In this study we quantify the ability of dynamic cardiovascular parameters measured by the PulseCO™ algorithm of the LiDCO™plus monitor to predict the response to a fluid challenge in post-operative ...patients.
Surgical patients, admitted to the Intensive Care Unit from the operating theatre were monitored with the LiDCO™plus system. A number of static and dynamic cardiovascular measurements were recorded before and after a fluid challenge. Receiver Operator Characteristic (ROC) curve analysis was used to identify the baseline values, with optimum sensitivity and specificity, to predict responsiveness to a fluid challenge.
Thirty-one patients were enrolled, and received protocol-based fluid challenges. Twelve (38%) responded by demonstrating an increase in stroke volume of >15%. Heart rate (HR) and central venous pressure (CVP) were not statistically different between responders and non-responders. Mean arterial pressure (mAP), systolic pressure variation (SPV), pulse pressure variation (PPV) and stroke volume variation (SVV) were statistically different between responders and non-responders. Parameters with a ROC area under the curve (AUC) significantly >0.5 included SPV 0.70 (0.52-0.88) P=0.046, PPV 0.87 (0.76-0.99) P<0.0002 and SVV 0.84 (0.71-0.96) P=0.0005. The best cut-off values (sensitivity and specificity) to predict fluid were SPV >9 mmHg (73%, 76%), PPV >13% (83%, 74%) and SVV >12.5% (75%, 83%). ROC analysis did not show the AUC to be significantly >0.5 for HR, mAP and CVP CONCLUSION: Dynamic indices measured by PulseCO™ (LiDCO) have a high sensitivity and specificity in predicting fluid responsiveness in sedated and mechanically ventilated patients. A cut-off value for PPV of 13% is the most sensitive and specific indicator of fluid responsiveness.
We have performed radial velocity (RV) monitoring of the components of the binary system HD 106515 over almost 11 years using the high-resolution spectrograph SARG at Telescopio Nazionale Galileo ...(TNG). The primary shows long-period radial velocity variations that indicate the presence of a low-mass companion whose projected mass is in the planetary regime (msini = 9.33 MJ). The 9.8 year orbit is quite eccentric (e = 0.57), as is typical for massive giant planets. Our results confirm the previously made preliminary announcement of the planet by Mayor et al. (2011, A&A, submitted arXiv:1109.2497). The secondary instead does not show significant RV variations. The two components do not differ significantly in chemical composition, as was also found for other pairs of which one component hosts giant planets. Adaptive optics images obtained with TNG/AdOpt do not reveal additional stellar companions. From the analysis of the relative astrometry of the components of the wide pair we compute an upper limit on the mass of the newly detected companion of about 0.25 M⊙. State-of-the-art or near-future instrumentation can provide true mass determination, thanks to the availability of the wide companion HD106515B as reference. Therefore, HD 106515Ab will allow a deeper insight into the transition region between planets and brown dwarfs.
Aims. We present data to improve the known parameters of the HD 17156 system (peculiar due to the eccentricity and long orbital period of its transiting planet) and constrain the presence of stellar ...companions. Methods. Photometric data were acquired for 4 transits, and high precision radial velocity measurements were simultaneously acquired with the SARG spectrograph at TNG for one transit. The template spectra of HD 17156 was used to derive effective temperature, gravity, and metallicity. A fit of the photometric and spectroscopic data was performed to measure the stellar and planetary radii, and the spin-orbit alignment. Planet orbital elements and ephemeris were derived from the fit. Near infrared adaptive optic images were acquired with the AdOpt module of TNG. Results. We found that the star has a radius of $R_{\mathrm{S}}$ = 1.44±0.03 $R_\odot$ and the planet $R_{\mathrm{P}}$ = 1.02±0.08 $R_{\mathrm{J}}$. The transit ephemeris is $T_{\mathrm{c}}$ = 2 454 756.73134 ± 0.00020 + N $\cdot$ 21.21663 ± 0.00045 BJD. Analysis of the Rossiter-Mclaughlin effect shows that the system is spin orbit aligned with an angle β = 4.8°±5.3°. The analysis of high resolution images did not reveal any stellar companion with a projected separation between of 150 and 1 000 AU from HD 17156.
Pulse pressure (PP) analysis from a radial arterial line is available with the LiDCO plus monitor (LiDCO, Cambridge, UK) and FloTrac/Vigileo (Edwards Lifesciences, Irvine, CA, USA). The aim of this ...study was to investigate the agreement of continuous PP analysis against intermittent thermodilution (ITD) using the pulmonary artery catheter (PAC).
This was a six-hour study in 29 patients monitored with a PAC. All measurements were referenced against CO measured from the average of four ITD curves from the PAC. The LiDCO plus was calibrated with a lithium dilution (PulseCOLi) and with ITD (PulseCOITD) at baseline. Measurements from Vigileo software 1.03 (APCO), LiDCO plus (PulseCOLi and PulseCOITD), CCO and ITD were taken every hour for the next six hours. The bias and precision between the two devices were calculated as well as the percentage error (PE) of agreement between the tested device and the reference. The coefficient of variation (CV) of the tested device was then derived.
The average bias, PE and coefficient of variation for CCO vs. ITD of the tested device were 0.3 L/min, 28% and 13%, respectively; for APCO vs. ITD the calculations were -1.1 L/min, 55% and 27%; for PulseCOLi Cardiac output Blood pressure Thermodilution. ITD they were 0.5 L/min, 40% and 19%; and for PulseCOITD vs. ITD they were 0.2 L/min, -31% and 15%.
APCO (Vigileo software 1.03) and PulseCOLi showed a moderate agreement with the PAC. When PulseCO was calibrated with ITD (PulseCOITD) it showed excellent agreement, demonstrating that PulseCO performs well against ITD when the calibration process is optimally performed.
There is little evidence to support the management of severe COVID-19 patients.
To document this variation in practices, we performed an online survey (April 30-May 25, 2020) on behalf of the ...European Society of Intensive Care Medicine (ESICM). A case vignette was sent to ESICM members. Questions investigated practices for a previously healthy 39-year-old patient presenting with severe hypoxemia from COVID-19 infection.
A total of 1132 ICU specialists (response rate 20%) from 85 countries (12 regions) responded to the survey. The survey provides information on the heterogeneity in patient's management, more particularly regarding the timing of ICU admission, the first line oxygenation strategy, optimization of management, and ventilatory settings in case of refractory hypoxemia. Practices related to antibacterial, antiviral, and anti-inflammatory therapies are also investigated.
There are important practice variations in the management of severe COVID-19 patients, including differences at regional and individual levels. Large outcome studies based on multinational registries are warranted.
We tested the hypothesis that pain relief after total hip replacement (THR) can be obtained with a multimodal approach using oral controlled release (CR) oxycodone plus IV paracetamol.
Two hundred ...and sixty patients undergoing THR were randomized into two groups. A group of 130 patients (EPI) under epidural anesthesia followed by continuous infusion of levobupivacaine 0.125% and sufentanil 0.7 mcg/mL at 7 mL/h was compared with a group (OXY) of 130 patients under spinal anesthesia and oral CR oxycodone 10 mg/q12h plus IV paracetamol 1g/q6h. Pain intensity at rest and dynamic by visual analogue scores (VAS), rescue dose consumption and side effects of three postoperative days (POD) were collected and analyzed with Mann-Withney test (P<0.05 was considered significant).
VAS values at rest were similar in both groups at POD#1, significantly lower in the OXY group either at POD#2 (P=0.018) and POD#3 (P=0.001). Dynamic VAS values were significantly lower in the EPI group at POD#1 (P=0.001), similar for both groups at POD#2 and significantly lower in the OXY group at POD#3 (P=0.026) than the comparing group. Rescue dose consumption was significantly lower in the EPI group during the POD#1 (P=0.009), similar for both groups at POD#2 and higher in the EPI at POD#3 (P=0.008). The incidence of vomiting was similar for the two groups. Nausea was more frequent in the OXY group at POD#3 and more hypotension events occurred in the OXY group at POD#2.
Oral CR oxycodone plus IV paracetamol was as effective as epidural levobupivacaine and sufentanil for postoperative pain relief after THR.
Hypovolemia is frequent in patients with sepsis and may contribute to worse outcome. The management of these patients is impeded by the low quality of the evidence for many of the specific components ...of the care. In this paper, we discuss recent advances and controversies in this field and give expert statements for the management of hypovolemia in patients with sepsis including triggers and targets for fluid therapy and volumes and types of fluid to be given. Finally, we point to unanswered questions and suggest a roadmap for future research.
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