The Experts below are selected from a list of 44028 Experts worldwide ranked by ideXlab platform
Todd W Rice - One of the best experts on this subject based on the ideXlab platform.
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Impact of Initial Central Venous Pressure on Outcomes of Conservative Versus Liberal Fluid Management in Acute Respiratory Distress Syndrome.
Critical Care Medicine, 2016Co-Authors: Matthew W Semler, Arthur P Wheeler, Gordon R Bernard, Herbert P Wiedemann, B. Taylor Thompson, Todd W RiceAbstract:OBJECTIVES In acute respiratory distress syndrome, conservative fluid management increases ventilator-free days without affecting mortality. Response to fluid management may differ based on patients' initial central Venous Pressure. We hypothesized that initial central Venous Pressure would modify the effect of fluid management on outcomes. DESIGN Retrospective analysis of the Fluid and Catheter Treatment Trial, a multicenter randomized trial comparing conservative with liberal fluid management in acute respiratory distress syndrome. We examined the relationship between initial central Venous Pressure, fluid strategy, and 60-day mortality in univariate and multivariable analysis. SETTING Twenty acute care hospitals. PATIENTS Nine hundred thirty-four ventilated acute respiratory distress syndrome patients with a central Venous Pressure available at enrollment, 609 without baseline shock (for whom fluid balance was managed by the study protocol). INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Among patients without baseline shock, those with initial central Venous Pressure greater than 8 mm Hg experienced similar mortality with conservative and liberal fluid management (18% vs 18%; p = 0.928), whereas those with central Venous Pressure of 8 mm Hg or less experienced lower mortality with a conservative strategy (17% vs 36%; p = 0.005). Multivariable analysis demonstrated an interaction between initial central Venous Pressure and the effect of fluid strategy on mortality (p = 0.031). At higher initial central Venous Pressures, the difference in treatment between arms was predominantly furosemide administration, which was not associated with mortality (p = 0.122). At lower initial central Venous Pressures, the difference between arms was predominantly fluid administration, with additional fluid associated with increased mortality (p = 0.013). CONCLUSIONS Conservative fluid management decreases mortality for acute respiratory distress syndrome patients with a low initial central Venous Pressure. In this population, the administration of IV fluids seems to increase mortality.
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impact of initial central Venous Pressure on outcomes of conservative versus liberal fluid management in acute respiratory distress syndrome
Critical Care Medicine, 2016Co-Authors: Matthew W Semler, Arthur P Wheeler, Taylor B Thompson, Gordon R Bernard, Herbert P Wiedemann, Todd W RiceAbstract:Abstract In acute respiratory distress syndrome, conservative fluid management increases ventilator-free days without affecting mortality. Response to fluid management may differ based on patients' initial central Venous Pressure. We hypothesized that initial central Venous Pressure would modify the effect of fluid management on outcomes. Retrospective analysis of the Fluid and Catheter Treatment Trial, a multicenter randomized trial comparing conservative with liberal fluid management in acute respiratory distress syndrome. We examined the relationship between initial central Venous Pressure, fluid strategy, and 60-day mortality in univariate and multivariable analysis. Twenty acute care hospitals. Nine hundred thirty-four ventilated acute respiratory distress syndrome patients with a central Venous Pressure available at enrollment, 609 without baseline shock (for whom fluid balance was managed by the study protocol). None. Among patients without baseline shock, those with initial central Venous Pressure greater than 8 mm Hg experienced similar mortality with conservative and liberal fluid management (18% vs 18%; p = 0.928), whereas those with central Venous Pressure of 8 mm Hg or less experienced lower mortality with a conservative strategy (17% vs 36%; p = 0.005). Multivariable analysis demonstrated an interaction between initial central Venous Pressure and the effect of fluid strategy on mortality (p = 0.031). At higher initial central Venous Pressures, the difference in treatment between arms was predominantly furosemide administration, which was not associated with mortality (p = 0.122). At lower initial central Venous Pressures, the difference between arms was predominantly fluid administration, with additional fluid associated with increased mortality (p = 0.013). Conservative fluid management decreases mortality for acute respiratory distress syndrome patients with a low initial central Venous Pressure. In this population, the administration of IV fluids seems to increase mortality.
Matthew W Semler - One of the best experts on this subject based on the ideXlab platform.
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Impact of Initial Central Venous Pressure on Outcomes of Conservative Versus Liberal Fluid Management in Acute Respiratory Distress Syndrome.
Critical Care Medicine, 2016Co-Authors: Matthew W Semler, Arthur P Wheeler, Gordon R Bernard, Herbert P Wiedemann, B. Taylor Thompson, Todd W RiceAbstract:OBJECTIVES In acute respiratory distress syndrome, conservative fluid management increases ventilator-free days without affecting mortality. Response to fluid management may differ based on patients' initial central Venous Pressure. We hypothesized that initial central Venous Pressure would modify the effect of fluid management on outcomes. DESIGN Retrospective analysis of the Fluid and Catheter Treatment Trial, a multicenter randomized trial comparing conservative with liberal fluid management in acute respiratory distress syndrome. We examined the relationship between initial central Venous Pressure, fluid strategy, and 60-day mortality in univariate and multivariable analysis. SETTING Twenty acute care hospitals. PATIENTS Nine hundred thirty-four ventilated acute respiratory distress syndrome patients with a central Venous Pressure available at enrollment, 609 without baseline shock (for whom fluid balance was managed by the study protocol). INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Among patients without baseline shock, those with initial central Venous Pressure greater than 8 mm Hg experienced similar mortality with conservative and liberal fluid management (18% vs 18%; p = 0.928), whereas those with central Venous Pressure of 8 mm Hg or less experienced lower mortality with a conservative strategy (17% vs 36%; p = 0.005). Multivariable analysis demonstrated an interaction between initial central Venous Pressure and the effect of fluid strategy on mortality (p = 0.031). At higher initial central Venous Pressures, the difference in treatment between arms was predominantly furosemide administration, which was not associated with mortality (p = 0.122). At lower initial central Venous Pressures, the difference between arms was predominantly fluid administration, with additional fluid associated with increased mortality (p = 0.013). CONCLUSIONS Conservative fluid management decreases mortality for acute respiratory distress syndrome patients with a low initial central Venous Pressure. In this population, the administration of IV fluids seems to increase mortality.
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impact of initial central Venous Pressure on outcomes of conservative versus liberal fluid management in acute respiratory distress syndrome
Critical Care Medicine, 2016Co-Authors: Matthew W Semler, Arthur P Wheeler, Taylor B Thompson, Gordon R Bernard, Herbert P Wiedemann, Todd W RiceAbstract:Abstract In acute respiratory distress syndrome, conservative fluid management increases ventilator-free days without affecting mortality. Response to fluid management may differ based on patients' initial central Venous Pressure. We hypothesized that initial central Venous Pressure would modify the effect of fluid management on outcomes. Retrospective analysis of the Fluid and Catheter Treatment Trial, a multicenter randomized trial comparing conservative with liberal fluid management in acute respiratory distress syndrome. We examined the relationship between initial central Venous Pressure, fluid strategy, and 60-day mortality in univariate and multivariable analysis. Twenty acute care hospitals. Nine hundred thirty-four ventilated acute respiratory distress syndrome patients with a central Venous Pressure available at enrollment, 609 without baseline shock (for whom fluid balance was managed by the study protocol). None. Among patients without baseline shock, those with initial central Venous Pressure greater than 8 mm Hg experienced similar mortality with conservative and liberal fluid management (18% vs 18%; p = 0.928), whereas those with central Venous Pressure of 8 mm Hg or less experienced lower mortality with a conservative strategy (17% vs 36%; p = 0.005). Multivariable analysis demonstrated an interaction between initial central Venous Pressure and the effect of fluid strategy on mortality (p = 0.031). At higher initial central Venous Pressures, the difference in treatment between arms was predominantly furosemide administration, which was not associated with mortality (p = 0.122). At lower initial central Venous Pressures, the difference between arms was predominantly fluid administration, with additional fluid associated with increased mortality (p = 0.013). Conservative fluid management decreases mortality for acute respiratory distress syndrome patients with a low initial central Venous Pressure. In this population, the administration of IV fluids seems to increase mortality.
Richard L Hughson - One of the best experts on this subject based on the ideXlab platform.
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optical hemodynamic imaging of jugular Venous dynamics during altered central Venous Pressure
IEEE Transactions on Biomedical Engineering, 2021Co-Authors: Robert Amelard, Andrew D Robertson, Courtney A Patterson, Hannah Heigold, Essi Saarikoski, Richard L HughsonAbstract:Objective: An optical imaging system is proposed for quantitatively assessing jugular Venous response to altered central Venous Pressure. Methods: The proposed system assesses sub-surface optical absorption changes from jugular Venous waveforms with a spatial calibration procedure to normalize incident tissue illumination. Widefield frames of the right lateral neck were captured and calibrated using a novel flexible surface calibration method. A hemodynamic optical model was derived to quantify jugular Venous optical attenuation (JVA) signals, and generate a spatial jugular Venous pulsatility map. JVA was assessed in three cardiovascular protocols that altered central Venous Pressure: acute central hypovolemia (lower body negative Pressure), Venous congestion (head-down tilt), and impaired cardiac filling (Valsalva maneuver). Results: JVA waveforms exhibited biphasic wave properties consistent with jugular Venous pulse dynamics when time-aligned with an electrocardiogram. JVA correlated strongly (median, interquartile range) with invasive central Venous Pressure during graded central hypovolemia (r=0.85, [0.72, 0.95]), graded Venous congestion (r=0.94, [0.84, 0.99]), and impaired cardiac filling (r=0.94, [0.85, 0.99]). Reduced JVA during graded acute hypovolemia was strongly correlated with reductions in stroke volume (SV) (r=0.85, [0.76, 0.92]) from baseline (SV: 7915 mL, JVA: 0.560.10 a.u.) to -40 mmHg suction (SV: 5918 mL, JVA: 0.470.05 a.u.; p<0.01). Conclusion: The proposed non-contact optical imaging system demonstrated jugular Venous dynamics consistent with invasive central Venous monitoring during three protocols that altered central Venous Pressure. Significance: This system provides non-invasive monitoring of Pressure-induced jugular Venous dynamics in clinically relevant conditions where catheterization is traditionally required, enabling monitoring in non-surgical environments.
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optical hemodynamic imaging of jugular Venous dynamics during altered central Venous Pressure
arXiv: Medical Physics, 2020Co-Authors: Robert Amelard, Andrew D Robertson, Courtney A Patterson, Hannah Heigold, Essi Saarikoski, Richard L HughsonAbstract:An optical imaging system is proposed for quantitatively assessing jugular Venous response to altered central Venous Pressure. The proposed system assesses sub-surface optical absorption changes from jugular Venous waveforms with a spatial calibration procedure to normalize incident tissue illumination. Widefield frames of the right lateral neck were captured and calibrated using a novel flexible surface calibration method. A hemodynamic optical model was derived to quantify jugular Venous optical attenuation (JVA) signals, and generate a spatial jugular Venous pulsatility map. JVA was assessed in three cardiovascular protocols that altered central Venous Pressure: acute central hypovolemia (lower body negative Pressure), Venous congestion (head-down tilt), and impaired cardiac filling (Valsalva maneuver). JVA waveforms exhibited biphasic wave properties consistent with jugular Venous pulse dynamics when time-aligned with an electrocardiogram. JVA correlated strongly (median, interquartile range) with invasive central Venous Pressure during graded central hypovolemia (r=0.85, [0.72, 0.95]), graded Venous congestion (r=0.94, [0.84, 0.99]), and impaired cardiac filling (r=0.94, [0.85, 0.99]). Reduced JVA during graded acute hypovolemia was strongly correlated with reductions in stroke volume (SV) (r=0.85, [0.76, 0.92]) from baseline (SV: 79$\pm$15mL, JVA: 0.56$\pm$0.10a.u.) to -40mmHg suction (SV: 59$\pm$18mL, JVA: 0.47$\pm$0.05a.u.; p$<$0.01). The proposed non-contact optical imaging system demonstrated jugular Venous dynamics consistent with invasive central Venous monitoring during three protocols that altered central Venous Pressure. This system provides non-invasive monitoring of Pressure-induced jugular Venous dynamics in clinically relevant conditions where catheterization is traditionally required, enabling monitoring in non-surgical environments.
Gordon R Bernard - One of the best experts on this subject based on the ideXlab platform.
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Impact of Initial Central Venous Pressure on Outcomes of Conservative Versus Liberal Fluid Management in Acute Respiratory Distress Syndrome.
Critical Care Medicine, 2016Co-Authors: Matthew W Semler, Arthur P Wheeler, Gordon R Bernard, Herbert P Wiedemann, B. Taylor Thompson, Todd W RiceAbstract:OBJECTIVES In acute respiratory distress syndrome, conservative fluid management increases ventilator-free days without affecting mortality. Response to fluid management may differ based on patients' initial central Venous Pressure. We hypothesized that initial central Venous Pressure would modify the effect of fluid management on outcomes. DESIGN Retrospective analysis of the Fluid and Catheter Treatment Trial, a multicenter randomized trial comparing conservative with liberal fluid management in acute respiratory distress syndrome. We examined the relationship between initial central Venous Pressure, fluid strategy, and 60-day mortality in univariate and multivariable analysis. SETTING Twenty acute care hospitals. PATIENTS Nine hundred thirty-four ventilated acute respiratory distress syndrome patients with a central Venous Pressure available at enrollment, 609 without baseline shock (for whom fluid balance was managed by the study protocol). INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Among patients without baseline shock, those with initial central Venous Pressure greater than 8 mm Hg experienced similar mortality with conservative and liberal fluid management (18% vs 18%; p = 0.928), whereas those with central Venous Pressure of 8 mm Hg or less experienced lower mortality with a conservative strategy (17% vs 36%; p = 0.005). Multivariable analysis demonstrated an interaction between initial central Venous Pressure and the effect of fluid strategy on mortality (p = 0.031). At higher initial central Venous Pressures, the difference in treatment between arms was predominantly furosemide administration, which was not associated with mortality (p = 0.122). At lower initial central Venous Pressures, the difference between arms was predominantly fluid administration, with additional fluid associated with increased mortality (p = 0.013). CONCLUSIONS Conservative fluid management decreases mortality for acute respiratory distress syndrome patients with a low initial central Venous Pressure. In this population, the administration of IV fluids seems to increase mortality.
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impact of initial central Venous Pressure on outcomes of conservative versus liberal fluid management in acute respiratory distress syndrome
Critical Care Medicine, 2016Co-Authors: Matthew W Semler, Arthur P Wheeler, Taylor B Thompson, Gordon R Bernard, Herbert P Wiedemann, Todd W RiceAbstract:Abstract In acute respiratory distress syndrome, conservative fluid management increases ventilator-free days without affecting mortality. Response to fluid management may differ based on patients' initial central Venous Pressure. We hypothesized that initial central Venous Pressure would modify the effect of fluid management on outcomes. Retrospective analysis of the Fluid and Catheter Treatment Trial, a multicenter randomized trial comparing conservative with liberal fluid management in acute respiratory distress syndrome. We examined the relationship between initial central Venous Pressure, fluid strategy, and 60-day mortality in univariate and multivariable analysis. Twenty acute care hospitals. Nine hundred thirty-four ventilated acute respiratory distress syndrome patients with a central Venous Pressure available at enrollment, 609 without baseline shock (for whom fluid balance was managed by the study protocol). None. Among patients without baseline shock, those with initial central Venous Pressure greater than 8 mm Hg experienced similar mortality with conservative and liberal fluid management (18% vs 18%; p = 0.928), whereas those with central Venous Pressure of 8 mm Hg or less experienced lower mortality with a conservative strategy (17% vs 36%; p = 0.005). Multivariable analysis demonstrated an interaction between initial central Venous Pressure and the effect of fluid strategy on mortality (p = 0.031). At higher initial central Venous Pressures, the difference in treatment between arms was predominantly furosemide administration, which was not associated with mortality (p = 0.122). At lower initial central Venous Pressures, the difference between arms was predominantly fluid administration, with additional fluid associated with increased mortality (p = 0.013). Conservative fluid management decreases mortality for acute respiratory distress syndrome patients with a low initial central Venous Pressure. In this population, the administration of IV fluids seems to increase mortality.
Arthur P Wheeler - One of the best experts on this subject based on the ideXlab platform.
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Impact of Initial Central Venous Pressure on Outcomes of Conservative Versus Liberal Fluid Management in Acute Respiratory Distress Syndrome.
Critical Care Medicine, 2016Co-Authors: Matthew W Semler, Arthur P Wheeler, Gordon R Bernard, Herbert P Wiedemann, B. Taylor Thompson, Todd W RiceAbstract:OBJECTIVES In acute respiratory distress syndrome, conservative fluid management increases ventilator-free days without affecting mortality. Response to fluid management may differ based on patients' initial central Venous Pressure. We hypothesized that initial central Venous Pressure would modify the effect of fluid management on outcomes. DESIGN Retrospective analysis of the Fluid and Catheter Treatment Trial, a multicenter randomized trial comparing conservative with liberal fluid management in acute respiratory distress syndrome. We examined the relationship between initial central Venous Pressure, fluid strategy, and 60-day mortality in univariate and multivariable analysis. SETTING Twenty acute care hospitals. PATIENTS Nine hundred thirty-four ventilated acute respiratory distress syndrome patients with a central Venous Pressure available at enrollment, 609 without baseline shock (for whom fluid balance was managed by the study protocol). INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Among patients without baseline shock, those with initial central Venous Pressure greater than 8 mm Hg experienced similar mortality with conservative and liberal fluid management (18% vs 18%; p = 0.928), whereas those with central Venous Pressure of 8 mm Hg or less experienced lower mortality with a conservative strategy (17% vs 36%; p = 0.005). Multivariable analysis demonstrated an interaction between initial central Venous Pressure and the effect of fluid strategy on mortality (p = 0.031). At higher initial central Venous Pressures, the difference in treatment between arms was predominantly furosemide administration, which was not associated with mortality (p = 0.122). At lower initial central Venous Pressures, the difference between arms was predominantly fluid administration, with additional fluid associated with increased mortality (p = 0.013). CONCLUSIONS Conservative fluid management decreases mortality for acute respiratory distress syndrome patients with a low initial central Venous Pressure. In this population, the administration of IV fluids seems to increase mortality.
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impact of initial central Venous Pressure on outcomes of conservative versus liberal fluid management in acute respiratory distress syndrome
Critical Care Medicine, 2016Co-Authors: Matthew W Semler, Arthur P Wheeler, Taylor B Thompson, Gordon R Bernard, Herbert P Wiedemann, Todd W RiceAbstract:Abstract In acute respiratory distress syndrome, conservative fluid management increases ventilator-free days without affecting mortality. Response to fluid management may differ based on patients' initial central Venous Pressure. We hypothesized that initial central Venous Pressure would modify the effect of fluid management on outcomes. Retrospective analysis of the Fluid and Catheter Treatment Trial, a multicenter randomized trial comparing conservative with liberal fluid management in acute respiratory distress syndrome. We examined the relationship between initial central Venous Pressure, fluid strategy, and 60-day mortality in univariate and multivariable analysis. Twenty acute care hospitals. Nine hundred thirty-four ventilated acute respiratory distress syndrome patients with a central Venous Pressure available at enrollment, 609 without baseline shock (for whom fluid balance was managed by the study protocol). None. Among patients without baseline shock, those with initial central Venous Pressure greater than 8 mm Hg experienced similar mortality with conservative and liberal fluid management (18% vs 18%; p = 0.928), whereas those with central Venous Pressure of 8 mm Hg or less experienced lower mortality with a conservative strategy (17% vs 36%; p = 0.005). Multivariable analysis demonstrated an interaction between initial central Venous Pressure and the effect of fluid strategy on mortality (p = 0.031). At higher initial central Venous Pressures, the difference in treatment between arms was predominantly furosemide administration, which was not associated with mortality (p = 0.122). At lower initial central Venous Pressures, the difference between arms was predominantly fluid administration, with additional fluid associated with increased mortality (p = 0.013). Conservative fluid management decreases mortality for acute respiratory distress syndrome patients with a low initial central Venous Pressure. In this population, the administration of IV fluids seems to increase mortality.
