Emerging technologies

Divisions of Critical Care and Cardiology, Department of Pediatrics, St. Louis Children's Hospital, Washington University, St. Louis, MO, USA.
Pediatric Critical Care Medicine (Impact Factor: 2.34). 07/2011; 12(4 Suppl):S55-61. DOI: 10.1097/PCC.0b013e3182211c2b
Source: PubMed


Hemodynamic monitoring in critically ill patients has been considered part of the standard of care in managing patients with shock and/or acute lung injury, but outcome benefit, particularly in pediatric patients, has been questioned. There is difficulty in validating the reliability of monitoring devices, especially since this validation requires comparison to the pulmonary artery catheter, which has its own problems as a measurement tool. Interpretation of the available evidence reveals advantages and disadvantages of the available hemodynamic monitoring devices.

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    ABSTRACT: The primary aim of the study was to determine the changes, if any, in cardiac output (CO) and stroke volume (SV) in normal infants with RSV bronchiolitis. The secondary aim was to determine whether changes in CO (ΔCO) and SV (ΔSV) are associated with changes in respiratory rate (ΔRR). Non-invasive CO recordings were obtained within 24 h of admission and discharge. Changes in CO, SV, and HR measurements were compared using paired t-tests. The effect of fluid boluses during the first 24 h (<60 or ≥60 cc/kg) on CO was assessed by 2 way ANOVA with time and group as main effect. The relationship between ΔRR and ΔCO or ΔSV was assessed by linear regression. Data is presented as Mean ± SEM and mean differences with 95 % confidence interval (p < 0.05 considered significant). 15 infants with RSV bronchiolitis were studied. CO (1.31 ± 0.13 to 1.11 ± 0.11 l/min (0.21 [0.04-0.37]) and SV (9.42 ± 1.10 to 7.75 ± 0.83 ml/beat (1.67 [0.21-3.12]) decreased significantly while HR (142.1 ± 4.0 to 145.2 ± 3.1 beats/min 3.0 [-5.3 to 11.3]) was unchanged. SV (p = 0.02) and CO (p = 0.04) significantly decreased only in the 7 infants that received ≥60 cc/kg. ΔRR correlated significantly with ΔCO (r (2) = 0.28, p = 0.04); but not with ΔSV (r (2) = 0.20, p = 0.09). ∆CO was related to ΔSV and not Δ HR. The ∆CO and ΔSV were affected by fluid boluses. ΔRR correlated with ΔCO. Non-invasive CO monitoring can trend CO and SV in infants with bronchiolitis during hospitalization.
    International Journal of Clinical Monitoring and Computing 04/2012; 26(3):197-205. DOI:10.1007/s10877-012-9361-1 · 1.99 Impact Factor
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    ABSTRACT: This article reviews potential pediatric applications of 3 new technologies. (1) Pulse oximetry-based hemoglobin determination: Hemoglobin determination using spectrophotometric methods recently has been introduced in adults with varied success. This non-invasive and continuous technology may avoid veni-puncture and unnecessary transfusion in children undergoing surgery with major blood loss, premature infants undergoing unexpected and complicated emergency surgery, and children with chronic illness. (2) Continuous cardiac output monitoring: In adults, advanced hemodynamic monitoring such as continuous cardiac output monitoring has been associated with better surgical outcomes. Although it remains unknown whether similar results are applica-ble to children, current technology enables the monitoring of cardiac output non-invasively and continuously in pediatric patients. It may be important to integrate the data about cardiac output with other information to facilitate therapeutic interventions. (3) Anesthesia information management systems: Although perioperative electronic anesthesia information management sys-tems are gaining popularity in operating rooms, their potential functions may not be fully appreciated. With advances in information technology, anesthesia information management systems may facilitate bedside clinical decisions, administrative needs, and research in the perioperative setting.
    Pediatric Anesthesia 08/2012; 22(10):952-61. DOI:10.1111/pan.12007 · 1.85 Impact Factor
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    ABSTRACT: Purpose of review: Survival of critically ill patients with severe acute kidney injury is still low. The aim of this review is to describe recent scientific evidence on renal replacement therapy (RRT) and its potential implications for future research and clinical practice. Recent findings: Timing, dose and special indications of RRT will be described: recent literature provided new answers and new controversies about these three topics. Summary: Specific research on RRT timing will be mandatory in the next few years: a standard definition of timing will certainly help to shed new light on how to improve RRT patients' outcome. Dialytic dose of continuous RRT has been recently and definitely standardized to 20-25 ml/kg per hour (dialysis or hemofiltration), however, application to clinical practice still needs to be improved and new evidence on net ultrafiltration prescription showed that fluid balance may be as important as blood purification in critically ill patients with renal dysfunction. Special settings such as septic RRT, pediatric RRT, and RRT during extracorporeal membrane oxygenation recently achieved important results and new applications in clinical practice with important consequences for technical improvement and future care of these patients.
    Current opinion in critical care 11/2012; 18(6). DOI:10.1097/MCC.0b013e328359fdb5 · 2.62 Impact Factor
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