Nursing skin assessment is an important pressure ulcer risk stratification tool in the ICU despite the availability of a large number of objectively measureable ICU specific parameters in these patients.

Background. Early haemodynamic assessment is of particular importance in the evaluation of haemodynamically compromised patients, but is often precluded by the invasiveness and complexity of the established cardiac output (CO) monitoring techniques. The FloTrac TM /Vigileo TM system allows minimally invasive CO determination based on the arterial pressure waveform derived from any standard arterial catheter, and the algorithm underlying CO calculation was recently modified to allow a more precise estimate of aortic compliance.Methods. Using the new software, we studied 25 haemodynamically unstable patients who had a radial artery catheter and underwent invasive haemodynamic monitoring with the PiCCO TM system. PiCCO TM -derived transpulmonary thermodilution and pulse contour CO (reference-CO) were compared with the CO values obtained with the FloTrac TM /Vigileo TM system (AP-CO). Reported CO values are indexed to body surface area. Agreement between reference-CO and AP-CO recorded during routine clinical care was assessed using Bland -Altman statistics.Results. Overall bias between the reference-CO and the AP-CO (n¼324) was 0.68 litre min 21 m 22 with a high percentage error of +58.8% (95% limits of agreement +1.94 l min 21 m 22 ). There was a significant difference (P,0.001) between the radial and the femoral mean arterial pressures, and bias was significantly larger for a mean pressure difference of .5 mm Hg (0.93 vs 0.57 litre min 21 m 22 , P¼0.032). No connection was found between the norepinephrine dose and the CO agreement.Conclusions. Despite the updated algorithm, AP-CO still showed a limited agreement with the reference-CO and systematically underestimated the CO so that the method is not suitable to replace invasive CO monitoring at present.

Abstract-The introduction of automated oscillometric blood pressure monitors was the basis for today's widespread use of blood pressure self-measurement. However, in atrial fibrillation, there is a controversial debate on the use of oscillometry because there is a high variability of heart rate and stroke volume. To date, the accuracy of oscillometric blood pressure monitoring in atrial fibrillation has only been investigated using auscultatory sphygmomanometry as reference method, which may be biased by arrhythmia as well. We performed a cross-sectional study in 102 patients (52 sinus rhythm, 50 atrial fibrillation) assessing the accuracy of an automated and validated oscillometric upper arm (M5 Professional, Omron) and wrist device (R5 Professional, Omron) to invasively assessed arterial pressure. Blood pressure values were calculated as the mean of 3 consecutive measurements. Systolic and diastolic blood pressure did not significantly differ in patients with sinus rhythm and atrial fibrillation, independent of the method of measurement (P>0.05 each). The within-subject variability of the oscillometric measurements was higher in patients with atrial fibrillation compared with sinus rhythm (P<0.01 each). The biases of systolic and diastolic blood pressure, however, did not significantly differ in presence or absence of atrial fibrillation in Bland-Altmann analysis (P>0.05 each). In conclusion, atrial fibrillation did not significantly affect the accuracy of oscillometric measurements, if 3 repeated measurements were performed. (Hypertension. 2013;62:579-584.)

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Transpulmonary thermodilution measurements with a cold saline bolus via a femoral catheter provide clinically reliable cardiac output and extravascular lung water index values. Concerning global end-diastolic volume index, there is a good correlation as well, but in the interpretation of the results, an overestimation has to be taken into account.

BackgroundArginine-vasopressin (AVP) binding to vasopressin V2 receptors promotes redistribution of the water channel aquaporin-2 (AQP2) from intracellular vesicles into the plasma membrane of renal collecting duct principal cells. This pathway fine-tunes renal water reabsorption and urinary concentration, and its perturbation is associated with diabetes insipidus. Previously, we identified the antimycotic drug fluconazole as a potential modulator of AQP2 localization.MethodsWe assessed the influence of fluconazole on AQP2 localization in vitro and in vivo as well as the drug's effects on AQP2 phosphorylation and RhoA (a small GTPase, which under resting conditions, maintains F-actin to block AQP2-bearing vesicles from reaching the plasma membrane). We also tested fluconazole's effects on water flow across epithelia of isolated mouse collecting ducts and on urine output in mice treated with tolvaptan, a VR2 blocker that causes a nephrogenic diabetes insipidus–like excessive loss of hypotonic urine.ResultsFluconazole increased plasma membrane localization of AQP2 in principal cells independent of AVP. It also led to an increased AQP2 abundance associated with alterations in phosphorylation status and ubiquitination as well as inhibition of RhoA. In isolated mouse collecting ducts, fluconazole increased transepithelial water reabsorption. In mice, fluconazole increased collecting duct AQP2 plasma membrane localization and reduced urinary output. Fluconazole also reduced urinary output in tolvaptan-treated mice.ConclusionsFluconazole promotes collecting duct AQP2 plasma membrane localization in the absence of AVP. Therefore, it might have utility in treating forms of diabetes insipidus (e.g., X-linked nephrogenic diabetes insipidus) in which the kidney responds inappropriately to AVP.

Analysis of TPTD data shows that thermodilution curve forms are modified with RRT, resulting in an erroneous calculation of thermodilution-derived hemodynamic parameters.

Although cardiac output (CO) monitoring is usually only used in intensive care units (ICUs) and operating rooms, there is increasing evidence that CO should be determined and optimized as early as possible, even before admission to the ICU, in the care of hemodynamically compromised patients. A variety of different minimally or noninvasive CO determination techniques have been developed, but not all of them are suitable for early hemodynamic monitoring outside the ICU. In this review, the different available methods for CO monitoring are presented and their potential for early hemodynamic assessment is discussed.