Thoracic electrical bioimpedance theory and clinical possibilities in perioperative medicine

This article is a short review of thoracic electrical bioimpedance (TEB) theory and clinical capabilities. Cardiac output measurement is used primarily to guide therapy in complex, critically ill patients. Thoracic electrical bioimpedance is one of several noninvasive techniques that have been investigated to measure cardiac output and other hemodynamic parameters. Opinions in current literature continue to be conflicting as to the utility of thoracic electrical bioimpedance to that purpose. There is a limited number of good designed studies but they imply TEB is an accurate and reliable noninvasive method for determining cardiac output/cardiac index and it would be valuable for patients and circumstances in which intracardiac pressures and mixed venous blood samples are not necessary

High-normal blood pressure, functional capacity and left heart mechanics: is there any connection?

Objective. To evaluate the relationship between functional capacity and left ventricular (LV) and left atrial (LA) myocardial deformation, assessed by two- and three-dimensional (2DE and 3DE) strain analysis, in subjects with high-normal blood pressure (BP). Methods. This cross-sectional study included 64 subjects with optimal BP and 75 subjects with high-normal BP of similar gender and age. All the subjects underwent a complete 2DE and 3DE examination and cardiopulmonary exercise testing. Results. 3DE global longitudinal strain was significantly lower in the group with high-normal BP than in the optimal BP group (- 20.1 ± 2.4 vs - 18.5 ± 2.3%, p < 0.001). Similar results were obtained for 3DE global circumferential strain (- 21.8 ± 2.6 vs - 19.3 ± 2.4%, p < 0.001), as well as for 3DE global radial strain (45.1 ± 8.8 vs 42.3 ± 7.2%, p = 0.042), and 3DE global area strain (- 30.1 ± 4.2 vs - 28.1 ± 3.8%, p < 0.001). LV twist was similar between the observed groups, whereas untwisting rate was significantly decreased in the subjects with high-normal BP (- 123 ± 30 vs - 112 ± 26°/s, p = 0.023). Peak VO2 was significantly lower in the high-normal BP group (30.8 ± 4 vs 28.3 ± 3.7 ml/kg/min, p < 0.001). 2DE LV ejection fraction (β = 0.38, p = 0.014), 2DE global longitudinal strain (β = 0.35, p = 0.019) and 3DE global longitudinal strain (β = 0.27, p = 0.042) were independently associated with peak VO2. Conclusion. LV and LA mechanics, as well as functional capacity are significantly impaired in the subjects with high-normal BP. LV and LA myocardial deformations are associated with peak oxygen uptake

The impact of high-normal blood pressure on left ventricular mechanics: A three-dimensional and speckle tracking echocardiography study

none10sinoneTadic, Marijana; Majstorovic, Anka; Pencic, Biljana; Ivanovic, Branislava; Neskovic, Aleksandar; Badano, Luigi; Stanisavljevic, Dejana; Scepanovic, Radisav; Stevanovic, Predrag; Celic, VeraTadic, Marijana; Majstorovic, Anka; Pencic, Biljana; Ivanovic, Branislava; Neskovic, Aleksandar; Badano, Luigi; Stanisavljevic, Dejana; Scepanovic, Radisav; Stevanovic, Predrag; Celic, Ver

Differences in antimicrobial consumption, prescribing and isolation rate of multidrug resistant Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii on surgical and medical wards.

In order to provide guidance data for clinically rational use of an antibiotics consuption, prescribing and prevalence of multidrug resistant (MDR) Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii were monitored on the surgical (S) and medical (M) wards of the University Hospital Center "Dr. Dragisa Misovic-Dedinje" (Belgrade, Serbia), in the study period from 2012 to 2015. Appropriateness of antimicrobial use was evaluated using the Global-Prevalence Survey method designed by the University of Antwerp. The percentages of MDR pathogens relative to the total number of isolates of K. pneumoniae and P. aeruginosa were higher on the S (86.2% and 49.1%) than on the M (63.2% and 36.9%) wards. The percentage of MDR A. baumannii was not different between S (93.7%) and M (79.5%) wards. An overall antibiotics consumption (defined daily doses/100 bed-days) during study was 369.7 and 261.5 on the S and M wards, respectively. A total of 225 prescriptions of antimicrobials were evaluated in138 adults admitted to wards on the day of the survey. The percentage of antimicrobials prescribed for prophylaxis on the M and S wards were 0% and 25%, respectively. Therapies were more frequently empiric (S, 86.8% and M, 80%). The percentages of medical errors on the S and M wards were 74.6% and 27.3%, respectively. The quality indicators for antibiotic prescribing on the S and M wards were as follows: the incorrect choice of antimicrobials (35.6% vs. 20.0%), inappropriate dose interval (70.6% vs. 16.9%) or duration of therapy (72.5% vs. 23.1%), a non-documented stop/review data (73.6% vs. 16.9%) and divergence from guidelines (71.9% vs. 23.1%). Treatment based on biomarkers was more common on the M wards as compared to the S wards. The increasing prevalence of MDR pathogens, a very high consumption and incorrect prescribing of antimicrobials need special attention, particularly on the S wards

Quality of antimicrobial prescribing obtained by Global-Point Prevalence Survey method.

<p>Quality of antimicrobial prescribing obtained by Global-Point Prevalence Survey method.</p

Reasons for antibiotics prescribing obtained by Global-Point Prevalence Survey method.

<p>Reasons for antibiotics prescribing obtained by Global-Point Prevalence Survey method.</p

Association between antimicrobial consumption and isolation rate of multi drugs resistant <i>K</i>. <i>pneumoniae</i>, <i>P</i>. <i>aeruginosa</i> and <i>A</i>. <i>baumannii</i> at surgical (A) and medical (B) wards.

<p>Association between antimicrobial consumption and isolation rate of multi drugs resistant <i>K</i>. <i>pneumoniae</i>, <i>P</i>. <i>aeruginosa</i> and <i>A</i>. <i>baumannii</i> at surgical (A) and medical (B) wards.</p

Resistance rate (%) of <i>Klebsiella pneumoniae</i>, <i>Pseudomonas aeruginosa</i> and <i>Acinetobacter baumannii</i> strains isolated from 2012–2015.

<p>Resistance rate (%) of <i>Klebsiella pneumoniae</i>, <i>Pseudomonas aeruginosa</i> and <i>Acinetobacter baumannii</i> strains isolated from 2012–2015.</p

Annual distribution of isolation rates and patients on surgical and medical wards.

<p>Annual distribution of isolation rates and patients on surgical and medical wards.</p