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Lori Kozikowski - One of the best experts on this subject based on the ideXlab platform.
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validation of a continuous arterial pressure based Cardiac Output measurement a multicenter prospective clinical trial
Critical Care, 2007Co-Authors: William T Mcgee, Jeffrey L Horswell, Joachim Calderon, Gerard Janvier, Tom Van Severen, Greet Van Den Berghe, Lori KozikowskiAbstract:Introduction The present study compared measurements of Cardiac Output by an arterial pressure-based Cardiac Output (APCO) analysis method with measurement by intermittent thermodilution Cardiac Output (ICO) via pulmonary artery catheter in a clinical setting.
Vivek Rao - One of the best experts on this subject based on the ideXlab platform.
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predictors of low Cardiac Output syndrome after isolated mitral valve surgery
The Journal of Thoracic and Cardiovascular Surgery, 2010Co-Authors: Manjula Maganti, Mitesh V Badiwala, Amir M Sheikh, Hugh E Scully, Christopher M Feindel, Tirone E David, Vivek RaoAbstract:Background Low Cardiac Output syndrome is defined as the need for a postoperative intra-aortic balloon pump or inotropic support for longer than 30 minutes in the intensive care unit. Mitral valve surgery is increasingly being performed in high-risk patients who might require mechanical circulatory support for low Cardiac Output syndrome. Therefore the aim of this study was to identify the preoperative predictors of low Cardiac Output syndrome after mitral valve surgery. Methods We conducted a retrospective review of data prospectively entered into an institutional database. Between 1990 and February 2008, 3039 patients underwent isolated mitral valve surgery with or without coronary bypass surgery. The independent predictors of low Cardiac Output syndrome and operative mortality were determined by means of stepwise logistic regression analysis. Results The overall prevalence of low Cardiac Output syndrome was 7%. The independent predictors of low Cardiac Output syndrome were urgency of the operation (odds ratio, 2.9), earlier year of operation (odds ratio, 2.4), left ventricular ejection fraction of less than 40% (odds ratio, 2.1), New York Heart Association class IV (odds ratio, 2), body surface area of 1.7 m 2 or less (odds ratio, 1.6), ischemic mitral valve pathology (odds ratio, 1.6), and cardiopulmonary bypass time (odds ratio, 1.02). The operative mortality was higher in patients with low Cardiac Output syndrome (30% vs 1.3%, P Conclusions Low Cardiac Output syndrome is associated with significantly increased morbidity and mortality. Novel strategies to preserve renal function, optimization of pre-existing heart failure symptoms, and use of artificial polytetrafluoroethylene sutures might reduce the incidence of low Cardiac Output syndrome and lead to improved results after mitral valve surgery.
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predictors of low Cardiac Output syndrome after coronary artery bypass
The Journal of Thoracic and Cardiovascular Surgery, 1996Co-Authors: Vivek Rao, Joan Ivanov, Richard D Weisel, John S Ikonomidis, George T Christakis, Tirone E DavidAbstract:The purpose of this study was to identify patients at risk for the development of low Cardiac Output syndrome after coronary artery bypass. Low Cardiac Output syndrome was defined as the need for postoperative intraaortic balloon pump or inotropic support for longer than 30 minutes in the intensive care unit to maintain the systolic blood pressure greater than 90 mm Hg and the Cardiac index greater than 2.2 L/min per square meter. The preoperative patient characteristics that were independent predictors of low Cardiac Output syndrome were identified among 4558 consecutive patients who underwent isolated coronary artery bypass at The Toronto Hospital between July 1, 1990, and December 31, 1993. The overall prevalence of low Cardiac Output syndrome was 9.1% (n = 412). The operative mortality rate was higher in patients in whom low Cardiac Output syndrome developed than in those in whom it did not develop (16.9% versus 0.9%, p < 0.001). Stepwise logistic regression analyses identified nine independent predictors of low Output syndrome (percent frequency in parentheses) and calculated the factor-adjusted odds ratios associated with each predictor: (1) left ventricular ejection fraction less than 20% (27%, odds ratio 5.7); (2) repeat operation (25%, odds ratio 4.4); (3) emergency operation (27%, odds ratio 3.7); (4) female gender (16%, odds ratio 2.5); (5) diabetes (13%, odds ratio 1.6); (6) age older than 70 years (13%, odds ratio 1.5); (7) left main coronary artery stenosis (12%, odds ratio 1.4); (8) recent myocardial infarction (16%, odds ratio 1.4); and (9) triple-vessel disease (10%, odds ratio 1.3). Low Cardiac Output syndrome is a clinical outcome that may result from inadequate myocardial protection or perioperative ischemic injury. Patients at high risk for the development of low Cardiac Output syndrome should be the focus of trials of new techniques of myocardial protection to resuscitate the ischemic myocardium.
Tirone E David - One of the best experts on this subject based on the ideXlab platform.
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predictors of low Cardiac Output syndrome after isolated mitral valve surgery
The Journal of Thoracic and Cardiovascular Surgery, 2010Co-Authors: Manjula Maganti, Mitesh V Badiwala, Amir M Sheikh, Hugh E Scully, Christopher M Feindel, Tirone E David, Vivek RaoAbstract:Background Low Cardiac Output syndrome is defined as the need for a postoperative intra-aortic balloon pump or inotropic support for longer than 30 minutes in the intensive care unit. Mitral valve surgery is increasingly being performed in high-risk patients who might require mechanical circulatory support for low Cardiac Output syndrome. Therefore the aim of this study was to identify the preoperative predictors of low Cardiac Output syndrome after mitral valve surgery. Methods We conducted a retrospective review of data prospectively entered into an institutional database. Between 1990 and February 2008, 3039 patients underwent isolated mitral valve surgery with or without coronary bypass surgery. The independent predictors of low Cardiac Output syndrome and operative mortality were determined by means of stepwise logistic regression analysis. Results The overall prevalence of low Cardiac Output syndrome was 7%. The independent predictors of low Cardiac Output syndrome were urgency of the operation (odds ratio, 2.9), earlier year of operation (odds ratio, 2.4), left ventricular ejection fraction of less than 40% (odds ratio, 2.1), New York Heart Association class IV (odds ratio, 2), body surface area of 1.7 m 2 or less (odds ratio, 1.6), ischemic mitral valve pathology (odds ratio, 1.6), and cardiopulmonary bypass time (odds ratio, 1.02). The operative mortality was higher in patients with low Cardiac Output syndrome (30% vs 1.3%, P Conclusions Low Cardiac Output syndrome is associated with significantly increased morbidity and mortality. Novel strategies to preserve renal function, optimization of pre-existing heart failure symptoms, and use of artificial polytetrafluoroethylene sutures might reduce the incidence of low Cardiac Output syndrome and lead to improved results after mitral valve surgery.
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predictors of low Cardiac Output syndrome after coronary artery bypass
The Journal of Thoracic and Cardiovascular Surgery, 1996Co-Authors: Vivek Rao, Joan Ivanov, Richard D Weisel, John S Ikonomidis, George T Christakis, Tirone E DavidAbstract:The purpose of this study was to identify patients at risk for the development of low Cardiac Output syndrome after coronary artery bypass. Low Cardiac Output syndrome was defined as the need for postoperative intraaortic balloon pump or inotropic support for longer than 30 minutes in the intensive care unit to maintain the systolic blood pressure greater than 90 mm Hg and the Cardiac index greater than 2.2 L/min per square meter. The preoperative patient characteristics that were independent predictors of low Cardiac Output syndrome were identified among 4558 consecutive patients who underwent isolated coronary artery bypass at The Toronto Hospital between July 1, 1990, and December 31, 1993. The overall prevalence of low Cardiac Output syndrome was 9.1% (n = 412). The operative mortality rate was higher in patients in whom low Cardiac Output syndrome developed than in those in whom it did not develop (16.9% versus 0.9%, p < 0.001). Stepwise logistic regression analyses identified nine independent predictors of low Output syndrome (percent frequency in parentheses) and calculated the factor-adjusted odds ratios associated with each predictor: (1) left ventricular ejection fraction less than 20% (27%, odds ratio 5.7); (2) repeat operation (25%, odds ratio 4.4); (3) emergency operation (27%, odds ratio 3.7); (4) female gender (16%, odds ratio 2.5); (5) diabetes (13%, odds ratio 1.6); (6) age older than 70 years (13%, odds ratio 1.5); (7) left main coronary artery stenosis (12%, odds ratio 1.4); (8) recent myocardial infarction (16%, odds ratio 1.4); and (9) triple-vessel disease (10%, odds ratio 1.3). Low Cardiac Output syndrome is a clinical outcome that may result from inadequate myocardial protection or perioperative ischemic injury. Patients at high risk for the development of low Cardiac Output syndrome should be the focus of trials of new techniques of myocardial protection to resuscitate the ischemic myocardium.
Maurizio Cecconi - One of the best experts on this subject based on the ideXlab platform.
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Noninvasive continuous Cardiac Output monitoring in perioperative and intensive care medicine
BJA: British Journal of Anaesthesia, 2015Co-Authors: Bernd Saugel, Maurizio Cecconi, J.y. Wagner, Daniel A. ReuterAbstract:Summary. The determination of blood flow, i.e. Cardiac Output, is an integral part of haemodynamic monitoring. This is a review on noninvasive continuous Cardiac Output monitoring in perioperative and intensive care medicine. We present the underlying principles and validation data of the following technologies: thoracic electrical bioimpedance, thoracic bioreactance, vascular unloading technique, pulse wave transit time, and radial artery applanation tonometry. According to clinical studies, these technologies are capable of providing Cardiac Output readings noninvasively and continuously. They, therefore, might prove to be innovative tools for the assessment of advanced haemodynamic variables at the bedside. However, for most technologies there are conflicting data regarding the measurement performance in comparison with reference methods for Cardiac Output assessment. In addition, each of the reviewed technology has its own limitations regarding applicability in the clinical setting. In validation studies comparing Cardiac Output measurements using these noninvasive technologies in comparison with a criterion standard method, it is crucial to correctly apply statistical methods for the assessment of a technology's accuracy, precision, and trending capability. Uniform definitions for ‘clinically acceptable agreement' between innovative noninvasive Cardiac Output monitoring systems and criterion standard methods are currently missing. Further research must aim to further develop the different technologies for noninvasive continuous Cardiac Output determination with regard to signal recording, signal processing, and clinical applicability.
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Cardiac Output monitoring: an integrative perspective
Critical Care, 2011Co-Authors: Jamal A. Alhashemi, Maurizio Cecconi, Christoph K. HoferAbstract:Cardiac Output monitoring in the critically ill patient is standard practice in order to ensure tissue oxygenation [1] and has been traditionally accomplished using the pulmonary artery catheter (PAC). In recent years, however, the value of PAC has been questioned with some suggesting that its use might not only be unnecessary but also potentially harmful [1]. This notion, together with the availability of new less invasive Cardiac Output measuring devices, has markedly decreased the widespread use of the PAC [2]. Today, various devices are available to measure or estimate Cardiac Output using different methods. Some of these less invasive devices track stroke volume (SV) continuously and provide dynamic indices of fluid responsiveness, others allow assessment of volumetric preload variables, and some also provide continuous measurement of central venous saturation via the use of proprietary catheters that are attached to the same monitor. All these variables — together with Cardiac Output — may result in an improved hemodynamic assessment of the critically ill patient. However, it is important to appreciate that each device has its inherent limitations and that no Cardiac Output monitoring device can change patient outcome unless its use is coupled with an intervention that by itself has been associated with improved patient outcomes. Therefore, the concept of hemodynamic optimization is increasingly recognized as a cornerstone in the management of critically ill patients and has been shown to be associated with improved outcome in the perioperative [3] and in the intensive care unit (ICU) [4] setting.
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lithium dilution Cardiac Output measurement in the critically ill patient determination of precision of the technique
Intensive Care Medicine, 2009Co-Authors: Maurizio Cecconi, Deborah Dawson, R M Grounds, A RhodesAbstract:Background Lithium dilution Cardiac Output by LiDCO™plus (LiDCO, Cambridge, UK) is a validated methodology for measuring Cardiac Output. It is used to calibrate a pulse pressure analysis algorithm (PulseCO) for the continuous measurement of subsequent changes in this variable. The variability of measurements, or precision, within patients of lithium dilution Cardiac Output has not previously been described.
Bernd Saugel - One of the best experts on this subject based on the ideXlab platform.
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Pulse Wave Analysis to Estimate Cardiac Output.
Anesthesiology, 2020Co-Authors: Karim Kouz, Thomas Scheeren, Daniel De Backer, Bernd SaugelAbstract:Pulse wave analysis enables Cardiac Output to be estimated continuously and in real time. Pulse wave analysis methods can be classified into invasive, minimally invasive, and noninvasive and into externally calibrated, internally calibrated, and uncalibrated methods.
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Noninvasive continuous Cardiac Output monitoring in perioperative and intensive care medicine
BJA: British Journal of Anaesthesia, 2015Co-Authors: Bernd Saugel, Maurizio Cecconi, J.y. Wagner, Daniel A. ReuterAbstract:Summary. The determination of blood flow, i.e. Cardiac Output, is an integral part of haemodynamic monitoring. This is a review on noninvasive continuous Cardiac Output monitoring in perioperative and intensive care medicine. We present the underlying principles and validation data of the following technologies: thoracic electrical bioimpedance, thoracic bioreactance, vascular unloading technique, pulse wave transit time, and radial artery applanation tonometry. According to clinical studies, these technologies are capable of providing Cardiac Output readings noninvasively and continuously. They, therefore, might prove to be innovative tools for the assessment of advanced haemodynamic variables at the bedside. However, for most technologies there are conflicting data regarding the measurement performance in comparison with reference methods for Cardiac Output assessment. In addition, each of the reviewed technology has its own limitations regarding applicability in the clinical setting. In validation studies comparing Cardiac Output measurements using these noninvasive technologies in comparison with a criterion standard method, it is crucial to correctly apply statistical methods for the assessment of a technology's accuracy, precision, and trending capability. Uniform definitions for ‘clinically acceptable agreement' between innovative noninvasive Cardiac Output monitoring systems and criterion standard methods are currently missing. Further research must aim to further develop the different technologies for noninvasive continuous Cardiac Output determination with regard to signal recording, signal processing, and clinical applicability.
