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- Vistisen, Simon Tilma, et al.
(författare)
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Automated pre-ejection period variation indexed to tidal volume predicts fluid responsiveness after cardiac surgery
- 2009
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 53:4, s. 534-42
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Reliable continuous monitoring of fluid responsiveness is an unsolved issue in patients ventilated with low tidal volume. We hypothesised that variations in the pre-ejection period (PEP) defined as the time interval between electrocardiogram (ECG) R-wave and onset of systolic upstroke in arterial blood pressure could reliably predict fluid responsiveness in patients ventilated with moderately low tidal volume. Furthermore, we hypothesised that indexing dynamic parameters to tidal volume would improve their prediction. The aim was to refine and automate a previously suggested algorithm for PEP variation (DeltaPEP) and to test this new parameter indexed to tidal volume (PEPV), as a marker of fluid responsiveness along with central venous pressure (CVP), pulse pressure variation (PPV) and DeltaPEP. Additionally, the aim was to evaluate the concept of indexing dynamic parameters to tidal volume. METHODS: Arterial pressure, CVP, ECG and cardiac index (CI) were acquired from 23 mechanically ventilated post-cardiac surgery patients scheduled for volume expansion. PEPV, PPV and DeltaPEP were extracted. RESULTS: Using responder/non-responder classification (response=change in CI>+15%), sensitivity and specificity were 100% and 83%, respectively, for PEPV, 94% and 83% for DeltaPEP, and 94% and 83% for PPV. CVP offered no relevant information. Tidal volume indexing improved sensitivity for DeltaPEP to 100%. CONCLUSION: In this study in post-cardiac surgery patients, a refined parameter, PEPV, predicted fluid responsiveness better than PPV and DeltaPEP. Our results suggest that dynamic parameters using variations in PEP should be indexed to tidal volume.
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- Kohls, Mirjam, et al.
(författare)
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Impact of cumulative body mass index and cardiometabolic diseases on survival among patients with colorectal and breast cancer : a multi-centre cohort study
- 2022
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Ingår i: BMC Cancer. - : BioMed Central (BMC). - 1471-2407 .- 1471-2407. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Body mass index (BMI) and cardiometabolic comorbidities such as cardiovascular disease and type 2 diabetes have been studied as negative prognostic factors in cancer survival, but possible dependencies in the mechanisms underlying these associations remain largely unexplored. We analysed these associations in colorectal and breast cancer patients.Methods: Based on repeated BMI assessments of cancer-free participants from four European countries in the European Prospective Investigation into Cancer and nutrition (EPIC) study, individual BMI-trajectories reflecting predicted mean BMI between ages 20 to 50 years were estimated using a growth curve model. Participants with incident colorectal or breast cancer after the age of 50 years were included in the survival analysis to study the prognostic effect of mean BMI and cardiometabolic diseases (CMD) prior to cancer. CMD were defined as one or more chronic conditions among stroke, myocardial infarction, and type 2 diabetes. Hazard ratios (HRs) and confidence intervals (CIs) of mean BMI and CMD were derived using multivariable-adjusted Cox proportional hazard regression for mean BMI and CMD separately and both exposures combined, in subgroups of localised and advanced disease.Results: In the total cohort of 159,045 participants, there were 1,045 and 1,620 eligible patients of colorectal and breast cancer. In colorectal cancer patients, a higher BMI (by 1 kg/m2) was associated with a 6% increase in risk of death (95% CI of HR: 1.02–1.10). The HR for CMD was 1.25 (95% CI: 0.97–1.61). The associations for both exposures were stronger in patients with localised colorectal cancer. In breast cancer patients, a higher BMI was associated with a 4% increase in risk of death (95% CI: 1.00–1.08). CMDs were associated with a 46% increase in risk of death (95% CI: 1.01–2.09). The estimates and CIs for BMI remained similar after adjustment for CMD and vice versa.Conclusions: Our results suggest that cumulative exposure to higher BMI during early to mid-adulthood was associated with poorer survival in patients with breast and colorectal cancer, independent of CMD prior to cancer diagnosis. The association between a CMD diagnosis prior to cancer and survival in patients with breast and colorectal cancer was independent of BMI.
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- Vistisen, Simon Tilma, et al.
(författare)
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Automated pre-ejection period variation predicts fluid responsiveness in low tidal volume ventilated pigs
- 2010
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 54:2, s. 199-205
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: The respiratory variation in the pre-ejection period (DeltaPEP) has been used to predict fluid responsiveness in mechanically ventilated patients. Recently, we automated this parameter and indexed it to tidal volume (PEPV) and showed that it was a reliable predictor for post-cardiac surgery, mainly paced, patients ventilated with low tidal volumes. The aims of the present animal study were to investigate PEPV's ability to predict fluid responsiveness under different fluid loading conditions and natural heart rates during low tidal volume ventilation (6 ml/kg) and to compare the performance of PEPV with other markers of fluid responsiveness. Methods: Eight prone, anesthetized piglets (23-27 kg) ventilated with tidal volumes of 6 ml/kg were subjected to a sequence of 25% hypovolemia, normovolemia, and 25% and 50% hypervolemia. PEPV, DeltaPEP, pulse pressure variation (PPV), central venous pressure (CVP), and pulmonary artery occlusion pressure (PAOP) were measured before each volume expansion. Results: Sensitivity was 89% and specificity was 93% for PEPV, 78% and 93% for DeltaPEP, 89% and 100% for PPV, 78% and 93% for CVP, and 89% and 87% for PAOP. Conclusion: PEPV predicts fluid responsiveness in low tidal volume ventilated piglets.
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