Arterial Blood Pressure Monitoring Research Articles

ROLE OF THE NURSE IN MANAGING INVASIVE BLOOD PRESSURE MONITORING

Abstract Introduction Arterial blood pressure (BP) monitoring is an invasive system for directly tracking and measuring BP and finds its use in critically ill patients who require continuous hemodynamic monitoring and frequent arterial blood test. [1] Invasive monitoring requires the use of sophisticated equipment and specific skills for its management, which influence the quality of care, including the introduction of a catheter inside the arterial vessel. [2] Intra–arterial catheterization is considered the Gold Standard for a direct measurement of BP. [3] Therefore, the objective of this work is to outline the role of the nurse in the management of invasive BP monitoring, with particular attention to the possibility of independently managing the positioning of the arterial cannula itself. Materials and Methods A review was performed on the management of invasive BP monitoring, with a particular focus on the role of the nurse in arterial cannula positioning. The Pubmed database was consulted. The search strategy involved the use of Mesh terms and free terms, including "Hemodynamic Monitoring" “Vascular Access Devices” “Critical Care Nursing” “Arterial cannulation”. The terms used were combined together using the Boolean operator “AND”. The Code of Conduct for the Nursing ProfessionsMand the National Collective Labor Agreement were also examinatedand, along with everyday practice of professionals in this field of action. Results There are no studies in literature that clearly outline the role of the different professional figures in the management of invasive BP monitoring and there are no clear references regarding who is responsible for positioning the arterial cannula. The development of continuing education programs in the area of clinical reasoning skills for hemodynamic monitoring should be more emphasized. Furthermore, we should focus more on improving practical skills for hemodynamic monitoring. [4] Conclusions Advanced skills need to be officially acknowledge to the expert professional by the institutions they belong to, which should contribute to training by creating accredited company courses. Not only to protect assisted people and the professional, but also in order to enhance their work and give it the right recognition. Subsequently, studies could be carried out to evaluate the effective reduction in latency times between non–invasive monitoring and invasive monitoring on critically ill patients, if managed by the nurse.

Invasive arterial blood pressure delineator for cardiopulmonary resuscitation patients during pauses of chest compressions

Invasive arterial blood pressure (IBP) monitoring is important to assess patient’s cardiovascular competence and guide clinical treatment. Besides, international resuscitation guidelines in force suggest its use during Cardiopulmonary Resuscitation (CPR), but current automated algorithms for IBP variables computation were not designed for cardiac arrest patients. A lack of knowledge is detected in the automated processing of IBP signal during CPR.The aim of this study was to design algorithms for heartbeat detection and for IBP physiological variable computation during CPR, and compare to state-of-the-art (SoA) proposals. The dataset used consists of 81 out-of-hospital-cardiac-arrest (OHCA) patients and two additional public datasets with hemodynamically stable patients. A set of 377 IBP segments, total duration of 1127 min, were extracted from the OHCA dataset during the pauses of chest compressions. The method includes artifact removing from the in IBP using Stationary Wavelet Decomposition and heartbeat detection in the first difference signal. A multicomponent evaluation and two adaptive thresholds were applied to compute IBP physiological variables.Pulsatile segments with heartbeats were discriminated from pulseless segments with mean (standard deviation) sensitivity(Se)/specificity and positive (PPV)/negative predictive values of 98.8(6.9)/91.6(20.2)% and 97.4(9.7)/98.7(6.1)%, respectively. The heartbeat detection showed 96.1(8.3)% of Se, 96.1(7.6)% of PPV and 95.7(6.4)% of F1-score , with absolute errors of 0.55(2.91)/0.39(4.87)/0.78(6.08)mmHg in systolic, diastolic and pulse pressure values, respectively. The proposed algorithms outperformed SoA solutions with both OHCA and stable patients.

Visualization of Cerebral Pressure Autoregulatory Insults in Traumatic Brain Injury.

The first aim was to investigate the combined effect of insult intensity and duration of the pressure reactivity index (PRx) and deviation from the autoregulatory cerebral perfusion pressure target (∆CPPopt = actual CPP - optimal CPP [CPPopt]) on outcome in traumatic brain injury. The second aim was to determine if PRx influenced the association between intracranial pressure (ICP), CPP, and ∆CPPopt with outcome. Observational cohort study. Neurocritical care unit, Cambridge, United Kingdom. Five hundred fifty-three traumatic brain injury patients with ICP and arterial blood pressure monitoring and 6-month outcome data (Glasgow Outcome Scale [GOS]). None. The insult intensity (mm Hg or PRx coefficient) and duration (minutes) of ICP, PRx, CPP, and ∆CPPopt were correlated with GOS and visualized in heatmaps. In these plots, there was a transition from favorable to unfavorable outcome when PRx remained positive for 30 minutes and this was also the case for shorter durations when the intensity was higher. In a similar plot of ∆CPPopt, there was a gradual transition from favorable to unfavorable outcome when ∆CPPopt went below -5 mm Hg for 30-minute episodes of time and for shorter durations for more negative ∆CPPopt. Furthermore, the percentage of monitoring time with certain combinations of PRx with ICP, CPP, and ∆CPPopt were correlated with GOS and visualized in heatmaps. In the combined PRx/ICP heatmap, ICP above 20 mm Hg together with PRx above 0 correlated with unfavorable outcome. In a PRx/CPP heatmap, CPP below 70 mm Hg together with PRx above 0.2-0.4 correlated with unfavorable outcome. In the PRx-/∆CPPopt heatmap, ∆CPPopt below 0 together with PRx above 0.2-0.4 correlated with unfavorable outcome. Higher intensities for longer durations of positive PRx and negative ∆CPPopt correlated with worse outcome. Elevated ICP, low CPP, and negative ∆CPPopt were particularly associated with worse outcomes when the cerebral pressure autoregulation was concurrently impaired.

A New Approach to Vascular Screening: Identification of Impaired Vascular Function Using the FMSF Technique.

Arterial blood pressure monitoring plays an important role in preventive medicine, allowing, in selected cases, the identification of vascular dysfunction. In this review, we propose a new non-invasive approach to assessment of the circulatory system, based on its reaction to hypoxia induced by post-occlusive reactive hyperemia (PORH). Three key parameters can be used for vascular screening: the Reactive Hyperemia Response (RHR), which represents the overall reaction of the macro- and microcirculation to transient hypoxia; Hypoxia Sensitivity (HS), which reflects hypoxia-induced activation of myogenic oscillations of the microcirculation; and Normoxia Oscillatory Index (NOI), which characterizes microcirculatory oscillations under normoxia conditions. A method for assessing these parameters, analogous in simplicity to arterial blood pressure measurement, is provided by the Flow Mediated Skin Fluorescence (FMSF) technique. Reference values are proposed based on numerous test measurements.

Sex differences in in-hospital management in patients with sepsis and septic shock: a prospective multicenter observational study

Sex differences in the in-hospital management of sepsis exist. Previous studies either included patients with sepsis that was defined using previous definitions of sepsis or evaluated the 3-h bundle therapy. Therefore, this study sought to assess sex differences in 1-h bundle therapy and in-hospital management among patients with sepsis and septic shock, defined according to the Sepsis-3 definitions. This observational study used data from Korean Shock Society (KoSS) registry, a prospective multicenter sepsis registry. Adult patients with sepsis between June 2018 and December 2021 were included in this study. The primary outcome was adherence to 1-h bundle therapy. Propensity score matching (PSM) and multivariable logistic regression analyses were performed. Among 3264 patients with sepsis, 3129 were analyzed. PSM yielded 2380 matched patients (1190 men and 1190 women). After PSM, 1-h bundle therapy was performed less frequently in women than in men (13.0% vs. 19.2%; p < 0.001). Among the bundle therapy components, broad-spectrum antibiotics were administered less frequently in women than in men (25.4% vs. 31.6%, p < 0.001), whereas adequate fluid resuscitation was performed more frequently in women than in men (96.8% vs. 95.0%, p = 0.029). In multivariable logistic regression analysis, 1-h bundle therapy was performed less frequently in women than in men [adjusted odds ratio (aOR) 1.559; 95% confidence interval (CI) 1.245–1.951; p < 0.001] after adjustment. Among the bundle therapy components, broad-spectrum antibiotics were administered less frequently to women than men (aOR 1.339, 95% CI 1.118–1.605; p = 0.002), whereas adequate fluid resuscitation was performed more frequently for women than for men (aOR 0.629, 95% CI 0.413–0.959; p = 0.031). Invasive arterial blood pressure monitoring was performed less frequently in women than in men. Resuscitation fluid, vasopressor, steroid, central-line insertion, ICU admission, length of stay in the emergency department, mechanical ventilator use, and renal replacement therapy use were comparable for both the sexes. Among patients with sepsis and septic shock, 1-h bundle therapy was performed less frequently in women than in men. Continuous efforts are required to increase adherence to the 1-h bundle therapy and to decrease sex differences in the in-hospital management of patients with sepsis and septic shock.

Hemodynamic Renal Reserve Response in Conscious Normotensive and Hypertensive Mice.

Renal function may be compromised following recovery from kidney insults. Renal functional reserve (RFR) is a measure of the difference between the kidney's maximum capacity and its baseline function, which helps identify any areas of the kidney with compromised function. Usually, RFR is evaluated using acute volume expansion (AVE), but this is typically done in anesthetized animals, which may not accurately represent the kidney's complete functional capacity. In this study, we have introduced a novel method that enables AVE to be conducted in conscious mice. We have implemented this innovative approach in two animal models representing either intact or impaired renal function, specifically utilizing a lower nephron hypertensive model. Mice were implanted with radio-transmitters for mean artery blood pressure (MAP) monitoring during the experiment. After recovery, half of the mice were induced hypertension by right kidney nephrectomy combined with the ligation of the upper branch of the left kidney. For the AVE, a volume equivalent to 5% of the mouse's body weight was administered via intravenous (IV) or intraperitoneal bolus injection. Subsequently, the mice were individually housed in cages covered with plastic wrap. Urine was collected every hour for a total of 3 h for the measurement of urine and sodium excretion. The MAPs for all normotensive mice were consistent throughout the AVE, but it increased 5-16 mm Hg in the hypertensive mice upon AVE. Remarkably, conscious mice exhibited a significantly stronger response to IV-administered AVE when compared to anesthetized mice. This response was evident in the increase in urinary flow, which was approximately 170% and 145% higher in conscious normotensive and hypertensive mice, respectively, compared to their respective baselines. In contrast, anesthetized normotensive and hypertensive mice showed only around a 130% and 100% increase in urinary flow, respectively. Additionally, upon AVE, conscious normotensive mice excreted approximately 47% more sodium than conscious hypertensive mice. In contrast, anesthetized normotensive mice excreted only about 30% more sodium than their anesthetized hypertensive counterparts. Performing a kidney stress test with a significant solution load in conscious mice seems to be a superior method for evaluating RFR compared to conducting the test under anesthesia. Assessing kidney clearance while the mice are conscious has the potential to enhance the precision of diagnosing and predicting both acute and chronic kidney diseases.

Improving the precision of shock resuscitation by predicting fluid responsiveness with machine learning and arterial blood pressure waveform data

Fluid bolus therapy (FBT) is fundamental to the management of circulatory shock in critical care but balancing the benefits and toxicities of FBT has proven challenging in individual patients. Improved predictors of the hemodynamic response to a fluid bolus, commonly referred to as a fluid challenge, are needed to limit non-beneficial fluid administration and to enable automated clinical decision support and patient-specific precision critical care management. In this study we retrospectively analyzed data from 394 fluid boluses from 58 pigs subjected to either hemorrhagic or distributive shock. All animals had continuous blood pressure and cardiac output monitored throughout the study. Using this data, we developed a machine learning (ML) model to predict the hemodynamic response to a fluid challenge using only arterial blood pressure waveform data as the input. A Random Forest binary classifier referred to as the ML fluid responsiveness algorithm (MLFRA) was trained to detect fluid responsiveness (FR), defined as a ≥ 15% change in cardiac stroke volume after a fluid challenge. We then compared its performance to pulse pressure variation, a commonly used metric of FR. Model performance was assessed using the area under the receiver operating characteristic curve (AUROC), confusion matrix metrics, and calibration curves plotting predicted probabilities against observed outcomes. Across multiple train/test splits and feature selection methods designed to assess performance in the setting of small sample size conditions typical of large animal experiments, the MLFRA achieved an average AUROC, recall (sensitivity), specificity, and precision of 0.82, 0.86, 0.62. and 0.76, respectively. In the same datasets, pulse pressure variation had an AUROC, recall, specificity, and precision of 0.73, 0.91, 0.49, and 0.71, respectively. The MLFRA was generally well-calibrated across its range of predicted probabilities and appeared to perform equally well across physiologic conditions. These results suggest that ML, using only inputs from arterial blood pressure monitoring, may substantially improve the accuracy of predicting FR compared to the use of pulse pressure variation. If generalizable, these methods may enable more effective, automated precision management of critically ill patients with circulatory shock.

Accuracy of Noninvasive Blood Pressure Monitoring in Critically Ill Adults.

Blood pressure (BP) is routinely invasively monitored by an arterial catheter in the intensive care unit (ICU). However, the available data comparing the accuracy of noninvasive methods to arterial catheters for measuring BP in the ICU are limited by small numbers and diverse methodologies. To determine agreement between invasive arterial blood pressure monitoring (IABP) and noninvasive blood pressure (NIBP) in critically ill patients. This was a single center, observational study of critical ill adults in a tertiary care facility evaluating agreement (≤10% difference) between simultaneously measured IABP and NIBP. We measured clinical features at time of BP measurement inclusive of patient demographics, laboratory data, severity of illness, specific interventions (mechanical ventilation and dialysis), and vasopressor dose to identify particular clinical scenarios in which measurement agreement is more or less likely. Of the 1852 critically ill adults with simultaneous IABP and NIBP readings, there was a median difference of 6 mm Hg in mean arterial pressure (MAP), interquartile range (1-12), P < .01. A logistic regression analysis identified 5 independent predictors of measurement discrepancy: increasing doses of norepinephrine (adjusted odds ratio [aOR] 1.10 [95% confidence interval, CI 1.08-1.12] P = .03 for every change in 5 µg/min), lower MAP value (aOR 0.98 [0.98-0.99] P < .01 for every change in 1 mm Hg), higher body mass index (aOR 1.04 [1.01-1.09] P = .01 for an increase in 1), increased patient age (aOR 1.31 [1.30-1.37] P < .01 for every 10 years), and radial arterial line location (aOR 1.74 [1.16-2.47] P = .04). There was broad agreement between IABP and NIBP in critically ill patients over a range of BPs and severity of illness. Several variables are associated with measurement discrepancy; however, their predictive capacity is modest. This may guide future study into which patients may specifically benefit from an arterial catheter.

Intraoperative Hypotension Prediction Based on Features Automatically Generated Within an Interpretable Deep Learning Model.

The monitoring of arterial blood pressure (ABP) in anesthetized patients is crucial for preventing hypotension, which can lead to adverse clinical outcomes. Several efforts have been devoted to develop artificial intelligence-based hypotension prediction indices. However, the use of such indices is limited because they may not provide a compelling interpretation of the association between the predictors and hypotension. Herein, an interpretable deep learning model is developed that forecasts hypotension occurrence 10 min before a given 90-s ABP record. Internal and external validations of the model performance show the area under the receiver operating characteristic curves of 0.9145 and 0.9035, respectively. Furthermore, the hypotension prediction mechanism can be physiologically interpreted using the predictors automatically generated from the proposed model for representing ABP trends. Finally, the applicability of a deep learning model with high accuracy is demonstrated, thus providing an interpretation of the association between ABP trends and hypotension in clinical practice.

A flexible multimodal pulse sensor for wearable continuous blood pressure monitoring.

Monitoring of arterial blood pressure via cuffless pulse waveform measurement at the wrist has an important clinical value for the early diagnosis and prevention of cardiovascular disease. However, accurate measurement of the radial pulse waveform is challenging owing to its subtle, wideband, and preload-dependent variation characteristics. Evidence shows that uncertainties or variations of wearing pressure and skin temperature can cause artifact signals in wrist pulse measurements, thus degrading blood pressure estimate accuracy and hindering precise clinical diagnosis. Herein, we report a flexible multisensory pulse sensor utilizing natural piezo-thermic transduction of human skin in conjunction with thin-film thermistors for the accurately measuring radial artery pulse waves with high fidelity and good anti-artifact performance. The flexible pulse sensor achieved a wide pressure measuring range (228.2 kPa), low detection limit (4 Pa), good linearity (R2 = 0.999), low hysteresis (2.45%), fast response (88 ms), and good durability and stability, thereby enabling accurate pulse measurement with high fidelity. The pulse sensor also monolithically integrated the simultaneous detections of skin temperature and wearing pressure for resisting artifact effects in pulse measurements. Through the fusion of multiple features extracted from the pulse waveform, wearing pressure, skin temperature and user's personal physical characteristics using an efficient multilayer perceptron, blood pressure is accurately estimated and good generalizability is achieved.

Design and Optimization of Flexible and Stretchable Ultrasonic Transducer Array for Arterial Blood Pressure Monitoring

Design and Optimization of Flexible and Stretchable Ultrasonic Transducer Array for Arterial Blood Pressure Monitoring

Continuous non-invasive arterial blood pressure monitoring with photoplethysmography via SE-MSResUNet network

ObjectiveArterial blood pressure (ABP) waveforms include physiological parameters closely related to BP values, while only a few studies predict BP values through the monitoring ABP waveforms. Current ABP waveforms monitoring methods are limited by its high computing cost and information redundancy of multi-channel input signals. The aim of our work is to propose a new end-to-end method for monitoring the ABP waveforms using single-channel photoplethysmography (PPG) signals by constructing a lightweight Multi-Scale Residual U-Net fused with Squeeze-and-Excitation module (SE-MSResUNet) model. MethodsFirstly, the PPG and ABP signals are preprocessed with denoising, segmentation, and eliminating phase difference. Subsequently, the SE-MSResUNet model is constructed and trained using training data to achieve the mapping relationship between PPG and ABP signals. Then, the BP values are extracted from the monitored ABP waveforms. Finally, the performance of the SE-MSResUNet in ABP waveform monitoring and BP estimation is investigated. ResultsThe ABP waveforms monitored by our proposed SE-MSResUNet network with PPG signals only are highly consistent with the reference ABP waveforms. The MAE ± SD of estimated diastolic blood pressure (DBP), mean arterial pressure (MAP) and systolic blood pressure (SBP) compared with reference values are 2.16 ± 3.75, 2.29 ± 3.72, and 3.88 ± 6.17 mmHg, respectively. The proposed method meets the Association for the Advancement of Medical Instrumentation (AAMI) standard and reach A level of the British Hypertension Society (BHS) standard. ConclusionsOur proposed method outperforms current state-of-the-art methods for non-invasive blood pressure monitoring from PPG signals. The algorithm provides a potential possibility for continuous non-invasive blood pressure monitoring through portable wearable devices.

Effectiveness of the preventive administration of vasoactive amines in counterbalancing significant patient blood pressure drops following nimodipine administration during mechanical thrombectomy procedures

Background Focal vasospasm (FV) of the occluded vessel can occur during the endovascular treatment of acute ischemic stroke (AIS). Nimodipine is commonly used to treat vasospasm and can play a role in distinguishing it from artery narrowing due to iatrogenic dissection or residual clot. However, nimodipine administration can result in arterial hypotension and subsequent enlargement of the ischemic core. Objective To assess the efficacy of preventive and continuous vasoactive amine infusion to counterbalance nimodipine-induced hypotension. Methods We reviewed data from a prospective registry of patients treated for AIS between January 2019 and January 2022 who were administered nimodipine. All patients were equipped with an arterial cannula for invasive blood pressure measurement and given vasoactive amines preemptively before general anesthesia and throughout the procedure. Data obtained from invasive monitoring of mean arterial blood pressure (MABP) in a time-lapse of 25 min before and after nimodipine administration were analyzed. Results MABP significantly decreased after nimodipine administration but remained within the recommended range (81.79 ± 0.49 mmHg). Nimodipine was effective in reducing FV caused by stent retriever passage in 76.3% of cases. Furthermore, it proved valuable in diagnosing iatrogenic dissection (9.2%), residual clot (10.5%), or intracranial stenosis (4%). Conclusions Infusion of vasoactive amines effectively counteracted the intraarterial nimodipine effect, thus avoiding frank arterial hypotension during endovascular treatment. Nimodipine has been useful in differentiating the diagnosis of FV resulting from mechanical thrombectomy and other potential causes, such as iatrogenic dissection or residual clot.

Micro- and macrocirculatory effects of norepinephrine on anaesthesia-induced hypotension: a prospective preliminary study

BackgroundIntraoperative arterial hypotension (IOH) leads to increased postoperative morbidity. Norepinephrine is often use to treat IOH. The question regarding the mode of administration in either a bolus or continuous infusion remains unanswered. The aim of the present study was to describe and compare the effects on macrocirculation and microcirculation of a bolus and a continuous infusion of norepinephrine to treat IOH.MethodsWe conducted a prospective observational study with adult patients who underwent neurosurgery. Patients with invasive arterial blood pressure and cardiac output (CO) monitoring were screened for inclusion. All patients underwent microcirculation monitoring by video-capillaroscopy, laser doppler, near-infrared spectroscopy technology, and tissular CO2. In case of IOH, the patient could receive either a bolus of 10 µg or a continuous infusion of 200 µg/h of norepinephrine. Time analysis for comparison between bolus and continuous infusion were at peak of MAP. The primary outcome was MFI by videocapillaroscopy.ResultsThirty-five patients were included, with 41 boluses and 33 continuous infusion.Bolus and continuous infusion induced an maximal increase in mean arterial pressure of +30[20-45] and +23[12-34] %, respectively (P=0,07). For macrocirculatory parameters, continuous infusion was associated with a smaller decrease in CO and stroke volume (p<0.05).For microcirculatory parameters, microvascular flow index (-0,1 vs. + 0,3, p=0,03), perfusion index (-12 vs. +12%, p=0,008), total vessel density (-0,2 vs. +2,3 mm2/mm2, p=0,002), showed significant opposite variations with bolus and continuous infusion, respectively.ConclusionsThese results on macro and microcirculation enlighten the potential benefits of a continuous infusion of norepinephrine rather than a bolus to treat anaesthesia-induced hypotension.Trial registration(NOR-PHARM: 1-17-42 Clinical Trials: NCT03454204), 05/03/2018

Agreement of continuous non-invasive arterial blood pressure monitoring (CNAP) and pulmonary artery catheter thermodilution method in estimating the hemodynamic parameters of post CABG patients

Abstract Background The use of hemodynamic parameters in monitoring patients after coronary artery bypass surgery is an essential element of clinical practice. It helps intensivist and physicians to properly manage patients after surgery where hemodynamic parameters are usually dynamic and complicated. Pulmonary artery guided thermodilution (PACT) has been the gold standard in assessing the adequacy of cardiac output, however, its invasive nature is also associated with more complex procedures and the risk of complications, including infections. With the emergence of new non-invasive hemodynamic monitoring devices such as the CNAP (continuous non-invasive arterial pressure), alternative methods for hemodynamic monitoring is now possible. Compared to invasive methods, it is easier to use with an error-free application, safer, less risk of infection and more cost effective. Purpose To determine the agreement of Continuous non-invasive arterial pressure (CNAP) and pulmonary artery guided thermodilution in monitoring the hemodynamic parameters of patients who underwent coronary artery bypass graft surgery. Methods This is a cross-sectional study conducted at the cardiovascular surgical intensive care unit and included 63 patients with Coronary artery disease who underwent elective coronary artery bypass graft surgery. Cardiac output, Cardiac Index, Stroke volume and Systemic vascular resistance were simultaneously obtained using both the CNAP and PACT. Three consecutive sets of measurements were recorded for each patient with a 3 hour interval; during arrival at the ICU, 3 hours post op, and 6 hours post op. Results The mean difference between PACT-CO and CNAP-CO was -0.81 L/min (SD -1.18 to -0.44) with a 95% limits of agreement of -3.74 to 2.11 L/min on the 0 hour, -0.81L/min (SD -1.22 to -0.41) with a 95% limits of agreement of -1.98 to 1.18 L/min on the 3rd hour, and -0.77L/min (SD -1.08 to -0.46) with a 95% limits of agreement of -3.22 to 1.68 L/min on the 6th hour post op. The results showed a significant difference between the PACT and CNAP. However, a positive correlation was noted between PACT-CO and CNAP-CO, the correlation coefficient on the 0, 3rd and 6th hour were 0.5384, 0.5158, and 0.6265 respectively. Conclusion CNAP derived hemodynamic parameters had a high mean difference compared to the PACT and there was no agreement between the two methods. However, it was able to have a positive correlation with the PACT, making it possible for the CNAP to track the hemodynamic changes during the post operative course.

The effect of intraoperative cerebral oxygen desaturations on postoperative cerebral oxygen metabolism in neonates and infants a pilot study.

Cerebral oxygen desaturation during pediatric surgery has been associated with adverse perioperative outcomes. The aim of this pilot study was to analyze the frequency and severity of intraoperative cerebral oxygen desaturations and their impact on postoperative cerebral oxygen metabolism in neonates and infants undergoing pediatric surgery. In a prospective pilot study, intra- and postoperative regional cerebral oxygen saturation and blood flow were measured noninvasively using a device combining laser Doppler flowmetry and white-light-spectrometry. Thirty-seven consecutive neonates and infants undergoing noncardiac surgery under general anesthesia for more than 30 min and necessity for invasive arterial blood pressure monitoring were included. Patients with pre-known congenital structural heart disease or cerebral disease were excluded. Continuously brain monitor recording was started in sedated patients before induction of anesthesia (preoperative baseline) and was completed 1 h postoperatively in the PICU in sedated, intubated, and mechanically ventilated states at the PICU (postoperative state). Baseline and postoperative state for cerebral fractional tissue oxygen extraction and approximated cerebral metabolic rate of oxygen were calculated. Seventeen (46%) of the 37 studied neonates and infants suffered from intraoperative periods of regional cerebral oxygen desaturation below 20% of the baseline (event group). Severity of cerebral desaturations was median 4.0%min/h [range 0.1-58.7; interquartile range [IQR] 0.99-21.29]. In the event group, the duration of surgery was significantly longer (median 135 min [range 11-260; IQR 113.5-167.0] vs median 46.5 min [range 11-180; IQR 30.5-159.3]; difference of -62.94; 95% confidence interval [CI] -105.17 to -20.71; p = .021). In the event group, cerebral fractional tissue oxygen extraction (median 0.41 [range 0.20-0.55; IQR 0.26-0.44] vs. median 0.27 [range 0.11-0.41; IQR 0.20-0.31]; difference of -0.11; 95% CI -0.17 to -0.05; p = .001) and approximated cerebral metabolic rate of oxygen (median 6.15 arbitrary unit [range 2.69-12.07; IQR 5.12-7.21] vs. median 4.14 arbitrary unit [range 1.78-7.86; IQR 3.82-6.31]; difference of -1.76; 95% CI -3.03 to -0.49; p = .009) were significantly higher and the cerebral regional oxygen saturation (median 58.99% [range 44.87-79.1; IQR 54.26-72.61] vs median 70.94% [range 57.9-86.13; IQR 67.07-76.59]; difference of 10.01; 95% CI 4.13-15.90; p = .002) significantly lower after surgery compared to the nonevent group. The increase of approximated cerebral metabolic rate of oxygen could indicate an elevated oxidative energy metabolism in the "stressed" brain, due to repair processes. The increased cerebral fractional tissue oxygen extraction fits with the decreased NIRS cerebral oxygenation. Our data suggest that an increase in cerebral oxygen metabolism was the cause. Cerebral oxygen desaturation during major surgery in neonates and infants is associated with early postoperative increased cerebral oxygen extraction and possibly increased cerebral oxygen metabolism.

SAT306 Comparison Of Sodium Nitroprusside And Urapidil In Laparoscopic Adrenalectomy For Pheochromocytoma

Abstract Disclosure: M.G. Rusalenko: None. E. Pispanen: None. M. Wisham: None. I. Savasteeva: None. S. Marchenko: None. D. Borovik: None. D.O. Rusalenko: None. The aim: of the study was to compare the efficacy of Sodium Nitroprusside and Urapidil in management of blood pressure in laparoscopic adrenalectomy for pheochromocytoma. Material and methods : This study includes of 58 cases of pheochromocytoma operated in the Republican Scientific and Practical Center for Radiation Medicine. The mean age of patients was 57.0 years (31 men and 27 women). For preliminary preparations, oral α1-blocker Doxazosin was used. In-operative blood pressure (BP) was recorded via intra-radial artery BP monitoring and via intra-venous BP monitoring from the external jugular vein. Fluid loading was done with colloids and crystalloids. Epidural anesthesia was given with a combination of Ropivacaine 10mg/ml-10ml and Spinal Morphine 1mg/ml-1-2ml was given between T4 - T5 for relaxation of the abdominal cavity. For anesthesia Sevoflurane was used with non-depolarizing short and medium-acting muscle relaxants (rocuronium, atracurium). In the study we included 12 patients who underwent surgery under BP control with Uradipil and 46 patients with Nitroprusside. Results: Long-term administered Doxazosin (more than 14 days) demonstrated lower BP values ​​in the starting phase of the operations (SBP 125.0[110.0; 130.0]; DBP [75.0(60.0; 80.0]) § (SBP 140.0[130.0; 150.0]; DBP [90.0(80.0; 90.0]); p&amp;lt;0.05. Statistically significant differences in BP variability from baseline to maximum values, as well as minimum values were obtained. In both groups (Nitroprusside and Urapidil), using the Wilcoxon criteria, we did not obtain significant differences in the increase in the initial blood pressure in maximum values. In contrast, in the Nitroprusside group, a statistically significant decrease in baseline blood pressure to the minimum values (SBP 90.0[75.0; 100.0]; DBP [50.0(50.0; 55.0]); p&amp;lt;0.004) was obtained, as in the Urapidil group: (SBP 130.0[ 110.0; 140.0]; DBP [80.0(60.0; 90.0]), to minimal values (SBP 95.0[90.0; 110.0]; DBP [60.0(50.0; 60.0]); p&amp;lt;0.008. Comparison of all blood pressure indicators when using Nitroprusside or Urapidil using the Mann-Whitney U test did not show statistically significant differences. However, there was a minor significance in minimum SBP values ​​(N 90.0[75.0; 100.0] § [U 95.0(90.0; 110.0]); z=-1.44; p=0.15) and DBP (N 50.0[50.0; 55.0] § [U 60.0(50.0; 60.0]); z=-1.81; p=0.07. Initial, maximum and final BP values ​​were equivalent in two groups. Conclusion: This data shows that to stabilize patient blood pressure in adrenalectomy for pheochromocytoma, preparation with α1-blockers is significant. The use of Sodium Nitroprusside and Urapidil is equally effective for managing BP during adrenalectomy, however, Urapidil shows to have advantages due to its lower side effects compared to Nitroprusside. Presentation: Saturday, June 17, 2023

Risk predict model using multi-drug resistant organism infection from Neuro-ICU patients: a retrospective cohort study

The aim of this study was to analyze the current situation and risk factors of multi-drug-resistant organism (MDRO) infection in Neuro-intensive care unit (ICU) patients, and to develop the risk predict model. The data was collected from the patients discharged from Neuro-ICU of grade-A tertiary hospital at Guizhou province from January 2018 to April 2020. Binary Logistics regression was used to analyze the data. The model was examined by receiver operating characteristic curve (ROC). The grouped data was used to verify the sensitivity and specificity of the model. A total of 297 patients were included, 131 patients infected with MDRO. The infection rate was 44.11%. The results of binary Logistics regression showed that tracheal intubation, artery blood pressure monitoring, fever, antibiotics, pneumonia were independent risk factors for MDRO infection in Neuro-ICU (P < 0.05), AUC = 0.887. The sensitivity and specificity of ROC curve was 86.3% and 76.9%. The risk prediction model had a good predictive effect on the risk of MDRO infection in Neuro ICU, which can evaluate the risk and provide reference for preventive treatment and nursing intervention.

Some perspectives of continuous arterial blood pressure measurements: from kymograph to tonoarteriographic imaging

The measurement and monitoring of continuous arterial blood pressure (BP) have undergone significant evolution over the past 170 years, transitioning from ancient invasive approaches, like kymograph, to modern non-invasive and unobtrusive technologies such as tonoarteriography (TAG). This progressive shift has revolutionized the way we track BP, providing safer, more accurate, and convenient methods for monitoring BP. This paper aims to provide some historical perspectives on the development of continuous BP technology, highlight key milestones that have shaped the field, discuss the state-of-the-art two-dimensional TAG imaging, and address challenges for future unobtrusive BP measurements. In addition to presenting a concise review of the progression of continuous BP measurement technologies, this article also emphasizes the importance of adopting more precise, convenient and affordable approaches for personalized BP monitoring at home and patient care optimizations at hospitals, thereby empowering healthcare professionals to enhance pervasive hypertension management anywhere.

Thin, soft, wearable system for continuous wireless monitoring of artery blood pressure

Continuous monitoring of arterial blood pressure (BP) outside of a clinical setting is crucial for preventing and diagnosing hypertension related diseases. However, current continuous BP monitoring instruments suffer from either bulky systems or poor user-device interfacial performance, hampering their applications in continuous BP monitoring. Here, we report a thin, soft, miniaturized system (TSMS) that combines a conformal piezoelectric sensor array, an active pressure adaptation unit, a signal processing module, and an advanced machine learning method, to allow real wearable, continuous wireless monitoring of ambulatory artery BP. By optimizing the materials selection, control/sampling strategy, and system integration, the TSMS exhibits improved interfacial performance while maintaining Grade A level measurement accuracy. Initial trials on 87 volunteers and clinical tracking of two hypertension individuals prove the capability of the TSMS as a reliable BP measurement product, and its feasibility and practical usability in precise BP control and personalized diagnosis schemes development.