Therapeutic Optimization of Atrioventricular Delay in Cardiosurgical ICU Patients by Noninvasive Cardiac Output Measurements versus Pulse Contour Analysis

Mellert, Fritz; Lindner, Peter; Schiller, Wolfgang; Gersing, E; Heinze, Ingo; Kreuz, Jens; Welz, Armin; Cj, Preusse

doi:10.1055/s-2008-1038515

Cited by 6 publications

(4 citation statements)

References 11 publications

(12 reference statements)

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“…Close monitoring of pediatric patients [12], aged patients [13] and patients with unstable vital signs can greatly improve their survival rate [14-16]. ICU plays an unreplaceble role in saving the lives of victims after major disasters such as earthquakes, especially those with crush syndrome and complications [17-19]. Demirkiran and colleagues considered that immediate intensive care is vital to the survival of patients with crush injury and compartment syndrome [20]…”

Section: Introductionmentioning

confidence: 99%

Management of severe crush injury in a front-line tent ICU after 2008 Wenchuan earthquake in China: an experience with 32 cases

Qian²,

Liu

et al. 2009

Crit Care

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IntroductionThe experience on management of crush injury after a devastating earthquake is lacking, and there are even less reports on the front-line critical care of these patients. A front-line intensive care unit (ICU) was set up in a tent after the disastrous Wenchuan earthquake (May, 12, 2008, China), where 32 patients suffering from crush injury were treated from May 12 to May 26. This study summarized our experience on management of 32 crush injury patients in a front-line tent ICU.MethodsWe retrospectively analyzed the clinical data of 32 crush injury patients treated in our frontline tent ICU. Using limited equipment, we observed the arterial blood gas parameters, blood routine, alanine aminotransferase, lactate dehydrogenase, creatine kinase, creatinine, blood urea nitrogen, and urine protein of patients. We also closely watched for changes in crush injury symptoms, urine output, and the dangerous complications of crush injury.ResultsEighteen of the 32 patients developed traumatic shock, 9 had acute renal failure, 6 had acute heart failure, 2 had stress ulcers and 4 had multiple organ dysfunction syndrome (MODS). The symptoms of 17 patients met the criteria of crush syndrome; hemodialysis and prompt surgical intervention were given to them when necessary. Prompt treatment in our tent ICU improved the symptoms of patients to different degrees. The limb distension and sensory dysfunction were improved and the urine output was increased or even restored to the normal level in some patients. Serological parameters were improved in most patients after admission. Five (15.63%) patients underwent amputation due to severe infection in our group. Six (18.75%) patients died, 4 due to MODS and 2 due to acute renal failure.ConclusionsSevere crushing injuries and life-threatening complications are major causes of death after major disasters like earthquakes. Prompt treatment and close monitoring of the severe complications are of great importance in saving patients' lives. Establishment of a well-equipped front-line ICU close to the epicentre of the earthquake allows for prompt on the spot rescue of critical patients with crush injury, greatly decreasing the mortality rate and complications and avoiding amputation. There should be sufficient equipment to meet the needs of more patients.

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Section: Introductionmentioning

confidence: 99%

Management of severe crush injury in a front-line tent ICU after 2008 Wenchuan earthquake in China: an experience with 32 cases

Qian²,

Liu

et al. 2009

Crit Care

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“…Khan et al performed NICOM‐based CRT optimization with bioreactance cardiography system 23 . Mellert et al 10 succesfully performed the AV delay optimization using NICOM based impedance cardiography. In this study, we performed the NICOM based CRT optimization method with Mobil‐O‐Graph device that is faster, easier to use, and does not require high experience.…”

Section: Discussionmentioning

confidence: 99%

“…Noninvasive cardiac output measurement (NICOM) is a relatively new method of hemodynamic assessment and cardiac output. Various NICOM based instruments including impedance cardiography, bioreactance, and arterial pulse contour have been used successfully in CRT optimization 10‐12 . The Mobil‐O‐Graph 24 h Ambulatory Blood Pressure Monitoring (ABPM) NG ® instrument (IEM, Stolberg, Germany) is an arteriograph from which noninvasive cardiac output (CO) was obtained using the pulse count analysis method.…”

Section: Introductionmentioning

confidence: 99%

Noninvasive cardiac output measurement based optimization in nonresponders of cardiac resynchronization therapy

Yenerçağ

Yüksel

Çoksevim

et al. 2020

Pacing Clinical Electrophis

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Background: Cardiac resynchronization therapy (CRT) is an important and effective therapy for end-stage heart failure (HF). Nonresponse to CRT is one of the main obstacles to its application in clinical practice. Herein, we investigated the utilization of the optimization technique using noninvasive cardiac output measurement (NICOM) based Mobil-O-Graph device that measures several circulation parameters noninvasively.Methods: Seventy-five CRT nonresponder HF patients with an implanted CRT device were included. Patients were randomized equally to 3 groups: NICOM, echocardiographic, and empirical optimization groups. After 3 months of optimization, changes in six minutes walk test (6-MWT), cardiac output (CO), left ventricular ejection fraction (LVEF), and end-systolic volume (LVESV) were measured. New York Heart Association (NYHA) class and hospitalization for HF were also determined.

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“…It is compatible with all pacemakers in the market and may use indices that are available in most EP and surgery procedure rooms and newer methods. 31,32 The use of the system does not present any additional risk to patient. It provides the clinician with a quantitative assessment that will facilitate the treatment course to take.…”

Section: Discussionmentioning

confidence: 99%

Clinical Validation of a Real-Time Data Processing System for Cardiac Output and Arterial Pressure Measurement During Intraoperative Biventricular Pacing Optimization

et al. 2012

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Biventricular pacing (BiVP) improves cardiac output (CO) and mean arterial pressure (MAP) after cardiopulmonary bypass (CPB) in selected patients at risk for acute left heart failure after cardiac surgery. Optimization of atrioventricular delay (AVD) and interventricular delay (VVD) to maximize the hemodynamic effect of pacing requires rapid and accurate data processing. Conventional post hoc data processing (PP) is accurate but time-consuming, and infeasible in the intraoperative setting. We created a customized, real-time data processing (RTP) system to improve data processing efficiency, while maintaining accuracy. Biventricular pacing optimization was performed within 1 hour of the conclusion of CPB in 10 patients enrolled in the Biventricular Pacing After Cardiac Surgery trial. Cardiac output, measured by an electromagnetic flow meter, and arterial pressure were recorded as AVD was randomly varied across seven settings and VVD across nine settings. Post hoc data processing values calculated by two observers were compared to RTP-generated outputs for CO and MAP. Interexaminer reliability coefficients were generated to access the dependability of RTP. Interexaminer reliability coefficient values ranged from 0.997 to 0.999, indicating RTP is as reliable as PP for optimization. Real-time data processing is instantaneous and therefore is more practical in a clinical setting than the PP method. Real-time data processing is useful for guiding intraoperative BiVP optimization and merits further development.

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Therapeutic Optimization of Atrioventricular Delay in Cardiosurgical ICU Patients by Noninvasive Cardiac Output Measurements versus Pulse Contour Analysis

Abstract: Inappropriate selection of AVD can compromise the hemodynamic situation of cardiosurgical patients. As it is totally noninvasive, ICG is a reliable and effective tool for tailoring AVD. Both systems (CI and EV) offer valid OAV determination.

Cited by 6 publications

References 11 publications

Management of severe crush injury in a front-line tent ICU after 2008 Wenchuan earthquake in China: an experience with 32 cases

Management of severe crush injury in a front-line tent ICU after 2008 Wenchuan earthquake in China: an experience with 32 cases

Noninvasive cardiac output measurement based optimization in nonresponders of cardiac resynchronization therapy

Clinical Validation of a Real-Time Data Processing System for Cardiac Output and Arterial Pressure Measurement During Intraoperative Biventricular Pacing Optimization

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