129 research outputs found

    Evaluation of a new arterial pressure-based cardiac output device requiring no external calibration

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    <p>Abstract</p> <p>Background</p> <p>Several techniques have been discussed as alternatives to the intermittent bolus thermodilution cardiac output (CO<sub>PAC</sub>) measurement by the pulmonary artery catheter (PAC). However, these techniques usually require a central venous line, an additional catheter, or a special calibration procedure. A new arterial pressure-based cardiac output (CO<sub>AP</sub>) device (FloTrac™, Vigileo™; Edwards Lifesciences, Irvine, CA, USA) only requires access to the radial or femoral artery using a standard arterial catheter and does not need an external calibration. We validated this technique in critically ill patients in the intensive care unit (ICU) using CO<sub>PAC </sub>as the method of reference.</p> <p>Methods</p> <p>We studied 20 critically ill patients, aged 16 to 74 years (mean, 55.5 ± 18.8 years), who required both arterial and pulmonary artery pressure monitoring. CO<sub>PAC </sub>measurements were performed at least every 4 hours and calculated as the average of 3 measurements, while CO<sub>AP </sub>values were taken immediately at the end of bolus determinations. Accuracy of measurements was assessed by calculating the bias and limits of agreement using the method described by Bland and Altman.</p> <p>Results</p> <p>A total of 164 coupled measurements were obtained. Absolute values of CO<sub>PAC </sub>ranged from 2.80 to 10.80 l/min (mean 5.93 ± 1.55 l/min). The bias and limits of agreement between CO<sub>PAC </sub>and CO<sub>AP </sub>for unequal numbers of replicates was 0.02 ± 2.92 l/min. The percentage error between CO<sub>PAC </sub>and CO<sub>AP </sub>was 49.3%. The bias between percentage changes in CO<sub>PAC </sub>(ΔCO<sub>PAC</sub>) and percentage changes in CO<sub>AP </sub>(ΔCO<sub>AP</sub>) for consecutive measurements was -0.70% ± 32.28%. CO<sub>PAC </sub>and CO<sub>AP </sub>showed a Pearson correlation coefficient of 0.58 (<it>p </it>< 0.01), while the correlation coefficient between ΔCO<sub>PAC </sub>and ΔCO<sub>AP </sub>was 0.46 (<it>p </it>< 0.01).</p> <p>Conclusion</p> <p>Although the CO<sub>AP </sub>algorithm shows a minimal bias with CO<sub>PAC </sub>over a wide range of values in an inhomogeneous group of critically ill patients, the scattering of the data remains relative wide. Therefore, the used algorithm (V 1.03) failed to demonstrate an acceptable accuracy in comparison to the clinical standard of cardiac output determination.</p

    Support for a synaptic chain model of neuronal sequence generation

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    In songbirds, the remarkable temporal precision of song is generated by a sparse sequence of bursts in the premotor nucleus HVC. To distinguish between two possible classes of models of neural sequence generation, we carried out intracellular recordings of HVC neurons in singing zebra finches (Taeniopygia guttata). We found that the subthreshold membrane potential is characterized by a large, rapid depolarization 5–10 ms before burst onset, consistent with a synaptically connected chain of neurons in HVC. We found no evidence for the slow membrane potential modulation predicted by models in which burst timing is controlled by subthreshold dynamics. Furthermore, bursts ride on an underlying depolarization of ~10-ms duration, probably the result of a regenerative calcium spike within HVC neurons that could facilitate the propagation of activity through a chain network with high temporal precision. Our results provide insight into the fundamental mechanisms by which neural circuits can generate complex sequential behaviours.National Institutes of Health (U.S.) (Grant MH067105)National Institutes of Health (U.S.) (Grant DC009280)National Science Foundation (U.S.) (IOS-0827731)Alfred P. Sloan Foundation (Research Fellowship
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