Journal of clinical monitoring and computing
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J Clin Monit Comput · Aug 2014
Controlled Clinical TrialRight ventricular function in late-onset Pompe disease.
Pompe's disease is a glycogen storage disease (type II) characterized by inherited autosomal recessive transmission. The right ventricular (RV) function is a determinant parameter of clinical outcome in patients with heart failure. We sought to characterize the RV function using Doppler-echocardiography completed by Doppler tissular imaging and tricuspid annular plane systolic excursion (TAPSE) measurement. ⋯ Mean peak systolic RV velocity Sm was not significantly different in the two groups (17.11 ± 3.4 cm/s in Pompe disease vs 16.14 ± 3.8 cm/s in control group p = 0.61). Mean peak early diastolic Ea velocity in the RV were not significantly different in the two groups (15.6 ± 5.6 vs 18.2 ± 4.9 cm/s p = 0.34). According to our data, RV systolic function seems preserved in late-onset Pompe disease.
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J Clin Monit Comput · Aug 2014
Case ReportsImpact of changes in systemic vascular resistance on a novel non-invasive continuous cardiac output measurement system based on pulse wave transit time: a report of two cases.
The inaccuracy of arterial waveform analysis for measuring continuos cardiac output (CCO) associated with changes in systemic vascular resistance (SVR) has been well documented. A new non-invasive continuous cardiac output monitoring system (esCCO) mainly utilizing pulse wave transit time (PWTT) in place of arterial waveform analysis has been developed. However, the trending ability of esCCO to measure cardiac output during changes in SVR remains unclear. ⋯ In each case, the trending ability of esCCO to measure cardiac output and time component of PWTT were analyzed. Recorded data suggest that the time component of PWTT may have a significant impact on the accuracy of estimating stroke volume during changes in SVR. However, further prospective clinical studies are required to test this hypothesis.
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J Clin Monit Comput · Aug 2014
Variations in the pre-ejection period induced by ventricular extra systoles may be feasible to predict fluid responsiveness.
Monitoring that can predict fluid responsiveness is an unsettled matter for spontaneously breathing patients. Based on the convincing results with dynamic monitoring based on preload variations induced by mechanical ventilation, we hypothesised that the extra systolic post-ectopic beat could constitute a similar intermittent preload shift inducing a brief variation in blood pressure and that the magnitude of this variation could predict the hemodynamic response to volume expansion in sedated pigs. Ten pigs were sedated and hemodynamically monitored and four intravascular volume shifts were made: blood depletion (25% of estimated blood volume; 660 ml), retransfusion (of 500 ml depleted blood), and two sequential volume expansions (500 ml colloid each). ⋯ Ventricular extra systoles were generally useful for fluid responsiveness prediction (ROC areas >0.65). ∆PEP variables best predicted fluid responsiveness: ∆PEP derived from arterial pressure curve and ECG had ROC area of 0.84 and sensitivity of 0.77 and specificity of 0.71; ∆PEP derived from plethysmographic curve and ECG had ROC area of 0.79 and sensitivity of 0.71 and specificity of 0.70. However, ∆PP was not a useful variable in this study (ROC area <0.65). Hemodynamic analysis of post ectopic beats may be a feasible method for fluid responsiveness prediction.
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J Clin Monit Comput · Aug 2014
Randomized Controlled TrialThe effect of desflurane versus propofol on regional cerebral oxygenation in the sitting position for shoulder arthroscopy.
The sitting position may cause significant hemodynamic instability and cerebral hypoperfusion. We investigated the effects of desflurane and propofol on regional cerebral oxygenation (rSO2) in the sitting position during arthroscopic shoulder surgery. Forty patients undergoing arthroscopic shoulder surgery in the sitting position were randomly allocated to the desflurane group (n = 20) or the propofol group (n = 20). ⋯ The incidence of rSO2 <75% of the baseline values after the sitting position was similar between the groups (0 and 10% in the desflurane and propofol group, respectively, P = 0.487). When anesthetized patients were raised to the sitting position, desflurane preserved cerebral oxygenation better than propofol at equipotent concentrations in terms of BIS. However, both anesthetics were associated with significant decrease in the rSO2 values during the sitting position.