Cardiac output measurement : evaluation of methods in ICU patients

Accurate clinical assessment of the circulatory status is particular desirable in critically ill patients in the intensive care unit (ICU) and patients undergoing cardiac, thoracic, or vascular interventions. As the patient__s haemodynamic status may change rapidly, continuous monitoring of cardiac output will provide information allowing rapid adjustment of therapy. Aim of this thesis is an overview and evaluation with respect to less invasive cardiac output measurement and monitoring systems, especially the pulse contour technique. The introduction highlights historical and physiological aspects of cardiac output measurement and effect of respiratory changes on blood flow and pressure. Secondly it introduces methodological aspects of measurement, with attention to the reference method and analysis of agreementUBL - phd migration 201

Biventricular function in exercise during autonomic (thoracic epidural) block

Background Blockade of cardiac sympathetic fibers by thoracic epidural anesthesia (TEA) was previously shown to reduce right and left ventricular systolic function and effective pulmonary arterial elastance. At conditions of constant paced heart rate, cardiac output and systemic hemodynamics were unchanged. In this study, we further investigated the effect of cardiac sympathicolysis during physical stress and increased oxygen demand.Methods In a cross-over design, 12 patients scheduled to undergo thoracic surgery performed dynamic ergometric exercise tests with and without TEA. Hemodynamics were monitored and biventricular function was measured by transthoracic two-dimensional and M-mode echocardiography, pulsed wave Doppler and tissue Doppler imaging.Results TEA attenuated systolic RV function (TV SMODIFIER LETTER PRIME: - 21%, P < 0.001) and LV function (MV SMODIFIER LETTER PRIME: - 14%, P = 0.025), but biventricular diastolic function was not affected. HR (- 11%, P < 0.001), SVI (- 15%, P = 0.006), CI (- 21%, P < 0.001) and MAP (- 12%, P < 0.001) were decreased during TEA, but SVR was not affected. Exercise resulted in significant augmentation of systolic and diastolic biventricular function. During exercise HR, SVI, CI and MAP increased (respectively, + 86%, + 19%, + 124% and + 17%, all P < 0.001), whereas SVR decreased (- 49%, P < 0.001). No significant interactions between exercise and TEA were found, except for RPP (P = 0.024) and MV E DT (P = 0.035).Conclusion Cardiac sympathetic blockade by TEA reduced LV and RV systolic function but did not significantly blunt exercise-induced increases in LV and RV function. These data indicate that additional mechanisms besides those controlled by the cardiac sympathetic nervous system are involved in the regulation of cardiac function during dynamic exercise.Perioperative Medicine: Efficacy, Safety and Outcome (Anesthesiology/Intensive Care

Vasoresponsiveness in patients with heart failure (VASOR): protocol for a prospective observational study

BACKGROUND: Vasoplegia is a severe complication which may occur after cardiac surgery, particularly in patients with heart failure. It is a result of activation of vasodilator pathways, inactivation of vasoconstrictor pathways and the resistance to vasopressors. However, the precise etiology remains unclear. The aim of the Vasoresponsiveness in patients with heart failure (VASOR) study is to objectify and characterize the altered vasoresponsiveness in patients with h

Less invasive determination of cardiac output from the arterial pressure by aortic diameter-calibrated pulse contour

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Cerebral blood flow velocity during chest compressions in cardiac arrest

Perioperative Medicine: Efficacy, Safety and Outcom

Arm occlusion pressure is a useful predictor of an increase in cardiac output after fluid loading following cardiac surgery

Perioperative Medicine: Efficacy, Safety and Outcom

A RETROSPECTIVE AUDIT OF TRACHEAL EXTUBATION IN PAEDIATRIC CARDIOTHORACIC SURGERY PATIENTS

Perioperative Medicine: Efficacy, Safety and Outcom