Background: Elevated Fontan pressure (FP) alone cannot fully predict clinical outcomes. We hypothesized thathemodynamic profiling using a cardiac index (CI)-systemic vascular resistance (SVR) plot could characterize c...Background: Elevated Fontan pressure (FP) alone cannot fully predict clinical outcomes. We hypothesized thathemodynamic profiling using a cardiac index (CI)-systemic vascular resistance (SVR) plot could characterize clinicalfeatures and predict the prognosis of post-Fontan patients. Methods: We included post-Fontan patients whounderwent cardiac catheterization at age < 10 years. Patients were classified into four categories: A, CI ≥ 3, SVRindex (SVRI) ≥ 20;B, CI < 3, SVRI ≥ 20;C, CI ≥ 3, SVRI < 20;and D, CI < 3, SVRI < 20. The primary outcome wasfreedom from the combined endpoint: new onset of protein-losing enteropathy or plastic bronchitis, heart transplant,and death. Clinical and hemodynamic variables and freedom from the endpoint were compared betweenthe hemodynamic categories and outcome predictors were evaluated. Results: Eighty-three patients wereincluded. Median follow-up was 5.3 years. Category A/B/C/D consisted of 4/15/53/11 patients, respectively. Allthe patients in category A were New York Heart Association I/II and had a significantly lower pulmonary vascularresistance index (PVRI). Patients in category C had lower pulmonary/systemic blood flow. Patients in category Dhad a higher PVRI and had the poorest freedom from the endpoint (44% at 5 years). Elevated FP and category Dwere outcome predictors. Conclusions: CI-SVR plots was a novel adjunctive method for Fontan hemodynamicprofiling.展开更多
Methods: Sixteen patients with American Society of Anesthesiologists status (ASA) II-III, age ≤ 70 yr, male or female, preoperatively NYHA II-III and EF ≥ 45%, scheduled for mitral valve replacement (MVR) were studi...Methods: Sixteen patients with American Society of Anesthesiologists status (ASA) II-III, age ≤ 70 yr, male or female, preoperatively NYHA II-III and EF ≥ 45%, scheduled for mitral valve replacement (MVR) were studied. Complete intravenous general anesthesia was used for induction and anesthesia maintenance. After anesthesia induction we put the TEE probe into the esophagus. The cardiac index was determined at three periods following MVR: T1 30 minutes later following cessation of bypass, T2 60 minutes after cessation of bypass, T3 90 minutes after cessation of bypass. Statistical analysis was made with the Bland and Altman method. Results: Ninety-six measurements were compared. The cardiac index values at the level of prosthesis mitral valve (CIMV) ranged from 1.3 to 5.5 L·min-1·m-2 (mean 2.6 ± 0.9). The Values of cardiac index at aortic valve (CIAA) ranged from 2.7 to8.8 L·min-1·m-2 (mean 4.9 ± 1.7). Bias was -2.3 L·min-1·m-2 and limits of agreement -5.6 to 1.0 L·min-1·m-2. Conclusion: During mitral valve replacement, doubtful correlations were observed between values of cardiac index at the mitral valve and the ascending aorta using TEE.展开更多
The cardio-ankle vascular index (CAVI) is a new index of arterial stiffness that can be measured with a VaSera VS-1000 device. An association between certain arterial stiffness indices and cardiac function has been fo...The cardio-ankle vascular index (CAVI) is a new index of arterial stiffness that can be measured with a VaSera VS-1000 device. An association between certain arterial stiffness indices and cardiac function has been found but has not yet been validated. The aim of this study was to establish whether any significant relationship exists between cardiac index (CI) and CAVI. Twenty healthy male volunteers with a mean age of 30 ± 5 years and a mean BMI of 23.1 ± 1.1 kg/m2 participated in the study. CO was estimated using a Doppler technique, and CAVI was measured with a VaSeraVS-1000 device. A motorised tilting table was used to achieve head-up tilt (HUT) angles of 0°, 30°and 60°, to modify the peripheral sympathetic outflow. We found that there was a significant inverse correlation between CI and the degree of head-up tilt, ( for 0°and 30°;for 0° and 60°, p for both;for 30° and 60°, ). CAVI showed a significant positive correlation relative with the degree of HUT, ( for 0° and 30°;for 0° and 60°;for 30° and 60°, for all). A significant negative correlation was found between CI and CAVI r = - 0.47, p Additionally, a significant p increase in PVR values was observed for increasing HUT values. In conclusion: An inverse relationship between CI and CAVI was shown;a decrease in cardiac output is associated with an increase in CAVI values at different degrees of HUT. This association provides further insight into the postural link between cardiac output and arterial compliance.展开更多
BACKGROUND Cardiogenic shock (CS) secondary to acute myocardial infarction (AMI) complicates management of the condition, and often leads to poor prognosis. Prompt and accurate monitoring of cardiovascular and accompa...BACKGROUND Cardiogenic shock (CS) secondary to acute myocardial infarction (AMI) complicates management of the condition, and often leads to poor prognosis. Prompt and accurate monitoring of cardiovascular and accompanying hemodynamic changes is crucial in achieving adequate management of the condition. Advances in technology has availed procedures such as pulse index continuous cardiac output (PiCCO), which can offer precise monitoring of cardiovascular functions and hemodynamic parameters. In this study, PiCCO is evaluated for its potential utility in improving management and clinical outcomes among elderly patients with AMI complicated by CS. AIM To assess whether use of the PiCCO system can improve clinical outcomes in elderly patients with AMI complicated by CS.METHODS Patients from emergency intensive care units (EICU) or coronary care units (CCU) were randomized to receive PiCCO monitoring or not. The APACHE II score, SOFA score, hs-TnI, NT-proBNP, PaO2/FiO2 ratio and lactate levels on day 1, 3 and 7 after treatment were compared. The infusion and urine volume at 0-24 h, 24-48 h and 48-72 h were recorded, as were the cardiac index (CI), extravascular lung water index (EVLWI), intrathoracic blood volume index (ITBVI) and global end diastolic volume index (GEDVI) at similar time intervals. RESULTS Sixty patients with AMI complicated by CS were included in the study. The PiCCO group had a significantly lower APACHE II score, SOFA score, hs-TnI and NT-proBNP levels on day 1, 3 and 7 after treatment. The infusion and urine volume during 0-24 h in the PiCCO group were significantly greater, and this group also showed significantly higher ADL scores. Furthermore, the PiCCO group spent lesser days on vasoactive agents, mechanical ventilation, and had a reduced length of stay in EICU/CCU. Additionally, the CI was significantly higher at 48 h and 72 h in the PiCCO group compared with that at 24 h, and the EVLWI, ITBVI and GEDVI were significantly decreased at 48 h and 72 h. CONCLUSION Applying the PiCCO system could improve the clinical outcomes of elderly patients with AMI complicated by CS.展开更多
<strong>Background</strong><strong>:</strong><b><span style="font-family:;" "=""> </span></b><span style="font-family:;" "=&qu...<strong>Background</strong><strong>:</strong><b><span style="font-family:;" "=""> </span></b><span style="font-family:;" "=""><span style="font-family:Verdana;">Septic shock is a rapidly changing and fatal syndrome that can </span><span style="font-family:Verdana;">cause comprehensive deterioration of cardiopulmonary and renal function and multiple organ failure. At the same time, septic shock has the complex clinical manifestations and hemodynamics. PiCCO can accurately </span><span style="font-family:Verdana;">monitor blood flow, physical and volume indicators, and active and effective fluid resuscitation are important measures to reduce the fatality rate of septic shock and improve the prognosis of patients. </span><b><span style="font-family:Verdana;">Objectives: </span></b><span style="font-family:Verdana;">To explore the application an</span><span style="font-family:Verdana;">d nursing of PiCCO in early fluid resuscitation in patie</span><span style="font-family:Verdana;">nts with septic shock. </span><b><span style="font-family:Verdana;">Me</span><span style="font-family:Verdana;">thods:</span></b><span style="font-family:Verdana;"> This was a retrospective observ</span><span style="font-family:Verdana;">ational study. The observation group and the control group each had 30 cases. The observation group used PiCCO to guide fluid resuscitation;the control group used conventional methods to guide fluid resuscitation.</span></span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">The changes in CVP, HR, MAP, and urine volume per hour were observed in the two groups. The changes of various indicators before and after fluid resuscitation, the length of stay in ICU and the mortality rate were compared between the two groups. All the outcomes were collected from the electronic medical case system after patients’ discharge from the hospital. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">APACHE </span></span><span style="font-family:Verdana;">II</span><span style="font-family:;" "=""><span style="font-family:Verdana;">, CVP, HR, MAP were compared between th</span><span style="font-family:Verdana;">e obse</span><span style="font-family:Verdana;">rvation group and th</span></span><span style="font-family:;" "=""><span style="font-family:Verdana;">e control group, and the differences w</span><span><span style="font-family:Verdana;">ere statistically significant (</span><i><span style="font-family:Verdana;">P</span></i></span></span><i><span style="font-family:;" "=""> </span></i><span style="font-family:Verdana;"><</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">0.05). The blood volume of patients in the observatio</span><span style="font-family:;" "=""><span style="font-family:Verdana;">n group was significantly improved after fluid supplementation</span><span><span style="font-family:Verdana;"> (</span><i><span style="font-family:Verdana;">P</span></i></span></span><i><span style="font-family:;" "=""> </span></i><span style="font-family:Verdana;"><</span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">0.05). Compared with the control group, the length of stay in ICU in the observation group was significantly shorter, and the mortality rate was also significantly reduced</span><span style="font-family:Verdana;"> (</span><i><span style="font-family:Verdana;">P</span></i></span><span> </span><span style="font-family:Verdana;"><</span><span> </span><span style="font-family:Verdana;">0.05</span><span><span style="font-family:Verdana;">). </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> PiCCO can be better used in early fluid resuscitation of patients with septic shock.</span></span>展开更多
Objective To determine whether reduction in central pressure augmentation and central systolic blood pressure by nitroglycerine (NTG) results from effects on pre-load or is due to arterial dilation. Methods We compare...Objective To determine whether reduction in central pressure augmentation and central systolic blood pressure by nitroglycerine (NTG) results from effects on pre-load or is due to arterial dilation. Methods We compared effects of NTG with those of lower body negative pressure (LBNP). Hemodynamic measurements were made at rest,during LBNP (10,20 and 30 mmHg,each for 15 min) and after NTG (10,30 and 100 μg/min,each dose for 15 min) in ten healthy volunteers. Cardiac pre-load,stroke volume and cardiac output were assessed by echocardiography. Central pressure augmentation and central systolic pressure were obtained by radial tonometry using a transfer function. Results LBNP (20 mmHg) and NTG (30 μg/min) reduced pre-load (as measured by the peak velocity of the S wave in the superior vena cava) to a similar degree [by (26.8±3.8)% and (23.9±3.4)%,respectively]. Compared to LBNP,NTG reduced systemic vascular resistance [by (32.9±7.5)%,P<0.01],decreased peripheral and central pressure augmentation [by (20.8±3.4)% units and (12.9±2.9)% units,respectively,each P<0.01]. Conclusion These results suggest that a reduction in pre-load does not explain reduction in pressure augmentation and central systolic blood pressure by NTG and that these effects are mediated through arterial dilation.展开更多
文摘Background: Elevated Fontan pressure (FP) alone cannot fully predict clinical outcomes. We hypothesized thathemodynamic profiling using a cardiac index (CI)-systemic vascular resistance (SVR) plot could characterize clinicalfeatures and predict the prognosis of post-Fontan patients. Methods: We included post-Fontan patients whounderwent cardiac catheterization at age < 10 years. Patients were classified into four categories: A, CI ≥ 3, SVRindex (SVRI) ≥ 20;B, CI < 3, SVRI ≥ 20;C, CI ≥ 3, SVRI < 20;and D, CI < 3, SVRI < 20. The primary outcome wasfreedom from the combined endpoint: new onset of protein-losing enteropathy or plastic bronchitis, heart transplant,and death. Clinical and hemodynamic variables and freedom from the endpoint were compared betweenthe hemodynamic categories and outcome predictors were evaluated. Results: Eighty-three patients wereincluded. Median follow-up was 5.3 years. Category A/B/C/D consisted of 4/15/53/11 patients, respectively. Allthe patients in category A were New York Heart Association I/II and had a significantly lower pulmonary vascularresistance index (PVRI). Patients in category C had lower pulmonary/systemic blood flow. Patients in category Dhad a higher PVRI and had the poorest freedom from the endpoint (44% at 5 years). Elevated FP and category Dwere outcome predictors. Conclusions: CI-SVR plots was a novel adjunctive method for Fontan hemodynamicprofiling.
文摘Methods: Sixteen patients with American Society of Anesthesiologists status (ASA) II-III, age ≤ 70 yr, male or female, preoperatively NYHA II-III and EF ≥ 45%, scheduled for mitral valve replacement (MVR) were studied. Complete intravenous general anesthesia was used for induction and anesthesia maintenance. After anesthesia induction we put the TEE probe into the esophagus. The cardiac index was determined at three periods following MVR: T1 30 minutes later following cessation of bypass, T2 60 minutes after cessation of bypass, T3 90 minutes after cessation of bypass. Statistical analysis was made with the Bland and Altman method. Results: Ninety-six measurements were compared. The cardiac index values at the level of prosthesis mitral valve (CIMV) ranged from 1.3 to 5.5 L·min-1·m-2 (mean 2.6 ± 0.9). The Values of cardiac index at aortic valve (CIAA) ranged from 2.7 to8.8 L·min-1·m-2 (mean 4.9 ± 1.7). Bias was -2.3 L·min-1·m-2 and limits of agreement -5.6 to 1.0 L·min-1·m-2. Conclusion: During mitral valve replacement, doubtful correlations were observed between values of cardiac index at the mitral valve and the ascending aorta using TEE.
文摘The cardio-ankle vascular index (CAVI) is a new index of arterial stiffness that can be measured with a VaSera VS-1000 device. An association between certain arterial stiffness indices and cardiac function has been found but has not yet been validated. The aim of this study was to establish whether any significant relationship exists between cardiac index (CI) and CAVI. Twenty healthy male volunteers with a mean age of 30 ± 5 years and a mean BMI of 23.1 ± 1.1 kg/m2 participated in the study. CO was estimated using a Doppler technique, and CAVI was measured with a VaSeraVS-1000 device. A motorised tilting table was used to achieve head-up tilt (HUT) angles of 0°, 30°and 60°, to modify the peripheral sympathetic outflow. We found that there was a significant inverse correlation between CI and the degree of head-up tilt, ( for 0°and 30°;for 0° and 60°, p for both;for 30° and 60°, ). CAVI showed a significant positive correlation relative with the degree of HUT, ( for 0° and 30°;for 0° and 60°;for 30° and 60°, for all). A significant negative correlation was found between CI and CAVI r = - 0.47, p Additionally, a significant p increase in PVR values was observed for increasing HUT values. In conclusion: An inverse relationship between CI and CAVI was shown;a decrease in cardiac output is associated with an increase in CAVI values at different degrees of HUT. This association provides further insight into the postural link between cardiac output and arterial compliance.
文摘BACKGROUND Cardiogenic shock (CS) secondary to acute myocardial infarction (AMI) complicates management of the condition, and often leads to poor prognosis. Prompt and accurate monitoring of cardiovascular and accompanying hemodynamic changes is crucial in achieving adequate management of the condition. Advances in technology has availed procedures such as pulse index continuous cardiac output (PiCCO), which can offer precise monitoring of cardiovascular functions and hemodynamic parameters. In this study, PiCCO is evaluated for its potential utility in improving management and clinical outcomes among elderly patients with AMI complicated by CS. AIM To assess whether use of the PiCCO system can improve clinical outcomes in elderly patients with AMI complicated by CS.METHODS Patients from emergency intensive care units (EICU) or coronary care units (CCU) were randomized to receive PiCCO monitoring or not. The APACHE II score, SOFA score, hs-TnI, NT-proBNP, PaO2/FiO2 ratio and lactate levels on day 1, 3 and 7 after treatment were compared. The infusion and urine volume at 0-24 h, 24-48 h and 48-72 h were recorded, as were the cardiac index (CI), extravascular lung water index (EVLWI), intrathoracic blood volume index (ITBVI) and global end diastolic volume index (GEDVI) at similar time intervals. RESULTS Sixty patients with AMI complicated by CS were included in the study. The PiCCO group had a significantly lower APACHE II score, SOFA score, hs-TnI and NT-proBNP levels on day 1, 3 and 7 after treatment. The infusion and urine volume during 0-24 h in the PiCCO group were significantly greater, and this group also showed significantly higher ADL scores. Furthermore, the PiCCO group spent lesser days on vasoactive agents, mechanical ventilation, and had a reduced length of stay in EICU/CCU. Additionally, the CI was significantly higher at 48 h and 72 h in the PiCCO group compared with that at 24 h, and the EVLWI, ITBVI and GEDVI were significantly decreased at 48 h and 72 h. CONCLUSION Applying the PiCCO system could improve the clinical outcomes of elderly patients with AMI complicated by CS.
文摘<strong>Background</strong><strong>:</strong><b><span style="font-family:;" "=""> </span></b><span style="font-family:;" "=""><span style="font-family:Verdana;">Septic shock is a rapidly changing and fatal syndrome that can </span><span style="font-family:Verdana;">cause comprehensive deterioration of cardiopulmonary and renal function and multiple organ failure. At the same time, septic shock has the complex clinical manifestations and hemodynamics. PiCCO can accurately </span><span style="font-family:Verdana;">monitor blood flow, physical and volume indicators, and active and effective fluid resuscitation are important measures to reduce the fatality rate of septic shock and improve the prognosis of patients. </span><b><span style="font-family:Verdana;">Objectives: </span></b><span style="font-family:Verdana;">To explore the application an</span><span style="font-family:Verdana;">d nursing of PiCCO in early fluid resuscitation in patie</span><span style="font-family:Verdana;">nts with septic shock. </span><b><span style="font-family:Verdana;">Me</span><span style="font-family:Verdana;">thods:</span></b><span style="font-family:Verdana;"> This was a retrospective observ</span><span style="font-family:Verdana;">ational study. The observation group and the control group each had 30 cases. The observation group used PiCCO to guide fluid resuscitation;the control group used conventional methods to guide fluid resuscitation.</span></span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">The changes in CVP, HR, MAP, and urine volume per hour were observed in the two groups. The changes of various indicators before and after fluid resuscitation, the length of stay in ICU and the mortality rate were compared between the two groups. All the outcomes were collected from the electronic medical case system after patients’ discharge from the hospital. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">APACHE </span></span><span style="font-family:Verdana;">II</span><span style="font-family:;" "=""><span style="font-family:Verdana;">, CVP, HR, MAP were compared between th</span><span style="font-family:Verdana;">e obse</span><span style="font-family:Verdana;">rvation group and th</span></span><span style="font-family:;" "=""><span style="font-family:Verdana;">e control group, and the differences w</span><span><span style="font-family:Verdana;">ere statistically significant (</span><i><span style="font-family:Verdana;">P</span></i></span></span><i><span style="font-family:;" "=""> </span></i><span style="font-family:Verdana;"><</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">0.05). The blood volume of patients in the observatio</span><span style="font-family:;" "=""><span style="font-family:Verdana;">n group was significantly improved after fluid supplementation</span><span><span style="font-family:Verdana;"> (</span><i><span style="font-family:Verdana;">P</span></i></span></span><i><span style="font-family:;" "=""> </span></i><span style="font-family:Verdana;"><</span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">0.05). Compared with the control group, the length of stay in ICU in the observation group was significantly shorter, and the mortality rate was also significantly reduced</span><span style="font-family:Verdana;"> (</span><i><span style="font-family:Verdana;">P</span></i></span><span> </span><span style="font-family:Verdana;"><</span><span> </span><span style="font-family:Verdana;">0.05</span><span><span style="font-family:Verdana;">). </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> PiCCO can be better used in early fluid resuscitation of patients with septic shock.</span></span>
文摘Objective To determine whether reduction in central pressure augmentation and central systolic blood pressure by nitroglycerine (NTG) results from effects on pre-load or is due to arterial dilation. Methods We compared effects of NTG with those of lower body negative pressure (LBNP). Hemodynamic measurements were made at rest,during LBNP (10,20 and 30 mmHg,each for 15 min) and after NTG (10,30 and 100 μg/min,each dose for 15 min) in ten healthy volunteers. Cardiac pre-load,stroke volume and cardiac output were assessed by echocardiography. Central pressure augmentation and central systolic pressure were obtained by radial tonometry using a transfer function. Results LBNP (20 mmHg) and NTG (30 μg/min) reduced pre-load (as measured by the peak velocity of the S wave in the superior vena cava) to a similar degree [by (26.8±3.8)% and (23.9±3.4)%,respectively]. Compared to LBNP,NTG reduced systemic vascular resistance [by (32.9±7.5)%,P<0.01],decreased peripheral and central pressure augmentation [by (20.8±3.4)% units and (12.9±2.9)% units,respectively,each P<0.01]. Conclusion These results suggest that a reduction in pre-load does not explain reduction in pressure augmentation and central systolic blood pressure by NTG and that these effects are mediated through arterial dilation.