Multicenter Study of Noninvasive Monitoring Systems as Alternatives to Invasive Monitoring of Acutely III Emergency Patients

Shoemaker, William C.; Belzberg, Howard; Wo, Charles C.J.; Milzman, David; Pasquale, Michael D.; Baga, Leslie; Fuss, Mae Ann; Fulda, Gerard J.; Yarbrough, Karen; DeWater, Joseph P. Van; Ferraro, P J; Thangathurai, Duraiyah; Roffey, Peter; Velmahos, George C.; Murray, James A.; Asensio, Juan A.; El-Tawil, Khalid; Dougherty, William; Sullivan, Michael J.; Patii, Ramesh S.; Adibi, Jafar; James, C. S.; Δημητριάδης, Δημήτριος

doi:10.1378/chest.114.6.1643

Cited by 128 publications

(109 citation statements)

References 38 publications

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“…This is also consistent with previous studies where thermodilution decreased an average of 15% with expiration and increased 12%-15% with inspiration. 21 The correlations of ICG versus thermodilution cardiac output were also equivalent to those of pulse oximetry when compared with the standard blood gas analysis performed in the same clinical series. 21 In the study, noninvasive monitoring favorably compared with invasive thermodilution catheter monitoring in postoperative patients and patients with blunt trauma, gunshot wounds, head injuries, sepsis, strokes, drug overdose, hypertensive crises, acute myocardial infarction, and acute gastrointestinal bleeding.…”

Section: Validation Of the Techniquementioning

confidence: 81%

“…21 The correlations of ICG versus thermodilution cardiac output were also equivalent to those of pulse oximetry when compared with the standard blood gas analysis performed in the same clinical series. 21 In the study, noninvasive monitoring favorably compared with invasive thermodilution catheter monitoring in postoperative patients and patients with blunt trauma, gunshot wounds, head injuries, sepsis, strokes, drug overdose, hypertensive crises, acute myocardial infarction, and acute gastrointestinal bleeding. Of note, there was appreciable disparity in the presence of severe pulmonary edema, advanced adult respiratory distress syndrome, congestive heart failure, and late-stage septic shock with capillary leak.…”

Section: Validation Of the Techniquementioning

confidence: 81%

“…20 Using this statistical method, there has been very good agreement between ICG and thermodilution techniques. 21 In a recent large multicenter study, the ICG provided stable signals and reliable cardiac output estimations even under extenuating emergency conditions. 21 In this study there were 2,081 simultaneous bioimpedance and thermodilution cardiac output measurements in 860 critically ill patients from the ED, operating room (OR), and intensive care unit (ICU).…”

Section: Validation Of the Techniquementioning

confidence: 98%

“…21 In a recent large multicenter study, the ICG provided stable signals and reliable cardiac output estimations even under extenuating emergency conditions. 21 In this study there were 2,081 simultaneous bioimpedance and thermodilution cardiac output measurements in 860 critically ill patients from the ED, operating room (OR), and intensive care unit (ICU). The correlation coefficient, r, was 0.85; the precision and bias were ÿ0.124 þ 0.75 L/min/m 2 .…”

Section: Validation Of the Techniquementioning

confidence: 98%

“…No instances of spurious impedance values that would have led to incorrect or harmful therapy were observed. 21 When conditions interfere with accuracy, they could be identified by reductions in the baseline impedance (Z 0 ) \15 V and by the height of the impedance waveform \0.3 V. Using these values as criteria in a prospective evaluation of 213 data pairs in 46 patients, the correlation coefficient, r, was 0.93; bias and precision were ÿ0.14 þ 0.54 L/min/m 2 . The average difference between thermodilution and impedance measurements was 9.8% 6 6.7% and was similar to the differences between successive thermodilution measurements (9.4% 6 6.2%) under similar conditions.…”

Section: Validation Of the Techniquementioning

confidence: 99%

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Bench to Bedside: Electrophysiologic and Clinical Principles of Noninvasive Hemodynamic Monitoring Using Impedance Cardiography

Summers

Shoemaker

Peacock

et al. 2003

Academic Emergency Medicine

Self Cite

115

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The evaluation of the hemodynamic state of the severely ill patient is a common problem in emergency medicine. While conventional vital signs offer some insight into delineating the circulatory pathophysiology, it is often impossible to determine the true clinical state from an analysis of blood pressure and heart rate alone. Cardiac output measurements by thermodilution have been the criterion standard for the evaluation of hemodynamics. However, this technology is invasive, expensive, time-consuming, and impractical for most emergency department environments. Impedance cardiography (ICG) is a noninvasive method of obtaining continuous measurements of hemodynamic data such as cardiac output that requires little technical expertise. ICG technology was first developed by NASA in the 1960s and is based on the idea that the human thorax is electrically a nonhomogeneous, bulk conductor. Variation in the impedance to flow of a high-frequency, low-magnitude alternating current across the thorax results in the generation of a measured waveform from which stroke volume can be calculated by a modification of the pulse contour method. To adequately judge the possible role of this technology in the practice of emergency medicine, it is important to have a sufficient understanding of the basic scientific principles involved as well as the clinical validity and limitations of the technique.

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Section: Validation Of the Techniquementioning

confidence: 81%

Section: Validation Of the Techniquementioning

confidence: 81%

Section: Validation Of the Techniquementioning

confidence: 98%

Section: Validation Of the Techniquementioning

confidence: 98%

Section: Validation Of the Techniquementioning

confidence: 99%

See 3 more Smart Citations

Bench to Bedside: Electrophysiologic and Clinical Principles of Noninvasive Hemodynamic Monitoring Using Impedance Cardiography

Summers

Shoemaker

Peacock

et al. 2003

Academic Emergency Medicine

Self Cite

115

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Minimally Invasive and Noninvasive Diagnosis and Therapy in Critically Ill and Injured Patients

Eachempati¹

1999

Arch Surg

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n this review, both the newer noninvasive (ie, those that pose no breach of an epithelial barrier) and minimally invasive techniques relevant to the treatment of the critically ill or injured patient will be discussed. In some cases, the development of the technology is so recent that published data describing their clinical applications may be scant. The emphasis herein is on newer technologies; therefore, the discussion of certain established noninvasive techniques, such as pulse oximetry, and minimally invasive therapies, such as percutaneous abscess drainage, will be deferred.

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Point‐of‐Care Testing: Principles, Practice, and Critical‐Emergency‐Disaster Medicine

Kost

Tran

Louie

2008

Encyclopedia of Analytical Chemistry

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Point‐of‐care testing (POCT) is defined as testing at or near the site of patient care, wherever that medical care is needed. The goal of POCT is to facilitate immediate evidence‐based medical decisions that improve patient outcomes and reduce patient acuity, criticality, morbidity, and mortality, especially during life‐threatening crises and emergency resuscitations. POCT is efficient and efficacious because it facilitates rapid diagnosis, faster treatment decisions, high‐quality trend monitoring, and patient and physician satisfaction. New point‐of‐care (POC) technologies are appearing rapidly. This article summarizes principles and analytical methods of whole‐blood analysis (WBA) for chemistry, hematology, and hemostasis analytes, cardiac injury markers, and other POC diagnostic tests. Then, the article discusses important clinical aspects, including test clusters and medical indications, methods of monitoring and enhancing performance, and optimization strategies. In the next two decades, diagnostic testing will continue to shift to the POC, necessitating collaborative integration, information consolidation, and Knowledge Optimization ® in surgery, intensive care, emergency medicine, public health, and other settings extending from the acute care center to the patient's home.

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Multicenter Study of Noninvasive Monitoring Systems as Alternatives to Invasive Monitoring of Acutely III Emergency Patients

Cited by 128 publications

References 38 publications

Bench to Bedside: Electrophysiologic and Clinical Principles of Noninvasive Hemodynamic Monitoring Using Impedance Cardiography

Bench to Bedside: Electrophysiologic and Clinical Principles of Noninvasive Hemodynamic Monitoring Using Impedance Cardiography

Minimally Invasive and Noninvasive Diagnosis and Therapy in Critically Ill and Injured Patients

Point‐of‐Care Testing: Principles, Practice, and Critical‐Emergency‐Disaster Medicine

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