Hemodynamic Monitoring System Research Articles

ECG Features in Orthotopic Cardiac Xenotransplantation: Comparisons With Published Literature

ABSTRACTIntroductionAlthough there is a plethora of literature on electrocardiographic changes following cardiac allotransplantation, there is little in the field of cardiac xenotransplantation. The only published literature to date is that of the first pig‐to‐human cardiac xenotransplantation. Here we take a close look at the electrocardiographic parameters in four non‐human primate recipients of orthotopic cardiac xenotransplantation to develop baseline metrics for comparison.MethodsOrthotopic cardiac xenotransplantion was carried out in four non‐human primate recipients. Electrocardiographic parameters were followed at various intervals using an internal hemodynamic monitoring system (DSI) as well as a standard 12‐lead electrocardiogram (ECG). ECG intervals were then compared to published literature on porcine ECG intervals and pig‐to‐human cardiac xenotransplantation.ResultsThere were no significant differences observed between timepoints for HR, PR, QRS, QT, or QTc after cardiac xenotransplantation for each animal subject. ECG parameters were statistically similar to those of in situ mini‐pig hearts in the literature. ECG parameters from the DSI on average were shorter than those from a traditional ECG, however, DSI parameters were consistent over time.ConclusionThese results demonstrate the possibility of conduction health for genetically engineered porcine donor hearts following cardiac xenotransplantation. Ongoing work to compare the results of an ECG in a porcine donor heart before and after implantation into a NHP is necessary to better characterize variables that may be at play in the function of the conduction system.

Rosmanol Alleviates Myocardial Ischemia-Reperfusion Injury by Enhancing the Myocardial miR-126/VEGF/PI3K/AKT Signaling in STZ-Induced Diabetic Rats.

A major factor in type 1 diabetes mortality is Ischemic Heart Disease (IHD). In order to treat IHD, blood flow must be restored to the heart, which results in myocardial ischemia-reperfusion (MI/R) damage. While rosmanol inhibits MI/R damage, its role in diabetic- MI/R (D-MI/R) injury remains unclear. Both microRNA (miR) 126 and the PI3K/AKT signaling pathway have been linked to preventing MI/R damage. The objective of the present study was to investigate whether rosmanol inhibits DMI/ R-injury in diabetic rats and whether miR-126-phosphatidylinositol 3-kinase (PI3K)/ protein kinase B axis (miR-126-PI3K/AKT) is implicated in this protective effect. For 30 days, diabetic rats received either distilled water or the drug rosmanol (40 mg/kg, orally) before being subjected to MI/R. The findings from the current study demonstrated how rosmanol reduced MI/R damage in rats with diabetes caused by streptozotocin (STZ). Using spectrophotometry, it was possible to measure the decrease in myocardial enzyme levels, the rise in cardiac viability, the inhibition of myocardial oxidative stress, the increase in cardiac function, and the detection of these changes using a hemodynamic monitoring system. In addition, rosmanol augmented the miR- 126-PI3K/AKT in the hearts of ischemic rats. After stimulating the myocardial miR-126- PI3K/AKT axis, our results showed that rosmanol protected the heart against MI/R in STZinduced diabetic rats. According to the most recent research, rosmanol may be a useful tool in the therapy of diabetic IHD since it is an effective agent against D-MI/R damage.

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.

The Use of Pressure Recording Analytical Method in Patients Undergoing Endovascular Repair for Abdominal Aortic Aneurysm: The Impact on Clinical Decisions for the Appropriate Postoperative Setting and Cost-effective Analysis.

To analyze the use of the Pressure Recording Analytical Method (PRAM), an hemodynamic monitoring system, in evaluating intraoperative and postoperative hemodynamic instability in patients undergoing endovascular repair for abdominal aortic aneurysm, and to evaluate if the decision to refer patients to a ordinary ward or to a Cardiac Step-Down Unit (CSDU) after the intervention on the basis of intraoperative hemodynamic monitoring could be more cost-effective. After preoperative clinical evaluation, 44 patients were divided in this non-randomised study into two groups according to their postoperative destination: Group 1-ward (N=22) and Group 2-CSDU (N=22). All patients underwent monitoring with PRAM during the intervention and in the 24 postoperative hours, measuring several indices of myocardial contractility and other hemodynamic variables. According to the variability of two parameters, Stroke Volume Variation and Pulse Pressure Variation, patients were classified as stable or unstable. Unstable patients showed a significant alteration in several hemodynamic indices, in comparison to stable ones. According to the intraoperative monitoring, eight high risk patients could have been sent to an ordinary ward due to their stability, with a reduction in the improper use of CSDU and, consequently, in costs. Hemodynamic monitoring with PRAM can be useful in these patients, both for intraoperative management and for the choice of the more appropriate postoperative setting, possibly reducing the improper use of CSDU for hemodynamically stable patients who are judged to be at high risk preoperatively, and re-evaluating low surgical risk patients with an unstable intraoperative pattern, with a possible reduction in costs.

Non-Invasive Hemodynamic Monitoring System Integrating Spectrometry, Photoplethysmography, and Arterial Pressure Measurement Capabilities.

Minimally invasive and non-invasive hemodynamic monitoring technologies have recently gained more attention, driven by technological advances and the inherent risk of complications in invasive techniques. In this article, an experimental non-invasive system is presented that effectively combines the capabilities of spectrometry, photoplethysmography (PPG), and arterial pressure measurement. Both time- and wavelength-resolved optical signals from the fingertip are measured under external pressure, which gradually increased above the level of systolic blood pressure. The optical channels measured at 434-731 nm divided into three groups separated by a group of channels with wavelengths approximately between 590 and 630 nm. This group of channels, labeled transition band, is characterized by abrupt changes resulting from a decrease in the absorption coefficient of whole blood. External pressure levels of maximum pulsation showed that shorter wavelengths (<590 nm) probe superficial low-pressure blood vessels, whereas longer wavelengths (>630 nm) probe high-pressure arteries. The results on perfusion indices and DC component level changes showed clear differences between the optical channels, further highlighting the importance of wavelength selection in optical hemodynamic monitoring systems. Altogether, the results demonstrated that the integrated system presented has the potential to extract new hemodynamic information simultaneously from macrocirculation tomicrocirculation.

Abstract 15449: Cardiopulmonary Best Abstract Award : Pausing Reveals Exercise-Induced Uncoupling: Exploring the Dynamics of RV-PA Coupling in the Six-Minute Walking Test

Background: The six-minute walking test (6MWT) is a commonly used test for assessing the functional capacity of patients with pulmonary hypertension (PH), providing functional and prognostic information. Functional capacity depends on RV-PA coupling, the matching of right ventricular contractility to afterload. However, the dynamics of RV-PA coupling during the 6MWT have never been studied. Methods: We used a wireless hemodynamic monitoring system (CorLog, emka-medical, Germany) to continuously measure right ventricular pressure in 10 patients with PH (8 = group I, 1 = III, 1 = IV) during a 6MWT. We calculated right ventricular ejection fraction (RVEF) and Ees/Ea based on the pressure signal as shown in the figure (panel a). Dyspnea was evaluated using the Borg scale. Results: By analyzing the hemodynamic response during the 6MWT, we identified two patterns: 1) Improved/preserved coupling: Five patients exhibited an initial improvement in Ees/Ea and maintained coupling at least at the baseline level throughout the test, without requiring pauses. 2) Uncoupling associated with pauses: Five patients experienced a slight increase in Ees/Ea at the beginning, followed by a progressive loss of coupling and ejection fraction, necessitating pauses. During pauses, Ees/Ea values restored, enabling patients to resume walking. Patients of the second phenotype reported higher levels of dyspnea. The highest reported Borg score was 8 ± 0.9 vs. 4.6 ± 1.2 in the first group. Also, the covered distance was shorter in the second group (159 ± 64m vs. 288 ± 88m, p=0.03). Both groups showed differences in Ees/Ea (0.47 [0.46 - 0.57] vs. 0.34 [0.30 - 0.43], P=0.05) and RVEF (34 ± 4.1% vs. 28.5 ± 2.6%, P=0.03) at baseline, with Group One exhibiting superior values. Conclusion: This is the first investigation into the significance of RV-PA coupling in real-life exercise limitation and dyspnea during the 6MWT. Pauses observed during the 6MWT can serve as indicators of exercise-induced uncoupling.

Cerebrovascular reactivity to carbon dioxide tension in newborns: data from combined time-resolved near-infrared spectroscopy and diffuse correlation spectroscopy.

Critically ill newborns are at risk of brain damage from cerebrovascular disturbances. A cerebral hemodynamic monitoring system would have the potential role to guide targeted intervention. To obtain, in a population of newborn infants, simultaneous near-infrared spectroscopy (NIRS)-based estimates of cerebral tissue oxygen saturation () and blood flow during variations of carbon dioxide tension () levels within physiologic values up to moderate permissive hypercapnia, and to examine if the derived estimate of metabolic rate of oxygen would stay constant, during the same variations. We enrolled clinically stable mechanically ventilated newborns at postnatal age without brain abnormalities at ultrasound. and blood flow index were measured using a non-invasive device (BabyLux), which combine time-resolved NIRS and diffuse-correlation spectroscopy. The effect of changes in transcutaneous on , cerebral blood flow (CBF), and cerebral metabolic rate of oxygen index () were estimated. Ten babies were enrolled and three were excluded. Median GA at enrollment was 39 weeks and median weight 2720 g. increased 0.58% (95% CI 0.55; 0.61, ), CBF 2% (1.9; 2.3, ), and 0.3% (0.05; 0.46, ) per mmHg increase in . BabyLux device detected -induced changes in cerebral and CBF, as expected. The small statistically significant positive relationship between and variation is not considered clinically relevant and we are inclined to consider it as an artifact.

Conservative management a safer option in high-grade renal injuries: Our institutional experience

Background: Renal injuries constitute around 1–5% of all trauma associated injuries. In present era, there has been a focus toward conservative management for blunt renal injuries. Advancement in radiographic injury grading, improved hemodynamic monitoring systems, valid renal injury grading systems allows successful non-operative management for renal preservation even in cases of Grades IV and V. Aims and Objectives: The aim of our study was to assess outcomes of patients managed conservatively (non-operatively) for high-grade blunt renal injury at our center. The objective of this study is to assess whether high-grade renal injuries can be managed by conservative management successfully or not. Materials and Methods: The study conducted in a retrospective manner using hospital records of the past 2 years. Thirty patients with blunt renal injuries were included in the study and were categorized based on the American association for the surgery of trauma (2018 revised) injury grading. These management strategies were analyzed in terms of “failure of conservative management,” complications, and need for adjuvant procedures. Statistical data analysis was done using Microsoft Excel (2019) software. Results: Thirty patients were included in the study with a mean age of years. Out of the total 30 patients, 17 had Grade I–III injuries, and 13 had Grade IV. All the Grade I–III patients were managed conservatively and required no adjunctive procedures. 10 out of 13 cases of Grade IV injuries underwent non-operative management. Complications included urinary tract infection (5), persistent hematuria (3), hypertension (1), urinoma (2), and ileus (1). All complications were of Clavien Dindo classification of grade 1–2. Conclusion: Grade IV blunt renal injuries can be managed conservatively if the patient is hemodynamically stable.

Expert Consensus on the Use of Human Serum Albumin in Adult Cardiac Surgery.

Expert Consensus on the Use of Human Serum Albumin in Adult Cardiac Surgery.

Current Commonly Used Dynamic Parameters and Monitoring Systems for Perioperative Goal-Directed Fluid Therapy: A Review.

Goal-directed fluid therapy (GDFT) is usually recommended in patients undergoing major surgery and is essential in enhanced recovery after surgery (ERAS) protocols. This fluid regimen is usually guided by dynamic hemodynamic parameters and aims to optimize patients' cardiac output to maximize oxygen delivery to their vital organs. While many studies have shown that GDFT benefits patients perioperatively and can decrease postoperative complications, there is no consensus on which dynamic hemodynamic parameters to guide GDFT with. Furthermore, there are many commercialized hemodynamic monitoring systems to measure these dynamic hemodynamic parameters, and each has its pros and cons. This review will discuss and review the commonly used GDFT dynamic hemodynamic parameters and hemodynamic monitoring systems.

Optimization of Hemodynamic Monitoring System of Heart Rate using Cardiac Sensor

The principles of hemodynamic monitoring have not yet altered in terms of technological development in recent years. The main goal of hemodynamic monitoring system is targeted for critically ill patients’ remains to be an accurate assessment of the systemic circulation and its response to tissue oxygen requirements. The problem due to heart failure caused by a different disease that harms the activity of the heart and hemodynamic circulatory system. It comprises cardiomyopathy, heart disease, a high blood pressure, heart inflammation, and increased heart rate. In present research an attempt was made for hemodynamic monitoring of heart rate by using fabricated cardiac sensor which provide to detect abnormal physiology and take action before the problem starts, such as the cases of organ failure and death arise. The most popular invasive hemodynamic monitoring system is arterial pulse-wave analysis, pulmonary artery catheters, but also central venous catheters. It finds that monitoring of the patient's cardiac output, Pulmonary Artery Pressure (PAP), volume status, and tissue oxygen absorption may be necessary in certain critical cases. It concludes that as medical knowledge of a patient's critical disease is improved, their capacity to monitor and treat efficiently will increase with help of hemodynamic monitoring. In future, On the basis of large data, the advent of artificial intelligence and machine learning may enable predictive analyses of hemodynamic issues before they really arise.

Successful management of a patient with preoperative respiratory failure due to a solid giant retroperitoneal tumor: a case report

BackgroundWe report the successful preoperative management of respiratory failure in a patient with a solid giant retroperitoneal tumor with a hemodynamic monitoring system and nasal high-flow therapy (NHFT).Case presentationTwenty days before his scheduled resection of a giant retroperitoneal liposarcoma, a 64-year-old man presented with dyspnea. After admission to our intensive care unit, he received NHFT and hemodynamic therapy using a LiDCOrapid V3™ monitor (Masimo Japan, Tokyo). NHFT and intense diuresis improved his respiratory condition. The tumor resection was performed on the 5th day. He was discharged to the general ward with an oxygen nasal cannula on the second postoperative day. Although preoperative transthoracic echography showed mild aortic regurgitation and moderate mitral regurgitation, the degree of regurgitation had become trivial about 1-month post-surgery.ConclusionsA cause of preoperative respiratory failure associated with a giant retroperitoneal tumor might be not only diaphragmatic compression but also heart failure and excess fluid volume.

A new noninvasive finger sensor (NICCI system) for continuous blood pressure and pulse pressure variation monitoring: A method comparison study in patients having neurosurgery.

The NICCI system (Getinge, Gothenburg, Sweden) is a new noninvasive haemodynamic monitoring system using a finger sensor. We aimed to investigate the performance of the NICCI system to measure blood pressure and pulse pressure variation compared with intra-arterial measurements. A prospective method comparison study. University Medical Center Hamburg-Eppendorf, Hamburg, Germany. Forty-seven neurosurgery patients. We performed a method comparison study in 47 neurosurgery patients to compare NICCI blood pressure measurements (BP NICCI ) with intra-arterial blood pressure measurements (BP ART ) (Bland-Altman analysis, four-quadrant plot, error grid analysis) and NICCI pulse pressure variation measurements (PPV NICCI ) with pulse pressure variation calculated manually from the intra-arterial blood pressure waveform (PPV ART ) (Bland-Altman analysis, predictive agreement, Cohen's kappa). The mean of the differences ± standard deviation (95% limits of agreement) between BP NICCI and BP ART was 11 ± 10 mmHg (-8 to 30 mmHg) for mean blood pressure (MBP), 3 ± 12 mmHg (-21 to 26 mmHg) for systolic blood pressure (SBP) and 12 ± 10 mmHg (-8 to 31 mmHg) for diastolic blood pressure (DBP). In error grid analysis, 54% of BP NICCI and BP ART MBP measurement pairs were classified as 'no risk', 43% as 'low risk', 3% as 'moderate risk' and 0% as 'significant risk' or 'dangerous risk'. The mean of the differences between PPV NICCI and PPV ART was 1 ± 3% (-4 to 6%). The predictive agreement between PPV NICCI and PPV ART was 80% and Cohen's kappa was 0.55. The absolute agreement between BP NICCI and BP ART was not clinically acceptable. We recommend not using the current version of the NICCI system for blood pressure monitoring during surgery. The absolute agreement between PPV NICCI and PPV ART was clinically acceptable with moderate predictive agreement regarding pulse pressure variation categories. The NICCI system needs to be further developed and re-evaluated when an improved version is available. The study was registered in the German Clinical Trials Register (DRKS00023188) on 2 October 2020.

Comparison of Stroke Volume Variation-based goal-directed Therapy Versus Standard Fluid Therapy in Patients Undergoing Head and Neck Surgery: A Randomized Controlled Study

Background:Perioperative fluid therapy is used to avoid dehydration and hypovolemia. Optimum perioperative fluid administration may improve postoperative outcomes after major surgery, and the optimal strategy remains controversial and uncertain.Aims:The primary outcome was the total amount of intraoperative fluids given between perioperative goal-directed fluid therapy (GDFT) guided by a hemodynamic monitoring system and standard fluid therapy based on “mean arterial pressure-diuresis” data in patients undergoing head and neck surgery. The secondary outcomes were the hemodynamics and laboratory variables, postoperative complications, length of mechanical ventilation, intensive care unit and hospital stay.Study Design:A randomized controlled study.Methods:Sixty patients were scheduled and randomized into two groups of 30 patients each: in the study group, an arterial pressure catheter was inserted and connected to the FloTrac system, whereas in the control group, an arterial pressure catheter was inserted and integrated into the hemodynamic monitoring system with a special transducer. The control group had fluids administered at the discretion of the anesthesiologist according to the mean arterial pressure >65 mmHg and diuresis >0.5 ml/kg/h. In the study group, fluid management was administered to achieve a target value of ≤13% through the stroke volume variation.Results:The total amounts of fluid in the intraoperative period were different between the groups, with the study group receiving significantly more fluids (P = 0.0455). The length of hospital stay was significantly longer in the study group than in the control group (P = 0.012), but prolonged oxygen demand was significantly more frequent in the control group than in the study group (P = 0.017). No difference was found in hemodynamics, lactate kinetics, and vasoactive agent requirements.Conclusion:The standard fluid therapy guided by conventional circulatory parameters appears sufficient for patients with low-to-moderate risk during head and neck surgery.

Facing the Digital Divide: Increasing Video Visits Among Veterans Experiencing Homelessness.

Traditionally, cardiovascular well-being was essentially based on whether the mean blood pressure was above or below a certain value. However, this singular crude method of assessment provides limited insight into overall cardiovascular well-being. Echocardiography has become increasingly used and incorporated into clinical care. New objective modality assessments of cardiovascular status continue to evolve and are being evaluated and incorporated into clinical care. In this review article, we will discuss some of the recent advances in objective assessment of cardiovascular well-being, including the concept of multimodal monitoring. Sophisticated haemodynamic monitoring systems are being developed, including mechanisms of data acquisition and analysis. Their incorporation into clinical care represents an exciting next stage in the management of the infant with cardiovascular compromise.

Performance of the Hypotension Prediction Index May Be Overestimated Due to Selection Bias.

The Hypotension Prediction Index is a proprietary prediction model incorporated into a commercially available intraoperative hemodynamic monitoring system. The Hypotension Prediction Index uses multiple features of the arterial blood pressure waveform to predict hypotension. The index publication introducing the Hypotension Prediction Index describes the selection of training and validation data. Although precise details of the Hypotension Prediction Index algorithm are proprietary, the authors describe a selection process whereby a mean arterial pressure (MAP) less than 75 mmHg will always predict hypotension. We hypothesize that the data selection process introduced a systematic bias that resulted in an overestimation of the current MAP value's ability to predict future hypotension. Since current MAP is a predictive variable contributing to Hypotension Prediction Index, this exaggerated predictive performance likely also applies to the corresponding Hypotension Prediction Index value. Other existing validation studies appear similarly problematic, suggesting that additional validation work and, potentially, updates to the Hypotension Prediction Index model may be necessary.

Sepsis and the microcirculation: the impact on outcomes.

Advances in the treatment of septic shock have historically focused on resuscitation endpoints, mainly mean arterial pressure and cardiac output. As the definitions of sepsis and septic shock have shifted to focus on the diversity of causes of dysregulated host-response we have seen an emerging phenotype where tissue hypoxia persists despite adequate macrocirculatory parameters. Interest in the topic of microcirculation is re-emerging as validated bedside techniques for hemodynamic monitoring, such as video microscopes, are becoming available. We review the current understanding of how sepsis induced hypoperfusion with a focus on recent advances in monitoring the microcirculation, and how a proliferation of biomarkers and emerging therapeutic targets may impact future research. Conventional hemodynamic monitoring systems fail to assess the microcirculation, and it's response to treatment. Lactate and venous oxygen saturations often drive biomarker-guided sepsis management. Visual assessments such as mottling and capillary refill time are often associated with predicting outcomes, but sometimes can have issues with inter-provider reliability. Microcirculatory damage can be observed sublingually and appears to have prognostic value. Sepsis is associated with changes in the microcirculation that can lead to tissue hypoxia and organ dysfunction. Further studies are needed to validate the usefulness of microcirculatory bedside tools in guiding resuscitative efforts.

Control of Postoperative Hypotension Using a Closed-Loop System for Norepinephrine Infusion in Patients After Cardiac Surgery: A Randomized Trial.

Vasopressors are a cornerstone for the management of vasodilatory hypotension. Vasopressor infusions are currently adjusted manually to achieve a predefined arterial pressure target. We have developed a closed-loop vasopressor (CLV) controller to help correct hypotension more efficiently during the perioperative period. We tested the hypothesis that patients managed using such a system postcardiac surgery would present less hypotension compared to patients receiving standard management. A total of 40 patients admitted to the intensive care unit (ICU) after cardiac surgery were randomized into 2 groups for a 2-hour study period. In all patients, the objective was to maintain mean arterial pressure (MAP) between 65 and 75 mm Hg using norepinephrine. In the CLV group, the norepinephrine infusion was controlled via the CLV system; in the control group, it was adjusted manually by the ICU nurse. Fluid administration was standardized in both groups using an assisted fluid management system linked to an advanced hemodynamic monitoring system. The primary outcome was the percentage of time patients were hypotensive, defined as MAP <65 mm Hg, during the study period. Over the 2-hour study period, the percentage of time with hypotension was significantly lower in the CLV group than that in the control group (1.4% [0.9-2.3] vs 12.5% [9.9-24.3]; location difference, -9.8% [95% CI, -5.4 to -15.9]; P < .001). The percentage of time with MAP between 65 and 75 mm Hg was also greater in the CLV group (95% [89-96] vs 66% [59-77]; location difference, 27.6% [95% CI, 34.3-19.0]; P < .001). The percentage of time with an MAP >75 mm Hg (and norepinephrine still being infused) was also significantly lower in patients in the CLV group than that in the control group (3.2% [1.9-5.4] vs 20.6% [8.9-32.5]; location difference, -17% [95% CI, -10 to -24]; P < .001).The number of norepinephrine infusion rate modifications over the study period was greater in the CLV group than that in the control group (581 [548-597] vs 13 [11-14]; location difference, 568 [578-538]; P < .001). No adverse event occurred during the study period in both groups. Closed-loop control of norepinephrine infusion significantly decreases postoperative hypotension compared to manual control in patients admitted to the ICU after cardiac surgery.

Choosing the Best Method for Hemodynamic Monitoring

Optimizing hemodynamics improves patient outcomes in critically ill patients. There are many types of hemodynamic monitoring. When choosing the monitoring type, factors include accuracy, invasiveness, the desired hemodynamic variables, and potential complications. For example, the Pulmonary Artery Catheter is invasive and can be associated with catheter-related complications. Still, the values it provides have been validated and may be more useful when treating patients with heart problems. New minimally invasive and noninvasive hemodynamic monitoring systems, such as the Flo Trac and the ClearSight, deliver functional hemodynamic values that can be used to evaluate the real-time response to fluid administration. Minimally invasive and noninvasive devices’ ease of use, availability, and relative lack of patient complications make them appealing. However, they may lack accuracy in some situations.

Blood circulation changes associated with switching to non-invasive ventilation in COVID-19 patients

Background. Various methods of respiratory support in combination with prone positioning have been used during the COVID-19 pandemic. The effects of combination of these two factors on hemodynamics are of interest for clinical practitioners.The aim: to evaluate the effect of prone positioning on hemodynamics in COVID-19 patients depending on the method of respiratory support.Materials and methods. The study included 17 patients of both sexes diagnosed with COVID-19-associated community-acquired polysegmental viral and bacterial pneumonia with progressive respiratory failure. The study consisted of two stages. During the first stage, the patients were receiving respiratory support with humidified oxygen (3–7 liters per minute). The second stage was initiated after switching to noninvasive ventilation (NIV). The measurements were performed using a technique of volumetric compression oscillometry on a non-invasive hemodynamic monitoring system KAP CGosm-Globus (Russia).Results. The study showed that prone positioning in patients with severe COVID-19 when switching from oxygen therapy to NIV resulted in a change in the diastolic blood pressure difference module from 2.5 (1.0; 8.2) to 8.0 (5.7; 14.0) (p = 0.016). Escalation of respiratory support led to the changes in the left ventricular outflow tract velocity difference module from 11.5 (9.5; 34.2) to 31.0 (15.7; 42.0) (p = 0.049).Conclusions. Patients with community-acquired polysegmental viral and bacterial pneumonia associated with COVID-19 demonstrated changes in diastolic blood pressure and left ventricular outflow tract velocity as a result of prone positioning following switching from oxygen therapy to NIV.