Noninvasive Monitoring of the Autonomic Nervous System and Hemodynamics of Patients With Blunt and Penetrating Trauma

Abstract

In the nonsurvivors, low flow, low MAP, and reduced tissue perfusion were associated with pronounced increases in PSNS and lesser increases in SNS activity. In the survivors, higher CI, MAP, and PtcO2/FIO2 values were associated with lesser increases in both PSNS and SNS activities.

Non-invasive hemodynamic monitoring in trauma patients

“…Motion artifacts, restlessness, shivering, anxiety, hyperventilation and agitation can interfere with the measurements [5,6,11]. However, all these circumstances may also limit the accuracy of pulmonary artery thermodilution and most other hemodynamic monitoring techniques [8,11]. Faulty electrode placement can obviously prevent good monitoring [5,6].…”

“…Moreover, extensive pulmonary edema, pleural effusion, valvular heart disease, dysrhythmias, extensive chest wall edema, and chest tubes parallel to the aorta can reduce the impedance measured by the device, and lead to false data [5,6,8,11]. In this case, the device’s measurements do not provide a reliable basis for clinical decisions [11].…”

“…Eleven non-invasive disposable prewired hydrogen electrodes need to be placed on predefined locations on the skin. Three electrodes function as electrocardiography leads and are placed across the precordium and left shoulder [2,4-8,11-13]. The other eight are positioned in pairs so that they lie over the top and bottom of the lung [5,11].…”

“…This is in accordance with many studies that have demonstrated that surviving patients exhibit significantly different hemodynamic patterns from non-survivors, and that these differences are already apparent in the Emergency Department (ED). For example, it has been repeatedly shown that cardiac index is higher in survivors than in non-survivors [2-8]. …”

Noninvasive techniques for probing neurocircuitry and treating illness: vagus nerve stimulation (VNS), transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS)

“…There are several other potential VNS clinical applications, reasoning from the known role of the vagus, including obesity (Roslin and Kurian, 2001), craving (Bodenlos et al, 2007), pain (Borckardt et al, 2006a(Borckardt et al, , 2005, traumatic brain injury (Colombo et al, 2008;Neese et al, 2007;Ottani et al, 2009), and anxiety (George et al, 2008b). These small sample size trials all suggest potential efficacies in these domains but RCT are needed.…”