A New Monitor to Measure Dermal Blood Flow in Critically Ill Patients: A Preliminary Study

Background. Conditions of reduced perfusion are characterized by redistribution of blood flow away from the skin to more vital organs. Objectives. To assess the efficacy of a noninvasive, dermal blood flow (DBF) monitor in detecting changes in perfusion in critically ill patients. Methods. Eleven adult, critically ill patients in a general ICU were studied. DBF, finger plethysmography, and invasive mean arterial pressure (MAP) were recorded over an 8-hour period. DBF was measured using the DermaFlow DBF monitor via a skin probe placed on the anterior chest wall. Sensitivity was evaluated by visual inspection during active states, either induced, for example, fluid administration, or spontaneous, for example, altered hemodynamics, while specificity was evaluated during stable states. Data are expressed in terms of standard deviation of the difference (SDD) between the MAP and each of the tested methods. Results. The DBF detected all true changes detected by MAP while plethysmography detected fewer of these events. Based on SDD, the specificity of the DBF was found to be better than that of plethysmography and close in value to the MAP. Conclusions. This preliminary study suggests that the DBF monitor may be a useful noninvasive method for detecting changes in perfusion in critically ill patients.

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Continuous noninvasive measurement of aortic blood flow in critically ill patients with a new esophageal echo-Doppler system

Journal of Critical Care ◽

10.1016/s0883-9441(98)90003-x ◽

1998 ◽

Vol 13 (4) ◽

pp. 177-183 ◽

Cited By ~ 39

Author(s):

Gilles Bernardin ◽

Fabrice Tiger ◽

Renaud Fouché ◽

Mathieu Mattéi

Keyword(s):

Blood Flow ◽

Critically Ill ◽

Critically Ill Patients ◽

Noninvasive Measurement ◽

Aortic Blood Flow ◽

Doppler System ◽

Aortic Blood

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The effect of Trendelenburg and modified trendelenburg positions on cardiac output, blood pressure, and oxygenation: a preliminary study

American Journal of Critical Care ◽

10.4037/ajcc1994.3.5.382 ◽

1994 ◽

Vol 3 (5) ◽

pp. 382-386 ◽

Cited By ~ 15

Author(s):

CL Ostrow ◽

E Hupp ◽

D Topjian

Keyword(s):

Blood Pressure ◽

Cardiac Output ◽

Critically Ill ◽

Systemic Vascular Resistance ◽

Vascular Resistance ◽

Critically Ill Patients ◽

Hemodynamic Parameters ◽

Trendelenburg Position ◽

Dependent Variables ◽

Preliminary Study

BACKGROUND: Although we have insufficient knowledge about the effects of Trendelenburg positions on various hemodynamic parameters, these positions are frequently used to influence cardiac output and blood pressure in critically ill patients. OBJECTIVES: To determine the effect of Trendelenburg and modified Trendelenburg positions on five dependent variables: cardiac output, cardiac index, mean arterial pressure, systemic vascular resistance, and oxygenation in critically ill patients. METHODS: In this preliminary study subjects were 23 cardiac surgery patients (mean age, 55; SD, 8.09) who had a pulmonary artery catheter for cardiac output determination and who were clinically stable, normovolemic and normotensive. Baseline measurements of the dependent variables were taken in the supine position. Patients were then placed in 10 degrees Trendelenburg or 30 degrees modified Trendelenburg position. The dependent variables were measured after 10 minutes in each position. A 2-period, 2-treatment crossover design with a preliminary baseline measurement was used. RESULTS: Five subjects were unable to tolerate Trendelenburg position because of nausea or pain in the sternal incision. In the 18 who were able to tolerate both position changes, no statistically significant changes were found in the five dependent variables. Changes in systemic vascular resistance over time approached statistical significance and warrant further study. CONCLUSIONS: This preliminary study does not provide support for Trendelenburg positions as a means to influence hemodynamic parameters such as cardiac output and blood pressure in normovolemic and normotensive patients.

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Assessment of Effective Hepatic Blood Flow in Critically Ill Patients by Noninvasive Pulse Dye-Densitometry

Surgery Today ◽

10.1007/s005950300021 ◽

2003 ◽

Vol 33 (2) ◽

pp. 101-105 ◽

Cited By ~ 12

Author(s):

Yasuaki Mizushima ◽

Hideo Tohira ◽

Yasumitsu Mizobata ◽

Tetsuya Matsuoka ◽

Junichiro Yokota

Keyword(s):

Blood Flow ◽

Critically Ill ◽

Hepatic Blood Flow ◽

Critically Ill Patients

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Pilot study on the influence of liver blood flow and cardiac output on the clearance of propofol in critically ill patients

European Journal of Clinical Pharmacology ◽

10.1007/s00228-007-0399-9 ◽

2007 ◽

Vol 64 (3) ◽

pp. 329-334 ◽

Cited By ~ 21

Author(s):

Mariska Y. M. Peeters ◽

Leon P. H. J. Aarts ◽

Ferenc A. Boom ◽

Leo J. Bras ◽

Dick Tibboel ◽

...

Keyword(s):

Blood Flow ◽

Cardiac Output ◽

Pilot Study ◽

Critically Ill ◽

Critically Ill Patients ◽

Liver Blood Flow

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Are two (inexperienced) heads better than one (experienced) head? Averaging house officers' prognostic judgments for critically ill patients

Archives of Internal Medicine ◽

10.1001/archinte.150.9.1874 ◽

1990 ◽

Vol 150 (9) ◽

pp. 1874-1878 ◽

Cited By ~ 3

Author(s):

R. M. Poses

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Better Than

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Editorial Commentary: Critically Ill Patients WithClostridium difficileInfection: Are 2 Antibiotics Better Than One?

Clinical Infectious Diseases ◽

10.1093/cid/civ413 ◽

2015 ◽

Vol 61 (6) ◽

pp. 942-944 ◽

Cited By ~ 1

Author(s):

Mark H. Wilcox

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Editorial Commentary ◽

Better Than

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Differences in Glucose Values Obtained From Point-of-Care Glucose Meters and Laboratory Analysis in Critically Ill Patients

American Journal of Critical Care ◽

10.4037/ajcc2009626 ◽

2009 ◽

Vol 18 (1) ◽

pp. 65-72 ◽

Cited By ~ 34

Author(s):

Anjannette Cook ◽

Delyla Laughlin ◽

Margery Moore ◽

Doreen North ◽

Kathleen Wilkins ◽

...

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Point Of Care ◽

Method Comparison ◽

Venous Catheter ◽

Laboratory Analysis ◽

Hematocrit Level ◽

Convenience Sample ◽

Indwelling Catheters ◽

The Difference

Background Blood for glucose analysis is often obtained interchangeably from indwelling catheters and fingersticks. Objectives To determine the level of agreement between glucose values obtained by laboratory analysis and with a point-of-care device for blood from 2 different sources: fingerstick and a central venous catheter. Methods A method-comparison design was used. Point-of-care values for blood from fingersticks and catheters were compared with laboratory values for blood from catheters in a convenience sample of 67 critically ill patients. The effects of hematocrit level and finger edema on differences in glucose values between the 2 methods were also evaluated. A t test was used to determine differences in glucose values obtained via the 2 methods. Differences and limits of agreement were also calculated. Results Laboratory glucose values for blood from a catheter differed significantly from point-of-care values for blood from the catheter (t1,66 = −9.18; P < .001) and from a fingerstick (t1,66 = 6.53; P < .001). Glucose values for the 2 methods differed by 20 mg/dL or more for 1 of 6 patients (15%) for catheter samples and for 1 of 5 (21%) for fingerstick samples. Point-of-care glucose values for fingerstick and catheter samples did not differ (P = .98). Hematocrit level significantly explained the difference in glucose values between the 2 methods for both catheter (R2 = 0.288; P < .001) and fingerstick (R2 = 0.280; P = .02) samples. Conclusions Use of a commonly used point-of-care device when precise glucose values are needed may lead to faulty treatment decisions.

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