Plethysmography System to Monitor the Jugular Venous Pulse: A Feasibility Study

Cerebral venous outflow is investigated in the diagnosis of heart failure through the monitoring of jugular venous pulse, an indicator to assess cardiovascular diseases. The jugular venous pulse is a weak signal stemming from the lying internal jugular vein and often invasive methodologies requiring surgery are mandatory to detect it. Jugular venous pulse can also be extrapolated via the ultrasound technique, but it requires a qualified healthcare operator to perform the examination. In this work, a wireless, user-friendly, wearable device for plethysmography is developed to investigate the possibility of monitoring the jugular venous pulse non-invasively. The proposed device can monitor the jugular venous pulse and the electrocardiogram synchronously. To study the feasibility of using the proposed device to detect physiological variables, several measurements were carried out on healthy subjects by considering three different postures: supine, sitting, and upright. Data acquired in the experiment were properly filtered to highlight the cardiac oscillation and remove the breathing contribution, which causes a considerable shift in the amplitude of signals. To evaluate the proper functioning of the wearable device for plethysmography, a comparison with the ultrasound technique was carried out. As a satisfactory result, the acquired signals resemble the typical jugular venous pulse waveforms found in literature.

How is the hyponatremia management in hospitalized patients? A cross-sectional study

Background: Hyponatremia is the most frequent hydroelectrolytic disorder in hospitalized patients and is associated with mortality. A lack in the diagnostic and therapeutic management of the hyponatremic hospitalized patient has been reported. Hyponatremia in hospitalized patients is usually managed by specialties other than nephrology and endocrinology. The aim of our study is to describe the diagnostic and therapeutic management of hyponatremia by clinicians from services other than endocrinology and nephrology in hospitalized patients.Methods: Cross-sectional, descriptive study of a consecutive case series of adult patients hospitalized with hyponatremia, in a tertiary hospital of Madrid, during January 1st-May 30th 2019, handled by non-endocrinologist nor nephrologist clinicians. We analyzed data regarding the details of the diagnostic assessment and the treatment established by the clinicians of the respective hospitalization service. Results: 32 cases studied, all of them with hypovolemic hyponatremia, 50% women, 50% managed in the emergency room. Volemic classification of hyponatremia was described in only 18.8%. The height of the internal jugular venous pulse was not measured in any case. Urine studies were developed in below 70% of cases. 50% of patients had a congruent treatment with the previous described volemic status. Only one case had a complete and successful diagnostic and therapeutic approach in accordance to clinical guidelines.Conclusion: In our series there was a lack in the diagnostic and therapeutic management of hyponatremia of hospitalized patients by non-endocrinologists and non-nephrologists.

Technical note for post processing of jugular venous pulse, central venous pressure and velocity trace

In this paper an original reasoning about the post processing elaboration of medical studies is presented. The aim is to suggest a method to extrapolate numerical information from clinical images. The here described elaboration is referred to ultrasound examination of internal jugular veins and central venous pressure (CVP) measures. Firstly, the operator has to collect clinical images following precise indications, then specific techniques are applied to analyze the stored data and extrapolate quantifiable measures. Analyzing the studies with ImageJ software, jugular venous pulse, velocity, CVP and electrocardiogram traces can be drown in detail. Then, significant details can be highlighted using Matlab software. Finally, using R software, the traces can be cropped, aligned and synchronized together. The obtained results allow the operator to compare different kinds of traces of the same subject, or the same type of traces between a particular group of subjects. Before using these contents, everyone is invited to verify the accuracy of assumptions, calculations and conclusions.