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cardiac index goal-directed therapy pulse pressure

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
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
Duane Funk, James Bohn, Wac Mutch, Tom Hayakawa, Edward W Buchel
BACKGROUND: Fluid management of the surgical patient has undergone a paradigm shift over the past decade. A change from 'wet' to 'dry' to a 'goal-directed' approach has been witnessed. The fluid management of patients undergoing free flap reconstruction is particularly challenging. This is typically a long operation with minimal surgical stimulation, and hypotension often ensues. The use of vasopressors in these cases is contraindicated to maintain adequate flow to the flap. Hypotension is often treated with intravenous fluid boluses...
2015: Plastic Surgery
Eric M Suess, Michael R Pinsky
Hemodynamic monitoring has become a fundamental and ubiquitous, if not defining, aspect of critical care medicine practice. Modern monitoring techniques have changed significantly over the past few years and are now able to rapidly identify shock states earlier, define the etiology, and monitor the response to therapies. Many of these techniques are now minimally invasive or noninvasive. Basic hemodynamic monitoring and evaluation usually includes a focused physical examination and static hemodynamic vital signs: temperature, heart rate, respiratory rate, mean arterial pressure, and arterial hemoglobin oxygen saturation, typically measured with pulse photoplethysmography...
December 2015: Seminars in Respiratory and Critical Care Medicine
Gordana Pavlovic, John Diaper, Christoph Ellenberger, Angela Frei, Karim Bendjelid, Fanny Bonhomme, Marc Licker
Haemodynamic goal-directed therapies (GDT) may improve outcome following elective major surgery. So far, few data exist regarding haemodynamic optimization during emergency surgery. In this randomized, controlled trial, 50 surgical patients with hypovolemic or septic conditions were enrolled and we compared two algorithms of GDTs based either on conventional parameters and pressure pulse variation (control group) or on cardiac index, global end-diastolic volume index and stroke volume variation as derived from the PiCCO monitoring system (optimized group)...
February 2016: Journal of Clinical Monitoring and Computing
A Joosten, T Huynh, K Suehiro, C Canales, M Cannesson, J Rinehart
BACKGROUND: Goal directed fluid therapy (GDFT) has been shown to improve outcomes in moderate to high-risk surgery. However, most of the present GDFT protocols based on cardiac output optimization use invasive devices and the protocols may require significant practitioner attention and intervention to apply them accurately. The aim of this prospective pilot study was to evaluate the clinical feasibility of GDFT using a closed-loop fluid administration system with a non-invasive cardiac output monitoring device (Nexfin™, BMEYE, Amsterdam, Netherlands)...
June 2015: British Journal of Anaesthesia
Jan Benes, Mariateresa Giglio, Nicola Brienza, Frederic Michard
INTRODUCTION: Dynamic predictors of fluid responsiveness, namely systolic pressure variation, pulse pressure variation, stroke volume variation and pleth variability index have been shown to be useful to identify in advance patients who will respond to a fluid load by a significant increase in stroke volume and cardiac output. As a result, they are increasingly used to guide fluid therapy. Several randomized controlled trials have tested the ability of goal-directed fluid therapy (GDFT) based on dynamic parameters (GDFTdyn) to improve post-surgical outcome...
2014: Critical Care: the Official Journal of the Critical Care Forum
Martijn van Lavieren, Jeroen Veelenturf, Charlotte Hofhuizen, Marion van der Kolk, Johannes van der Hoeven, Peter Pickkers, Joris Lemson, Benno Lansdorp
BACKGROUND: Optimizing cardiac stroke volume during major surgery is of interest to many as a therapeutic target to decrease the incidence of postoperative complications. Because dynamic preload indicators are strongly correlated with stroke volume, it is suggested that these indices can be used for goal directed fluid therapy. However, threshold values of these indicators depend on many factors that are influenced by surgery, including opening of the abdomen. The aim of this study was therefore to assess the effect of opening the abdomen on arterial pressure variations in patients undergoing abdominal surgery...
2014: BMC Anesthesiology
Anne-Sophie G T Bronzwaer, Wim J Stok, Berend E Westerhof, Johannes J van Lieshout
RATIONALE: A critical reduction in central blood volume (CBV) is often characterized by hemodynamic instability. Restoration of a volume deficit may be established by goal-directed fluid therapy guided by respiration-related variation in systolic- and pulse pressure (SPV and PPV). Stroke volume index (SVI) serves as a surrogate end-point of a fluid challenge but tissue perfusion itself has not been addressed. OBJECTIVE: To delineate the relationship between arterial pressure variations, SVI and regional brain perfusion during CBV depletion and repletion in spontaneously breathing volunteers...
2014: Frontiers in Physiology
Nianfang Lu, Ruiqiang Zheng, Hua Lin, Jun Shao, Jiangquan Yu
OBJECTIVE: To explore the effect of early goal-directed therapy (EGDT) according to pulse indicated continuous cardiac output (PiCCO) on septic shock patients. METHODS: Eighty-two septic shock patients in Subei People's Hospital of Jiangsu Province from January 2009 to December 2012 were enrolled and randomly divided into two groups using a random number table, standard surviving sepsis bundle group (n=40) and modified surviving sepsis bundles group (n=42). The patients received the standard EGDT bundles in standard surviving sepsis bundle group...
January 2014: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
Qianghong Xu, Jing Yan, Guolong Cai, Jin Chen, Li Li, Caibao Hu
BACKGROUND: Few studies have reported the effect of different volume responsiveness evaluation methods on volume therapy results and prognosis. This study was carried out to investigate the effect of two volume responsiveness evaluation methods, stroke volume variation (SVV) and stroke volume changes before and after passive leg raising (PLR-ΔSV), on fluid resuscitation and prognosis in septic shock patients. METHODS: Septic shock patients admitted to the Department of Critical Care Medicine of Zhejiang Hospital, China, from March 2011 to March 2013, who were under controlled ventilation and without arrhythmia, were studied...
2014: Chinese Medical Journal
Cornelie Salzwedel, Jaume Puig, Arne Carstens, Berthold Bein, Zsolt Molnar, Krisztian Kiss, Ayyaz Hussain, Javier Belda, Mikhail Y Kirov, Samir G Sakka, Daniel A Reuter
INTRODUCTION: Several single-center studies and meta-analyses have shown that perioperative goal-directed therapy may significantly improve outcomes in general surgical patients. We hypothesized that using a treatment algorithm based on pulse pressure variation, cardiac index trending by radial artery pulse contour analysis, and mean arterial pressure in a study group (SG), would result in reduced complications, reduced length of hospital stay and quicker return of bowel movement postoperatively in abdominal surgical patients, when compared to a control group (CG)...
2013: Critical Care: the Official Journal of the Critical Care Forum
Poonam Malhotra Kapoor, Madhava Kakani, Ujjwal Chowdhury, Minati Choudhury, Lakshmy, Usha Kiran
Early goal-directed therapy is a term used to describe the guidance of intravenous fluid and vasopressor/inotropic therapy by using cardiac output or similar parameters in the immediate post-cardiopulmonary bypass in cardiac surgery patients. Early recognition and therapy during this period may result in better outcome. In keeping with this aim in the cardiac surgery patients, we conducted the present study. The study included 30 patients of both sexes, with EuroSCORE >or=3 undergoing coronary artery bypass surgery under cardiopulmonary bypass...
January 2008: Annals of Cardiac Anaesthesia
Rupert Pearse, Deborah Dawson, Jayne Fawcett, Andrew Rhodes, R Michael Grounds, E David Bennett
INTRODUCTION: Goal-directed therapy (GDT) has been shown to improve outcome when commenced before surgery. This requires pre-operative admission to the intensive care unit (ICU). In cardiac surgery, GDT has proved effective when commenced after surgery. The aim of this study was to evaluate the effect of post-operative GDT on the incidence of complications and duration of hospital stay in patients undergoing general surgery. METHODS: This was a randomised controlled trial with concealed allocation...
2005: Critical Care: the Official Journal of the Critical Care Forum
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