Cardiac Output Monitoring Research Articles

Fluid balance neutralization secured by hemodynamic monitoring versus protocolized standard of care in patients with acute circulatory failure requiring continuous renal replacement therapy: results of the GO NEUTRAL randomized controlled trial.

Net ultrafiltration (UFNET) during continuous renal replacement therapy (CRRT) can control fluid balance (FB), but is usually 0ml·h-1 in patients with vasopressors due to the risk of hemodynamic instability associated with CRRT (HIRRT). We evaluated a UFNET strategy adjusted by functional hemodynamics to control the FB of patients with vasopressors, compared to the standard of care. In this randomized, controlled, open-label, parallel-group, multicenter, proof-of-concept trial, adults receiving vasopressors, CRRT since ≤ 24h and cardiac output monitoring were randomized (ratio 1:1) to receive during 72h a UFNET ≥ 100ml·h-1, adjusted using a functional hemodynamic protocol (intervention), or a UFNET ≤ 25ml·h-1 (control). The primary outcome was the cumulative FB at 72 h and was analyzed in patients alive at 72 h and in whom monitoring and CRRT were continuously provided (modified intention-to-treat population [mITT]). Secondary outcomes were analyzed in the intention-to-treat (ITT) population. Between June 2021 and April 2023, 55 patients (age 69 [interquartile range, IQR: 62; 74], 35% female, Sequential Organ Failure Assessment (SOFA) 13 [11; 15]) were randomized (25 interventions, 30 controls). In the mITT population, (21 interventions, 24 controls), the 72 h FB was -2650 [-4574; -309] ml in the intervention arm, and 1841 [821; 5327] ml in controls (difference: 4942 [95% confidence interval: 2736-6902] ml, P < 0.01). Hemodynamics, oxygenation and the number of HIRRT at 72 h, and day-90 mortality did not statistically differ between arms. In patients with vasopressors, a UFNET fluid removal strategy secured by a hemodynamic protocol allowed active fluid balance control, compared to the standard of care.

Pulse index contour continuous cardiac output (PICCO) monitoring in critically ill patients.

Objective: To evaluate the utility of Pulse index Contour Continuous Cardiac Output (PiCCO) monitoring in critically ill patients. Study Design: Cross-sectional study. Setting: Intensive Care Unti of Sindh Institute of Urology and Transplant, Karachi, Pakistan. Period: October 2022 to March 2023. Methods: Patients presenting with various types of shock, requiring high-dose vasopressors or inotropes, and not responding to initial fluid therapy were analyzed. Demographic details, SOFA score, APACHE score, and invasive hemodynamic parameters using the PiCCO system were documented. Results: Out of 142 ICU admissions, 38 patients were included in the study. Most patients were males (73%) with a median age of 39 years. Significant changes were observed in the cardiac index, cardiac performance index, global ejection fraction, and systemic vascular resistance index (SVRI), all with p-values less than 0.05. The interventions included the initiation of inotropes in 22 patients (57.8%), diuretics in 4 patients (10.5%), and intravenous fluids in 19 patients (50%). Additionally, vasopressor doses were adjusted in 18 patients (47.3%). Initially, patients were presumed to have pure septic shock based on CO2 gap, mixed venous saturation, and echocardiographic assessment. However, after applying PiCCO monitoring, the diagnosis was revised to mixed shock in 21 patients (55.2%). Conclusion: PiCCO monitoring appears to be a valuable tool in the ICU for managing patients with complex hemodynamic profiles, facilitating targeted interventions that lead to significant improvements in hemodynamic stability.

Ultrasound-Based Cardiac Output Monitoring During Pediatric Open-Heart Surgery in Children

Aim of the study. To evaluate the feasibility of using non-invasive hemodynamic monitoring technology based on Doppler ultrasound during open-heart surgery in children.Material and methods. Prospective, observational, single-center cohort study included 20 patients aged 10 to 34 months undergoing surgery for congenital heart defects. Ten patients underwent atrial septal defect closure (ASD group), other 10 patients had ventricular septal defect closure (VSD group). Cardiac output (CO) was measured in all patients to guide inotropic and infusion therapy adjustments at three control time points: (1) after intubation and before skin incision, (2) during the immediate post-bypass period with the chest open after weaning from cardiopulmonary bypass (CPB), and (3) after sternal closure and before transfer to the intensive care unit (ICU).Results. At time point 1, the CO values for both the ASD and VSD groups were within the normal reference range: 5.2 L/min [4.7; 5.5] and 5.1 L/min [4.6; 5.6], respectively. At time point 2, CO was measured in 15 of 20 patients, including 8 patients in the ASD group and 7 in the VSD group. Coverage was 75% because of the challenges of measuring 5 patients on the operating table. In the immediate post-bypass period, two patients with VSD (25%) developed hypotension with CO reduced to 3.6 L/min, which is lower than the age-related hemodynamic reference value (5.1 L/min). Inotropic support in these two patients was increased by switching from dopamine, 7 mcg/kg/min, to adrenaline at a dose of 0.05 mcg/kg/min, resulting in improvement of hemodynamic parameters and an increase in CO to 5.2 L/min and 5.0 L/min, respectively, compared to normal agerelated reference values (4.1; 6.1 L/min). After sternal closure, CO values in both groups did not differ significantly from age-related reference values.Conclusion. The USCOM cardiac output monitoring device can be used to manage intraoperative hemodynamics and adjust inotropic therapy even during open chest surgery. However, its routine use in all stages of surgery with median sternotomy is difficult because it requires more time to align the aortic valve projection.

Beneficial effects of extravascular lung water index-guided volum management in patients with cardiogenic shock

Objective: To evaluate the role of volume management guided by extravascular lung water index(EVLWI) in improving the clinical outcomes and cardiac function for patients with cardiogenic shock. Methods: This study was a single-center, prospective cohort study. Patients with cardiogenic shock admitted to the Department of Cardiovascular Medicine, Shanghai East Hospital from July 2022 to December 2023 were enrolled. Patients were matched 1∶1 by propensity score and divided into EVLWI group and control group. In the control group, the volume management strategy was determined by the attending physician based mainly on conventional factors, including clinical features, biochemical assessments, and certain blood pressure measurements. In EVLWI group, the volume management plan was formulated by integrating conventional factors with EVLWI derived from pulse index continuous cardiac output (PiCCO) monitoring. Baseline clinical data, in-hospital treatment, and hemodynamic data were collected. Major adverse cardiovascular events and cardiac function related parameters were compared at 30 d after treatment between the two groups. Baseline EVLWI levels were compared between the non-survivors and the survivors in the EVLWI group. The receiver operating characteristic curve was plotted to assess the accuracy of baseline EVLWI and central venous pressure in predicting all-cause mortality at 30 d after treatment in patients with cardiogenic shock, and subgroup analysis was performed according to ischemic/non-ischemic etiology and with/without use of inotropic drugs. Kaplan-Meier curve was used for survival analysis, with log-rank tests comparing all-cause mortality, cardiac death, and readmission rate for heart failure at 30 d after treatment. Results: A total of 200 patients with cardiogenic shock were enrolled, aged (71.35±12.82) years, 144(72%) males, EVLWI group and control group 100 patients each. Compared with the control group, EVLWI group had lower all-cause mortality (16%(16/100) vs. 42%(42/100), log-rank P<0.01), cardiac death (14%(14/100) vs. 34%(34/100), log-rank P<0.01), and readmission rate for heart failure (4%(4/100) vs. 12%(12/100), log-rank P=0.03) at 30 d after treatment. Subgroup analysis showed that EVLWI-guided volume management was associated with lower all-cause mortality at 30 d after treatment in patients with cardiogenic shock of ischemic or non-ischemic etiology and with or without inotropic drugs (all P<0.05). In EVLWI group, baseline EVLWI levels were higher in non-survivors than those in survivors [(15.99±6.47) ml/kg vs.(9.75±2.55) ml/kg, P<0.01]. The baseline EVLWI could predicting all-cause mortality at 30 d after treatment in patients with cardiogenic shock, with an area under the receiver operating characteristic curve of 0.84 (95%CI: 0.75-0.94, P<0.01), while the baseline central venous pressure had no predicting value (AUC=0.54, 95%CI: 0.40-0.69, P=0.60). The optimal cutoff value of EVLWI in pridicting all-cause mortality at 30 d after treatment in patients with cardiogenic shock was >10.3 ml/kg. With the optimization of hemodynamic parameters, left ventricular ejection fraction was improved in EVLWI group, and serum levels of N-terminal pro-brain natriuretic peptide, creatinine, alanine aminotransferase and lactic acid were decreased (all P<0.05). Conclusion: EVLWI-guided volume management exerts a beneficial effect on therapeutic decision-making and improves clinical outcomes and cardiac function in patients with cardiogenic shock.

A Pilot and Feasibility Study of Continuous Cardiac Output and Blood Pressure Monitoring during Intermittent Hemodialysis

Introduction: Hypotension is common during intermittent hemodialysis (IHD) and may be due to a decreased cardiac index (CI). However, no study has simultaneously and continuously measured CI and mean arterial pressure (MAP) to understand the prevalence, severity, and duration of CI decreases or relate them to MAP, blood volume (BV), and net ultrafiltration (NUF) rate. Methods: In a prospective, pilot and feasibility investigation, we studied 10 chronic IHD patients. We used the ClearSight System™ to continuously monitor CI and MAP; the CRIT-LINE®IV monitor to detect BV changes and collected data on NUF rate. Results: Device tolerance and compliance were 100%. All patients experienced at least ≥1 episode of severe CI decrease (>25% from baseline), with a median duration of 24 min (IQR 6–87) and of 68 min [14–106] for moderate decreases (>15% but ≤25% from baseline). Eight patients experienced a low CI state (<2.2 L/min/m2). The lowest CI was 0.9 L/min/m2 with a concomitant MAP of 94 mm Hg. When the fall in CI was severe, MAP increased in 58% of cases and remained stable in 28%. Overall, CI decreased by −0.55 L/min/m2 when BV decrease was moderate versus mild (p < 0.001) and by −0.8 L/min/m2 when NUF rate was high versus low (p < 0.001). Conclusion: Continuous CI monitoring is feasible in IHD and shows frequent moderate-severe CI decreases, sometimes to low CI state levels. Such decreases are typically associated with markers of decreased intravascular volume status but not with a decrease in MAP, implying marked vasoconstriction.

A real-time cardiac output monitoring system based on photoplethysmography

Abstract Cardiac output is a critical parameter for assessing the cardiovascular system, and thermodilution is commonly used as CO monitoring in clinical settings. Thermodilution cannot be applied in continuous monitoring due to invasion. Photoplethysmography signal originates from the cardiovascular system. We proposed a CO continuous monitoring system based on photoplethysmography and deep learning method. PPG waveform parameters are extracted during the pre-processing stage, and fed into the deep learning model to calculate cardiac output. The system employs an analog front-end chip and an HPS_FPGA architecture to capture PPG signals. The pre-processing and the deep learning model-driven algorithm are designed in Python on the custom Linux for HPS. It realizes the real-time processing of the PPG signals and the continuous monitoring of cardiac output. Validated by an FPGA, the system reported average cardiac output monitoring results of approximately 5.09 L/min at rest and about 7.39 L/min after exercise.

Bioreactance noninvasive cardiac output monitoring in euvolemic adult horses subjected with 7.2% saline and 6% hydroxyethyl starch (130/0.4) solution infusions.

To compare the ability of bioreactance noninvasive cardiac output (BR-NICO) with thermodilution cardiac output (TDCO) for the measurement of cardiac output (CO) in healthy adult horses receiving 2 different IV volume replacement solutions. Prospective randomized crossover study from September to November 2021. University teaching hospital. Six university-owned adult horses. Horses were randomly assigned to receive 7.2% hypertonic saline solution (HSS) or 6% hydroxyethyl starch (130/0.4) solution (HETA). BR-NICO and TDCO were measured simultaneously at baseline, 10, 20, 30, 40, 50, 60, 90, and 120minutes before fluid administration and again at the same times after starting a bolus infusion of IV volume replacers. All solutions were administered within 10minutes. BR-NICO and TDCO were strongly correlated (Pearson r2=0.93; P<0.01). Regression analysis showed the relationship between TDCO and BR-NICO was BR-NICO=0.48×TDCO+0.6. For the corrected BR-NICO values, the Bland-Altman agreement mean bias and lower/upper limits of agreement were -0.62 and -5.3 to 3.9L/min, respectively. Lin's concordance (95% confidence interval) between methods was 0.894 (0.825-1.097). Compared with baseline, HSS increased the CO at 10 and 20minutes (TDCO and BR-NICO). Compared with baseline, HETA decreased the CO at 10 and 20minutes (TDCO and BR-NICO) and increased the CO at 90 (TDCO only) and 120minutes (TDCO and BR-NICO). BR-NICO strongly agreed with TDCO in the measurement of CO in healthy unsedated adult horses. HSS administration significantly increased CO in the first 30minutes, while HETA initially decreased CO at 10minutes but increased CO to above baseline values by 90minutes.

Occurrence of Low Cardiac Index During Normotensive Periods in Cardiac Surgery: A Prospective Cohort Study Using Continuous Noninvasive Cardiac Output Monitoring.

Continuous cardiac output monitoring is not standard practice during cardiac surgery, even though patients are at substantial risk for systemic hypoperfusion. Thus, the frequency of low cardiac output during cardiac surgery is unknown. We conducted a prospective cohort study at a tertiary medical center from July 2021 to November 2023. Eligible patients were ≥18 undergoing isolated coronary bypass (CAB) surgery with the use of cardiopulmonary bypass (CPB). Cardiac output indexed to body surface area (CI) was continuously recorded at 5-second intervals throughout surgery using a US Food and Drug Administration (FDA)-approved noninvasive monitor from the arterial blood pressure waveform. Mean arterial blood pressure (MAP) and central venous pressure (CVP) were also analyzed. Low CI was defined as <2 L/min/m2 and low MAP as <65 mm Hg. We calculated time with low CI for each patient for the entire surgery, pre-CPB and post-CPB periods, and the proportion of time with low CI and normal MAP. We used Pearson correlation to evaluate the relationship between CI and MAP and paired Wilcoxon rank sum tests to assess the difference in correlations of CI with MAP before and after CPB. In total, 101 patients were analyzed (age [standard deviation, SD] 64.8 [9.8] years, 25% female). Total intraoperative time (mean [SD]) with low CI was 86.4 (62) minutes, with 61.2 (42) minutes of low CI pre-CPB and 25.2 (31) minutes post-CPB. Total intraoperative time with low CI and normal MAP was 66.5 (56) minutes, representing mean (SD) 69% (23%) of the total time with low CI; 45.8 (38) minutes occurred pre-CPB and 20.6 (27) minutes occurred post-CPB. Overall, the correlation (mean [SD]) between CI and MAP was 0.33 (0.31), and the correlation was significantly higher pre-CPB (0.53 [0.32]) than post-CPB (0.29 [0.28], 95% confidence interval [CI] for difference [0.18-0.34], P < .001); however, there was substantial heterogeneity among participants in correlations of CI with MAP before and after CPB. Secondary analyses that accounted for CVP did not alter the correlation between CI and MAP. Exploratory analyses suggested duration of low CI (C <2 L/min/m2) was associated with increased risk of postoperative acute kidney injury (odds ratios [ORs] = 1.09; 95% CI; 1.01-1.13; P = .018). In a prospective cohort of patients undergoing CAB surgery, low CI was common even when blood pressure was normal. CI and MAP were correlated modestly. Correlation was higher before than after CPB with substantial heterogeneity among individuals. Future studies are needed to examine the independent relation of low CI to postoperative kidney injury and other adverse outcomes related to hypoperfusion.

Agreement of cardiac index measurements between ultrasonic cardiac output monitor and transthoracic echocardiography in neonates.

To evaluate the agreement of cardiac index (CI) calculated by Ultrasonic sonic cardiac output monitor (USCOM) and transthoracic thoracic echocardiography (TTE) in order to know if we can recommend USCOM in our pediatric intensive care unit (PICU). Prospective observational evaluative study carried out over a period of 3 months Setting: PICU at children's hospital in Tunis Participants: All newborns without tracheostomy or a known congenital heart disease, admitted to the PICU during the study period were enrolled. Paired and consecutive measurements of CI were obtained in all patients with both technologies. All measurements by TTE and USCOM were performed by two distinct operators. It is the average of three successive measures of the CI, in the same patient, with each technology, which was considered. Agreement of CI between the 2 techniques was assessed by Bland-Altman analysis and percentage error. Forty-two infants were analyzed with the mean (standard deviation) gestation 36 weeks ( 5 days), age 1 days (1.09) , and weight 2.9 kg (0.87). Respiratory failure was the main cause of admission 75%. At the time of the study, 33 (75.%) patients were ventilated artificially. Bias (mean difference) of the CI between the two methods was 1.2 l/min/m2 and precision (± 2 SD of differences) was 1.08 l/min/m2. The MPE of CI measurement for USCOM vs TTE was 54.9%. The USCOM showed a poor agreement to TTE measures of CI. The two methods cannot be considered interchangeable.

Reliability and benefit of estimated continuous cardiac output measurement using shunt-side SpO2 monitor in hemodialysis.

Estimated continuous cardiac output (esCCO) is a novel technology that enables non-invasive and continuous monitoring of cardiac output. We compared the concordance in accuracies among esCCO measurements in the shunt limb and non-shunt limb. In this single-center prospective observational study, we include Japanese patients who underwent dialysis at our center between April 27, 2021, and February 28, 2023. Clinical accuracy of esCCO was evaluated in the shunted and non-shunted bilateral digits. Agreement between the measurements was analyzed using Lin's congruent correlation and Bland-Altman analysis. For 43 individuals, Lin's concordance correlation coefficient was 0.9887 (95% confidence interval of 0.9886-0.9887) indicating good agreement. The values of esCCO measured in the shunt and non-shunt limbs were compatible. The percentage errors for the 43 patients with arterio-venous fistula (AVF) or arterio-venous graft (AVG), 32 with AVF, and 11 with AVG were 9.3%, 9.3%, and 8.9%, respectively. esCCO could be used in shunt as well as non-shunt limbs during dialysis, allowing continuous and non-invasive hemodynamic monitoring.

An hypertensive crisis post caesarean section valuated by UltraSonic Cardiac Output Monitoring (USCOM): a case report

An hypertensive crisis post caesarean section valuated by UltraSonic Cardiac Output Monitoring (USCOM): a case report

Effect of Hemodynamic Monitoring Systems on Short-Term Outcomes after Living Donor Liver Transplantation.

Background and Objectives: To evaluate the effects of the pulse index continuous cardiac output and MostCare Pressure Recording Analytical Method hemodynamic monitoring systems on short-term graft and patient outcomes during living donor liver transplantation in adult patients. Materials and Methods: Overall, 163 adult patients who underwent living donor liver transplantation between January 2018 and March 2022 and met the study inclusion criteria were divided into two groups based on the hemodynamic monitoring systems used during surgery: the MostCare Pressure Recording Analytical Method group (n = 73) and the pulse index continuous cardiac output group (n = 90). The groups were compared with respect to preoperative clinicodemographic features (age, sex, body mass index, graft-to-recipient weight ratio, and Model for End-stage Liver Disease score), intraoperative clinical characteristics, and postoperative biochemical parameters (aspartate aminotransferase, alanine aminotransferase, total bilirubin, direct bilirubin, prothrombin time, international normalized ratio, and platelet count). Results: There were no significant between-group differences with respect to recipient age, sex, body mass index, graft-to-recipient weight ratio, Child, Model for End-stage Liver Disease score, ejection fraction, systolic pulmonary artery pressure, surgery time, anhepatic phase, cold ischemia time, warm ischemia time, erythrocyte suspension use, human albumin use, crystalloid use, urine output, hospital stay, and intensive care unit stay. However, there was a significant difference in fresh frozen plasma use (p < 0.001) and platelet use (p = 0.037). Conclusions: The clinical and biochemical outcomes are not significantly different between pulse index continuous cardiac output and MostCare Pressure Recording Analytical Method as hemodynamic monitoring systems in living donor liver transplantation. However, the MostCare Pressure Recording Analytical Method is more economical and minimally invasive.

A recommendation for the use of electrical biosensing technology in neonatology.

Non-invasive cardiac output monitoring, via electrical biosensing technology (EBT), provides continuous, multi-parameter hemodynamic variable monitoring which may allow for timely identification of hemodynamic instability in some neonates, providing an opportunity for early intervention that may improve neonatal outcomes. EBT encompasses thoracic (TEBT) and whole body (WBEBT) methods. Despite the lack of relative accuracy of these technologies, as compared to transthoracic echocardiography, the use of these technologies in neonatology, both in the research and clinical arena, have increased dramatically over the last 30 years. The European Society of Pediatric Research Special Interest Group in Non-Invasive Cardiac Output Monitoring, a group of experienced neonatologists in the field of EBT, deemed it appropriate to provide recommendations for the use of TEBT and WBEBT in the field of neonatology. Although TEBT is not an accurate determinant of cardiac output or stroke volume, it may be useful for monitoring longitudinal changes of hemodynamic parameters. Few recommendations can be made for the use of TEBT in common neonatal clinical conditions. It is recommended not to use WBEBT to monitor cardiac output. The differences in technologies, study methodologies and data reporting should be addressed in ongoing research prior to introducing EBT into routine practice. IMPACT STATEMENT: TEBT is not recommended as an accurate determinant of cardiac output (CO) (or stroke volume (SV)). TEBT may be useful for monitoring longitudinal changes from baseline of hemodynamic parameters on an individual patient basis. TEBT-derived thoracic fluid content (TFC) longitudinal changes from baseline may be useful in monitoring progress in respiratory disorders and circulatory conditions affecting intrathoracic fluid volume. Currently there is insufficient evidence to make any recommendations regarding the use of WBEBT for CO monitoring in neonates. Further research is required in all areas prior to the implementation of these monitors into routine clinical practice.

The therapeutic effect of levosimendan in patients with prolonged ventilator weaning and cardiac dysfunction.

To explore the therapeutic effect of levosimendan in patients with prolonged ventilator weaning and cardiac dysfunction. Patients with prolonged ventilator weaning and cardiac dysfunction were randomly allocated to receive conventional treatment (control group) or intravenous infusion of levosimendan for 24 h based on conventional treatment (levosimendan group). Weaning success rates were then compared between the two groups. The study was retrospectively registered with Research Registry (ID No. researchregistry10304). A total of 40 patients were included (20 per group). Within 3 days after initiation of treatment, significantly more cases were successfully weaned in the levosimendan group versus control group (eight versus four cases, respectively). Among the eight patients who underwent pulse indicator continuous cardiac output monitoring in the levosimendan group, the global ejection fraction increased 24 h after treatment, and the cardiac function index and cardiac index increased 72 h after treatment. For patients requiring prolonged mechanical ventilation who have concomitant cardiac dysfunction, levosimendan may be considered to increase the probability of weaning success.

Hemodynamic Changes of Women with Preeclampsia Undergoing Spinal Anesthesia for Emergency Cesarean Section: A Prospective Observational Study

Abstract Background: Preeclampsia is a multisystem disorder in pregnancy and remains a significant cause of maternal morbidity and mortality. In this prospective observational study, we used a continuous noninvasive cardiac output monitor to investigate the changes in arterial blood pressure, cardiac output, systemic vascular resistance, stroke volume, and stroke volume variation during the immediate perioperative period. Materials and Methods: Women with preeclampsia undergoing emergency cesarean section under spinal anesthesia were recruited in this prospective observational study. Cardiac output and arterial blood pressures were measured by the Nexfin monitor. Cardiovascular parameters were recorded intraoperatively and up to 48 h postoperatively. The primary outcome was to examine the differences in cardiac output between the intraoperative and postoperative periods. Results: Thirty patients included in the data analysis had a mean age of 35.6 ± 5.2 years and gestation of 35.4 ± 2.1 weeks. Post-spinal anesthesia, 50% experienced hypotension. 26.7% had nausea, 10% vomited, and other events included shivering, reactive hypertension, and bradycardia. The use of spinal anesthesia was associated with a significant reduction in systolic (126.7 ± 16.9 vs. 142.0 ± 21.2 mm Hg, P &lt; 0.001), diastolic (71.2 ± 8.4 vs. 77.0 ± 11.3 mm Hg, P &lt; 0.001), mean arterial pressure (92.6 ± 12.2 vs. 103.7 ± 15.3 mm Hg, P &lt; 0.001), cardiac output, and stroke volume compared to postoperative readings. No significant difference was found in cardiac output, cardiac index, or systemic vascular resistance indices between the intraoperative and postoperative periods. Conclusion: Spinal anesthesia may have short-term hemodynamic changes in women with preeclampsia. Continuous noninvasive cardiac monitoring can be used to monitor specific cardiac hemodynamic parameters, which may resolve in the immediate postoperative period.

Controlled ovarian stimulation leads to cardiovascular changes in patients undergoing in vitro fertilization

ObjectiveTo study hemodynamic changes along controlled ovarian stimulation in women undergoing in vitro fertilization. Study designProspective observational cohort study conducted at Mother and Child Department of University Hospital Federico II, in Naples, Italy, between April 2021 and July 2022. Sixty-eight infertile patients undergoing controlled ovarian stimulation with gonadotropin, antagonist protocol and a fresh embryo transfer were included. Haemodynamic assessment was carried out using UltraSonic Cardiac Output Monitor at baseline (T1), estradiol peak (T2), fresh embryo-transfer day (T3). To evaluate relationships between quantitative variables and groups a Student T test for independent data was assessed. One-way analysis of variance (ANOVA) was used to determine the differences between the means of three time points (T1, T2 and T3) for quantitative variables. A mixed-model analysis of variance (ANOVA) was used to determine the differences between groups, among time points (T1, T2 and T3). ResultsSixty-eight patients were included. Significant differences over the three time points have been observed for CO (f = 3.78 l/min; p = 0.025), SVI (f = 3.56 ml/m2;p = 0.013), and RSVI (f = 4.84 dscm-5 m2; p = 0.009). No significant differences in trends have been found between beta hCG positive and beta hCG negative groups. There were no significant differences in maternal hemodynamic parameters at time-point T3 between patients treated with hCG 10,000 UI and with Triptorelin. Patients considered at increased risk of hyperstimulation reported a significant increase in SVI at baseline (26.9 ± 9.0 mL/m2 vs 21.9 ± 7.0 mL/m2; p = 0.010). ConclusionAccording to the results of our study, during controlled ovarian stimulation with antagonist protocol, patients undergo significant changes in maternal cardiovascular parameters over a very short period.

Ultrasonic Cardiac Output Monitor (USCOM) Parameters in Pediatric COVID-19 Patients: A Case Series

Background: The increase in the spread of the novel coronavirus (SARS-CoV-2) has put many children at risk around the world. Some of these patients are in critical condition and present with shock symptoms and cardiac system problems. The ultrasonic cardiac output monitor (USCOM) is a non-invasive device that determines a person's cardiac output using continuous wave Doppler ultrasound. Objectives: The current study aims to present the clinical and laboratory manifestations of children with coronavirus disease (COVID-19) and to use a USCOM device for hemodynamic assessment to record and review their clinical information. Patients and Methods: We introduce 22 cases of children infected with coronavirus admitted to a public hospital in Iran. We examined the hemodynamics of these patients using USCOM and reported our experience with pediatric patients presenting with shock. This was a retrospective study, and data were collected using medical records. Results: In this study, 22 pediatric cases (10 girls and 12 boys) infected with coronavirus were reported. The youngest was 3 months old and the oldest was 14 years old. The most commonly observed symptoms were low back pain (N = 15), fever (N = 12), and seizures (N = 10). We found that the hemodynamics of the patients, including systemic vascular resistance (SVR), were abnormal and were associated with hypotension and unstable hemodynamics. The children responded well to the administration of an intravenous norepinephrine drip. Conclusion: This study presents detailed clinical and laboratory results of 22 children with COVID-19. Additionally, their hemodynamic status was measured and presented using the USCOM device. This information can provide physicians with a comprehensive understanding of the clinical history of patients referred with COVID-19, thereby improving their knowledge and care delivery.

A comparison of hemodynamic measurement methods during orthotopic liver transplantation: evaluating agreement and trending ability of PiCCO versus pulmonary artery catheter techniques

BackgroundSignificant hemodynamic changes occur during liver transplantation, emphasizing the importance of precious and continuous monitoring of cardiac output, cardiac index, and other parameters. Although the monitoring of cardiac output by pulse indicator continuous cardiac output (PiCCO) was statistically homogeneous compared to the clinical gold standard pulmonary artery catheterization (PAC) in previous studies of liver transplantation, there are fewer statistical methods for the assessment of its conclusions, and a lack of comparisons of other hemodynamic parameters (e.g., SVRI, systemic vascular resistance index). Some studies have also concluded that the agreement between PiCCO and PAC is not good enough. Overall, there are no uniform conclusions regarding the agreement between PiCCO and PAC in previous studies. This study evaluates the agreement and trending ability of relevant hemodynamic parameters obtained with PiCCO compared to the clinical gold standard PAC from multiple perspectives, employing various statistical methods.MethodsFifty-two liver transplantation patients were included. Cardiac output (CO), cardiac index (CI), SVRI and stroke volume index (SVI) values were monitored at eight time points using both PiCCO and PAC. The results were analyzed by Bland-Altman analysis, Passing-bablok regression, intra-class correlation coefficient (ICC), 4-quadrant plot, polar plot, and trend interchangeability method (TIM).ResultsThe Bland-Altman analysis revealed high percentage errors for PiCCO: 54.06% for CO, 52.70% for CI, 62.18% for SVRI, and 51.97% for SVI, indicating poor accuracy. While Passing-Bablok plots showed favorable agreement for SVRI overall and during various phases, the agreement for other parameters was less satisfactory. The ICC results confirmed good overall agreement between the two devices across most parameters, except for SVRI during the new liver phase, which showed poor agreement. Additionally, four-quadrant and polar plot analyses indicated that all agreement rate values fell below the clinically acceptable threshold of over 90%, and all angular deviation values exceeded ± 5°, demonstrating that PiCCO is unable to meet the acceptable trends. Using the TIM, the interchangeability rates were found to be quite low: 20% for CO and CI, 16% for SVRI, and 13% for SVI.ConclusionsOur study revealed notable disparities in absolute values of CO, CI, SVRI and SVI between PiCCO and PAC in intraoperative liver transplant settings, notably during the neohepatic phase where errors were particularly pronounced. Consequently, these findings highlight the need for careful consideration of PiCCO’s advantages and disadvantages in liver transplantation scenarios, including its multiple parameters (such as the encompassing extravascular lung water index), against its limited correlation with PAC.

Derivation of Stroke Volume from Pulmonary Artery Pressures.

Intermittent cardiac output (CO) studies using thermodilution are considered the gold standard. We have developed a stroke volume (SV) calculator from pulmonary pulse pressure (PP) to allow continuous monitoring of SV and CO from PP. Hemodynamic data on 169 patients following orthotopic heart transplantation were used to compare our calculator-derived SV (and SV index, or SVi) against thermodilution-derived SV on admission into intensive care unit immediately following heart transplantation (T0) and 6h after admission (T6). The calculated SV correlated with thermodilution-derived SV T0 (r = 0.920, p < 0.001, coefficient of 0.539 and the constant of 2.06). The median calculator SV, adjusted for coefficient and constant, was 48.4ml (37.7, 60.7), comparable to the median thermodilution-derived SV 47.9ml (37.5, 61.0), p = 0.737 with acceptable agreement on Bland-Altman plots. The thermodilution-derived SVi was 28.1ml (19.7, 38.7) and adjusted calculator-derived SVi 28.9ml (19.7, 39.9), p = 0.781. At T6, median thermodilution-derived SVi was 27.7ml (19.5, 35.9) compared to the calculator-derived SVi median of 26.1ml (17.7, 37.7), p = 0.203. Changes in PP can be used to track changes in SV using this calculator. Changes in PP may be used to assess response to treatment in the early post-operative period.

The Effect of Mannitol and Hypertonic Sodium Administration on Hemodynamic Parameters Under LiDCO Monitoring in Patients Undergoing Elective Craniotomy

In craniotomy surgery, it is important to maintain hemodynamics and prevent the increase of intracranial pressure. Using semi-invasive methods such as LiDCO monitoring is a good option in this situation. This study aimed to evaluate the effectiveness of mannitol and hypertonic sodium on hemodynamic parameters in patients undergoing elective craniotomy. This randomized clinical trial was done on 40 patients of both genders. Patients whose ages were between 18-65 years, who had American Society of Anesthesiologists (ASA) score I and II, and who underwent craniotomy surgery were eligible for this study. Participants were divided into two groups receiving hypertonic sodium and mannitol. Hemodynamic parameters were evaluated before surgery, 20 minutes, and 60 minutes after surgery in both groups, under Lithium dilution cardiac output (LiDCO) monitoring. The results showed that there was no difference between groups in terms of the average fluid intake, the duration of the operation, the amount of urinary output, and the primary hemodynamic characteristics. Significant differences were recorded in the evaluation of hemodynamic parameters. The results demonstrated a reduction in systolic, diastolic, and mean arterial blood pressure during 20 to 60 minutes after mannitol injection compared to hypertonic sodium injection. Additionally, the effectiveness of both therapies on maintaining cardiac function was similar, but the use of mannitol led to a greater decrease in arterial and peripheral vascular resistance. It can be concluded that mannitol may be more effective than hypertonic sodium during craniotomy procedures in terms of reducing blood pressure monitored with LiDCO.