Functional Hemodynamic Monitoring With a Wireless Ultrasound Patch

نویسندگان

چکیده

In this Emerging Technology Review, a novel, wireless, wearable Doppler ultrasound patch is described as tool for resuscitation. The device designed, foremost, functional hemodynamic monitor—a simple, fast, and consistent method measuring change with preload variation. More generally, monitoring paradigm that helps predict stroke volume response to additional intravenous volume. Because of the left ventricular outflow tract noninvasively measures in realtime, it increasingly deployed purpose. Nevertheless, manner cumbersome, especially when repeat assessments are needed. Accordingly, peripheral arteries have been studied various from common carotid artery signal act windows ventricle. Yet, handheld susceptible human measurement error statistical limitations inadequate beat sample size. Therefore, capable continuous assessment minimizes inconsistencies smooths inherent physiologic variation by sampling many more cardiac cycles. Reaffirming clinical studies, tracks immediate SV excellent accuracy healthy volunteers altered maneuvers. also follows jugular venous Doppler, which qualitatively trends right atrial pressure. With further research application artificial intelligence, modalities new technology manifold. MEASURING cardiovascular after defined perturbation undergirds known “functional monitoring” (FHM).1Pinsky MR Payen D. Functional monitoring.Crit Care. 2005; 9: 566-572Crossref PubMed Scopus (199) Google Scholar, 2Pinsky MR. monitoring: Current concepts critical care.Curr Opin Crit 2014; 20: 288-293Crossref (46) 3Messina A Dell'Anna Baggiani M et al.Functional tests: systematic review metanalysis on reliability end-expiratory occlusion test mini-fluid challenge predicting fluid responsiveness.Crit 2019; 23: 264Crossref (20) 4Bentzer P Griesdale DE Boyd J al.Will hemodynamically unstable patient respond bolus fluids?.JAMA. 2016; 316: 1298-1309Crossref (108) Scholar Perhaps most widely taught measure orthostatic vital signs—whereby heart rate blood pressure measured before stands. Importantly, neither absolute nor key measure, but rather its gravitationally diminished preload. Thus, reaction standing reveals something clinically meaningful about status.2Pinsky FHM used similarly operating room intensive care unit (ICU).5Bednarczyk JM Fridfinnson JA Kumar al.Incorporating dynamic responsiveness into goal-directed therapy: meta-analysis.Crit Care Med. 2017; 45: 1538-1545Crossref (68) 6Monnet X Teboul J-L. Assessment responsiveness: Recent advances.Curr 2018; 24: 190-195Crossref (28) 7Calvo-Vecino Ripolles-Melchor Mythen al.Effect haemodynamic therapy postoperative complications low–moderate risk surgical patients: multicentre randomised controlled trial (FEDORA trial).Br Anaesth. 120: 734-744Abstract Full Text PDF (57) However, instead upright, may be reduced cyclically mechanical ventilation; underpins volume, pulse pressure, peak velocity variation, well tidal challenge.1Pinsky Scholar,2Pinsky Scholar,8Myatra SN Monnet J-L Use ‘tidal challenge’ improve variation.Crit 21: 60Crossref (16) Scholar,9Biais Lanchon R Sesay al.Changes induced lung recruitment maneuver mechanically ventilated patients room.Anesthesiology. 126: 260-267Crossref (37) Additionally, transiently end-inspiratory occlusion10Jozwiak Depret F al.Predicting critically ill using combined occlusions echocardiography.Crit e1131-e1138Crossref or augmented passive leg raise (PLR),4Bentzer Scholar,11Monnet Passive raising.Intensive 2008; 34: 659-663Crossref (234) Scholar,12Monnet Marik raising meta-analysis.Intensive 42: 1935-1947Crossref (149) test, challenge.3Messina Scholar,13Georges D de Courson H al.End-expiratory unit: An echocardiographic study.Crit 22: 32Crossref (19) 14Silva S Jozwiak predicts independently positive during acute respiratory distress syndrome.Crit 2013; 41: 1692-1701Crossref 15Dépret al.Esophageal can through tests.Crit 47: e96-102Crossref (15) 16Monnet Osman Ridel C patients.Crit 2009; 37: 951-956Crossref (185) Although each these stresses carries own indications contraindications,2Pinsky Scholar,17Monnet PE Prediction update.Ann Intensive 6: 111Crossref (212) reasoning flows previously described—nudging glean information. Though output typically (SV), surrogate, ultimate yield clinician slope Frank-Starling curve (Fig 1, A). other words, modified, large small intimates steep flattened curve, respectively.11Monnet Consequently, whether context ICU resuscitation part enhanced recovery, affords extra data—how will There ample evidence demonstrating superior static indices (eg, SV, output, central pressure) conflicting data exist,5Bednarczyk Scholar,7Calvo-Vecino Scholar,18Myles PS Andrews Nicholson al.Contemporary approaches perioperative IV therapy.World Surg. 2457-2463Crossref Scholar,19Varadhan KK Lobo DN. meta-analysis trials major elective open abdominal surgery: Getting balance right.Proc Nutr Soc. 2010; 69: 488-498Crossref (189) recovery beneficial reducing length stay. As well, decreases unnecessary and, potentially harmful, fluids ICU.5Bednarczyk Scholar,20Douglas IS Alapat PM Corl KA al.Fluid evaluation sepsis hypotension shock: randomized trial.Chest. 2020; 158: 1431-1445Abstract 21Malbrain ML Regenmortel N Saugel B al.Principles management stewardship septic It time consider 4 D's phases therapy.Ann 8: 66Crossref (150) 22Kattan E Ospina-Tascón GA al.Systematic early shock resuscitation: Secondary analysis ANDROMEDA-SHOCK trial.Crit 23Crossref numerous utensils FHM. Ultimately, them directly because leaving dependent variable traditional Evaluating technologies beyond scope Review. Instead, emphasis placed ultrasound, noninvasive adopted intensivists anesthesiologists.23Barjaktarevic I Kenny J-ÉS Berlin al.The evolution care: From procedural guidance monitor.J Ultrasound 2021; 40: 401-405Crossref (4) cursory overview their use offered background thereafter C). When frequency reflects off moving red cells, returned imputes equation. area under velocity-time yields distance, centimeters per second (cm/s) integrated give integral (ie, VTI, distance centimeters) travels over single beat. Then, multiplied vessel (assumed circular, π2) confers cylindrical cm3. For example, if insonated at (LVOT), then aforementioned calculation cm3 milliliters (mL). assuming constant LVOT area, depends only velocity.24Blanco P. Rationale velocity–time minute assessing point-of-care settings.Ultrasound J. 12: 21Crossref (14) principles help gauge curve.7Calvo-Vecino Scholar,25Lamia Ochagavia al.Echocardiographic prediction spontaneously breathing activity.Intensive 2007; 33: 1125-1132Crossref (239) VTI transthoracic echocardiography (TTE) PLR accurately detects who preload.12Monnet TTE conjunction an end-inspiratory, (EEOT), does same.10Jozwiak EEOT applied ventilator, physiologically akin Valsalva release.16Monnet similar approach has extrapolated descending aorta. Esophageal was pioneered anesthesiologists26Singer M. Oesophageal Doppler.Curr 15: 244-248Crossref expanded ICU.27Monnet Rienzo al.Passive ill.Crit 2006; 1402-1407Crossref (512) Again, PLR,27Monnet EEOT,15Dépret systolic controlled, ventilation,28Feissel Mangin Ruyer O al.Respiratory changes aortic indicator shock.Chest. 2001; 119: 867-873Abstract (400) apply Notably, aorta elastic, diameter intervention important.29Monnet Chemla al.Measuring improves esophageal 35: 477-482Crossref (62) recent investigation revealed diagnostic attributes without diameter.15Dépret addition another commonly reported corrected flow (FTc).30Barjaktarevic Toppen WE Hu al.Ultrasound undifferentiated shock.Crit 46: e1040-e1046Crossref (18) duration systole trace corresponds valve ejecting blood. mediated multiple variables, rate,31Mohammadinejad Hossein-Nejad H. Calculation time: Wodey's formula vs. Bazett's formula.J 44: 154Crossref (6) afterload,32Shaver Kroetz FW Leonard JJ effect steady-state increases systemic arterial ejection time.J Clin Invest. 1968; 217-230Crossref Scholar,33Singer Allen MJ Webb AR al.Effects alterations filling, contractility, vascular resistance ascending waveform normal subjects.Crit 1991; 19: 1138-1145Crossref (101) SV. afterload kept raw mathematically obtain FTc equation34Wodey Carre Beneux al.Limits monitor status children.J Monit Comput. 2000; 16: 223-228Crossref (13) Scholar), there good correlation between SV.35Braunwald Sarnoff Stainsby W. Determinants mean ejection.Circ Res. 1958; 319-325Crossref 36Remington JW Hamilton W Ahlquist RP. Interrelation systole, work dog.Am Physiol. 1948; 154: 6-15Crossref (9) 37Wallace AG Mitchell JH Skinner NS al.Duration systole.Circ 1963; 611-619Crossref (112) 38Weissler AM Peeler RG Roehll Jr, WH Relationships time, individuals disease.Am Heart 1961; 62: 367-378Crossref (250) brachial infers informs origin. easier insonate bedside than LVOT, superficial window Roehrig al. observed significant surgery patients.39Roehrig Govier Robinson al.Carotid flowmetry correlates poorly thermodilution following surgery.Acta Anaesthesiol Scand. 61: 31-38Crossref (8) Further, flow40Marik Levitov Young bioreactance determine redistribution patients.Chest. 143: 364-370Abstract (140) both demonstrated patients,30Barjaktarevic Scholar,41Jalil Thompson Cavallazzi al.Comparing raising.Am Med Sci. 355: 168-173Abstract though supportive detailed review.42Beier L Davis Esener review.J 39: 1965-1976Crossref (7) gastrointestinal hemorrhage43Karadadaş Çorbacıoğlu ŞK Çevik Y al.Assessment upper bleeding.Turk Emerg 35-41Crossref (1) induction.44Maitra Baidya DK Anand RK variations induction general anesthesia adult undergoing prospective observational study.J 721-730Crossref anticipates donation donation.45Mackenzie DC Khan NA Blehar loss.Ann 2015; 66 (277-82.e1)Abstract (32) Scholar,46Mackenzie status.Crit 18: P131Crossref (0) Similar findings noted fast.47Shokoohi Berry GW Shahkolahi utility sonographic determining responsiveness.J 38: 231-235Crossref (17) Of interest, receiving dialysis reduce removal, augment dialysis.48Antiperovitch Iliescu Chan B. Carotid dialysis.J 83-86Crossref (10) Scholar,49Hossein-Nejad Mohammadinejad Lessan-Pezeshki via ultrasonography status.J 30: 1199-1203Crossref (33) This implies steepens successful stress cyclical intrathoracic passive, ventilation, accurate measure.39Roehrig Scholar,44Maitra Scholar,50Ibarra-Estrada MÁ López-Pulgarín Mijangos-Méndez JC cohort 7: 12Crossref 51Kim D-H Shin Kim measurements respirophasic velocity.Br 121: 541-549Abstract 52Song Kwak Song al.Respirophasic predictor coronary disease.Br 113: 61-66Abstract 53Lu Xi Jiang al.Exploring best predictors shock.Am 1258-1261Abstract however, respiration (even partially) patient, variation—such pulse-pressure stroke-volume variation—usually underperforms measure. one group found worked preoperative neurosurgery patients,51Kim could not replicate finding patients.54Abbasi Nayeemuddin Azab unable assessed novice physician sonologists [e-pub ahead print].J (Accessed February 1)https://doi.org/10.1177/0885066620934392Crossref all investigations confirmed site infer change. Girotto sensitive specific detecting index (CI),55Girotto V Beurton femoral do allow effects.Ann 67Crossref Abbasi sonographers were either adequate CI surrogates.56Abbasi al.Change fails patients.Ultrasound Biol. 2659-2666Abstract (2) elaborated next, inconsistency reflect investigational variability flaw. First, described, cross-sectional artery. radius amplified power, problematic, smaller arteries. concretely, 6-mm artery, 1-mm becomes 30% error.57Taylor KJW Burns PN Wells PNT Clinical applications ultrasound.2nd Edition. Raven Press, New York, NY1995: 94Google Second, subtle, yet sources error, requires user select insonation angle relative centerline flow; typically, 60°. equation cosine-dependent, relatively angles magnify error. If misjudges 5°, engenders 15% velocit

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ژورنال

عنوان ژورنال: Journal of Cardiothoracic and Vascular Anesthesia

سال: 2021

ISSN: ['1053-0770', '1532-8422']

DOI: https://doi.org/10.1053/j.jvca.2021.01.040