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1.
Continuous cardiac output monitoring after cardiopulmonary bypass: a comparison with bolus thermodilution measurement 总被引:2,自引:0,他引:2
Objective The interchangeability of continuous measurement of
cardiac output (CO) with the traditional bolus method in patients after
cardiopulmonary bypass (CPB) is uncertain.Design Prospective observational clinical study.Setting A 20-bed surgical ICU at a university
hospital.Patients Fourteen deeply sedated, ventilated, post-cardiac surgery
patients, all equipped with a pulmonary artery catheter.Interventions Six hours after the end of the CPB, 56 simultaneous
bolus and continuous measurements were compared by a linear regression
analysis and Bland–Altman analysis. Bolus CO was estimated by averaging
triplicate injections of 10 ml room-temperature NaCl 0.9%, delivered
randomly during the respiratory cycle. A stringent maximum difference of
0.55 l min—1 (about 10% of the mean bolus measured) was considered
as a clinically acceptable agreement between the two types of measurements.
To be interchangeable the limits of agreement (± 2 SD of the mean
difference between the two methods) should not exceed the chosen acceptable
difference.Measurements and results Continuous was correlated with bolus CO,
with a correlation coefficient of r2 = 0.68. (p< 0.01). The Bland–Altman
analysis demonstrated an objective mean bias of 0.33 ± 0.6 l min–1
(confidence interval of –0.87 – 1.58) with 34% of measured values
falling outside of the clinically acceptable limits.Conclusion Our results suggest that, in the first 6 h after CPB,
continuous and bolus CO determinations are not interchangeable; one third of
the values obtained by continuous CO fell outside the strict limits of
clinically useful precision.Electronic supplementary material The electronic reference of this article is . The online full-text version of this article includes electronic supplementary material. This material is available to authorised users and can be accessed by means of the ESM button beneath the abstract or in the structured full-text article. To cite or link to this article you can use the above reference.This work was performed in the Surgical Intensive Care Division at the
University Hospital of Geneva, Switzerland.The authors declare no conflict of interest (Financial and non-financial). 相似文献
2.
Grosek S Primozic J Ihan A Wraber B Gabrijelcic T Kosin M 《Intensive care medicine》2006,32(5):780-784
Objective To evaluate the acute inflammatory response and cardiac output in children
after surgery for ventricular septal defect.Design and setting Prospective, observational study in a level III multidisciplinary neonatal
and pediatric intensive care unit.Patients Ten children undergoing open-heart surgery for ventricular septal defect.Interventions All children received methylprednisolone (30 mg/kg) in cardiopulmonary
bypass (CPB) prime.Measurements and results Before and after cardiopulmonary bypass, plasma interleukin-10 and tumor
necrosis factor α were measured by enzyme-linked immunosorbent
assay, and lymphocyte subsets in peripheral blood by flow cytometry.
Relative values (post-/pre-CPB) of interleukin-10 and tumor necrosis factor
α were calculated. The cardiac index (CI) was measured continuously
beat-to-beat by a pulse contour analysis (PiCCO). Children above the cutoff
value (median cardiac index value 3.0 l min– 1 m– 2) were
designated as the normal CI group and those below this value as the low CI
group. In the normal CI group the relative values of interleukin-10 remained
almost seven times higher than pre-CPB values at 24 h while in the low CI
group they decreased almost to pre-CPB values. Furthermore, the normal CI
group, but not the low CI group, exhibited more than threefold decrease in
T-lymphocytes (lymphocyte T-cells, T-helper cells, and cytotoxic T-cells)
24 h after CPB.Conclusions Children operated on for ventricular septal defect developed either a normal
or low CI. The higher relative values of interleukin-10 and lower counts of
lymphocyte T-cells, T-helper and cytotoxic T-cells differentiated the normal
CI group from the low CI group at 24 h after cardiopulmonary bypass. 相似文献
3.
Savvas Eleftheriadis Zisis Galatoudis Vasilios Didilis Ioannis Bougioukas Julika Schön Hermann Heinze Klaus-Ulrich Berger Matthias Heringlake 《Critical care (London, England)》2009,13(6):1-5
Introduction
The reliability of autocalibrated pressure waveform analysis by the FloTrac-Vigileo® (FTV) system for the determination of cardiac output in comparison with intermittent pulmonary arterial thermodilution (IPATD) is controversial. The present prospective comparison study was designed to determine the effects of variations in arterial blood pressure on the reliability of the FTV system in patients undergoing coronary artery bypass grafting (CABG).Methods
Comparative measurements of cardiac output by FTV (derived from a femoral arterial line; software version 1.14) and IPATD were performed in 16 patients undergoing elective CABG in the period before institution of cardiopulmonary bypass. Measurements were performed after induction of anesthesia, after sternotomy, and during five time points during graft preparation. During graft preparation, arterial blood pressure was increased stepwise in intervals of 10 to 15 minutes by infusion of noradrenaline and lowered thereafter to baseline levels.Results
Mean arterial blood pressure was varied between 85 mmHg and 115 mmHg. IPATD cardiac output did not show significant changes during periods with increased arterial pressure either during sternotomy or after pharmacological manipulation. In contrast, FTV cardiac output paralleled changes in arterial blood pressure; i.e. increased significantly if blood pressure was raised and decreased upon return to baseline levels. Mean arterial blood pressure (MAP) and FTV cardiac output were closely correlated (r = 0.63 (95% confidence interval [CI]: 0.49 - 0.74), P < 0.0001) while no correlation between MAP and IPATD cardiac output was observed. Bland-Altman analyses for FTV versus IPATD cardiac output measurements revealed a bias of 0.4 l/min (8.5%) and limits of agreement from 2.1 to -1.3 l/min (42.2 to -25.3%).Conclusions
Acute variations in arterial blood pressure alter the reliability of the FlowTrac/Vigileo® device with the second-generation software. This finding may help to explain the variable results of studies comparing the FTV system with other cardiac output monitoring techniques, questions the usefulness of this device for hemodynamic monitoring of patients undergoing rapid changes in arterial blood pressure, and should be kept in mind when using vasopressors during FTV-guided hemodynamic optimization. 相似文献4.
5.
Droogh JM Noppers IM Tulleken JE Meertens JH Ligtenberg JJ Monteban-Kooistra WE Zijlstra JG 《Intensive care medicine》2007,33(3):561-561; author reply 564
6.
Boss A Kreis R Jenni S Ith M Nuoffer JM Christ E Boesch C Stettler C 《Diabetes care》2011,34(1):220-222
OBJECTIVE
Intramyocellular acetylcarnitine (IMAC) is involved in exercise-related fuel metabolism. It is not known whether levels of systemic glucose influence IMAC levels in type 1 diabetes.RESEARCH DESIGN AND METHODS
Seven male individuals with type 1 diabetes performed 120 min of aerobic exercise at 55–60% of Vo2max randomly on two occasions (glucose clamped to 5 or 11 mmol/l, identical insulinemia). Before and after exercise, IMAC was detected by 1H magnetic resonance spectroscopy in musculus vastus intermedius.RESULTS
Postexercise levels of IMAC were significantly higher than pre-exercise values in euglycemia (4.30 ± 0.54 arbitrary units [a.u.], P < 0.001) and in hyperglycemia (2.44 ± 0.53 a.u., P = 0.01) and differed significantly according to glycemia (P < 0.01). The increase in exercise-related levels of IMAC was significantly higher in euglycemia (3.97 ± 0.45 a.u.) than in hyperglycemia (1.71 ± 0.50 a.u.; P < 0.01).CONCLUSIONS
The increase in IMAC associated with moderate aerobic exercise in individuals with type 1 diabetes was significantly higher in euglycemia than in hyperglycemia.Intramyocellular acetylcarnitine (IMAC) is involved in the regulation of fat and carbohydrate oxidation in skeletal muscle during moderate aerobic exercise (1). Although carnitine metabolism appears comparable in patients with type 1 diabetes and healthy control subjects (2), it is not known whether IMAC is related to variations in fuel metabolism observed during exercise under differing glycemic levels in type 1 diabetes (3). Given the controversial results from previous studies linking IMAC to increased β-oxidation (4) but also to high glycolytic flux (1), the aim of the present study was to assess exercise-related concentrations of IMAC noninvasively by 1H magnetic resonance spectroscopy (1H MRS) (5,6) in patients with type 1 diabetes in euglycemia and hyperglycemia. 相似文献7.
Kawai N Ikematsu H Iwaki N Kondou K Hirotsu N Kawashima T Maeda T Tanaka O Doniwa K Iwakuni O Egashira K Yamaji K Kashiwagi S 《Journal of infection and chemotherapy》2012,18(2):180-186
Comparison of the viral persistence of pandemic H1N1 (H1N1pdm) and seasonal H1N1 with or without H275Y mutation after oseltamivir therapy has not been adequately done. Virus was isolated before and on days 4-6 from the start of oseltamivir treatment for 158 cases of seasonal (2007-2008 and 2008-2009 seasons) or pandemic (2009-2010 season) H1N1 influenza. Sequence analysis was done for each season and NA inhibition assay (IC(50)) was done in the 2009-2010 season. H275Y mutation before therapy was 0% in the 2007-2008 and 2009-2010 seasons, but 100% in the 2008-2009 season. Fever and other symptoms were noticeably prolonged after oseltamivir therapy for children with H275Y mutated seasonal H1N1 (2008-2009 season), but not in patients with seasonal H1N1 without mutation (2007-2008) or H1N1pdm (2009-2010). The viral persistence rate was significantly higher for patients 15 years or younger than for those 16 years and older with H275Y mutated seasonal H1N1 (46.2% and 10.5%, respectively) or with H1N1pdm (43.3% and 11.5%, respectively). The H275Y mutation emerged after oseltamivir treatment in 2.4% (2/82) of all patients with H1N1pdm. In two children, the H275Y mutation emerged after therapy and the IC(50) increased more than 200 fold; however, the prolongation of fever was not so prominent. In conclusion, oseltamivir was effective for fever and other clinical symptoms; however, the virus persisted longer than expected after treatment in H1N1pdm influenza-infected children in the 2009-2010 season, similar to seasonal H1N1 with H275Y mutation in the 2008-2009 season. 相似文献
8.
Martin Annborn John Bro-Jeppesen Niklas Nielsen Susann Ullén Jesper Kjaergaard Christian Hassager Michael Wanscher Jan Hovdenes Tommaso Pellis Paolo Pelosi Matt P. Wise Tobias Cronberg David Erlinge Hans Friberg 《Intensive care medicine》2014,40(9):1210-1219