The aim of this study was to investigate whether individualised goal-directed therapy targeting stroke volume and oxygen delivery could reduce the number of patients with post-operative complications and shorten hospital length of stay after open elective lower limb arterial surgery. The LiDCOplus system was used for hemodynamic monitoring. In the intervention group, stroke volume index was optimised by administering ml aliquots of colloid intra-operatively and during the first 6 h post-operatively. Central hemodynamic data were blinded in control patients. Patients were followed up after 30 days.
|Published (Last):||4 February 2019|
|PDF File Size:||16.32 Mb|
|ePub File Size:||15.95 Mb|
|Price:||Free* [*Free Regsitration Required]|
The aim of this study was to investigate whether individualised goal-directed therapy targeting stroke volume and oxygen delivery could reduce the number of patients with post-operative complications and shorten hospital length of stay after open elective lower limb arterial surgery. The LiDCOplus system was used for hemodynamic monitoring.
In the intervention group, stroke volume index was optimised by administering ml aliquots of colloid intra-operatively and during the first 6 h post-operatively. Central hemodynamic data were blinded in control patients. Patients were followed up after 30 days. The median length of hospital stay did not differ between groups. Haemodynamic optimisation in lower limb arterial surgery: Room for improvement?
Results showed significantly less fluid or adjusted all complications in the IGFT group. This concept of using the blood pressure waveform to measure blood flow changes has been validated in a wide range of conditions.
A small dose of lithium chloride is injected via a central or peripheral venous line; the resulting arterial lithium concentration-time curve is recorded by withdrawing arterial blood past a lithium sensor.
No further catheter is needed, so the method avoids the risks associated with more invasive arterial catheters. The injectate is a solution of lithium chloride.
The dose needed 0. Accurate — Clinical trials have been completed that demonstrate that the LiDCO system is at least as accurate as thermodilution2,3. Simple to use — The method is simple and quick to use. It has the advantage that there is no unpleasant procedure for a conscious patient to undergo such as insertion of femoral arterial line and the time taken to set up and apply is between 5 and 10 minutes4. The conclusions were that a single bolus of lithium was at least as accurate as mean triplicate bolus thermodilution.
Lithium Chloride Multiple dosages of lithium have been extensively investigated and the safety profile is well established. The pharmacokinetics of intravenous lithium chloride in man and animals have been documented1, lithium chloride has been used extensively in medicine for prophylactic and therapeutic treatment of unipolar and bipolar manic-depressive disorders5,6.
The lithium chloride is distributed throughout the total body water and excreted almost entirely by the kidneys. The half-life of lithium chloride in humans is The recommended maximum total dose for a lithium indicator dilution would have to be exceeded many times before toxic levels are reached. In fact, a single lithium chloride LiDCO indicator dilution determination at 0.
Lithium has been used for the measurement of cardiac output in thousands of patients over many years without a single side effect being reported.
The pharmacokinetics of intravenous lithium chloride in patients and normal volunteers. J Trace and Microprobe Tech. Lithium dilution cardiac output measurement: A comparison with thermodilution. Crit Care Med. Comparison of the accuracy of the lithium dilution technique with the thermodilution technique for measurement of cardiac output. Br J Anaesthesia. Real-time, continuous monitoring of cardiac output and oxygen delivery.
Int J Intensive Care. In: Schentag et al, Applied pharmacokinetics: principles of therapeutic drug monitoring. San Francisco: Therapeutics Inc. Lithium in the treatment of mood disorders. N Engl J Med. Analysis of the Pharmacokinetics in man. Eur J Clin Pharmacol.
Pharmacokinetics of lithium elimination and half-life, renal clearance and apparent volume distribution in schizophrenia. Clin Pharmacokinet.
Step 1: Build your hemodynamic monitor
In common with all cardiac output monitors this technology has both strengths and weaknesses. This review discusses the technological basis of the device and its clinical application. As outlined in the editorial [ 1 ], the format is a combination of information from the developer and a balanced independent review. These articles should be read in conjunction as they are designed to assess the technology from two different perspectives. The responses are presented unaltered for the reader to form their own opinion.
How the LiDCO hemodynamic monitor works
Equipment review: An appraisal of the LiDCO™plus method of measuring cardiac output