Journal of clinical monitoring and computing
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Recent advance in imaging modalities used frequently in clinical routine can provide description of the geometrical and hemodynamical properties of the arterial tree in great detail. The combination of such information with models of blood flow of the arterial tree can provide further information, such as details in pressure and flow waves or details in the local flow field. Such knowledge maybe be critical in understanding the development or state of arterial disease and can help clinicians perform better diagnosis or plan better treatments. ⋯ Our development of a generic and patient-specific model of the human arterial tree permitting to study pressure and flow waves propagation in patients is presented. The predicted pressure and flow waveforms are in good agreement with the in vivo measurements. We discuss the utility of these models in different clinical application and future development of interest.
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The transpulmonary thermodilution technique (TPTD) is a safe, multi-parametric advanced cardiopulmonary monitoring technique that provides important parameters required for making decisions in critically ill patients. The TPTD provides more reliable indicators of preload than filling pressures, the unique measurement of extravascular lung water (EVLW) and comparable accuracy in measuring cardiac output (CO). Intermittent measurement of the CO by TPTD when coupled with pulse contour analysis, offer automatic calibration of continuous CO, as well as accurate assessment of volumetric preload, fluid responsiveness and EVLW. TPTD-guided algorithms have been shown to improve the management of high-risk surgical and critically ill patients.
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The pulmonary artery catheter (PAC) has been widely used for monitoring of critically ill patients over the years, but with advances in less invasive monitoring techniques, notably echocardiography, there are fewer indications for PAC insertion. Nevertheless, the PAC provides simultaneous monitoring of pulmonary artery pressures, cardiac filling, cardiac output and mixed venous oxygen saturation, and still has an important role in complex cases. Adequate and continued training are required to ensure that PAC-derived data are correctly interpreted and applied.
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J Clin Monit Comput · Oct 2012
ReviewBedside echocardiography in critically ill patients: a true hemodynamic monitoring tool.
Echocardiography is a versatile, accurate and noninvasive tool suited to examination of shocked patients. Since the 1980s, intensive care practitioners have used ultrasound widely for hemodynamic evaluation and for cardiac anatomy visualization. ⋯ We will also report the main indications of echocardiography and the corresponding parameters. Finally, we will indicate educational programs and define minimum training that enable self-sufficiency.
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One of the main goals of hemodynamic support is to preserve tissue perfusion. However issue perfusion is related more to microvascular perfusion than aortic blood flow. Monitoring the microcirculation has long been difficult. ⋯ Transcutaneous PCO2 measurement at ear lobe is particularly promising. Finally, near infrared spectroscopy can also provide interesting information, especially using vascular occlusion tests which reactivity of the microcirculation to a transient hypoxic insult. These different devices have provided important data helping us to better understand the pathophysiology of sepsis and multiple organ failure.