alain Thibault ◽  
Mark A. Miller ◽  
Christina Gaese
Keyword(s):  
Risk Factors ◽  
Clostridium Difficile ◽  
Systemic Disease ◽  
Gastrointestinal Surgery ◽  
Significant Risk ◽  
Antibiotic Use ◽  
Surgical Patients ◽  
Convenience Sample ◽  
Significant Difference ◽  
Clostridium Difficile Associated Diarrhea

AbstractObjective:To evaluate the risk factors associated with a nosocomial outbreak of Clostridium difficile-associated diarrhea.Design:Case-control study with two control groups.Setting:University-affiliated urban hospital.Patients:A convenience sample of 26 patients was chosen out of a total of 78 hospitalized patients with C difficile-associated diarrhea, defined as the presence of diarrhea and a positive C difficile cytotoxin assay or stool culture. Twenty-six controls were matched for age, gender, ward, and date of admission; 18 additional controls were matched to surgical patients for date and ward of admission, as well as for the type of surgical procedure performed.Results:Significant risk factors for the development of C difficile-associated diarrhea were gastrointestinal surgery (exposure odds ratio [EOR] = 7.9, p= .004, 95% confidence interval [CI]= 1.9, 35), use of neomycin (EOR= 15.6, p=.012, 95% CI=1.7, 92), clindamycin (EOR=15.6, p=.005, 95% CI=1.7, 92), metronidazole (EOR=5.7,p=.02,95%CI= 1.4, 25), and excess antibiotic use (mean number of antibiotics = 4.2 versus 1.4, p<.00005). The presence of systemic disease and the use of antacids or immunosuppressive drugs were similar in cases and controls. In surgical patients, no specific antibiotic could be linked to C difficile-associated diarrhea because of uniform perioperative antibiotic use. There was a significant difference in the number of antibiotics administered to cases and controls (mean = 3.1 versus 1.9, p< .005).Conclusions:The results suggest that control of nosocomial C difficile-associated diarrhea may be attained by minimizing the administration of antibiotics, avoidance of high-risk antibiotics, and having a high index of suspicion of C difficile-associated diarrhea in patients who develop diarrhea after gastrointestinal surgery. Perioperative administration of metronidazole, when given with other antibiotics, failed to protect against the development of C difficile-associated diarrhea.

Rates of Surgical-Site Infection: An International Comparison

2005 ◽  
Vol 26 (5) ◽  
pp. 442-448 ◽  
Author(s):  
Maria Luisa Moro ◽  
Filomena Morsillo ◽  
Marilena Tangenti ◽  
Maria Mongardi ◽  
Maria Cristina Pirazzini ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Prospective Study ◽  
Surgical Site Infections ◽  
Public Hospitals ◽  
Operative Procedures ◽  
Surgical Patients ◽  
Site Infection ◽  
Italian Region ◽  
Convenience Sample ◽  
Study Population

AbstractObjectives:To quantify the occurrence of surgical-site infections (SSIs) in an Italian region and to estimate the proportion of potentially avoidable infections through benchmarking comparison.Design:Prospective study during 1 month based on a convenience sample of surgical patients admitted to 31 public hospitals. All of the patients undergoing an intervention included among the 44 operative procedures of the National Nosocomial Infections Surveillance (NNIS) System were enrolled. Ninety-five percent of the patients were actively observed after discharge for up to 30 days for all of the operations and for up to 1 year for operations involving implantation.Results:Among the 6,167 operative procedures studied, 290 infections were recorded (4.7 per 100 procedures), 206 (71%) of which were SSIs (3.3 per 100 procedures; 95% confidence interval, 2.9–3.9). One hundred thirty-five SSIs (65.5%) were superficial infections, 53 (25.7%) were deep infections, and 12 (5.8%) were organ–space infections; in 6 cases (2.9%), the type of SSI was not recorded. The frequency of SSIs observed in this study was significantly higher for several procedures than that expected when the NNIS System rates (standardized infection ratio [SIR] ranging from 1.77 to 6.42) or the Hungarian rates (SIR ranging from 1.28 to 3.04) were applied to the study population.Conclusions:The high intensity of postdischarge surveillance can in part explain the differences observed. To allow for meaningful benchmarking comparison, in addition to intrinsic patient risk, data on the intensity of postdischarge surveillance should be included in published reports.

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