Noninvasive Hemodynamic Monitoring for Combat Casualties

Abstract

The aims of this study were to develop and to test a noninvasive hemodynamic monitoring system that could be applied to combat casualties to supplement conventional vital signs, to use an advanced information system to predict outcomes, and to evaluate the relative effectiveness of various therapies with instant feedback information during acute emergency conditions. In a university-run inner city public hospital, we evaluated 1,000 consecutively monitored trauma patients in the initial resuscitation period, beginning shortly after admission to the emergency department. In addition to conventional vital signs, we used noninvasive monitoring devices (cardiac index by bioimpedance with blood pressure and heart rate to measure cardiac function, arterial hemoglobin oxygen saturation by pulse oximetry to reflect changes in pulmonary function, and tissue oxygenation by transcutaneous oxygen tension indexed to fractional inspired oxygen concentration and carbon dioxide tension to evaluate tissue perfusion). The cardiac index, mean arterial pressure, pulse oximetry (arterial hemoglobin oxygen saturation), and transcutaneous oxygen tension/fractional inspired oxygen concentration were significantly higher in survivors, whereas the heart rate and carbon dioxide tension were higher in nonsurvivors. The calculated survival probability was a useful outcome predictor that also served as a measure of severity of illness. The rate of misclassification of survival probability was 13.5% in the series as a whole but only 6% for patients without severe head injuries and brain death. Application of noninvasive hemodynamic monitoring to acute emergency trauma patients in the emergency department is feasible, safe, and inexpensive and provides accurate hemodynamic patterns in continuous, on-line, real-time, graphical displays of the status of cardiac, pulmonary, and tissue perfusion functions. Combined with an information system, this approach provided an early outcome predictor and evaluated, with an objective individualized method, the relative efficacy of alternative therapies for specific patients.

Comparison of Transcutaneous and Arterial Blood Gas Analyses in Patients with Sepsis and Septic Shock

“…This finding is not surprising because abolished peripheral microcirculation is a part of the septic shock pathophysiology itself. Hypo perfusion states like shock and/or acidosis may present decreased values of PtcO 2 and PtcCO 2 and vasoactive drug administration may also result in decreased PtcO 2 and PtcCO 2 (11)(12)(13)(14).…”

Physiology-Aware Rural Ambulance Routing

“…In this case, time is not critical, and in the face of stable patient and vital signs, the network connection becomes most critical. Precise monitoring and management of BP, TPA, and oxygenation (O2 saturation) is necessary if brain condition deteriorates [23], [24]. As a result, the ambulance may take the longer route, but more secure with coverage to assist EMT manage change in patient state in accordance with guidance from remote physicians.…”

Comparison of norepinephrine and dopamine in the management of septic shock using impedance cardiography

“…Impedance cardiography, the non-invasive method of cardiac output monitoring, has been found to be a satisfactory substitute for invasive monitoring as it provides essentially similar information and is easier, quicker, cheaper and much safer to use. [1][2][3][4][5][6] Hence in the present study, the effi ciency and dose requirement of two vasoconstrictors, dopamine and norepinephrine, were compared with predefi ned end points and continuous noninvasive hemodynamic monitoring.…”