To show the effect of dual monitoring including cardiac output (CO) and intracranial pressure (ICP) monitoring for severe traumatic brain injury (TBI) patiens. We hypothesized that meticulous treatment using dual monitoring is effective to sustain maintain minimal intensive care unit (ICU) complications and maintain optimal ICP and cerebral perfusion pressure (CPP) for severe TBI patiens.

We included severe TBI, below Glasgow Coma Scale (GCS) 8 and head abbreviation injury scale (AIS) >4 and performed decompressive craniectomy at trauma ICU of our hospital. We collected the demographic data, head AIS, injury severity score (ISS), initial GCS, ICU stay, sedation duration, fluid therapy related complications, Glasgow Outcome Scale (GOS) at 3 months and variable parameters of ICP and CO monitor.

Thirty patients with severe TBI were initially selected. Thirteen patients were excluded because 10 patients had fixed pupillary reflexes and 3 patients had uncontrolled ICP due to severe brain edema. Overall 17 patients had head AIS 5 except 2 patients and 10 patients (58.8%) had multiple traumas as mean ISS 29.1. Overall complication rate of the patients was 64.7%. Among the parameters of CO monitoring, high stroke volume variation is associated with fluid therapy related complications (p=0.043) and low cardiac contractibility is associated with these complications (p=0.009) statistically.

Combined use of CO and ICP monitors in severe TBI patients who could be necessary to decompressive craniectomy and postoperative sedation is good alternative methods to maintain an adequate ICP and CPP and reduce fluid therapy related complications during postoperative ICU care.

• Brain injuries
• Cardiac output
• Intracranial pressure
• Monitoring, physiologic
• Stroke volume

There has been a constant emphasis on developing management strategies to improve the outcome of high-risk cardiac patients undergoing surgical revascularization. The performance of coronary artery bypass surgery on an off-pump coronary artery bypass (OPCAB) avoids the risks associated with extra-corporeal circulation. The preliminary results of goal-directed therapy (GDT) for hemodynamic management of high-risk cardiac surgical patients are encouraging. The present study was conducted to study the outcome benefits with the combined use of GDT with OPCAB as compared to the conventional hemodynamic management.

Patients with the European System for Cardiac Operative Risk Evaluation ≥3 scheduled for OPCAB were randomly divided into two groups; the control and GDT groups. The GDT group included the monitoring and optimization of advanced parameters, including cardiac index (CI), systemic vascular resistance index, oxygen delivery index, stroke volume variation; continuous central venous oxygen saturation (ScVO₂), global end-diastolic volume, and extravascular lung water (EVLW), using FloTrac™, PreSep™, and EV-1000^® monitoring panels, in addition to the conventional hemodynamic management in the control group. The hemodynamic parameters were continuously monitored for 48 h in Intensive Care Unit (ICU) and corrected according to GDT protocol. A total of 163 patients consented for the study.

Seventy-five patients were assigned to the GDT group and 88 patients were in the control group. In view of 9 exclusions from the GDT group and 12 exclusions from control group, 66 patients in the GDT group and 76 patients in control group completed the study.

The length of stay in hospital (LOS-H) (7.42 ± 1.48 vs. 5.61 ± 1.11 days, P < 0.001) and ICU stay (4.2 ± 0.82 vs. 2.53 ± 0.56 days, P < 0.001) were significantly lower in the GDT group as compared to control group. The duration of inotropes (3.24 ± 0.73 vs. 2.89 ± 0.68 h, P = 0.005) was also significantly lower in the GDT group. The two groups did not differ in duration of ventilated hours, mortality, and other complications. The parameters such as ScVO₂, CI, and EVLW had a strong negative and positive correlation with the LOS-H with r values of − 0.331, −0.319, and 0.798, respectively. The study elucidates the role of a goal-directed hemodynamic optimization for improved outcome in high-risk cardiac patients undergoing OPCAB.

• Cardiac Surgical Procedures
• Catheterization, Swan-Ganz/adverse effects
• Heart Diseases/physiopathology
• Heart Diseases/surgery
• Hemodynamics/physiology
• Humans
• Monitoring, Intraoperative/methods
• Pulmonary Artery

• arterial pressure wave form technology
• cardiovascular surgery
• minimally invasive monitoring
• non-invasive monitoring
• perioperative hemodynamic optimization by goal-directed therapy

• Accuracy
• Cardiac output
• Hemodynamics
• Precision

• Accuracy
• Cardiac output
• Hemodynamics
• Precision

• Adult
• Anastomosis, Surgical
• Bile Ducts/surgery
• Blood Pressure
• Cardiac Output
• Catheterization
• Female
• Femoral Artery/pathology
• Femur/surgery
• Hemodynamics
• Humans
• Liver Failure/surgery
• Liver Transplantation/methods
• Male
• Middle Aged
• Monitoring, Intraoperative/methods
• Prospective Studies
• Pulmonary Artery
• Radial Artery/pathology
• Reproducibility of Results
• Thermodilution/methods
• Time Factors

The present study was designed to investigate the efficacy of stroke volume variation (SVV) in predicting fluid responsiveness and compare it to traditional measures of volume status assessment like central venous pressure (CVP).

Forty-five mechanically ventilated patients in sepsis with acute circulatory failure. Patients were not included when they had atrial fibrillation, other severe arrhythmias, permanent pacemaker, or needed mechanical cardiac support. Furthermore, excluded were patients with hypoxemia and a CVP >12. Patients received volume expansion in the form of 500 ml of 6% hydroxyethyl starch.

The volume expansion-induced increase in  cardiac index (CI) was >15% in 29 patients (labeled responders) and <15% in 16 patients (labeled nonresponders). Before volume expansion, SVV was higher in responders than in nonresponders. Receiver operating characteristic curves analysis showed that SVV was a more accurate indicator of fluid responsiveness than CVP. Before volume expansion, an SVV value of 13% allowed discrimination between responders and nonresponders with a sensitivity of 78% and a specificity of 89%. Volume expansion-induced changes in CI weakly and positively correlated with SVV before volume expansion. Volume expansion decreased SVV from 18.86 ± 4.35 to 7.57 ± 1.80 and volume expansion-induced changes in SVV moderately correlated with volume expansion-induced changes in CI.

When predicting fluid responsiveness in mechanically ventilated patients in septic shock, SVV is more effective than CVP. Nevertheless, the overall correlation of baseline SVV with increases in CI remains poor. Trends in SVV, as reflected by decreases with volume replacement, seem to correlate much better with increases in CI.

• Acute circulatory failure
• central venous pressure
• fluid responsiveness
• sepsis
• stroke volume variation

• Cardiac output
• Obese patient
• Pulmonary artery catheter
• Vigileo/FloTrac

• Anesthesiology
• Cardiac Surgical Procedures
• Critical Care
• Humans
• Monitoring, Physiologic
• Physicians
• Treatment Outcome
• Workforce

• cardiac output
• cardiac surgery
• clinical measurements
• measurement precision
• pulmonary artery catheter
• thermodilution

Cardiac output (CO) is the volume of blood ejected by each ventricle per minute and is the product of stroke volume and heart rate. CO can thus be manipulated by alteration in heart rate or rhythm, preload, contractility and afterload. Moreover it gives important information about tissue perfusion and oxygen delivery. CO can be measured by various methods and thermodilution method using pulmonary artery catheter (PAC) is till date considered as gold standard method. Complications associated with PAC led to development of newer methods which are minimally or non-invasive. Newer methods fulfil other properties like continuous and reproducible reading, cost effective, reliable during various physiological states and have fast response time. These methods are validated against the gold standard with good level agreement. In this review we have discussed various newer methods of CO monitoring and their effectiveness in clinical use.

• Cardiac output
• Pulse contour analysis
• Pulse power analysis
• Bioimpedance
• Doppler
• Echocardiography

• comparing cardiac output
• haemodynamic optimization
• stroke volume variations
• uncalibrated arterial pressure waveform analysis

During beating heart surgery, the accuracy of cardiac output (CO) measurement techniques may be influenced by several factors. This study was conducted to analyze the clinical agreement among stat CO mode (SCO), continuous CO mode (CCO), arterial pressure waveform-based CO estimation (APCO), and transesophageal Doppler ultrasound technique (UCCO) according to the vessel anastomosis sites.

This study was prospectively performed in 25 patients who would be undergoing elective OPCAB. Hemodynamic variables were recorded at the following time points: during left anterior descending (LAD) anastomosis at 1 min and 5 min; during obtuse marginal (OM) anastomosis at 1 min and 5 min: and during right coronary artery (RCA) anastomosis at 1 min and 5 min. The variables measured including the SCO, CCO, APCO, and UCCO.

CO measurement techniques showed different correlations according to vessel anastomosis site. However, the percent error observed was higher than the value of 30% postulated by the criteria of Critchley and Critchley during all study periods for all CO measurement techniques.

In the beating heart procedure, SCO, CCO and APCO showed different correlations according to the vessel anastomosis sites and did not agree with UCCO. CO values from the various measurement techniques should be interpreted with caution during OPCAB.

• Cardiac output
• Cardiovascular
• Measurement techniques
• OPCAB

• Cardiac Catheterization/instrumentation
• Cardiac Catheterization/methods
• Cardiac Output/physiology
• Cardiology/instrumentation
• Cardiology/methods
• Critical Care/methods
• Echocardiography, Doppler/instrumentation
• Echocardiography, Doppler/methods
• Echocardiography, Transesophageal/instrumentation
• Echocardiography, Transesophageal/methods
• Electric Impedance
• Equipment Design
• Equipment Safety
• Extracorporeal Membrane Oxygenation/instrumentation
• Extracorporeal Membrane Oxygenation/methods
• Female
• Hemodynamics/physiology
• Humans
• Lithium
• Male
• Monitoring, Physiologic/instrumentation
• Monitoring, Physiologic/methods
• Sensitivity and Specificity
• Ultrasonography, Doppler, Pulsed/instrumentation
• Ultrasonography, Doppler, Pulsed/methods
• Ultrasonography, Interventional/instrumentation
• Ultrasonography, Interventional/methods

• Cardiac output
• Measurement techniques
• Off pump coronary artery bypass

Second-generation FloTrac software has been shown to reliably measure cardiac output (CO) in cardiac surgical patients. However, concerns have been raised regarding its accuracy in vasoplegic states. The aim of the present multicenter study was to investigate the accuracy of the third-generation software in patients with sepsis, particularly when total systemic vascular resistance (TSVR) is low.

Fifty-eight septic patients were included in this prospective observational study in four university-affiliated ICUs. Reference CO was measured by bolus pulmonary thermodilution (iCO) using 3–5 cold saline boluses. Simultaneously, CO was computed from the arterial pressure curve recorded on a computer using the second-generation (CO_G2) and third-generation (CO_G3) FloTrac software. CO was also measured by semi-continuous pulmonary thermodilution (CCO).

A total of 401 simultaneous measurements of iCO, CO_G2, CO_G3, and CCO were recorded. The mean (95%CI) biases between CO_G2 and iCO, CO_G3 and iCO, and CCO and iCO were −10 (−15 to −5)% [−0.8 (−1.1 to −0.4) L/min], 0 (−4 to 4)% [0 (−0.3 to 0.3) L/min], and 9 (6–13)% [0.7 (0.5–1.0) L/min], respectively. The percentage errors were 29 (20–37)% for CO_G2, 30 (24–37)% for CO_G3, and 28 (22–34)% for CCO. The difference between iCO and CO_G2 was significantly correlated with TSVR (r² = 0.37, p < 0.0001). A very weak (r² = 0.05) relationship was also observed for the difference between iCO and CO_G3.

In patients with sepsis, the third-generation FloTrac software is more accurate, as precise, and less influenced by TSVR than the second-generation software.

The online version of this article (doi:10.1007/s00134-010-2098-8) contains supplementary material, which is available to authorized users.

• Animals
• Blood Pressure/physiology
• Cardiac Output/physiology
• Coronary Vessels/physiology
• Coronary Vessels/surgery
• Humans
• Monitoring, Intraoperative/instrumentation
• Monitoring, Intraoperative/methods
• Monitoring, Intraoperative/standards
• Prospective Studies
• Validation Studies as Topic