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goal directed haemodynamics

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https://www.readbyqxmd.com/read/27903339/-effect-of-goal-directed-haemodynamic-management-on-the-postoperative-outcome-in-elderly-patients-with-fragile-cardiac-function-undergoing-abdominal-surgery
#1
L S Zheng, E W Gu, X H Peng, L Zhang, Y Y Cao
Objective: To investigate the effect of goal-directed haemodynamic management based on stroke volume variation (SVV), cardiac index (CI) and mean arterial blood pressure (MAP) on the postoperative outcome in elderly patients with fragile cardiac function undergoing gastrointestinal surgery. Methods: Ninety patients with fragile cardiac function, aged 65-90 years old, ASAⅡ or Ⅲ, NYHA Ⅱor Ⅲ, scheduled for abdominal surgery were enrolled in this study.The patients were randomly assigned to two groups: Experience anesthesia group (group E, n=45) and goal-directed hemodynamic management group (G group, n=45)...
November 22, 2016: Zhonghua Yi Xue za Zhi [Chinese medical journal]
https://www.readbyqxmd.com/read/27680814/g3-intraoperative-haemodynamic-monitoring-during-high-risk-caesarean-section-a-comparison-between-bioreactance-nicom-r-and-pressure-waveform-analysis-lidcorapidr-preliminary-results
#2
D Vinayagam, S Bampoe, B Thilaganathan, A Khalil
BACKGROUND: Intraoperative haemodynamic monitoring is carried out in high-risk surgical patients, often using invasive methods, including pulmonary artery catheterisation. Early goal-directed therapy in high-risk surgical patients reduces tissue hypoxia, organ failure and improves outcomes. Significant maternal morbidity arises as a result of perioperative haemorrhage. At present, heart rate and brachial blood pressure are used as proxy markers to aid in fluid resuscitation, however, we know that these exhibit minimal change during early stages of shock, and are poor indicators of the adequacy of therapeutic intervention...
August 2016: Journal of Maternal-fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/27636735/perioperative-haemodynamic-therapy-goal-directed-or-meta-directed
#3
Christopher Uhlig, Peter M Spieth
No abstract text is available yet for this article.
September 16, 2016: Minerva Anestesiologica
https://www.readbyqxmd.com/read/27568347/the-use-of-the-oesophageal-doppler-in-perioperative-medicine-new-opportunities-in-research-and-clinical-practice
#4
Bernardo Bollen Pinto, Glen Atlas, Bart F Geerts, Karim Bendjelid
The oesophageal Doppler (OD) is a minimally invasive haemodynamic monitor used in the surgical theatre and the ICU. Using the OD, goal-directed therapy (GDT) has been shown to reduce perioperative complications in high-risk surgical patients. However, most GDT protocols currently in use are limited to stroke volume optimisation. In the present manuscript, we examine the conceptual models behind new OD-based measurements. These would provide the clinician with a comprehensive view of haemodynamic pathophysiology; including pre-load, contractility, and afterload...
August 27, 2016: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/27543527/baroreflex-impairment-and-morbidity-after-major-surgery
#5
A Toner, N Jenkins, G L Ackland
BACKGROUND: Baroreflex dysfunction is a common feature of established cardiometabolic diseases that are most frequently associated with the development of critical illness. Laboratory models show that baroreflex dysfunction impairs cardiac contractility and cardiovascular performance, thereby increasing the risk of morbidity after trauma and sepsis. We hypothesized that baroreflex dysfunction contributes to excess postoperative morbidity after major surgery as a consequence of the inability to achieve adequate perioperative tissue oxygen delivery...
September 2016: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/27543523/fluid-resuscitation-management-in-patients-with-burns-update
#6
REVIEW
P Guilabert, G Usúa, N Martín, L Abarca, J P Barret, M J Colomina
Since 1968, when Baxter and Shires developed the Parkland formula, little progress has been made in the field of fluid therapy for burn resuscitation, despite advances in haemodynamic monitoring, establishment of the 'goal-directed therapy' concept, and the development of new colloid and crystalloid solutions. Burn patients receive a larger amount of fluids in the first hours than any other trauma patients. Initial resuscitation is based on crystalloids because of the increased capillary permeability occurring during the first 24 h...
September 2016: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/27396808/goal-directed-therapy-to-maintain-haemostasis
#7
REVIEW
C Oscier, M Cecconi
Perioperative goal-directed therapy typically involves the use of haemodynamic targets to optimise oxygen delivery. Common goals include stroke volume, cardiac output and arterial blood pressure, although future protocols may also incorporate an assessment of vascular tone and the microcirculation. This article reviews the current evidence for goal-directed therapy and discusses future directions.
June 2016: Best Practice & Research. Clinical Anaesthesiology
https://www.readbyqxmd.com/read/27352070/non-invasive-haemodynamic-optimization-in-major-abdominal-surgery-a-feasibility-study
#8
Ole Broch, Arne Carstens, Matthias Gruenewald, Edith Nischelsky, Lukas Vellmer, Berthold Bein, Heiko Aselmann, Markus Steinfath, Jochen Renner
BACKGROUND: Today, most of the preemptive haemodynamic optimization algorithms are based on variables associated with invasive techniques like arterial cannulation. The non-invasive NexfinTM technology is able to estimate continuous cardiac index (CI) and pulse pressure variation (PPV). However, the efficiency of an early goal directed therapy (EGDT) algorithm based on non-invasive variables has to be proven. The aim of our study was to investigate the feasibility of a non-invasive driven EGDT protocol and its impact on patient's outcome...
June 28, 2016: Minerva Anestesiologica
https://www.readbyqxmd.com/read/27085221/oesophageal-doppler-to-optimize-intraoperative-haemodynamics-during-prone-position-a-randomized-controlled-trial
#9
Julien Picard, Damien Bedague, Pierre Bouzat, Céline Ollinet, Pierre Albaladejo, Jean-Luc Bosson, Jean-François Payen
BACKGROUND: Intraoperative use of oesophageal Doppler (OD) was associated with improved postoperative outcomes through the optimization of perioperative fluid management. We studied the effect on haemodynamics of a goal-directed fluid management approach, guided by OD, during elective spine surgery in the prone position. METHODS: Intraoperative fluid and vasopressor administration were directed according to one of two randomly chosen decision-making algorithms driven by either OD (OD group; n=33 patients) or standard parameters (standard group; n=34 patients)...
August 2016: Anaesthesia, Critical Care & Pain Medicine
https://www.readbyqxmd.com/read/27075210/perioperative-haemodynamic-goal-directed-therapy-and-mortality-systematic-review-and-meta-analysis-with-meta-regression
#10
Mariateresa Giglio, Fabio Manca, Lidia Dalfino, Nicola Brienza
BACKGROUND: Recent data found that perioperative goal directed therapy (GDT) was effective only in higher control mortality rate (>20%) with a relatively high heterogeneity that limited the strength of evidence. The aim of the present meta- analysis was to clearly understand which high risk patients may benefit of GDT. METHODS: Systematic review of randomised controlled trials with meta-analyses, including a meta regression technique. MEDLINE, EMBASE, and The Cochrane Library databases were searched (1980-January 2015)...
April 13, 2016: Minerva Anestesiologica
https://www.readbyqxmd.com/read/27073445/application-strategy-of-picco-in-septic-shock-patients
#11
Xiaoyun Liu, Wenli Ji, Jifeng Wang, Tao Pan
Septic shock, also known as infectious or toxic shock, is a medical condition caused by severe infection and sepsis. Early identification, timely diagnosis and effective treatments are imperative to prevent this medical condition. The aim of the present study was to examine the application of pulse index continuous cardiac output (PiCCO) technique in the treatment of septic shock patients. Fifty septic shock patients were randomly divided into the conventional detection group (group C, n=25) and the PiCCO detection group (group P, n=25)...
April 2016: Experimental and Therapeutic Medicine
https://www.readbyqxmd.com/read/27025128/-goal-directed-fluid-therapy-in-severe-concomitant-trauma
#12
A K Konkaev, E I Gurbanova, Z N Mynbaeva
METHODS: We examined 78 patients with severe concomitant injury. Were evaluated the severity of the injury and indices of volumetric haemodynamic monitoring by PICCO. The retrospective comparison group consisted of 50 patients with severe concomitant injury who were treated in the ICU of Trauma Institution during 2009-2011. RESULTS: In patients with severe concomitant injury goal-directed fluid therapy based on PICCO monitoring parameters increasing the volume of infusion on the second and third post-traumatic days by 45% and 24%, respectively (< 0...
November 2015: Anesteziologiia i Reanimatologiia
https://www.readbyqxmd.com/read/26994228/towards-individualized-perioperative-goal-directed-haemodynamic-algorithms-for-patients-of-advanced-age-observations-during-a-randomized-controlled-trial-nct01141894
#13
RANDOMIZED CONTROLLED TRIAL
E Bartha, C Arfwedson, A Imnell, S Kalman
BACKGROUND: During a previous study on intraoperative goal-directed haemodynamic treatment (GDHT) in elderly patients, cardiac performance did not improve as anticipated (ClinicalTrials.gov NCT01141894). We hypothesized that in this group, responsiveness to interventions could be predicted by individual patient characteristics. METHODS: Data for the present study were collected during a previously performed, single-centre, open, randomized, and controlled parallel-group superiority trial in patients aged ≥70 yr undergoing hip-fracture surgery...
April 2016: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/26951105/algorithm-guided-goal-directed-haemodynamic-therapy-does-not-improve-renal-function-after-major-abdominal-surgery-compared-to-good-standard-clinical-care-a-prospective-randomised-trial
#14
RANDOMIZED CONTROLLED TRIAL
Sebastian Schmid, Barbara Kapfer, Markus Heim, Ralph Bogdanski, Aida Anetsberger, Manfred Blobner, Bettina Jungwirth
BACKGROUND: Acute kidney injury is a common complication after major surgery. In this study, we investigated whether an algorithm-guided goal-directed haemodynamic therapy (GDT) can improve renal outcome compared to good standard clinical care. METHODS: A total of 180 patients undergoing major abdominal surgery were prospectively and randomly assigned to one of two groups: in the GDT group, patients were treated with a GDT algorithm using transpulmonary thermodilution while standard care was applied to the control patients...
2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/26878401/vasopressors-for-hypotensive-shock
#15
REVIEW
Gunnar Gamper, Christof Havel, Jasmin Arrich, Heidrun Losert, Nathan Leon Pace, Marcus Müllner, Harald Herkner
BACKGROUND: Initial goal-directed resuscitation for hypotensive shock usually includes administration of intravenous fluids, followed by initiation of vasopressors. Despite obvious immediate effects of vasopressors on haemodynamics, their effect on patient-relevant outcomes remains controversial. This review was published originally in 2004 and was updated in 2011 and again in 2016. OBJECTIVES: Our objective was to compare the effect of one vasopressor regimen (vasopressor alone, or in combination) versus another vasopressor regimen on mortality in critically ill participants with shock...
February 15, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/26839711/interpreting-intervention-induced-neuroplasticity-with-fmri-the-case-for-multimodal-imaging-strategies
#16
REVIEW
Lee B Reid, Roslyn N Boyd, Ross Cunnington, Stephen E Rose
Direct measurement of recovery from brain injury is an important goal in neurorehabilitation, and requires reliable, objective, and interpretable measures of changes in brain function, referred to generally as "neuroplasticity." One popular imaging modality for measuring neuroplasticity is task-based functional magnetic resonance imaging (t-fMRI). In the field of neurorehabilitation, however, assessing neuroplasticity using t-fMRI presents a significant challenge. This commentary reviews t-fMRI changes commonly reported in patients with cerebral palsy or acquired brain injuries, with a focus on studies of motor rehabilitation, and discusses complexities surrounding their interpretations...
2016: Neural Plasticity
https://www.readbyqxmd.com/read/26673584/pitfalls-in-haemodynamic-monitoring-in-the-postoperative-and-critical-care-setting
#17
REVIEW
K M Ho
Haemodynamic monitoring is a vital part of daily practice in anaesthesia and intensive care. Although there is evidence to suggest that goal-directed therapy may improve outcomes in the perioperative period, which haemodynamic targets we should aim at to optimise patient outcomes remain elusive and controversial. This review highlights the pitfalls in commonly used haemodynamic targets, including arterial blood pressure, central venous pressure, cardiac output, central venous oxygen saturation and dynamic haemodynamic indices...
January 2016: Anaesthesia and Intensive Care
https://www.readbyqxmd.com/read/26658203/neurocritical-care-for-intracranial-haemorrhage-a-systematic-review-of-recent-studies
#18
REVIEW
R Badenes, F Bilotta
Intracerebral haemorrhage (ICH) is associated with significant early mortality (up to 50% at 30 days) and long-term morbidity (with permanent neurological deficits in 75-80% of patients) and represents a serious health issue worldwide. The past decade has seen a dramatic increase in clinical research on ICH diagnosis and treatment that has led to revision of the guidelines for the diagnosis and management of ICH from the American Heart Association and American Stroke Association in 2013. This systematic review reports recent clinical evidence (original studies published between September 2013 and July 2015) related to neurocritical care and intensive care unit management of patients with ICH...
December 2015: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/26467180/lung-congestion-in-chronic-heart-failure-haemodynamic-clinical-and-prognostic-implications
#19
Vojtech Melenovsky, Mads J Andersen, Krystof Andress, Yogesh N Reddy, Barry A Borlaug
AIMS: The goal of the study was to examine the prognostic impact, haemodynamic and clinical features associated with lung congestion in patients with chronic heart failure (HF). METHODS AND RESULTS: HF patients (n = 186) and HF-free controls (n = 21) underwent right heart catheterization, echocardiography, pulmonary function testing and chest radiography that was blindly scored for the presence and severity of lung oedema. Lung congestion correlated directly with pulmonary vascular resistance (PVR, P = 0...
November 2015: European Journal of Heart Failure
https://www.readbyqxmd.com/read/26437713/protocol-for-a-systematic-review-of-the-impact-of-resuscitation-fluids-on-the-microcirculation-after-haemorrhagic-shock-in-animal-models
#20
REVIEW
David N Naumann, Janine Dretzke, Sam Hutchings, Mark J Midwinter
BACKGROUND: Modern resuscitation strategies following haemorrhagic shock are influenced by global haemodynamic parameters such as blood pressure and cardiac output. Microcirculatory dysfunction in this context may persist even after restoration of satisfactory global parameters. Additional monitoring of the microcirculatory function may therefore be warranted in order to facilitate goal-directed therapy at a tissue oxygenation level. Although such a phenomenon is recognised in the case of sepsis, clinical evidence regarding the behaviour of the microcirculation following the delivery of resuscitation fluids after haemorrhagic shock is sparse...
2015: Systematic Reviews
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