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  1. Book ; Online: Less and Non-invasive Hemodynamic Monitoring Techniques

    Bernd Saugel / Samir G. Sakka

    2018  

    Abstract: In the perioperative setting and in intensive care medicine, early and effective hemodynamic management including fluid therapy and administration of vasoactive drugs to maintain vital organ perfusion and oxygen delivery is mandatory. Understanding the ... ...

    Abstract In the perioperative setting and in intensive care medicine, early and effective hemodynamic management including fluid therapy and administration of vasoactive drugs to maintain vital organ perfusion and oxygen delivery is mandatory. Understanding the different approaches in the management of critically ill patients during the resuscitation and further management is essential to initiate adequate context- and time-specific interventions. Optimization of hemodynamic variables to achieve a balance between organ oxygen delivery and consumption is a cornerstone. In general, cardiac output (i.e., the blood flow) is considered a major determinant of oxygen supply and thus its monitoring is regarded helpful. However, indicators of oxygen requirements are equally necessary to assess adequacy of oxygen supply. Currently, more and more less or even totally non-invasive monitoring systems have been developed and clinically introduced, but they require validation in particular clinical settings. Cardiac output monitors and surrogates of organ oxygenation only enable to adequately guide management, as patient’s outcome is determined by acquisition and interpretation of accurate measurements, and finally, suitable management decisions.This Research Topic focuses on the currently available techniques, especially the less and non-invasive ones, in the field of hemodynamic monitoring in the perioperative setting and in critically ill patients while summarizing their advantages and limitations.
    Keywords Cardiovascular dynamics ; Cardiac Output ; Blood Pressure ; intensive care medicine ; Anesthesiology ; goal-directed therapy
    Subject code 610
    Language English
    Publisher Frontiers Media SA
    Document type Book ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  2. Article ; Online: Perioperative Goal-Directed Therapy Using Invasive Uncalibrated Pulse Contour Analysis

    Bernd Saugel / Daniel A. Reuter

    Frontiers in Medicine, Vol

    2018  Volume 5

    Abstract: Perioperative goal-directed therapy” (PGDT) aims at an optimization of basic and advanced global hemodynamic variables to maintain adequate oxygen delivery to the end-organs. PGDT protocols help to titrate fluids, vasopressors, or inotropes to ... ...

    Abstract “Perioperative goal-directed therapy” (PGDT) aims at an optimization of basic and advanced global hemodynamic variables to maintain adequate oxygen delivery to the end-organs. PGDT protocols help to titrate fluids, vasopressors, or inotropes to hemodynamic target values. There is considerable evidence that PGDT can improve patient outcome in high-risk patients if both fluids and inotropes are administered to target hemodynamic variables reflecting blood flow. Despite this evidence, PGDT strategies aiming at an optimization of blood flow seem to be not well implemented in routine clinical care. The analysis of the arterial blood pressure waveform using invasive uncalibrated pulse contour analysis can be used to assess hemodynamic variables used in PGDT protocols. Pulse contour analysis allows the assessment of stroke volume (SV)/cardiac output (CO) and pulse pressure variation (PPV)/stroke volume variation (SVV) and thus helps to titrate fluids and vasoactive agents based on principles of “functional hemodynamic monitoring.” Pulse contour analysis-based PGDT treatment algorithms can be classified according to the hemodynamic variables they use as targets: PPV/SVV, SV/CO, or a combination of these variables. From a physiologic point of view, algorithms using both dynamic cardiac preload and blood flow variables as hemodynamic targets might be most effective in improving patient outcome. Future research should focus on the improvement of hemodynamic treatment algorithms and on the identification of patient subgroups in which PGDT based on uncalibrated pulse contour analysis can improve patient outcome.
    Keywords hemodynamic monitoring ; cardiac output ; stroke volume ; pulse pressure variation ; stroke volume variation ; pulse wave analysis ; Medicine (General) ; R5-920
    Subject code 610 ; 006
    Language English
    Publishing date 2018-01-01T00:00:00Z
    Publisher Frontiers Media S.A.
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  3. Article ; Online: Techniques for Non-Invasive Monitoring of Arterial Blood Pressure

    Agnes S. Meidert / Bernd Saugel

    Frontiers in Medicine, Vol

    2018  Volume 4

    Abstract: Since both, hypotension and hypertension, can potentially impair the function of vital organs such as heart, brain, or kidneys, monitoring of arterial blood pressure (BP) is a mainstay of hemodynamic monitoring in acutely or critically ill patients. ... ...

    Abstract Since both, hypotension and hypertension, can potentially impair the function of vital organs such as heart, brain, or kidneys, monitoring of arterial blood pressure (BP) is a mainstay of hemodynamic monitoring in acutely or critically ill patients. Arterial BP can either be obtained invasively via an arterial catheter or non-invasively. Non-invasive BP measurement provides either intermittent or continuous readings. Most commonly, an occluding upper arm cuff is used for intermittent non-invasive monitoring. BP values are then obtained either manually (by auscultation of Korotkoff sounds or palpation) or automatically (e.g., by oscillometry). For continuous non-invasive BP monitoring, the volume clamp method or arterial applanation tonometry can be used. Both techniques enable the arterial waveform and BP values to be obtained continuously. This article describes the different techniques for non-invasive BP measurement, their advantages and limitations, and their clinical applicability.
    Keywords blood pressure monitoring ; perioperative monitoring ; non-invasive blood pressure ; arterial pressure ; oscillometry ; applanation tonometry ; Medicine (General) ; R5-920
    Subject code 610
    Language English
    Publishing date 2018-01-01T00:00:00Z
    Publisher Frontiers Media S.A.
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  4. Article ; Online: Editorial

    Bernd Saugel / Samir G. Sakka

    Frontiers in Medicine, Vol

    Less and Non-invasive Hemodynamic Monitoring Techniques

    2018  Volume 5

    Keywords cardiovascular dynamics ; cardiac output ; blood pressure ; intensive care medicine ; anesthesiology ; goal-directed therapy ; Medicine (General) ; R5-920
    Language English
    Publishing date 2018-09-01T00:00:00Z
    Publisher Frontiers Media S.A.
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  5. Article ; Online: Non-Invasive Hemodynamic Monitoring for Hemodynamic Management in Perioperative Medicine

    Julia Y. Nicklas / Bernd Saugel

    Frontiers in Medicine, Vol

    2017  Volume 4

    Keywords cardiovascular monitoring ; blood pressure ; advanced hemodynamic variables ; continuous cardiac output ; pulse contour analysis ; Medicine (General) ; R5-920
    Language English
    Publishing date 2017-11-01T00:00:00Z
    Publisher Frontiers Media S.A.
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  6. Article ; Online: How to measure blood pressure using an arterial catheter

    Bernd Saugel / Karim Kouz / Agnes S. Meidert / Leonie Schulte-Uentrop / Stefano Romagnoli

    Critical Care, Vol 24, Iss 1, Pp 1-

    a systematic 5-step approach

    2020  Volume 10

    Abstract: Abstract Arterial blood pressure (BP) is a fundamental cardiovascular variable, is routinely measured in perioperative and intensive care medicine, and has a significant impact on patient management. The clinical reference method for BP monitoring in ... ...

    Abstract Abstract Arterial blood pressure (BP) is a fundamental cardiovascular variable, is routinely measured in perioperative and intensive care medicine, and has a significant impact on patient management. The clinical reference method for BP monitoring in high-risk surgical patients and critically ill patients is continuous invasive BP measurement using an arterial catheter. A key prerequisite for correct invasive BP monitoring using an arterial catheter is an in-depth understanding of the measurement principle, of BP waveform quality criteria, and of common pitfalls that can falsify BP readings. Here, we describe how to place an arterial catheter, correctly measure BP, and identify and solve common pitfalls. We focus on 5 important steps, namely (1) how to choose the catheter insertion site, (2) how to choose the type of arterial catheter, (3) how to place the arterial catheter, (4) how to level and zero the transducer, and (5) how to check the quality of the BP waveform.
    Keywords Cardiovascular dynamics ; Hemodynamic monitoring ; Patient monitoring ; Critical care ; Intensive care medicine ; Anesthesia ; Medical emergencies. Critical care. Intensive care. First aid ; RC86-88.9
    Language English
    Publishing date 2020-04-01T00:00:00Z
    Publisher BMC
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  7. Article ; Online: A novel art of continuous noninvasive blood pressure measurement

    Jürgen Fortin / Dorothea E. Rogge / Christian Fellner / Doris Flotzinger / Julian Grond / Katja Lerche / Bernd Saugel

    Nature Communications, Vol 12, Iss 1, Pp 1-

    2021  Volume 14

    Abstract: Realizing wearable sensors for blood pressure (BP) monitoring with clinically-acceptable performance remains a significant challenge. Here, the authors report a continuous noninvasive blood pressure measurement system featuring a volume control technique ...

    Abstract Realizing wearable sensors for blood pressure (BP) monitoring with clinically-acceptable performance remains a significant challenge. Here, the authors report a continuous noninvasive blood pressure measurement system featuring a volume control technique for small wearable sensors.
    Keywords Science ; Q
    Language English
    Publishing date 2021-03-01T00:00:00Z
    Publisher Nature Portfolio
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  8. Article ; Online: Association of Preoperative Basal Inflammatory State, Measured by Plasma suPAR Levels, with Intraoperative Sublingual Microvascular Perfusion in Patients Undergoing Major Non-Cardiac Surgery

    Athanasios Chalkias / Nikolaos Papagiannakis / Bernd Saugel / Moritz Flick / Konstantina Kolonia / Zacharoula Angelopoulou / Dimitrios Ragias / Dimitra Papaspyrou / Aikaterini Bouzia / Nicoletta Ntalarizou / Konstantinos Stamoulis / Aikaterini Kyriakaki / Jesper Eugen-Olsen / Eleni Laou / Eleni Arnaoutoglou

    Journal of Clinical Medicine, Vol 11, Iss 3326, p

    2022  Volume 3326

    Abstract: It remains unknown whether chronic systemic inflammation is associated with impaired microvascular perfusion during surgery. We evaluated the association between the preoperative basal inflammatory state, measured by plasma soluble urokinase-type ... ...

    Abstract It remains unknown whether chronic systemic inflammation is associated with impaired microvascular perfusion during surgery. We evaluated the association between the preoperative basal inflammatory state, measured by plasma soluble urokinase-type plasminogen activator receptor (suPAR) levels, and intraoperative sublingual microcirculatory variables in patients undergoing major non-cardiac surgery. Plasma suPAR levels were determined in 100 non-cardiac surgery patients using the suPARnostic ® quick triage lateral flow assay. We assessed sublingual microcirculation before surgical incision and every 30 min during surgery using Sidestream Darkfield (SDF+) imaging and determined the De Backer score, the Consensus Proportion of Perfused Vessels (Consensus PPV), and the Consensus PPV (small). Elevated suPAR levels were associated with lower intraoperative De Backer score, Consensus PPV, and Consensus PPV (small). For each ng mL −1 increase in suPAR, De Backer score, Consensus PPV, and Consensus PPV (small) decreased by 0.7 mm −1 , 2.5%, and 2.8%, respectively, compared to baseline. In contrast, CRP was not significantly correlated with De Backer score (r = −0.034, p = 0.36), Consensus PPV (r = −0.014, p = 0.72) or Consensus PPV Small (r = −0.037, p = 0.32). Postoperative De Backer score did not change significantly from baseline (5.95 ± 3.21 vs. 5.89 ± 3.36, p = 0.404), while postoperative Consensus PPV (83.49 ± 11.5 vs. 81.15 ± 11.8, p < 0.001) and Consensus PPV (small) (80.87 ± 13.4 vs. 78.72 ± 13, p < 0.001) decreased significantly from baseline. In conclusion, elevated preoperative suPAR levels were associated with intraoperative impairment of sublingual microvascular perfusion in patients undergoing elective major non-cardiac surgery.
    Keywords anesthesiology ; inflammation ; suPAR ; microcirculation ; surgery ; perioperative ; Medicine ; R
    Language English
    Publishing date 2022-06-01T00:00:00Z
    Publisher MDPI AG
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  9. Article ; Online: Advanced Hemodynamic Management in Patients with Septic Shock

    Bernd Saugel / Wolfgang Huber / Axel Nierhaus / Stefan Kluge / Daniel A. Reuter / Julia Y. Wagner

    BioMed Research International, Vol

    2016  Volume 2016

    Abstract: In patients with sepsis and septic shock, the hemodynamic management in both early and later phases of these “organ dysfunction syndromes” is a key therapeutic component. It needs, however, to be differentiated between “early goal-directed therapy” (EGDT) ...

    Abstract In patients with sepsis and septic shock, the hemodynamic management in both early and later phases of these “organ dysfunction syndromes” is a key therapeutic component. It needs, however, to be differentiated between “early goal-directed therapy” (EGDT) as proposed for the first 6 hours of emergency department treatment by Rivers et al. in 2001 and “hemodynamic management” using advanced hemodynamic monitoring in the intensive care unit (ICU). Recent large trials demonstrated that nowadays protocolized EGDT does not seem to be superior to “usual care” in terms of a reduction in mortality in emergency department patients with early identified septic shock who promptly receive antibiotic therapy and fluid resuscitation. “Hemodynamic management” comprises (a) making the diagnosis of septic shock as one differential diagnosis of circulatory shock, (b) assessing the hemodynamic status including the identification of therapeutic conflicts, and (c) guiding therapeutic interventions. We propose two algorithms for hemodynamic management using transpulmonary thermodilution-derived variables aiming to optimize the cardiocirculatory and pulmonary status in adult ICU patients with septic shock. The complexity and heterogeneity of patients with septic shock implies that individualized approaches for hemodynamic management are mandatory. Defining individual hemodynamic target values for patients with septic shock in different phases of the disease must be the focus of future studies.
    Keywords Medicine ; R
    Subject code 610
    Language English
    Publishing date 2016-01-01T00:00:00Z
    Publisher Hindawi Limited
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  10. Article ; Online: Infection and Predictors of Outcome of Cirrhotic Patients after Emergency Care Hospital Admission

    Wajima Safi / Mayada Elnegouly / Raphael Schellnegger / Katrin Umgelter / Fabian Geisler / Wolfgang Reindl / Bernd Saugel / Alexander Hapfelmeier / Andreas Umgelter

    Annals of Hepatology, Vol 17, Iss 6, Pp 948-

    2018  Volume 958

    Abstract: Introduction and aims. We aimed to explore the impact of infection diagnosed upon admission and of other clinical baseline parameters on mortality of cirrhotic patients with emergency admissions.Material and methods. We performed a prospective ... ...

    Abstract Introduction and aims. We aimed to explore the impact of infection diagnosed upon admission and of other clinical baseline parameters on mortality of cirrhotic patients with emergency admissions.Material and methods. We performed a prospective observational monocentric study in a tertiary care center. The association of clinical parameters and established scoring systems with short-term mortality up to 90 days was assessed by univariate and multivariable Cox regression analysis. Akaike’s Information Criterion (AIC) was used for automated variable selection. Statistical interaction effects with infection were also taken into account.Results. 218 patients were included. 71.2% were male, mean age was 61.1 ± 10.5 years. Mean MELD score was 16.2 ± 6.5, CLIF-consortium Acute on Chronic Liver Failure-score was 34 ± 11. At 28, 90 and 365 days, 9.6%, 26.0% and 40.6% of patients had died, respectively. In multivariable analysis, respiratory organ failure [Hazard Ratio (HR) = 0.15], albumin substitution (HR = 2.48), non-HCC-malignancy (HR = 4.93), CLIF-C-ACLF (HR = 1.10), HCC (HR = 3.70) and first episode of ascites (HR = 0.11) were significantly associated with 90-day mortality. Patients with infection had a significantly higher 90-day mortality (36.3 vs. 20.1%, p = 0.007). Cultures were positive in 32 patients with resistance to cephalosporins or quinolones in 10, to ampicillin/sulbactam in 14 and carbapenems in 6 patients.Conclusion. Infection is common in cirrhotic ED admissions and increases mortality. The proportion of resistant microorganisms is high. The predictive capacity of established scoring systems in this setting was low to moderate.
    Keywords Cirrhosis ; Infection ; Prognostication ; Emergency care ; Akaike Information Criterion ; Specialties of internal medicine ; RC581-951
    Language English
    Publishing date 2018-11-01T00:00:00Z
    Publisher Elsevier
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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