Non-invasive cardiac output monitoring in patients with polytrauma
Background. Cardiac output monitoring is considered to be a standard for evaluation of central hemodynamic parameters and response to fluid therapy. Innovative technology for non-invasive estimated continuous cardiac output (esCCO) allows measure it in on-line mode, which is designed to enhance monitoring of patients’ hemodynamic status. The purpose of the study was to evaluate the effectiveness and expediency of non-invasive continuous monitoring of cardiac output using esCCO technology in polytrauma patients during the acute stage. Materials and methods. Data from clinical examination and treatment of 40 patients with polytrauma who were admitted to the intensive care unit of Lviv Municipal Clinical Emergency Hospital are presented. In addition to routine measurements, central hemodynamic parameters were monitored in 20 patients from group 1 using the esCCO integrated into the Life Scope monitor (Nihon Kohden, Japan). In the control group (n = 20), only traditional indexes such as non-invasive blood pressure (BP), electrocardiogram, hemoglobin oxygen saturation (SpO2) were registered using multifunctional Philips IntelliVue (MP20) monitors, and standard laboratory tests were conducted for the comparative analysis. Results. From the first to the second day in both groups, statistically significant changes in laboratory tests were observed: the level of hematocrit decreased from 32.0 ± 1.0 % to 29.0 ± 0.8 % (p < 0.01); the hemoglobin content reduced from 91.5 ± 2.1 g/l to 87.0 ± 1.9 g/l (p < 0.05) on average; the leukocyte count increased from (9.8 ± 0.4) • 106 to (12.0 ± 0.5) • 106 (р < 0.001) on average. These changes indicate the development of anemia, systemic inflammatory reaction that has a significant effect on the rheological properties of the blood and hemodynamics. Stable blood pressure parameters were registered in patients from group 1 (systolic BP 122.9 ± 6.2 mm Hg, diastolic BP 69.7 ± 2.3 mm Hg) compared to the control group (systolic BP 112.2 ± 5.9 mmHg, diastolic BP 67.5 ± 2.1 mmHg). The decrease in the volume of infusion therapy by 13.5 % and of early complications by 11.5 % was observed in patients from group 1 compared to the controls. Conclusions. We have established that in the state of traumatic shock with a following systemic inflammatory reaction, rheological changes that potentiate hemodynamic insufficiency occur. EsCCO is a simple non-invasive monitoring method, which provides an opportunity to accelerate the optimization of patient’s hemodynamic status in polytrauma.
Full Text:PDF (Українська)
Injuries and violence: the facts 2015. World Health Organization. Available from: http://apps.who.int/iris/bitstream/10665/149798/1/9789241508018_eng.pdf. Accessed: 2015 https://www.who.int/gho/publications/world_health_statistics/en https://www.who.int/violence_injury_prevention/road_safety_status/2015/en
Ustinov O.V. Travmatyzm — holovna prychyna smerti sered molodi ta lyudey vikom do 40 rokiv? [Traumatism is the main cause of death among young people and people under the age of 40?] [Electronic resource]. Mode of acsess: https://www.umj.com.ua/article/114805/travmatizm-golovna-prichina-smerti-sered-molodi-ta-lyudej-vikom-do-40-rokiv
David V. Feliciano, Kenneth L. Mattox, Ernest E. Moore Trauma. The McGraw-Hill Companies, Inc., 2009. ISBN 978-0-07-146912-8.
Cecconi M., De Backer D., Antonelli M., Beale R. Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine. Intensive Care Med. 2014;40(12):1795-815. doi: 10.1007/s00134-014-3525.
Pinsky M.R., Payen D. Functional Hemodynamic Monitoring (Update in Intensive Care Medicine). Springer. 2005.
Iovenko І.А., Kobelyatsky Yu.Yu., Tsarev A.V., Kuzmova E.A., Mashin A.M. Hemodynamic Monitoring in practice Intensive Care Unit. 2016;5(76) (In Ukrainian) DOI: https://doi.org/10.22141/2224-05188.8.131.526.76433
Vincent J.L., Rhodes А., Perel А., Martin Clinical review: Update on hemodynamic monitoring — a consensus of 16. Crit. Care. 2011;15(4): 229-235.
A Novel Technology to Non-Invasively Measure Continuous Cardiac Output from ECG and SpO2. [Internet resourse]. Mode of acsess: http://www.nihonkohden.de/uploads/media/esCCO_Info_Vol.1_10.pdf
The next generation of non-invasive hemodynamics monitoring, 2012. [Internet resourse]. Mode of acsess: http://www.nihonkohden.de/uploads/media/esCCO_Info_Vol.2_09.pdf
Peeters Y., Bernards J., Mekeirele М., Homann В., De Raes М. Malbrain Manu L.N.G. Hemodynamic monitoring: To calibrate or not to calibrate? Part 1. Calibrated techniques. Anaesthesiology Intensive Therapy.2015;47(5):487-500.
Bernards J., Mekeirele М., Homann В., Peeters Y., De Raes М. Malbrain Manu L.N.G. Hemodynamic monitoring: To calibrate or not to calibrate? Part 2. Non-calibrated. Anaesthesiology Intensive Therapy.2015;47(5): 501-16.
Boyd J.H. Demetrios Sirounis Assessment of adequacy of volume resuscitation Current Opinion in Critical Care: Post Author Corrections. 2016.
Yamada T., Tsutsui M., Sugo Y., Sato T., Akazawa T., Sato N., Yamashita K., Ishihara H., Takeda J. Multicenter study verifying a method of noninvasive continuous cardiac output measurement using pulse wave transit time: a comparison with intermittent bolus thermodilution cardiac output. Anesthesia and analgesia. 2012;115(1):82-7. DOI: 10.1213/ANE.0b013e31824e2b6c.
Bataille B. M., Bertuit M., Mora M., Mazerolles M., Cocquet P., Masson B., Comparison of esCCO and transthoracic echocardiography for non-invasive measurement of cardiac output intensive. British Journal of Anaesthesia. 2012;09(6): 879-86.
Stan Yastrebov. A simplified approach for avaluating haemodinamic state in ICU with Echocardiography [Electron resours] https://intensivecarenetwork.com/echo-for-shock-haemodynamics/ assessed 2/12/2018
Hironori Ishihara, Masato Tsutsui. Impact of changes in systemic vascular resistance on a novel non-invasive continuous cardiac output measurement system based on pulse wave transit time: a report of two cases. Journal of Clinical Monitoring and Computing. 2014;28(4):423–427.
Vincent J.L., Pelosi P., Pearse R. Perioperative cardiovascular monitoring of high-risk patients: a consensus of 12. Critical Care. 2015;8(19);224.
Harbrecht BG, Minei JP, Shapiro MB, Nathens AB, Moore EE, West MA, Bankey PE, Cuschieri J, Johnson JL, Maier RV, et al. Inflammation and the host response to injury, a large-scale collaborative project: patient-oriented research core-standard operating procedures for clinical care: VI.. The Journal of trauma. 2007;63(3):703–708.
Pop G.A.M., Duncker D.J., Gardien M., Vranckx Р., Versluis S., Hasan D., Slager C.J. The clinical significance of whole blood viscosity in (cardio)vascular medicine. Heart J. 2002;10(12):512–516. PMCID: PMC2499821
Teylor BS, Harbrecht BG: The physiologic response to injury. In Peitzman AB, Rhodes, Schwab CW, et al. The Trauma Manual, 2nd ed. Philadelphia: Lippincott, Williams and Wilkins. 2002;17-20
Cherpanath TG. Hirsch, Alexander Geerts, Bart F. Predicting Fluid Responsiveness by Passive Leg Raising: A Systematic Review and Meta-Analysis of 23 Clinical Trials / Cherpanath T.G. Critical Care Medicine. 2016; 44 (5):981-991.
van Genderen ME, Bartels SA, Lima A, Bezemer R, Ince C, Bakker J, van Bommel J. Peripheral perfusion index as an early predictor for central hypovolemia in awake healthy volunteers. Journal Anesthesia & Analgesia.2013;116:351–356
Shere-Wolfe R.F., Galvagno S.M., Grissom T.E. Critical care considerations in the management of the trauma patient following initial resuscitation. Scandinavian Journal of Trauma. Resuscitation and Emergency Medicine. 2012;20:68. doi: 10.1186/1757-7241-20-68.
Copyright (c) 2019 EMERGENCY MEDICINE
This work is licensed under a Creative Commons Attribution 4.0 International License.
© Publishing House Zaslavsky, 1997-2019