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PubMed2003

Evaluation of a new invasive continuous cardiac output monitoring system: the truCCOMS system.

OBJECTIVE: To compare measurements of cardiac output using a new pulmonary artery catheter with those obtained using two "gold standard" methods: the periaortic transit time ultrasonic flow probe and the conventional pulmonary artery thermodilution. DESIGN: Prospective clinical trial. SETTING: Cardiac surgery operating room and surgical ICU in a university hospital. MATERIAL AND METHODS: In the operating room, a new pulmonary artery catheter (truCCOMS system) was inserted in eight patients. A periaortic flow probe was inserted in four of them. Measurements of cardiac output obtained with the truCCOMS catheter and with the flow probe were compared at different phases of the surgical procedure. In the intensive care unit, the cardiac output displayed by the truCCOMS monitor was compared with the value obtained after bolus injection performed subsequently. RESULTS: In the operating room (70 measurements), the coefficient of correlation between cardiac output measured by the flow probe and the truCCOMS system was r2 = 0.79, the bias was +0.11 l/min with a precision of 0.47 l/min, and limits of agreement -0.83 to +1.05 l/min. In the intensive care unit (108 measurements), the coefficient of correlation between cardiac output measured by thermodilution and the truCCOMS system was r2 = 0.56, the bias was -0.07 l/min, the precision was 0.66 l/min, and the limits of agreement were -1.39 to +1.25 l/min. CONCLUSION: The truCCOMS system is a reliable method of continuous cardiac output measurement in cardiac surgery patients.

Aorta↗
PubMed1993

A glucose monitoring system for on line estimation in man of blood glucose concentration using a miniaturized glucose sensor implanted in the subcutaneous tissue and a wearable control unit.

We have developed a miniaturized glucose sensor which has been shown previously to function adequately when implanted in the subcutaneous tissue of rats and dogs. Following a glucose load, the sensor output increases, making it possible to calculate a sensitivity coefficient to glucose in vivo, and an extrapolated background current in the absence of glucose. These parameters are used for estimating at any time the apparent subcutaneous glucose concentration from the current. In the previous studies, this calibration was performed a posteriori, on the basis of the retrospective analysis of the changes in blood glucose and in the current generated by the sensor. However, for clinical application of the system, an on line estimation of glucose concentration would be necessary. Thus, this study was undertaken in order to assess the possibility of calibrating the sensor in real time, using a novel calibration procedure and a monitoring unit which was specifically designed for this purpose. This electronic device is able to measure, to filter and to store the current. During an oral glucose challenge, when a stable current is reached, it is possible to feed the unit with two different values of blood glucose and their corresponding times. The unit calculates the in vivo parameters, transforms every single value of current into an estimation of the glucose concentration, and then displays this estimation. In this study, 11 sensors were investigated of which two did not respond to glucose. In the other nine trials, the volunteers were asked to record every 30 s what appeared on the display during the secondary decrease in blood glucose.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2004

Perioperative hemodynamic measurements with an implantable monitoring system (Chronicle) in a patient with severe heart failure undergoing non-cardiac surgery.

A 53-year-old male patient with severe chronic heart failure due to ischemic cardiomyopathy (LVEF 25%) awaiting heart transplantation was admitted for resection of a bladder tumor. The patient underwent implantation of a Chronicle implantable hemodynamic monitor (IHM) two years before. Thus, perioperative monitoring of heart rate, right ventricular systolic, diastolic and pulse pressure, dP/dt and estimated pulmonary artery diastolic pressure through a lead implanted in the right ventricle was performed. In the postoperative period the patient developed low-output syndrome requiring catecholamine treatment. The patient was weaned from mechanical ventilation uneventfully the same day. However, he developed symptomatic and hemodynamic worsening of heart failure shortly after reduction of inotropes and required prolonged medical treatment with catecholamines. Patients with cardiac disease are known to be at increased risk for cardiovascular complications after noncardiac surgery. Therefore, it has been suggested that such patients could potentially benefit from perioperative invasive hemodynamic monitoring. For the first time, we report a case of perioperative continuous hemodynamic monitoring with a long term-implanted device in a potential heart transplant patient.

Blood Pressure Determination↗
PubMed1990

Clinical evaluation of a novel ambulatory automatic blood pressure monitoring system.

Reliability and reproducibility of a new automatic ambulatory blood pressure recorder were tested on 31 subjects (18 normotensives and 13 hypertensives). Of 3688 recordings, 1424 measurements were cross-checked with a sphygmomanometer in standing or sitting position at the beginning and at the end of a twenty-four hour monitoring period. In the normotensive subjects cross-checkings were performed also during a treadmill exercise stress test. Analysis of variance did not indicate statistical differences between the two types of measurement (p greater than 0.09 for systolic and p greater than 0.62 for diastolic), and a significant linear correlation was found at rest (r = 0.99, p less than 0.001 for systolic and r = 0.98, p less than 0.001 for diastolic pressure). During the effort test the device was unable to correctly measure blood pressure values after the first step. During the twenty-four hour monitoring period only 1.1% of the preprogrammed measurements were lost for each subject. The recorder seems to be a suitable and reliable tool for automatic blood pressure monitoring.

Adult↗
PubMed1999

Effect of a home monitoring system on hospitalization and resource use for patients with heart failure.

BACKGROUND: Heart failure has a large medical and economic impact on the elderly. Past studies have shown that high-intensity multidisciplinary interventions at academic medical centers can reduce future hospitalizations. Our pilot study examined the effects of a low-intensity monitoring program on hospitalizations and cost of care for patients with heart failure treated by community physicians. METHODS: We enrolled 68 patients with heart failure (mean age 73 +/- 13 years, 53% male) monitored by 31 physicians in a multidisciplinary program of patient education, daily self-monitoring, and physician notification of abnormal weight gain, vital signs, and symptoms. Comparisons of medical claims were made between the patients who received the intervention and a control group of 86 patients matched to the intervention group on medical claims during the preceding year. RESULTS: Compared with the prior year, medical claims per year decreased in the intervention group ($8500 +/- $13,000 to $7400 +/- $11,400), whereas they increased in the control group ($9200 +/- $15,000 to $18,800 +/- $34,000, P <.05). Similar differences were observed for hospitalizations and total hospital days. The program's effectiveness was unrelated to age, sex, or type of left ventricular dysfunction. CONCLUSIONS: These findings suggest that a multidisciplinary program of patient education, monitoring, and physician notification can reduce resource use in patients with heart failure managed in a community setting.

Aged↗