Uncalibrated pulse contour derived stroke volume variation predicts[1]
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This study evaluated the ability of stroke volume variation (SVV) measured by the FloTrac/Vigileo device to predict fluid responsiveness in 40 mechanically ventilated patients after liver transplantation, compared to commonly used hemodynamic variables. SVV and pulse pressure variation correlated well with changes in cardiac output after fluid administration, distinguishing responders from non-responders with high sensitivity and specificity. Cardiac output measured by FloTrac/Vigileo also correlated well with measurements from transthoracic echocardiography and pulmonary artery catheter. However, the study had some limitations including small sample size and certain patient conditions not represented.
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This document provides an overview of renal replacement therapy (RRT) for acute renal failure. It discusses indications for RRT, different modes of RRT including intermittent hemodialysis, continuous renal replacement therapy (CRRT), and peritoneal dialysis. It covers principles of diffusion, convection, and adsorption. Dosing, replacement solutions, and special circumstances are also summarized.
Traumatic haemorrhage
The document discusses damage control resuscitation (DCR) for trauma patients with hemorrhaging. It describes how uncontrolled hemorrhage is a leading cause of preventable trauma deaths and how DCR, which includes damage control surgery, hemostatic resuscitation, and permissive hypotension, improves outcomes. It discusses strategies for managing coagulopathy in trauma (ATC) and the pathophysiology involved. Case studies are presented to demonstrate DCR in practice and new strategies discussed, including use of hemostatic agents, tranexamic acid, and viscoelastic testing to guide resuscitation. The importance of DCR beginning in the pre-hospital setting is emphasized.
ICM case based discussions
This document discusses a case of blunt traumatic pericardial rupture and cardiac herniation in a 21-year old male following a motorbike accident. Key findings from imaging included a 10cm tear in the right pericardium, pneumopericardium, and herniation of the heart into the right hemithorax. The patient underwent thoracotomy for repair of the pericardial tear. Diagnosis of blunt traumatic pericardial rupture can be difficult due to subtle clinical signs and associated injuries from polytrauma. Imaging modalities like CT are useful for diagnosis. Surgical closure is usually required for moderate to large tears to prevent further herniation and hemodynamic compromise.
Intensivist delivered quaternary severe respiratory failure retrieval service
This document describes a mobile extracorporeal membrane oxygenation (ECMO) retrieval service for patients experiencing severe respiratory failure. The service consists of an intensivist, specialist ECMO nurse, perfusionist, and ambulance crew who can initiate ECMO onsite and transport critically ill patients long distances to an ECMO center. A study of 60 patients retrieved found that 80% required ECMO initiation onsite, all were successfully cannulated, and transfers occurred over an average of 59 miles without serious complications. Patients had significantly improved oxygenation and ventilation after transfer. Survival rates to discharge from the ECMO center were 77% for those on ECMO and 75% for conventionally ventilated patients.
Beyond 4G: A Venture into Digital Services
One of the speakers in International IT & Telecommunications Exhibition 2014 held in Phnom Penh on 14-17 November 2014. Here, I highlighted what it means by Digital Services from mobile operators' context, discussed briefly on one of the driving forces behind Digital Services, provided some illustrations on what could the verticals to served, highlighted what could possibly be the route opted by Smart (the sole 4G operator in Cambodia) and highlighted some commercial collaborations/partnerships Smart has with its partners.
Temasya Glenmarie - Anggun Series
The document describes the luxurious features and amenities of Temasya Anggun, a semi-detached residential development in Shah Alam. It has spacious interiors and exteriors, with luxurious finishes and fittings. Residents can enjoy luxurious living spaces within minutes of Kuala Lumpur. The development has excellent facilities, landscaped gardens, and spacious floorplans up to 4,389 square feet.
Atc presentation nbp
The document discusses forming a national broadband plan for Cambodia and key challenges. It outlines Cambodia's policy aspirations which lack clear targets. Key structural issues that need addressing include the interconnection regime, BWA spectrum allocation, and absence of strong governing structures and policies. The digital dividend presents an opportunity to enable mobile broadband if the 700MHz spectrum is designated for it. Harmonization efforts aim to adopt a harmonized band plan for the 698-806MHz spectrum range to facilitate international roaming and minimize border issues. Overall, a holistic broadband policy is needed that transforms the telecom industry and supports trans-sector policies and digital transformation across sectors.
Telecom Cambodia - SIM Box Issue 2013
SIM Box and its linked to external frauds affecting leading operators in Cambodia in the form of falling revenues, lower QoS for for International Incoming Calls and inbound roaming services. Arguably, such activity is becoming rampant due to lack of legal framework, poor enforcement and coordination among Government Ministries and Government agencies.
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Resuscitation, ALS/APLS/ATLS are just the beginning....
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Anaesthetic implications of chronic kidney disease and transplantation
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Effect of bed height on chest compression effectiveness
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Intensivist delivered quaternary severe respiratory failure retrieval service
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Similar to Uncalibrated pulse contour derived stroke volume variation predicts[1]
EuroPCR CV pipeline, Kovarnik
Novel hemodynamic monitoring tool for major surgery and ICU patients. With minimally invasive doppler probe insertable through regular central line, Nilus is adding right side perspective back into hemodynamic monitoring.
Hemodynamic parameters & fluid therapy Asim
Assessment of haemodynamics a critically ill patient and its management has always been a matter if debate. Over time a lot of studies and therapeutic interventions have been carried out. This presentation is a review of such interventions and their impact on the outcome.
cardiacoutputmonitoring-190708221224.pdf
Cardiac output can be measured through various invasive and non-invasive methods. The pulmonary artery catheter using thermodilution is still considered the gold standard but is invasive. Minimally invasive methods include lithium dilution, pulse contour analysis devices, esophageal Doppler, and transesophageal echocardiography. Non-invasive options include partial gas rebreathing, thoracic bioimpedance, and Doppler ultrasound. The ideal monitor is accurate, continuous, non-invasive and provides reliable measurements during different physiological states.
Cardiac output monitoring
Cardiac output can be measured through various invasive and non-invasive methods. The pulmonary artery catheter using thermodilution is still considered the gold standard but is invasive. Minimally invasive methods include lithium dilution, pulse contour analysis devices, esophageal Doppler, and transesophageal echocardiography. Non-invasive methods include partial gas rebreathing, thoracic bioimpedance, and Doppler ultrasound. The ideal monitor is accurate, continuous, non-invasive and provides reliable measurements during different physiological states.
Hemodynamic Monitoring .pptx
The document discusses various techniques for hemodynamic monitoring. It covers electrocardiography (ECG), arterial pressure monitoring, cardiac filling pressures including central venous pressure and pulmonary arterial pressure, and cardiac output monitoring. Standards for clinical monitoring are outlined by organizations like the American Society of Anesthesiologists. Hemodynamic monitoring provides valuable information for detecting changes that may require therapeutic interventions through noninvasive and invasive methods. Invasive techniques like the pulmonary artery catheter allow for monitoring multiple pressures and cardiac output but also involve greater risks.
Minimaly invasive hemodynamic monitoring for hepatic patients
Minimaly invasive Cardiovascular monitoring in hepatic patients in the icu lecture presented by Dr Khaled Yassen at the Egyptian African Critical care Summit
Principle of iv fluid in septic shock
This document discusses shock, sepsis management, and fluid resuscitation. It addresses:
1) Types of shock including hypovolemic, distributive, obstructive, cardiogenic, and neurogenic.
2) Principles of fluid resuscitation including increasing preload to improve stroke volume and cardiac output. However, fluid boluses only improve cardiac output in about 50% of ICU patients.
3) Dynamic measures like pulse pressure variation, stroke volume variation, passive leg raise, and echocardiography changes after fluid bolus are better than static measures at predicting fluid responsiveness.
fluid management monitor - Baxter Starling
1. The document discusses various questions about how the Starling device measures stroke volume variation, cardiac output, and other hemodynamic parameters noninvasively using bioreactance technology.
2. It provides details on studies that have validated Starling against invasive hemodynamic monitoring techniques. Starling can be used in various clinical settings such as the operating room and intensive care.
3. The document addresses limitations and appropriate use of the Starling device and sensors. It clarifies differences between bioreactance and bioimpedance technologies.
hemodynamic monitoring
Monitoring of physiologic variables is an integral part of caring for critically ill patients. Debate exists regarding the usefulness and safety of invasive hemodynamic monitoring in the intensive care unit. Several studies have shown improved outcomes with hemodynamic monitoring in high-risk surgical patients, but evidence is conflicting for medical patients. PiCCO monitoring combines transpulmonary thermodilution and pulse contour analysis to continuously measure cardiac output and other hemodynamic parameters noninvasively. It provides useful information to guide fluid management and assess fluid responsiveness.
Xavier Monnet - Monitoring hd pi cco java porto - IFAD 2012
This document discusses hemodynamic monitoring techniques to guide treatment for patients with hemodynamic failure. It describes using the PiCCO device to noninvasively monitor parameters such as cardiac output, lung water content, contractility, and fluid responsiveness to determine whether a patient needs vasopressors, volume expansion, inotropes, and when to stop fluid administration. Tests like pulse pressure variation, end-expiratory occlusion, and passive leg raising used with continuous cardiac output monitoring can predict fluid responsiveness, while extravascular lung water and pulmonary vascular permeability index measurements help avoid excessive fluid loading and lung injury.
2022 Conference hemodynamic monitoring in VA ECMO
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Internacional Young Academy of Cardiology "Back to the basics" course.
Non invasive estimation of pulmonary vascular resistance in patients of pulmo...
Context : Pulmonary vascular resistance (PVR) is a critical and essential parameter during the
assessment and selection of modality of treatment in patients with congenital heart
disease accompanied by pulmonary arterial hypertension.
Aim : The present study was planned to evaluate non-invasive echocardiographic parameters
to assess pulmonary vascular resistance.
Settings and
Design
: This prospective observational study included 44 patients admitted in the cardiology
and pediatric cardiology ward of our institution for diagnostic or pre-operative catheter
based evaluation of pulmonary arterial pressure and PVR.
Materials and
Methods
: Detailed echocardiographic evaluation was carried out including tricuspid regurgitation
velocity (TRV) and velocity time integral of the right-ventricular outflow tract (VTIRVOT).
These parameters were correlated with catheter-based measurements of PVR.
Results : The TRV/VTIRVOT ratio correlated well with PVR measured at catheterization
(PVRcath) (r = 0.896, 95% confidence interval [CI] 0.816 to 0.9423, P < 0.001). Using
the Bland-Altman analysis, PVR measurements derived from Doppler data showed
satisfactory limits of agreement with catheterization estimated PVR. For a PVR of 6
Wood units (WU), a TRV/VTIRVOT value of 0.14 provided a sensitivity of 96.67% and
a specificity of 92.86% (area under the curve 0.963, 95% confidence interval 0.858 to
0.997) and for PVR of 8 WU a TRV/VTIRVOT value of 0.17 provided a sensitivity of
79.17% and a specificity of 95% (area under the curve 0. 0.923, 95% confidence interval
0.801 to 0.982).
Conclusions : Doppler-derived ratio of TRV/VTIRVOT is a simple, non-invasive index, which can be
used to estimate PVR.
Catheterisation study and operability assessment
This document discusses catheterization and assessment of operability in patients with left-to-right shunts. Catheterization is needed to calculate pulmonary and systemic blood flows, vascular resistances, and reversibility. Reversibility testing uses pulmonary vasodilators like oxygen and nitric oxide to see if pulmonary vascular resistance decreases significantly. A positive response predicts operability. Balloon occlusion, lung biopsy, and other tests can also provide information but have limitations. The goal is to determine if pulmonary hypertension is fixed or responsive to treatment to guide surgical or medical management.
escpe1-191229130329.pptx
This document provides an overview of the key changes and recommendations in the 2019 guidelines for pulmonary embolism (PE). Some of the major updates include: revised criteria for diagnosing PE using D-dimer tests and imaging; a new definition of high-risk PE and assessment of severity; and preference for non-vitamin K antagonist oral anticoagulants as first-line treatment in eligible patients. The guidelines also provide new algorithms for diagnosing and managing PE in pregnancy and long-term follow-up care after PE.
2019 ESC guidelines on pulmonary embolism
The document provides an overview of the updates in the 2019 guidelines for pulmonary embolism (PE) diagnosis and treatment. Key changes include adjusted D-dimer cut-off values based on age and probability; revised algorithms for diagnosing high-risk PE and assessing severity; recommending non-vitamin K antagonist oral anticoagulants as first-line treatment for eligible patients; classifying recurrence risk factors and extending treatment duration indications; and proposing a comprehensive post-PE patient follow-up algorithm. The guidelines aim to improve PE risk stratification, optimize acute care, determine chronic anticoagulation regimens, and ensure long-term management and surveillance for complications.
Diagnosis and Assessment of copd
This document provides information about spirometry and its use in diagnosing chronic obstructive pulmonary disease (COPD). It defines spirometry as the measurement of breathing through forced expiration. A diagnosis of COPD requires post-bronchodilator spirometry showing an FEV1/FVC ratio of less than 0.7. Bronchodilator reversibility testing may help differentiate COPD from asthma by measuring improvement in FEV1 after bronchodilator administration. The document provides details on interpreting spirometry results and evaluating bronchodilator reversibility.
Fluid responsiveness - an ICU phoenix
Fluid administration is commonly used to resuscitate ICU patients, but determining which patients will respond to fluids, known as fluid responsiveness, remains challenging. Static parameters like CVP are poor predictors of fluid responsiveness. Dynamic parameters that measure beat-to-beat variations related to mechanical ventilation, such as PPV, SVV, IVC collapsibility, and changes in aortic blood flow with PLR have been shown to more accurately predict fluid responsiveness with sensitivities and specificities often over 90%. However, factors like arrhythmias, spontaneous breathing, and suboptimal ventilator settings can limit the reliability of dynamic parameters in some clinical situations.
Noninvasive ventilation in COPD
This is a case based discussion about non invasive ventilation in patients with acute exacerbation of COPD
Pulmonary Hypertension.pptx
This ppt is prepared from content of braunwald, and some latest international journals. In account it make more clear concept about pulmonary hypertension.
it also contain latest ESC 2022 guidelines of pulmonary hypertension.
Pulmonary hypertension
The document discusses updates to guidelines for defining and diagnosing pulmonary hypertension from the 5th World Symposium on Pulmonary Hypertension held in 2013. Key points include: maintaining the general definition of PH as a mPAP over 25 mm Hg, collecting more data on borderline PH cases with mPAP between 21-24 mm Hg, and not reintroducing exercise-induced PH criteria due to a lack of suitable definition. Recommendations are also provided on measuring and interpreting pulmonary vascular resistance and pulmonary artery wedge pressure during right heart catheterization.
Similar to Uncalibrated pulse contour derived stroke volume variation predicts[1] (20)
Minimaly invasive hemodynamic monitoring for hepatic patients
Minimaly invasive hemodynamic monitoring for hepatic patients
Xavier Monnet - Monitoring hd pi cco java porto - IFAD 2012
Xavier Monnet - Monitoring hd pi cco java porto - IFAD 2012
Non invasive estimation of pulmonary vascular resistance in patients of pulmo...
Non invasive estimation of pulmonary vascular resistance in patients of pulmo...
Uncalibrated pulse contour derived stroke volume variation predicts[1]
- 2. Optimal monitoring of critically ill patient is an important part of haemodynamic management. Not everything that counts can be counted and not everything that can be counted counts! CVP and PAOP involve large assumptions to equate to LVEDV. Liver transplants involve problems with bleeding and reduced SVR post graft reperfusion. Therefore, not only is it important to have an idea of various static cardiac indices but more importantly dynamic response to fluid loads and pharmacological interventions.
- 3. Waveform of a finger artery without invasive calibration before use. Type of pulse contour analysis, but not using calibration with dye/thermodilution instead using a computer algorithm . Measures SV, SVV, CO and ScvO2 if appropriate catheters in situ. FloTrac/Vigileo™, Edwards Lifesciences • individual demographic data • calibration is not required • Uses radial artery cannula • Aortic pulse pressure is proportional to SV and is inversely related to aortic compliance Earlier software versions: 4 earlier study • Not recommend routine use The new software version • Estimating vascular tone from 10 min to 60 s • Reduction of pulsewave detection noise. • More on Friday.
- 4. To assess whether SVV obtained with this new technology can predict fluid responsiveness in patients undergoing liver transplantation and to compare its predictive value to the commonly measured haemodynamic variables. Secondly, to compare CO obtained with Vigileo device and CO obtained from TTE and PAC.
- 5. Design: Single centre (University Hospital, France), prospective observational study. Intervention: 40 consecutive patients in the post-operative period of liver transplantation on the ICU, for whom the decision to give fluid was taken by the physician. The volume expansion used was 20ml x BMI of 4% albumin over 20 min. Patients were all sedated with Propofol/Sufentanil. VCV, Tv 10ml/kg, PEEP 3cmH20, I:E 1:2, PaO2 >90mmHg, PaCO2 35-40mmHg.
- 6. Exclusion criteria • Hypoxaemia PaO2/FiO2 <100mmHg • Blood volume overload PAOP >18mmHg • Pulmonary Oedema on Cxr • Patient less then 18 years old • Arrythmias • BMI >40-<15 kg m-2 • Significant Aortic/Mitral Valve disease • Intracardiac shunts • Spontaneous breathing activity • Unsatifactory cardiac echogenicity
- 7. All patients had • 7.5F Pac LSCV • 3F vygon Lt radial aterial line and Flotrac/Vigileo monitor set up • TTE performed by same operator, S obtained via product of VTI and Aortic valve area, averaged over 5 cycles. LVEF measure using Simpsons Biplane measurement. Two measurements were performed before and immediately after VE. CO via Flotrac/PPV/TTE/PAC were simultaneously measured . A rise in CO of >15% was used to distinguish between a Responder and a Non Responder.
- 8. 5 patients excluded VE given for • Tachycardia (8) • Mottling (7) • Low UO (14) • Acid-base derangement (6) 17 Responders, 18 Non responders Before VE: SVV and PPV were significantly higher and CVP/CO/PAOP were significantly lower in Rs than NRs. Post VE: all parameters showed significant changes in Rs and NRs. No correlation between CVP/PAOP and % change in CO-TTE post VE. However, SVV/PPV correlated significantly and closely with change in CO-TTE ( p< 0.0001). 10% SVV threshold discriminated between Rs and NRs with sensitivity of 94% (95% CI) and specificity 94% (95% CI).
- 9. Following VE, the % change in CO-vigileo correlated with % change in CO-TTE (p< 0.0001) and CO-PAC (p< 0.0001) R and NR classification was similar. 34 patients were well classified using CO-vigileo (97%). Only one patient in vigileo group was classified as NR and as a R in TTE/PAC group.
- 10. Demonstrated that uncalibrated SVV measurement by arterial waveform analysis can be used to predict the effects of VE in mechanically ventilated patients after liver transplantation. CO-vigileo correlated well with CO-TTE/PAC. Threshold of 10% SVV discriminated well between Rs and NRs. Correlated well with Hofer et al 9.6%, Berkenstadt et al 9.5%. Failure of CVP/PAOP to correlate fluid responsiveness goes with the mounting evidence that static preload indictators not suited for functional haemodynamic monitoring.
- 11. Using CO-TTE to define Rs and NRs. Some CO changes of 15.4-17.6%, ?guarantee these were all Rs. Small patient number. Real world limitations (Spontaneous breathing, arrythmias, LVEF >50%) Norephinephrine infusions, known to effect accuracy. High TV 8-10 ml/kg, realistic for modern ICU? SVV known to be effected by depth of respiration.
- 12. As above No declared conflict of interest. Limitations to note Interesting monitoring device for select patients. ? Suitability for MOF, shock, poor tissue perfusion, high dose NA etc. Await further large number, validation studies. More on Friday.