Document Detail


Noninvasive hemodynamic monitoring for combat casualties.
MedLine Citation:
PMID:  17036597     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The aims of this study were to develop and to test a noninvasive hemodynamic monitoring system that could be applied to combat casualties to supplement conventional vital signs, to use an advanced information system to predict outcomes, and to evaluate the relative effectiveness of various therapies with instant feedback information during acute emergency conditions. In a university-run inner city public hospital, we evaluated 1,000 consecutively monitored trauma patients in the initial resuscitation period, beginning shortly after admission to the emergency department. In addition to conventional vital signs, we used noninvasive monitoring devices (cardiac index by bioimpedance with blood pressure and heart rate to measure cardiac function, arterial hemoglobin oxygen saturation by pulse oximetry to reflect changes in pulmonary function, and tissue oxygenation by transcutaneous oxygen tension indexed to fractional inspired oxygen concentration and carbon dioxide tension to evaluate tissue perfusion). The cardiac index, mean arterial pressure, pulse oximetry (arterial hemoglobin oxygen saturation), and transcutaneous oxygen tension/fractional inspired oxygen concentration were significantly higher in survivors, whereas the heart rate and carbon dioxide tension were higher in nonsurvivors. The calculated survival probability was a useful outcome predictor that also served as a measure of severity of illness. The rate of misclassification of survival probability was 13.5% in the series as a whole but only 6% for patients without severe head injuries and brain death. Application of noninvasive hemodynamic monitoring to acute emergency trauma patients in the emergency department is feasible, safe, and inexpensive and provides accurate hemodynamic patterns in continuous, on-line, real-time, graphical displays of the status of cardiac, pulmonary, and tissue perfusion functions. Combined with an information system, this approach provided an early outcome predictor and evaluated, with an objective individualized method, the relative efficacy of alternative therapies for specific patients.
Authors:
William C Shoemaker; Charles C J Wo; Kevin Lu; Li-Chien Chien; Peter Rhee; David Bayard; Demetrios Demetriades; Roger W Jelliffe
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, U.S. Gov't, Non-P.H.S.    
Journal Detail:
Title:  Military medicine     Volume:  171     ISSN:  0026-4075     ISO Abbreviation:  Mil Med     Publication Date:  2006 Sep 
Date Detail:
Created Date:  2006-10-12     Completed Date:  2006-11-14     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  2984771R     Medline TA:  Mil Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  813-20     Citation Subset:  IM    
Affiliation:
Department of Surgery, Los Angeles County and University of Southern California Medical Center, CA 90033, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Blood Gas Monitoring, Transcutaneous
Blood Pressure
Cardiac Output
Computer Systems*
Decision Support Systems, Clinical*
Female
Heart Rate
Hemodynamics*
Humans
Male
Middle Aged
Military Medicine / methods*
Military Personnel
Monitoring, Physiologic*
Point-of-Care Systems
Shock, Traumatic / physiopathology,  prevention & control
Trauma Severity Indices
United States
Wounds and Injuries / classification,  physiopathology*
Wounds, Gunshot / physiopathology
Wounds, Nonpenetrating / physiopathology
Grant Support
ID/Acronym/Agency:
GM-65619/GM/NIGMS NIH HHS; RR-11526/RR/NCRR NIH HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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