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Esophageal Doppler monitor

Peter Deibert, Adhara Lazaro, Zoran Stankovic, Denise Schaffner, Martin Rössle, Wolfgang Kreisel
Non-selective beta-blockers are the mainstay of medical therapy for portal hypertension in liver cirrhosis. Inhibitors of phosphodiesterase-5 (PDE-5-inhibitors) reduce portal pressure in the acute setting by > 10% which may suggest a long-term beneficial effect. Currently, there is no available data on long-term treatment of portal hypertension with PDE-5-inhibitors. This case of a patient with liver cirrhosis secondary to autoimmune liver disease with episodes of bleeding from esophageal varices is the first documented case in which a treatment with a PDE-5-inhibitor for eight years was monitored...
January 21, 2018: World Journal of Gastroenterology: WJG
F Vallée, O Passouant, A Le Gall, J Joachim, J Mateo, A Mebazaa, E Gayat
INTRODUCTION: During general anesthesia, arterial hypotension is frequent and may be an important contributor to perioperative morbidity. We assessed the effect of a 5 μg bolus of Norepinephrine (NA) when compared with 50 μg bolus of Phenylephrine (PE) administered to treat hypotension during maintenance anesthesia, on MAP, derived cardiac output and arterial stiffness parameters. METHODS: Patients scheduled for a neurosurgical procedure under general anesthesia were prospectively included...
July 2017: Acta Anaesthesiologica Scandinavica
Gennaro De Pascale, Mervyn Singer, David Brealey
PURPOSE: Bioreactance is a non-invasive technology for measuring stroke volume (SV) in the operating room and critical care setting. We evaluated how the NICOM(®) bioreactance device performed against the CardioQ(®) esophageal Doppler monitor in patients undergoing major abdominal-pelvic surgery, focusing on the effect of different hemodynamic interventions. METHODS: SVNICOM and SVODM were simultaneously measured intraoperatively, including before and after interventions including fluid challenge, vasopressor boluses, peritoneal gas insufflation/removal, and Trendelenburg/reverse Trendelenburg patient positioning...
August 2017: Journal of Anesthesia
Fabrice Vallée, Arthur Le Gall, Jona Joachim, Olivier Passouant, Joaquim Matéo, Arnaud Mari, Sandrine Millasseau, Alexandre Mebazaa, Etienne Gayat
Continuous cardiac afterload evaluation could represent a useful tool during general anesthesia (GA) to titrate vasopressor effect. Using beat to beat descending aortic pressure(P)/flow velocity(U) loop obtained from esophageal Doppler and femoral pressure signals might allow to track afterload changes. Methods We defined three angles characterizing the PU loop (alpha, beta and Global After-Load Angle (GALA)). Augmentation index (AIx) and total arterial compliance (Ctot) were measured via radial tonometry. Peripheral Vascular Resistances (PVR) were also calculated...
January 20, 2017: Journal of Clinical Monitoring and Computing
Samantha R Warnakulasuriya, Simon J Davies, R Jonathan T Wilson, David R A Yates
STUDY OBJECTIVE: This study aims to investigate if there is equivalence in volumes of fluid administered when intravenous fluid therapy is guided by Pleth Variability Index (PVI) compared to the established technology of esophageal Doppler in low-risk patients undergoing major colorectal surgery. DESIGN: Randomized controlled trial. SETTING: Operating room. PATIENTS: Forty low-risk patients undergoing elective colorectal surgery...
November 2016: Journal of Clinical Anesthesia
Lindsay Wuellner, Lisa Sutton
The objectives of this review are to identify the effectiveness of esophageal Doppler monitoring (EDM) for goal-directed fluid therapy on postoperative outcomes during abdominal surgery when an enhanced recovery after surgery (ERAS) program is implemented.The specific question of this review is: does the guidance of fluid management by EDM versus fluid management without EDM affect the length of hospital stay, occurrence of postoperative infection, hemodynamic stability and 30-day postoperative complication rate in adult patients undergoing major abdominal surgery with ERAS or similar programs?...
July 2016: JBI Database of Systematic Reviews and Implementation Reports
A Zifan, Y Jiang, R K Mittal
BACKGROUND: The mechanism of esophageal pain in patients with nutcracker esophagus (NE) and other esophageal motor disorders is not known. Our recent study shows that baseline esophageal mucosal perfusion, measured by laser Doppler perfusion monitoring, is lower in NE patients compared to controls. The goal of our current study was to perform a more detailed analysis of esophageal mucosal blood perfusion (EMBP) waveform of NE patients and controls to determine the optimal EMBP biomarkers that combined with suitable statistical learning models produce robust discrimination between the two groups...
February 2017: Neurogastroenterology and Motility: the Official Journal of the European Gastrointestinal Motility Society
Walid El Sherbiny, Ashraf AbdelRahman, Muhammad Diasty, Shaker Wagih Shaltout
Hepatocellular carcinoma (HCC) has many options for management; some of them are complicated by development of portal hypertension (PHT). Doppler ultrasound is an effective method to diagnose and monitor PHT changes after HCC ablation procedures. The aim of this study is to investigate changes in portal pressure hemodynamics of HCC patients following treatment with different interventional strategies: radiofrequency ablation (RFA), microwave ablation (MWA), and transarterial chemoembolization (TACE). A total of 60 patients with HCC were divided into three main groups, and each group received a different type of therapy (RFA, MWA, and TACE)...
August 2016: Abdominal Radiology
J Ripollés-Melchor, R Casans-Francés, A Espinosa, A Abad-Gurumeta, A Feldheiser, F López-Timoneda, J M Calvo-Vecino
BACKGROUND: Numerous studies have compared perioperative esophageal doppler monitoring (EDM) guided intravascular volume replacement strategies with conventional clinical volume replacement in surgical patients. The use of the EDM within hemodynamic algorithms is called 'goal directed hemodynamic therapy' (GDHT). METHODS: Meta-analysis of the effects of EDM guided GDHT in adult non-cardiac surgery on postoperative complications and mortality using PRISMA methodology...
August 2016: Revista Española de Anestesiología y Reanimación
Mathieu Jozwiak, Xavier Monnet, Jean-Louis Teboul
PURPOSE OF REVIEW: Hemodynamic exploration is mandatory in patients with shock to identify the type of shock, to select the best therapeutic strategy, and to assess the efficacy of the selected therapy. In this review, we summarize the characteristics of the main available hemodynamic monitoring systems and emphasize on how to select the most appropriate ones in patients with circulatory shock. RECENT FINDINGS: Over the past decade, hemodynamic monitoring techniques have progressively evolved from intermittent toward real-time measurements and from invasive toward less invasive approaches...
October 2015: Current Opinion in Critical Care
Guillaume Legrand, Laura Ruscio, Dan Benhamou, Nathalie Pelletier-Fleury
BACKGROUND: Several minimally invasive techniques for cardiac output monitoring such as the esophageal Doppler (ED) and arterial pulse pressure waveform analysis (APPWA) have been shown to improve surgical outcomes compared with conventional clinical assessment (CCA). OBJECTIVE: To evaluate the cost-effectiveness of these techniques in high-risk abdominal surgery from the perspective of the French public health insurance fund. METHODS: An analytical decision model was constructed to compare the cost-effectiveness of ED, APPWA, and CCA...
July 2015: Value in Health: the Journal of the International Society for Pharmacoeconomics and Outcomes Research
Li Huang, Lester A H Critchley, Jie Zhang
BACKGROUND: Minimally invasive continuous cardiac output measurements are recommended for use during anesthesia to guide fluid therapy, but such measurements must trend changes reliably. The NICOM Cheetah, a BioReactance monitor, is being recommended for intraoperative use. To validate its use, Doppler methods, suprasternal USCOM and esophageal CardioQ, were used in tandem to provide reliable estimates of changing trends in cardiac output. Preliminary comparisons showed that upper abdominal surgical interventions caused shifts in the calibration of the NICOM...
October 2015: Anesthesia and Analgesia
Qiang Lin, Huodong Zhou, Dafeng Li, Jinfeng Ye, Jinfu Hong, Yemao Hu
OBJECTIVE: To assess the effect of perioperative goal-directed fluid therapy (GDFT) on clinical outcomes in elective colorectal resection. METHODS: A total of 42 patients undergoing elective colorectal resection between March 2013 and December 2014 were recruited prospectively. GDFT was administrated based on corrected left ventricular ejection time and stroke volume using the esophageal Doppler monitoring. These patients were compared with a historical cohort of 58 patients managed without GDFT from January 2012 to February 2013...
July 2015: Zhonghua Wei Chang Wai Ke za Zhi, Chinese Journal of Gastrointestinal Surgery
Clément Dubost, Adrien Bouglé, Calliope Hallynck, Matthieu Le Dorze, Philippe Roulleau, Catherine Baujard, Dan Benhamou
BACKGROUND AND AIMS: Cardiac output (CO) monitoring and goal-directed therapy during major abdominal surgery is currently used to decrease postoperative complications. However, few monitors are currently available for pediatric patients. Nicom(®) is a noninvasive CO monitoring technique based on the bioreactance principle (analysis of frequency variations of a delivered oscillating current traversing the thoracic cavity). Nicom(®) may be a useful monitor for pediatric patients. SUBJECTS AND METHODS: Pediatric patients undergoing major abdominal surgery under general anesthesia with cardiac monitoring by transesophageal Doppler (TED) were included...
January 2015: Indian Journal of Critical Care Medicine
Emily A Downs, James M Isbell
In recent years, there has been a tremendous growth in available hemodynamic monitoring devices to support clinical decision-making in the operating room and intensive care unit. In addition to the "tried and true" heart rate and blood pressure monitors, there are several newer applications of existing technologies including arterial waveform analysis, intraoperative and bedside critical care echocardiography, esophageal Doppler, and tissue oximetry, among others. Several monitoring devices demonstrate positive effect on outcomes, especially when used in conjunction with specific goal-directed therapy protocols to achieve a desired clinical effect...
December 2014: Best Practice & Research. Clinical Anaesthesiology
Robert H Thiele, Karsten Bartels, Tong-Joo Gan
PURPOSE: Goal-directed fluid therapy is an integral component of many Enhanced Recovery After Surgery (ERAS) protocols currently in use. The perioperative clinician is faced with a myriad of devices promising to deliver relevant physiologic data to better guide fluid therapy. The goal of this review is to provide concise information to enable the clinician to make an informed decision when choosing a device to guide goal-directed fluid therapy. PRINCIPAL FINDINGS: The focus of many devices used for advanced hemodynamic monitoring is on providing measurements of cardiac output, while other, more recent, devices include estimates of fluid responsiveness based on dynamic indices that better predict an individual's response to a fluid bolus...
February 2015: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
Guilherme Schettino, Rezende Ederlon, Ciro Leite Mendes, Alvaro Réa-Neto, Cid Marcos David, Suzana Margareth Ajeje Lobo, Alberto Barros, Eliézer Silva, Gilberto Friedman, José Luiz Gomes do Amaral, Marcelo Park, Maristela Monachini, Mirella Cristine de Oliveira, Murillo Santucci César Assunção, Nelson Akamine, Patrícia Veiga C Mello, Renata Andréa Pietro Pereira, Rubens Costa Filho, Sebastião Araújo, Sérgio Félix Pinto, Sérgio Ferreira, Simone Mattoso Mitushima, Sydney Agareno, Yuzeth Nóbrega de Assis Brilhante
BACKGROUND AND OBJECTIVES: Cardiac output and preload as absolute data do not offer helpful information about the hemodynamic of critically ill patients. However, monitoring the response of these variables to volume challenge or inotropic drugs is a very useful tool in the critical care setting, particularly for patients with signs of tissue hypoperfusion. Although PAC remains the " gold standard" to measure cardiac output and preload, new and alternative technologies were developed to evaluate these hemodynamic variables...
March 2006: Revista Brasileira de Terapia Intensiva
Andy Sisnata Siswojo, Daniel Mun-Yen Wong, Tuong Dien Phan, Roman Kluger
OBJECTIVE: To investigate whether the pleth variability index (PVI), derived noninvasively from a pulse oximeter probe, would predict fluid responsiveness in patients undergoing noncardiac surgeries. DESIGN: A clinical, prospective, observational study. SETTING: Operating room of a tertiary care hospital. PARTICIPANTS: Twenty-nine adult patients undergoing a range of noncardiac surgeries, requiring general anesthesia, tracheal intubation, and mechanical ventilation...
December 2014: Journal of Cardiothoracic and Vascular Anesthesia
Christoph Sponholz, Christoph Schelenz, Konrad Reinhart, Uwe Schirmer, Sebastian N Stehr
BACKGROUND: Management of cardiac surgery patients is a very standardized procedure in respective local institutions. Yet only very limited evidence exists concerning optimal indication, safety and efficacy of hemodynamic monitoring catecholamine and fluid therapy. METHODS: Between April and May 2013, all 81 German anaesthesia departments involved in cardiac surgery care were asked to participate in a questionnaire addressing the institutional specific current practice in hemodynamic monitoring, catecholamine and volume therapy...
2014: PloS One
Derek Nusbaum, Jonathan Clark, Kenneth Brady, Kathleen Kibler, Jeffrey Sutton, Ronald Blaine Easley
OBJECTIVES: Recent studies suggest that elevated intracranial pressure (ICP), created by hydrocephalus, can alter the lower limit of cerebrovascular autoregulation (LLA). Our objective in the present study was to determine if ICP elevation from cerebral venous outflow obstruction would result in comparable alterations in the LLA. METHODS: Anesthetized juvenile pigs were assigned to one of two groups: naïve ICP (n  =  15) or high ICP (>20 mmHg; n  =  20)...
December 2014: Neurological Research
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