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Michael R Pinsky - One of the best experts on this subject based on the ideXlab platform.

  • Hemodynamic Monitoring for the evaluation and treatment of shock what is the current state of the art
    Seminars in Respiratory and Critical Care Medicine, 2015
    Co-Authors: Eric M Suess, Michael R Pinsky
    Abstract:

    Hemodynamic Monitoring has become a fundamental and ubiquitous, if not defining, aspect of critical care medicine practice. Modern Monitoring techniques have changed significantly over the past few years and are now able to rapidly identify shock states earlier, define the etiology, and monitor the response to therapies. Many of these techniques are now minimally invasive or noninvasive. Basic Hemodynamic Monitoring and evaluation usually includes a focused physical examination and static Hemodynamic vital signs: temperature, heart rate, respiratory rate, mean arterial pressure, and arterial hemoglobin oxygen saturation, typically measured with pulse photoplethysmography. When available, measurement of urinary output is often included. Advanced Hemodynamic Monitoring incorporates both noninvasive and invasive continuous Hemodynamic Monitoring. Noninvasive ultrasound has emerged as a fundamental Hemodynamic evaluation tool and its use is now rapidly increasing. Invasive Monitoring from arterial and central venous catheters, and occasionally pulmonary artery catheters, provides measurement of arterial pressure, intracardiac filling pressures, arterial and venous blood gases, and cardiac index. Minimally invasive and noninvasive measure of arterial pressure and cardiac output are also possible and often remain as accurate as invasive measures. Importantly, such advanced Monitoring provides the foundation for goal-directed therapies for the treatment of shock. When coupled with functional Hemodynamic Monitoring analyses, these measures markedly extend the diagnostic and therapeutic potential of all Monitoring modalities by defining preload reserve, vasomotor tone, cardiac performance, and tissue perfusion.

  • understanding preload reserve using functional Hemodynamic Monitoring
    Intensive Care Medicine, 2015
    Co-Authors: Michael R Pinsky
    Abstract:

    The assessment critically ill patients’ cardiovascular state through Hemodynamic Monitoring is essential to define both stability and change. But Monitoring can be improved by maneuvers designed to stress the cardiovascular state. For example, gallop rhythms heard increasing with spontaneous inspiration or associated paradoxical septal shift by echocardiography connote right heart failure. Similarly, tachycardia and near syncope upon sitting up from a supine position connotes hypovolemia. These maneuvers reflect functional bedside tests of the patient’s physiologic reserve. Functional Hemodynamic Monitoring (FHM) is the process of assessing the dynamic response of a measured Hemodynamic variable to a defined, reproducible and readily reversible extrinsic stress (1). FHM parameters is commonly used to predict cardiac output responses to volume loading (2, 3), although its applications are broader.

  • Functional Hemodynamic Monitoring.
    Critical care clinics, 2015
    Co-Authors: Michael R Pinsky
    Abstract:

    Functional Hemodynamic Monitoring is the assessment of the dynamic interactions of Hemodynamic variables in response to a defined perturbation. Recent interest in functional Hemodynamic Monitoring for the bedside assessment of cardiovascular insufficiency has heightened with the documentation of its accuracy in predicting volume responsiveness using a wide variety of Monitoring devices, both invasive and noninvasive, and across multiple patient groups and clinical conditions. However, volume responsiveness, though important, reflects only part of the overall spectrum of functional physiologic variables that can be measured to define the physiologic state and monitor response to therapy.

  • Perioperative Hemodynamic Monitoring.
    Best practice & research. Clinical anaesthesiology, 2012
    Co-Authors: Matthew E. Cove, Michael R Pinsky
    Abstract:

    Hemodynamic Monitoring is the cornerstone of perioperative anesthetic Monitoring. In the unconscious patient, Hemodynamic Monitoring not only provides information relating to cardiac output, volume status and ultimately tissue perfusion, but also indicates depth of anesthesia and adequacy of pain control. In the 21st century the anesthesiologist has an array of devices to choose from. No single device provides a complete assessment of Hemodynamic status, and the use of all devices in every situation is neither practical nor appropriate. This article aims to provide the reader with an overview of the devices currently available, and the information they provide, to assist anesthesiologists in the selection of the most appropriate devices for any given situation.

  • Clinical applicability of functional Hemodynamic Monitoring
    Annals of intensive care, 2011
    Co-Authors: Xaime García, Michael R Pinsky
    Abstract:

    Recent interest in functional Hemodynamic Monitoring for the bedside assessment of cardiovascular insufficiency has heightened. Functional Hemodynamic Monitoring is the assessment of the dynamic interactions of Hemodynamic variables in response to a defined perturbation. Accordingly, fluid responsiveness can be predicted in a quantities fashion by measuring as arterial pulse pressure variation and left ventricular stroke volume variation during positive pressure breathing or the change in cardiac output response to a passive leg raising maneuver. However, volume responsiveness, though important, reflects only part of the overall spectrum of functional physiological variables that can be measured to define physiologic state and monitor response to therapy. Dynamic tissue O2 saturation (StO2) responses to complete stop flow conditions, which can be created by measuring hand StO2 and occluding flow with a blood pressure cuff, assesses cardiovascular sufficiency and microcirculatory blood flow distribution. Furthermore, these measures can be made increasingly more sensitive and specific if coupled to other "traditional" measures of organ perfusion, such as blood lactate levels.

Karim Bendjelid - One of the best experts on this subject based on the ideXlab platform.

  • Journal of Clinical Monitoring and Computing 2017 end of year summary: cardiovascular and Hemodynamic Monitoring
    Journal of Clinical Monitoring and Computing, 2018
    Co-Authors: Bernd Saugel, Karim Bendjelid, Lester A. H. Critchley, Thomas W. L. Scheeren
    Abstract:

    Hemodynamic Monitoring provides the basis for the optimization of cardiovascular dynamics in intensive care medicine and anesthesiology. The Journal of Clinical Monitoring and Computing (JCMC) is an ideal platform to publish research related to Hemodynamic Monitoring technologies, cardiovascular (patho)physiology, and Hemodynamic treatment strategies. In this review, we discuss selected papers published on cardiovascular and Hemodynamic Monitoring in the JCMC in 2017.

  • Journal of Clinical Monitoring and Computing 2016 end of year summary: cardiovascular and Hemodynamic Monitoring
    Journal of Clinical Monitoring and Computing, 2017
    Co-Authors: Bernd Saugel, Karim Bendjelid, Lester A. H. Critchley, Steffen Rex, Thomas W. L. Scheeren
    Abstract:

    The assessment and optimization of cardiovascular and Hemodynamic variables is a mainstay of patient management in the care for critically ill patients in the intensive care unit (ICU) or the operating room (OR). It is, therefore, of outstanding importance to meticulously validate technologies for Hemodynamic Monitoring and to study their applicability in clinical practice and, finally, their impact on treatment decisions and on patient outcome. In this regard, the Journal of Clinical Monitoring and Computing (JCMC) is an ideal platform for publishing research in the field of cardiovascular and Hemodynamic Monitoring. In this review, we highlight papers published last year in the JCMC in order to summarize and discuss recent developments in this research area.

  • Hemodynamic Monitoring in the ICU
    2016
    Co-Authors: Raphaël Giraud, Karim Bendjelid
    Abstract:

    The benefit of any Hemodynamic Monitoring technique is to provide reliable and reproducible information on the cardiocirculatory status of a patient in shock. The collected values will enable the intensivist to understand the Hemodynamic conditions of the patient and to make more informed treatment decisions to optimize the Hemodynamic status and improve the prognosis of the patient. Hemodynamic Monitoring is required to assess systemic and regional tissue perfusion as the correction of circulatory instability and tissue hypoperfusion is essential to prevent the occurrence of multiple organ failure. Resuscitation is characterized by a very close temporal relationship between Monitoring, decision-making, and treatment. Indeed, making prompt, appropriate management and diagnostic and therapeutic decisions in cases of Hemodynamic instability reduces mortality of critically ill patients [1]. To make treatment decisions, the intensivist has an arsenal of Monitoring devices. However, before using a device, it is imperative that the intensivist has sound knowledge of the pathophysiology of shock states to identify the parameters that he/she wants to monitor. Therefore, knowing the different Hemodynamic Monitoring parameters is important [2]. For instance, it is now established and accepted by clinicians that fluid responsiveness is determined by Monitoring dynamic indices, not static indices [3]. In addition, it is becoming increasingly common for mechanically ventilated critically ill patients to not be curarized. This condition requires clinicians to adapt their practice and to use other tactics to help assess the volume status of their patients. This is particularly true with the passive leg raising maneuver. However, the issue at hand is the overall choice of Monitoring technique. In the 1970s, the only advanced Hemodynamic Monitoring option was the pulmonary artery catheter. The use of the pulmonary artery catheter (PAC) has been challenged in recent years, and there has been debate regarding its impact on patient survival. Conflicting results have been published [5], though the widely varying conclusions are due to patient selection, incomplete information, and differences in specific treatment protocols (or lack thereof) [6]. In light of this and by following the developments in the industry, clinicians are now in favor of using less-invasive Monitoring techniques. During the past few years, different techniques have been made commercially available. These devices are diverse in concept, design, and functionality but have more or less been shown to be reliable in clinical practice. Moreover, relative to the PAC, these devices are more easily handled, which could lead to their adoption and early application for use in large populations of at-risk patients or in patients with Hemodynamic instability. However, for everyday use in clinical practice, the diversity of minimally invasive Hemodynamic Monitoring requires knowledge of a number of different techniques, their operating concepts, their settings, and their respective clinical validity. In the first part of the present book, we present the Hemodynamic Monitoring parameters available to the clinician and their pathophysiological importance. For instance, blood pressure is the basic parameter, but measuring the arterial tone is sometime also necessary [7]. Additionally, measuring the intravascular pressure [8], the cardiac output, and their derived parameters is essential to determine and manage a balance between oxygen supply and consumption [9]. In this regard, we review techniques for cardiac output measurements based on pulmonary thermodilution [10], transpulmonary thermodilution [11, 12], echocardiography [13, 14], and Doppler techniques [15]. We discuss the techniques based on calibrated and non-calibrated pulse contour analysis [16] and their limitations. Finally, we discuss the dynamic indices of fluid responsiveness and their clinical applications and issues. Geneva, Switzerland Raphael Giraud Karim Bendjelid

  • Journal of Clinical Monitoring and Computing 2015 end of year summary: cardiovascular and Hemodynamic Monitoring
    Journal of Clinical Monitoring and Computing, 2016
    Co-Authors: Karim Bendjelid, Thomas W. L. Scheeren, Steffen Rex, Bernd Saugel
    Abstract:

    Hemodynamic Monitoring is essential in critically ill patients. In this regard, the Journal of Clinical Monitoring and Computing (JCMC) has become an ideal platform for publishing cardiovascular and Hemodynamic Monitoring-related research, as reflected by an increasing number of articles related to this topic and published in the recent years. To highlight this new progress, every New Year the journal prints a descriptive review on some important papers published last year in the JCMC and related to blood, cardiovascular function and Hemodynamic Monitoring.

  • Hemodynamic Monitoring development: helpful technology or expensive luxury?
    Journal of clinical monitoring and computing, 2012
    Co-Authors: Karim Bendjelid
    Abstract:

    Few problems in intensive care demand finer judgment, further experience, and greater skill than the assessment of patient physiological variables and this is especially true in case of cardiopulmonary instability [1]. Therefore, during the last two decades many intensivists have come to regard shocks as carrying a high enough mortality risk to deserve an advanced Hemodynamic Monitoring. Indeed, new Monitoring techniques in intensive care may improve the prognosis for shock, so that full advantage can be taken of these new skills [2]. However, in spite of increased availability of the Monitoring process and Monitoring equipment, Hemodynamic Monitoring has not significantly improved survival rate. As part of the present special issue of the Journal of Clinical Monitoring and Computing, appreciated opinion leaders provide an outline of the important technologic advance in Hemodynamic Monitoring to manage critically ill patients. The present reviews take a deeper look at physiology principles, main beliefs which are the basis of intensive care medicine [1]. In fact, the assessment of physiological principles (by these various techniques described in these reviews) at the bedside, reinforces our use of these principles in clinical decision making [3]. As example, previous works have pointed out that classical thermodilution technique, transpulmonary thermodilution, and pulse-plethysmography, are valuable tools in evaluating the Hemodynamic status of critically ill patients [4–6]. On the other hand, when occurrences not in accord with these principles are observed and unintelligible observations are documented [7], a new conception is gained concerning human pathophysiology [7, 8]. In this specific case, such new scheme should improve our care and the outcome for ICU patients. For many years it was commonly taught that we should insist on adequate evaluation of Hemodynamic Monitoring before it is implemented. In this regard, over the last decades, anesthetists and intensivists had the support and resources to determine the meaning of Hemodynamic Monitoring using rigorous scientific methods (Fig. 1). However, it seems quite dangerous to make robust clinical recommendations in the absence of proofs on the usefulness of these techniques regarding patient outcome [9]. Similarly, it could be pertinent to ask whether it would not be easier to forgo the advantages resulting from such a technologic advance as Hemodynamic Monitoring. However, sometimes, our knowledge of these devices and techniques, we use, is imperfect and our understanding should be improved [10]. Of course, the most significant advantage of Hemodynamic Monitoring is that patients will have a more rapid and complete circulatory state recovery and we should define what we need to measure and monitor to do that. This should be done before the technology is too widely available; a detail that underlines the magnitude of pathophysiological studies. As well, it must be established and accepted that specific Hemodynamic Monitoring is essential if an appropriate form of intervention or treatment could be administered with safety. And, in the situation where these techniques could have the potential to improve patient K. Bendjelid (&) Medecin Adjoint Agrege, Intensive Care Division, Geneva University Hospitals, 1211 Geneva 14, Switzerland e-mail: karim.bendjelid@hcuge.ch

Bernd Saugel - One of the best experts on this subject based on the ideXlab platform.

  • Mobile Devices for Hemodynamic Monitoring
    Annual Update in Intensive Care and Emergency Medicine, 2020
    Co-Authors: L. Briesenick, Frederic Michard, Bernd Saugel
    Abstract:

    Smartphones and mobile devices using wireless internet are used ubiquitously today. The “internet of things” interconnects sensors in everyday objects with mobile and other computing devices via the internet, giving access to a multitude of new data sources. This provides the basis for Monitoring and recording physiologic information on mobile devices and has led to the development of new tools and applications that may improve patient safety and guide therapy. Hemodynamic Monitoring and management are essential to patient care in perioperative and intensive care medicine. However, conventional Hemodynamic Monitoring devices and their sensors today are often invasive and bulky, not wireless or integrated, expensive and uncomfortable for awake patients. Therefore, continuous Hemodynamic Monitoring is currently limited to the operating room and the intensive care unit. Monitoring of patients on medical and surgical normal wards remains basic and intermittent. In the future, mobile devices could offer small, wireless, non-invasive, and integrated Hemodynamic Monitoring options creating an accessible, integrated, and interconnected network of data sources. This network of data sources has the potential to optimize patient care, leveraging the use of real-time Hemodynamic Monitoring to a broader patient population and even facilitating ward and home Monitoring.

  • Journal of Clinical Monitoring and Computing 2017 end of year summary: cardiovascular and Hemodynamic Monitoring
    Journal of Clinical Monitoring and Computing, 2018
    Co-Authors: Bernd Saugel, Karim Bendjelid, Lester A. H. Critchley, Thomas W. L. Scheeren
    Abstract:

    Hemodynamic Monitoring provides the basis for the optimization of cardiovascular dynamics in intensive care medicine and anesthesiology. The Journal of Clinical Monitoring and Computing (JCMC) is an ideal platform to publish research related to Hemodynamic Monitoring technologies, cardiovascular (patho)physiology, and Hemodynamic treatment strategies. In this review, we discuss selected papers published on cardiovascular and Hemodynamic Monitoring in the JCMC in 2017.

  • Journal of Clinical Monitoring and Computing 2016 end of year summary: cardiovascular and Hemodynamic Monitoring
    Journal of Clinical Monitoring and Computing, 2017
    Co-Authors: Bernd Saugel, Karim Bendjelid, Lester A. H. Critchley, Steffen Rex, Thomas W. L. Scheeren
    Abstract:

    The assessment and optimization of cardiovascular and Hemodynamic variables is a mainstay of patient management in the care for critically ill patients in the intensive care unit (ICU) or the operating room (OR). It is, therefore, of outstanding importance to meticulously validate technologies for Hemodynamic Monitoring and to study their applicability in clinical practice and, finally, their impact on treatment decisions and on patient outcome. In this regard, the Journal of Clinical Monitoring and Computing (JCMC) is an ideal platform for publishing research in the field of cardiovascular and Hemodynamic Monitoring. In this review, we highlight papers published last year in the JCMC in order to summarize and discuss recent developments in this research area.

  • Journal of Clinical Monitoring and Computing 2015 end of year summary: cardiovascular and Hemodynamic Monitoring
    Journal of Clinical Monitoring and Computing, 2016
    Co-Authors: Karim Bendjelid, Thomas W. L. Scheeren, Steffen Rex, Bernd Saugel
    Abstract:

    Hemodynamic Monitoring is essential in critically ill patients. In this regard, the Journal of Clinical Monitoring and Computing (JCMC) has become an ideal platform for publishing cardiovascular and Hemodynamic Monitoring-related research, as reflected by an increasing number of articles related to this topic and published in the recent years. To highlight this new progress, every New Year the journal prints a descriptive review on some important papers published last year in the JCMC and related to blood, cardiovascular function and Hemodynamic Monitoring.

Thomas W. L. Scheeren - One of the best experts on this subject based on the ideXlab platform.

William T Abraham - One of the best experts on this subject based on the ideXlab platform.

  • wireless Hemodynamic Monitoring in patients with heart failure
    Current Heart Failure Reports, 2021
    Co-Authors: Matthew M Lander, Nael H Aldweib, William T Abraham
    Abstract:

    PURPOSE OF REVIEW: Wireless Hemodynamic Monitoring in heart failure patients allows for volume assessment without the need for physical exam. Data obtained from these devices is used to assist patient management and avoid heart failure hospitalizations. In this review, we outline the various devices, mechanisms they utilize, and effects on heart failure patients. RECENT FINDINGS: New applications of these devices to specific populations may expand the pool of patients that may benefit. In the COVID-19 pandemic with a growing emphasis on virtual visits, remote Monitoring can add vital ancillary data. Wireless Hemodynamic Monitoring with a pulmonary artery pressure sensor is a highly effective and safe method to assess for worsening intracardiac pressures that may predict heart failure events, giving lead time that is valuable to keep patients optimized. Implantation of this device has been found to improve outcomes in heart failure patients regardless of preserved or reduced ejection fraction.

  • Wireless Hemodynamic Monitoring in Patients with Heart Failure.
    Current heart failure reports, 2021
    Co-Authors: Matthew M Lander, Nael H Aldweib, William T Abraham
    Abstract:

    Wireless Hemodynamic Monitoring in heart failure patients allows for volume assessment without the need for physical exam. Data obtained from these devices is used to assist patient management and avoid heart failure hospitalizations. In this review, we outline the various devices, mechanisms they utilize, and effects on heart failure patients. New applications of these devices to specific populations may expand the pool of patients that may benefit. In the COVID-19 pandemic with a growing emphasis on virtual visits, remote Monitoring can add vital ancillary data. Wireless Hemodynamic Monitoring with a pulmonary artery pressure sensor is a highly effective and safe method to assess for worsening intracardiac pressures that may predict heart failure events, giving lead time that is valuable to keep patients optimized. Implantation of this device has been found to improve outcomes in heart failure patients regardless of preserved or reduced ejection fraction.

  • abstract 19802 implantable Hemodynamic Monitoring reduces heart failure hospitalizations due to congestion regardless of perfusion status
    Circulation, 2015
    Co-Authors: Alan B Miller, Edward M Gilbert, Eugene S Chung, Wayne C Levy, John R Teerlink, Peter E Carson, Philip B Adamson, William T Abraham
    Abstract:

    Introduction: Heart failure (HF) management guided by implantable Hemodynamic Monitoring systems reduces overall hospitalizations in NYHA Class III patients with a previous HF hospitalization. Hypothesis: Hemodynamic Monitoring may reduce hospitalizations with accompanying low output status, as well as those resulting primarily from congestion. Methods: The CHAMPION Trial enrolled 550 NYHA Class III patients and randomly assigned them to a treatment group who were managed by Hemodynamic Monitoring using a permanently implanted pulmonary artery (PA) MEMS-based sensor or to a control group who were managed by standard clinical assessments (MEMS-sensors were implanted, but the uploaded pressures were not available to investigators). The primary endpoints were the comparison of HF hospitalization rates between the treatment and control groups assessed after 6 and 17 months of randomized follow-up. The blinded Clinical Events Committee prospectively adjudicated each HF hospitalization based on documented clinical Hemodynamic characteristics: (1) well perfused/congested, (2) poorly perfused/congested or (3) poorly perfused without congestion. Group 3 events were rare and not different between groups. Results: Patients in the treatment group had fewer hospitalizations overall (182 hospitalizations, rate 0.46/patient/year treatment vs. 279 hospitalizations, rate 0.68/patient/year control; (HR 0.67 CI (0.55-0.80), p Conclusions: Compared to standard clinical assessments, HF managed with implantable Hemodynamic Monitoring results in significant reductions in heart failure hospitalization regardless of perfusion status.