Use of near-infrared spectroscopy as a physiologic monitor for intra-abdominal hypertension.

Background: Intra-abdominal hypertension (IAH) is increasingly recognized as an important parameter in critically ill (ICU) patients. IAH affects perfusion to all abdominal components including the abdominal wall (AW). Near infrared spectroscopy (NIRS) measures changes in three chromophores including oxygenated hemoglobin (HbO2), deoxygenated hemoglobin (Hb), and cytochrome aa3 (Cyt), providing information concerning dysoxia.

A randomized, controlled trial of the use of pulmonary-artery catheters in high-risk surgical patients.

Background: Some observational studies suggest that the use of pulmonary-artery catheters to guide therapy is associated with increased mortality.

Methods: We performed a randomized trial comparing goal-directed therapy guided by a pulmonary-artery catheter with standard care without the use of a pulmonary-artery catheter. The subjects were high-risk patients 60 years of age or older, with American Society of Anesthesiologists (ASA) class III or IV risk, who were scheduled for urgent or elective major surgery, followed by a stay in an intensive care unit.