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Cardiac output (CO) measurement is crucial for the guidance of therapeutic decisions in critically ill and high-risk surgical patients. Newly developed completely non-invasive CO technologies are commercially available; however, their accuracy and precision have not recently been evaluated in a meta-analysis. We conducted a systematic search using PubMed, Cochrane Library of Clinical Trials, Scopus, and Web of Science to review published data comparing CO measured by bolus thermodilution with commercially available non-invasive technologies including pulse wave transit time, non-invasive pulse contour analysis, thoracic electrical bioimpedance/bioreactance, and CO2 rebreathing. The non-invasive CO technology was considered acceptable if the pooled estimate of percentage error was

Although the occurrence of cellulitis in lymphedema (LE) is believed to be an infection-related event, many findings in its clinical course seem to suggest that it is unlikely to be an infection. Therefore, we tried to clarify the specific features of cellulitis in LE. In-hospital courses of cellulitis obtained from medical charts were reviewed in the patients with leg LE (LE; 24 patients, 72 admissions), chronic venous insufficiency (CVI; 28 patients, 29 admissions), and leg cellulitis secondary to wound infection without underlying disease (N; 42 patients, 42 admissions). The patients with LE complained of less local pain (peak numerical scale; LE: 1.4 ± 1.7, CVI: 4.1 ± 2.5, N: 3.2 ± 2.0, p < 0.0001), showed an abnormally higher peak procalcitonin level (LE: 33.8 ± 34.8 (N = 7), CVI: 2.9 ± 5.8 (N = 8), N: 0.4 ± 0.6 (N = 10), p < 0.05), and required fewer antibiotics (LE: 1.1 ± 0.3, CVI: 1.8 ± 0.9, N: 1.5 ± 0.9, p < 0.0001). These findings suggested that the occurrence of cellulitis in LE seems unlikely to be an infection-related type of cellulitis similar to that found in CVI. [ABSTRACT FROM AUTHOR]

We investigated the effectiveness of stroke volume variation (SVV) shown by the Vigileo-FloTrac™ system (Edwards Lifesciences, Irvine, CA) to predict fluid responsiveness in patients undergoing airway pressure release ventilation (APRV). All 80 patients mechanically ventilated in the intensive care unit of our hospital from April to November 2010 were included in this study. After starting APRV, Ringer's lactate solution was administered for 30 minutes. Haemodynamic variables including heart rate, mean arterial pressure, cardiac index (CI), stroke volume index (SVI) and SVV were measured before and after volume loading. SVV before volume loading was significantly correlated with absolute change in SVV (ΔSVV) and percentage change in stroke volume index (ΔSVI) after volume loading (ΔSVV: P<0.05, r2=0.534; ΔSVI: P<0.05, r2=0.217). Of the 80 patients, 38 (47.5%) were responders to intravascular volume expansion (increase in CI≥15%) and 42 (52.5%) were non-responders (increase in CI<15%). Receiver operating characteristic (ROC) curves were generated for SVV and central venous pressure by varying the discriminating threshold of the variable and areas under the ROC curves were calculated. The areas under the ROC curves were 0.793 for SVV (95% confidence interval: 0.709-0.877) and 0.442 for central venous pressure (95% confidence interval: 0.336-0.549), which were significantly different (P<0.05). The optimal threshold value of SVV to discriminate between responders and nonresponders was 14% (sensitivity: 78.9%; specificity: 64.3%). We found that SVV was able to predict fluid responsiveness in patients undergoing APRV with acceptable levels of sensitivity and specificity. [ABSTRACT FROM AUTHOR]

Objectives To study the differences in impact on venous hemodynamics between larger size strong graduated elastic compression stockings (GECS) and appropriate size strong/moderate GECS. Method In healthy legs fitted for a small (Group S; n = 8) and large (Group L; n = 8) GECS, air plethysmography was performed without GECS, with an appropriate size strong GECS (GECS1), with a three-size too large strong GECS (GECS2), and with an appropriate size moderate GECS (GECS3) in this order. Results In Group S, interface pressure with GECS2 was equal to or higher than that with GECS3. Decreased venous volume, unchanged ejection volume, and decreased residual volume were achieved by GECS, but differences in these parameters among GECS were not observed. Although insignificant, a similar tendency was found in Group L. Conclusions A larger size strong GECS seemed to have equivalent interface pressure and impact on venous hemodynamics compared to an appropriate size moderate or strong GECS. [ABSTRACT FROM AUTHOR]

The article discusses a study conducted to find relationship between stiffness of compression and interface pressure achieved by different bandages and application techniques. It mentions that stiffness at a certain interface pressure was influenced by extensibility with bandages having single-layer and not in cases of bandages having multi-layer.

This study aimed to assess whether preoperative oxidative stress levels can predict postoperative complications in patients undergoing cardiac surgery. Ninety-five cardiac surgery patients received an assessment of preoperative oxidative stress by measurement of hydroperoxide values in blood via the d-Rom test. Area under the receiver operating characteristic curve and also multivariate logistic regression were used to evaluate the prognostic significance of preoperative hydroperoxide concentrations in predicting the occurrence of major organ morbidity and mortality (MOMM). MOMM included death, deep sternal infection, reoperation, stroke, renal failure requiring haemodialysis and prolonged ventilation (>48 hours). The ability of preoperative hydroperoxide concentrations to predict MOMM was not significantly different from that of the European system for cardiac operative risk evaluation (EuroSCORE) (area under the receiver operating characteristic curve 0.822 versus 0.821 respectively, P=0.983). The optimal threshold value of hydroperoxide concentration to differentiate between patients with and without MOMM was 450 UCarr (sensitivity, 87.0%; specificity, 81.9%). Duration of intensive care unit stay, mechanical ventilation time and hospital stay were significantly longer in patients with preoperative hydroperoxide concentrations ≥450 UCarr (H group) compared to those patients with preoperative hydroperoxide concentrations <450 UCarr (L group). An increase in preoperative hydroperoxide concentrations remained associated with an increased risk of MOMM (odds ratios: 1.01, 95% confidence interval: 1.00 to 1.03) and prolonged intensive care unit stay (odds ratio 1.01, 95% confidence interval: 1.00 to 1.02), after adjusting for age, gender and EuroSCORE. In conclusion, an increased hydroperoxide concentration before cardiac surgery is an independent risk factor for severe postoperative complications. [ABSTRACT FROM AUTHOR]