Uncalibrated continuous cardiac output measurement in liver transplant patients: LiDCOrapid™ system versus pulmonary artery catheter.

Objective: The aim of the study was to assess the level of agreement between continuous cardiac output estimated by uncalibrated pulse-power analysis (PulseCOLiR) and intermittent (ICO) and continuous cardiac output (CCO) obtained using a pulmonary artery catheter (PAC).

Design: Prospective cohort study.

Setting: University hospital intensive care unit.

Effects of catecholamines on microcirculation during general inhalation anesthesia.

Objective: The aim of this study was to investigate the effects of clinical dosages of norepinephrine and dobutamine on sublingual microcirculation during general anesthesia with sevoflurane in minor surgical procedures.

Design: This prospective study was performed on patients scheduled for breast cancer surgery.

Setting: Tertiary care university hospital.

The dos and do knots of central venous catheterization.

Central venous catheterization plays an important role in patients with end-stage renal disease undergoing hemodialysis. Placement of a right subclavian hemodialysis catheter was complicated by looping and entrapment of the guidewire. Computed tomographic and three-dimensional scans were essential in locating and determining that the guidewire was outside the vessel.

Prognostic power of pre- and postoperative B-type natriuretic peptide levels in patients undergoing abdominal aortic surgery.

Objectives: The first aim of the present study was to evaluate the pre- and postoperative B-type natriuretic peptide (BNP) levels in patients undergoing surgery for repair of an infrarenal abdominal aortic aneurysm (AAA) and analyze their power as a predictor of in-hospital cardiac events. The second aim was to evaluate the association among pre- and postoperative BNP levels, postoperative patient complications, and length of hospital stay.

Design: Prospective observational study.

Lack of a correlation between portal vein flow and pressure: toward a shared interpretation of hemodynamic stress governing inflow modulation in liver transplantation.

The portal vein flow (PVF), portal vein pressure (PVP), and hepatic venous pressure gradient (HVPG) were prospectively assessed to explore their relationships and to better define hyperflow and portal hypertension (PHT) during liver transplantation (LT). Eighty-one LT procedures were analyzed. No correlation between PVF and PVP was observed.

Uncalibrated arterial pulse cardiac output measurements in patients with moderately abnormal left ventricular function.

Objective: The aim of the study was to evaluate the accuracy and precision of the Vigileo/FloTrac system (Edwards Lifesciences, Irvine, CA) when compared with the intermittent cardiac output and continuous cardiac output measurements obtained from pulmonary arterial catheters in patients with moderately abnormal left ventricular function undergoing elective coronary artery bypass graft surgery.

Design: A prospective, observational study.

Setting: Tertiary university hospital.

Intraoperative hemodynamic monitoring during organ transplantation: what is new?

Purpose Of Review: To highlight the recent developments in hemodynamic monitoring during liver and lung transplantation.

Recent Findings: Even though a consensus on intraoperative hemodynamic monitoring is still lacking, the most frequently monitoring tool used is the pulmonary artery catheter (PAC). The filling pressures are widely accepted as not being able to accurately define cardiac preload.

Continuous right ventricular end-diastolic volume in comparison with left ventricular end-diastolic area.

Background And Objective: Intraoperative management of patients with end-stage liver disease undergoing liver transplantation requires fluid administration to increase cardiac output and oxygen delivery to the tissues. Filling pressures have been widely shown to correlate poorly with changes in cardiac output in the critically ill patient. Continuous right ventricular end-diastolic volume index (cRVEDVI) and left ventricular end-diastolic area index (LVEDAI) monitoring have been increasingly used for preload assessment.

Arterial pulse cardiac output agreement with thermodilution in patients in hyperdynamic conditions.

Objective: This study aimed to compare continuous cardiac output (CCO) obtained using the arterial pulse wave (APCO) measurement with a simultaneous measurement of the intermittent cardiac output (ICO) and CCO obtained with a pulmonary artery catheter (PAC) in liver transplant patients.

Design: A prospective, single-center evaluation.

Setting: A university hospital intensive care unit.

Continuous right ventricular end diastolic volume and right ventricular ejection fraction during liver transplantation: a multicenter study.

Cardiac preload is traditionally considered to be represented by its filling pressures, but more recently, estimations of end diastolic volume of the left or right ventricle have been shown to better reflect preload. One method of determining volumes is the evaluation of the continuous right ventricular end diastolic volume index (cRVEDVI) on the basis of the cardiac output thermodilution technique. Because preload and myocardial contractility are the main factors determining cardiac output during liver transplantation (LTx), accurate determination of preload is important.

Continuous and intermittent cardiac output measurement in hyperdynamic conditions: pulmonary artery catheter vs. lithium dilution technique.

Objective: This study aimed to assess the level of agreement of both intermittent cardiac output monitoring by the lithium dilution technique (CO(Li)) and continuous cardiac output monitoring (PulseCO(Li)) using the arterial pressure waveform with intermittent thermodilution using a pulmonary artery catheter (CO(PAC)).

Design: Prospective, single-center evaluation.

Setting: University Hospital Intensive Care Unit.

How to measure and interpret volumetric measures of preload.

Purpose Of Review: To update the situation over the past few years on the clinical application of volumetric measures of preload in critically ill patients.

Recent Findings: Cardiac filling pressures monitoring is unreliable for assessing cardiac preload in mechanically ventilated critically ill patients. The transpulmonary dilution indicator technique was shown to better identify preload than pulmonary arterial catheterization.

Preload indexes in thoracic anesthesia.

Purpose Of The Review: An adequate cardiac preload is essential in the treatment of critically ill patients. During anesthesia for thoracic surgery, volume and vasoactive therapy to optimize cardiac output, oxygen delivery (tissue perfusion) and to avoid pulmonary edema is a central therapeutic aspect. Cardiac preload has been estimated with different techniques in clinical practice, even though studies performed on thoracic anesthesia are lacking.

Cardiac output monitoring: aortic transpulmonary thermodilution and pulse contour analysis agree with standard thermodilution methods in patients undergoing lung transplantation.

Purpose: The PiCCO System is a relatively new device allowing intermittent cardiac output monitoring by aortic transpulmonary thermodilution technique (Aorta intermittent) and continuous cardiac output monitoring by pulse contour analysis (Aorta continuous). The objective of this study was to assess the level of agreement of Aorta intermittent and Aorta continuous with intermittent (PA intermittent) and continuous cardiac output (PA continuous) measured through a special pulmonary artery catheter (Vigilance System SvO(2)/CCO Monitor) in patients undergoing single- or double-lung transplantation.

Methods: Measurements were obtained in 58 patients: at four time points in patients undergoing single-lung transplantation and at six time points in those undergoing double-lung transplantation.

Severe reperfusion lung injury after double lung transplantation.

Aim: To demonstrate the effects of combined inhaled nitric oxide and surfactant replacement as treatment for acute respiratory distress syndrome. This treatment has not previously been documented for reperfusion injury after double lung transplantation.

Method: A 24-year-old female with cystic fibrosis underwent double lung transplantation.