Monitoring in the Intensive Care

Kipnis, Éric; Ramsingh, Davinder; Bhargava, Maneesh; Dincer, Erhan; Broccard, Alain F.; Vallet, B.; Bendjelid, Karim; Thibault, Ronan

doi:10.1155/2012/473507

Cited by 46 publications

(58 citation statements)

References 184 publications

(179 reference statements)

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“…Confirmation of our findings in a larger cohort, or in a trial designed to test phosphate replacement strategies, is warranted. Future studies may directly measure tissue perfusion and oxygenation using gastric tonometry (29,30) to determine whether the reduction of 2,3-DPG with CRRT from elevated to normal levels is detrimental for tissue oxygen delivery. This may be especially relevant for longer duration of CRRT, which in our study was associated with substantial additional decrease in 2,3-DPG.…”

Section: Discussionmentioning

confidence: 99%

Reductions in Red Blood Cell 2,3-Diphosphoglycerate Concentration during Continuous Renal Replacment Therapy

Brugnara

Betensky

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives Hypophosphatemia is a frequent complication during continuous renal replacement therapy (CRRT), a dialytic technique used to treat AKI in critically ill patients. This study sought to confirm that phosphate depletion during CRRT may decrease red blood cell (RBC) concentration of 2,3-diphosphoglycerate (2,3-DPG), a crucial allosteric effector of hemoglobin's (Hgb's) affinity for oxygen, thereby leading to impaired oxygen delivery to peripheral tissues.Design, setting, participants, & measurements Phosphate mass balance studies were performed in 20 patients with severe AKI through collection of CRRT effluent. RBC concentrations of 2,3-DPG, venous blood gas pH, and oxygen partial pressure required for 50% hemoglobin saturation (P50) were measured at CRRT initiation and days 2, 4, and 7. Similar measurements were obtained on days 0 and 2 in a reference group of 10 postsurgical patients, most of whom did not have AKI. Associations of 2,3-DPG with laboratory parameters and clinical outcomes were examined using mixed-effects and Cox regression models.Results Mean 2,3-DPG levels decreased from a mean (6SD) of 13.463.4 mmol/g Hgb to 11.063.1 mmol/g Hgb after 2 days of CRRT (P,0.001). Mean hemoglobin saturation P50 levels decreased from 29.764.4 mmHg to 26.764.0 mmHg (P,0.001). No significant change was seen in the reference group. 2,3-DPG levels after 2 days of CRRT were not significantly lower than those in the reference group on day 2. Among patients receiving CRRT, 2,3-DPG decreased by 0.53 mmol/g Hgb per 1 g phosphate removed (95% confidence interval 0.38 to 0.68 mmol/g Hgb; P,0.001). Greater reductions in 2,3-DPG were associated with higher risk for death (hazard ratio, 1.43; 95% confidence interval, 1.09 to 1.88; P=0.01).Conclusions CRRT-induced phosphate depletion is associated with measurable reductions in RBC 2,3-DPG concentration and a shift in the O 2 :Hgb affinity curve even in the absence of overt hypophosphatemia. 2,3-DPG reductions may be associated with higher risk for in-hospital death and represent a potentially avoidable complication of CRRT.

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Section: Discussionmentioning

confidence: 99%

Reductions in Red Blood Cell 2,3-Diphosphoglycerate Concentration during Continuous Renal Replacment Therapy

Brugnara

Betensky

et al. 2015

Clinical Journal of the American Society of Nephrology

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“…Purpose: Monitoring surgical and intensive care patients is an usual procedure in hospital units [1]. The rise of intraabdominal pressure (IAP) is a well-documented phenomenon, leading to increased morbidity and mortality [2], [3].…”

Section: Extended Abstractmentioning

confidence: 99%

Non-Invasive System for Measuring Intra-Abdominal Pressure

Lopes¹,

Niza²,

Dourado³

2017

World Congress on Electrical Engineering and Computer Systems and Science

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Extended AbstractPurpose: Monitoring surgical and intensive care patients is an usual procedure in hospital units [1]. The rise of intraabdominal pressure (IAP) is a well-documented phenomenon, leading to increased morbidity and mortality [2], [3]. The objective of this study was to create a non-invasive system of IAP measurement based on computational intelligence systems [4]. From the bibliographic research carried out, no applications of artificial neural network (ANN) and adaptivenetwork-based fuzzy inference system (ANFIS) were used to determine IAP.Methods: The selection of the features was realized according with the literature review of the parameters that can be influenced by IAP [2]. The database used was collected in a population of 42 dogs submitted to surgery and divided into 2 groups: sick (with abdominal disease that can affect IAP) and healthy (dogs submitted to elective surgery). 372 measurements of 18 parameters (weight, abdominal perimeter, abdominal cavity surface area (ACSA), temperature, heart rate, amplitude measurement of P, R and T wave, intervals measurements of P, QRS, T, PQ and QT, systolic, diastolic and mean blood pressure, values of capnography and pulse oximetry) were used as input and 1 parameter as output (direct measurement of IAP) to build the ANN and ANFIS. In the construction of the ANN several types of architecture were tested, such as activation and training functions. The ANFIS was created with 2 types of inference system, Sugeno and Mandani, and the clustering of data were performed with the Fuzzy C-Means, subtractive clustering and self-organizing maps (SOM). Data were divided into 3 groups, training (50%), testing (25%) and validation (25%) in order to evaluate the networks [4], [5]. ResultsThe IAP showed average results of 4.05 ± 3.60 mmHg and the parameters with the highest statistical correlation with the IAP were: weight (cc0.48), ACSA (cc0.46), perimeter (cc0.34), diastolic (cc0.25) and mean blood pressure (cc0.17), duration of the QRS (cc0.20) and the amplitude of the R wave (cc0.12). Systems based on the 18 inputs were constructed and a simplified system was created only with the inputs with the highest correlation with the output. The best ANN created was built with 7 inputs, with the activation function Tansig and the training function Bayseian regularization. This network showed results of linear regression coefficient of 0.97. The ANFIS that demonstrated the best results was also constructed with the simplified model, with only 7 entries. The best results were obtained with Sugeno inference system and 20 rules demonstrating an error of 2.10 (training), 1.73 (test) and 3.79 (validation).Conclusion: This type of non-invasive methodology allows the determination of IAP continuously. The ANN and the ANFIS created allowed predicting IAP with low error compared to real values. This type of methodology can be used in human medicine.

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“…Benzer şekilde kalp debisi, myokart kontraktilitesi ve vasküler tonusun sürekli değerlendirilmesi yoğun bakım hastalarında tanı ve tedavi için mühimdir ve bu uzun süredir sadece PAC kateterle sağlanmıştır. Ancak son dönemde bu bilgiyi daha az invaziv veya tamamen non-invaziv yöntemlerle sağlayabilecek yeni teknolojiler vardır (10). Bu yöntemlere aşağıda değinilmiştir.…”

Section: Makrosi̇rkülasyon Moni̇togri̇zasyonuunclassified

“…Septik şok veya kalp yetmezliği gibi durumlarda uygun makroperfüzyona rağmen (kan basıncı, kalp debisi vs), mikrosirkülatuar perfüzyon yetersiz olabilir ve kapiller akım ciddi düzeyde deği-şebilir ve kalıcı doku iskemisinden sorumlu olabilir (10). Sidestream dark field (yan akım karanlık saha) (SDF) görüntülemesi kullanılarak, farklı doku bölgele-rindeki (sublingual, rektal mukoza vs.) mikrosirkülatu-ar akım noninvaziv olarak yatakbaşı görüntülenebilir (10).…”

Section: Mikrosirkülasyon Monitorizasyonuunclassified

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Yoğun Bakim Hastalarinin Monitorizasyonunda Gelişmeler

Çobanoğlu¹

2014

Toraks Cer Bult

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The most essential matter in following a patient in the intensive care unit is fine and correct monitorization. In intensive care units, monitorization is one of the basic applications for the detection of pathophysiologic abnormalities and the management of treatment. For this purpose, noninvasive and invasive monitoring techniques have been used. Recently, however, technological advancements in this area have introduced new methods of noninvasive and less invasive monitoring. In this paper, we discussed traditional monitorization methods and newer methods that have started to be used with the development of technology and their use in clinical practice.

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Monitoring in the Intensive Care

Cited by 46 publications

References 184 publications

Reductions in Red Blood Cell 2,3-Diphosphoglycerate Concentration during Continuous Renal Replacment Therapy

Reductions in Red Blood Cell 2,3-Diphosphoglycerate Concentration during Continuous Renal Replacment Therapy

Non-Invasive System for Measuring Intra-Abdominal Pressure

Yoğun Bakim Hastalarinin Monitorizasyonunda Gelişmeler

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