It was concluded that anthrax immunisation results in a higher than expected prevalence of adverse reaction with initial incapacity of military significance affecting 18%. Greater immune responses may increase adverse reaction but this does not affect acceptance of anthrax immunisation. Poor completion rates necessitate development of a new anthrax immunisation strategy.
Simultaneous estimation of cardiac output (CO) by thoracic electrical bioimpedance (TEB) and thermodilution (TD) confirmed the results of a previous study which showed good agreement between these methods in selected, principally non-septic, patients. Poor agreement was found between simultaneous TEB and oesophageal Doppler monitoring (ODM) estimates of baseline and acute changes in CO. Taken with the results of previous studies, this implies that although isolated ODM estimates of CO, which tend to underestimate, are less reliable, ODM is the preferred method to monitor acute changes in CO. For many reasons, not least the speed with which a large number of seriously injured soldiers could be assessed, ODM is probably the better method if a non-invasive estimate of CO is required in field hospitals.
Changes in thoracic electrical bioimpedance during the cardiac cycle have been related to the ejection of the stroke volume of blood during cardiac systole. Refinements in the recording and analysis of these changes permit estimation of cardiac output. Encouraging reports comparing results obtained by this method and those obtained simultaneously using the current standard invasive method have been published. While there are limitations, the advantages of this technique are sufficient to make bioimpedance cardiography attractive to the military physician. It is for these reasons that the principles of this technology are reviewed in this paper.
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