Emergency department noninvasive (NICOM) cardiac outputs are associated with trauma activation, patient injury severity and host conditions and mortality
ABSTRACT Anoninvasive cardiac output (CO) monitor (NICOM), using Bioreactance technology, has been validated in several nontrauma patient studies. We hypothesized that NICOM CO would have more significant associations with clinical conditions than would systolic blood pressure (sBP).
This is a prospective observational study of consecutive trauma activation patients during the first 10 to 60 minutes after emergency department arrival.
Analysis includes 270 consecutive trauma activation patients with 1,568 observations. CO was decreased (p ≤ 0.002) with major blood loss, hypotension, red blood cell transfusion, Injury Severity Score (ISS) higher than 20, low PetCO₂, abnormal pupils, elderly, preexisting conditions, low body surface area level, females, hypothermia, and death. CO was increased (p < 0.0001) with base deficit, ethanol positivity, and illicit drug positivity. The sBP was decreased (p ≤ 0.0005) with major blood loss, red blood cell transfusion, low PetCO₂, low body surface area level, and illicit drug positivity. The sBP was increased (p e 0.01) with ISS higher than 20, elderly, and preexisting conditions. Total significant condition associations were CO 83% (15 of 18 patients) and sBP 47% (8 of 17 patients; p = 0.03). In hypotensive patients, CO was lower with major blood loss (3.3 ± 2.1 L/ min) than without (6.0 ± 2.2 L/min; p < 0.0001). Of survivors with ISS 15 or higher, NICOM patients experienced a shorter hospital length of stay (10.5 days) when compared with 2009 and 2010 patients (14.0 days; p = 0.03).
The multiple associations of CO with patient conditions imply that NICOM provides an objective and clinically valid, relevant, and discriminate measure of cardiac function in acutely injured trauma activation patients. NICOM use may be associated with a shorter length of stay in surviving patients with complex injuries.
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ABSTRACT: Intravenous perfluorocarbons (PFC) have reduced the effects of decompression sickness (DCS) and improved mortality rates in animal models. However, concerns for the physiologic effects of DCS combined with PFC therapy have not been examined in a balanced mixed gender population. Methods: Thirty-two (16 male, 16 female) instrumented and sedated juvenile Yorkshire swine were exposed to 200 fsw for 31 minutes of hyperbaric air. Pulmonary artery pressure (PAP), cardiac output (CO) and systemic arterial pressure (SAP) were monitored before (control) and after exposure. Animals were randomized to treatment with Oxycyte (5cc/kg) vs saline (control) with 100% oxygen administered upon DCS onset; animals were observed for 90 minutes. Parameters recorded and analyzed included PAP, CO, SAP. Results: In all animals PAP began to rise prior cutis marmorata (CM) onset, the first sign of clinical DCS, generally peaking after CM onset. Female swine, compared to castrated males, had a more rapid onset of CM (7.30 vs. 11.46 min post-surfacing) and earlier onset to maximal PAP (6.41 vs. 9.69 min post-CM onset). Oxycyte therapy was associated with a sustained PAP elevation above controls in both genders (33.41 vs. 25.78 mm Hg). Significant pattern differences in PAP, CO and SAP were noted between genders and between therapeutic groups. There were no statistically significant differences in survival or paralysis between the PFC and control groups during the 48 hr observation period. Conclusions: Oxycyte therapy for DCS is associated with a prolonged PAP increase in swine. These species and gender differences warrant further exploration.Journal of Applied Physiology 10/2014; 118(1):jap.00727.2014. DOI:10.1152/japplphysiol.00727.2014 · 3.43 Impact Factor
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ABSTRACT: The assessment of hemodynamic status is a crucial task in the initial evaluation of trauma patients. However, blood pressure and heart rate are often misleading, as multiple variables may impact these conventional parameters. More reliable methods such as pulmonary artery thermodilution for cardiac output measuring would be necessary, but its applicability in the Emergency Department is questionable due to their invasive nature. Non-invasive cardiac output monitoring devices may be a feasible alternative. A systematic literature review was conducted. Only studies that explicitly investigated non-invasive hemodynamic monitoring devices in trauma patients were considered. A total of 7 studies were identified as suitable and were included into this review. These studies evaluated in a total of 1,197 trauma patients the accuracy of non-invasive hemodynamic monitoring devices by comparing measurements to pulmonary artery thermodilution, which is the gold standard for cardiac output measuring. The correlation coefficients r between the two methods ranged from 0.79 to 0.92. Bias and precision analysis ranged from -0.02 +/- 0.78 l/min/m(2) to -0.14 +/- 0.73 l/min/m(2). Additionally, data on practicality, limitations and clinical impact of the devices were collected. The accuracy of non-invasive cardiac output monitoring devices in trauma patients is broadly satisfactory. As the devices can be applied very early in the shock room or even preclinically, hemodynamic shock may be recognized much earlier and therapeutic interventions could be applied more rapidly and more adequately. The devices can be used in the daily routine of a busy ED, as they are non-invasive and easy to master.World Journal of Emergency Surgery 03/2015; 10(1):11. DOI:10.1186/s13017-015-0002-0 · 1.06 Impact Factor
Critical Care 03/2013; 17(2). DOI:10.1186/cc12139 · 5.04 Impact Factor