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1
O'Rourke, Michael F. The arterial pulse. Philadelphia: Lea & Febiger, 1992.
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H, Crawford Michael. Inspection and palpation of venous and arterial pulses. Dallas, Tex: American Heart Association, 1990.
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McLaughlin, Carolee. Does arterial oxygen desaturation as measured by pulse oximetry occur during aspiration or penetration in acute dysphagic stroke patients?. [S.l: The Author], 2003.
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Asmar, R. Arterial Stiffness and Pulse Wave Velocity. Clinical applications. Editions Scientifiques Et, 1999.
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Lee, Richard. Pulse oximetry and capnography in the ICU. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0073.
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The estimation of arterial oxygen saturation by pulse oximetry and arterial carbon dioxide tension by capnography are vital monitoring techniques in critical care medicine, particularly during intubation, ventilation and transport. Equivalent continuous information is not otherwise available. It is important to understand the principles of measurement and limitations, for safe use and error detection. PETCO2 and oxygen saturation should be regularly checked against PaCO2 and co-oximeter SO2 obtained from the blood gas machine. The PECO2 trace informs endotracheal tube placement, ventilation, and blood flow to the lungs. It is essential their principles of estimation, the information gained and the traps in interpretation are understood.
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Acute Effects of Hand Elevation and Wrist Position on Mean Arterial Pressure and Pulse Rate Measured in the Hand. Storming Media, 2000.
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Romagnoli, Stefano, i Giovanni Zagli. Blood pressure monitoring in the ICU. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0131.
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Two major systems are available for measuring blood pressure (BP)—the indirect cuff method and direct arterial cannulation. In critically-ill patients admitted to the intensive care unit, the invasive blood pressure is the ‘gold standard’ as a tight control of BP values, and its change over time is important for choosing therapies and drugs titration. Since artefacts due to the inappropriate dynamic responses of the fluid-filled monitoring systems may lead to clinically relevant differences between actual and displayed pressure values, before considering the BP value shown as reliable, the critical care giver should carefully evaluate the presence/absence of artefacts (over- or under-damping/resonance). After the arterial pressure waveform quality has been verified, the observation of each component of the arterial wave (systolic upstroke, peak, systolic decline, small pulse of reflected pressure waves, dicrotic notch) may provide a number of useful haemodynamic information. In fact, changes in the arterial pulse contour are due the interaction between the heart beat and the whole vascular properties. Vasoconstriction, vasodilatation, shock states (cardiogenic, hypovolaemic, distributive, obstructive), valve diseases (aortic stenosis, aortic regurgitation), ventricular dysfunction, cardiac tamponade are associated with particular arterial waveform characteristics that may suggest to the physician underlying condition that could be necessary to investigate properly. Finally, the effects of positive-pressure mechanical ventilation on heart–lung interaction, may suggest the existence of an absolute or relative hypovolaemia by means of the so-called dynamic indices of fluid responsiveness.
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Hatfield, Anthea. Monitoring and equipment. Oxford University Press, 2014. http://dx.doi.org/10.1093/med/9780199666041.003.0004.
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Routine monitoring is an essential part of recovery room procedure. Respiration, a vital concern while awakening after anaesthesia, is given specific attention with reference to modern capnography. This chapter also describes additional monitoring in detail: pulse oximetry, blood pressure, central venous pressure, and arterial blood gases are clearly described. A comprehensive description of electrocardiography guides the student through this complicated subject. The monitoring of temperature and warming blankets, with suggestions for purchasing equipment, are included.
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Sainz, Jorge G., i Bradley P. Fuhrman. Basic Pediatric Hemodynamic Monitoring. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199918027.003.0005.
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Physiological monitoring using a variety of technological advances supplements, but does not replace, our ability to distinguish normal from abnormal physiology traditionally gleaned from physical examination. Pulse oximetry uses the wavelengths of saturated and unsaturated hemoglobin to estimate arterial oxygenation noninvasively. Similar technology included on vascular catheters provides estimation of central or mixed venous oxygenation and helps assess the adequacy of oxygen delivered to tissues. End-tidal carbon dioxide measurements contribute to the assessment of ventilation. Systemic arterial blood pressure and central venous pressure measurements help evaluate cardiac performance, including the impact of ventilatory support. Intra-abdominal pressure may increase as a result of intraluminal air or fluid, abnormal fluid collections within the peritoneal cavity, or abnormal masses. Increased pressure may impede venous return to the heart and compromise intra-abdominal organ perfusion. Pressure measurement guides related management decisions.
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Prout, Jeremy, Tanya Jones i Daniel Martin. Respiratory system. Oxford University Press, 2014. http://dx.doi.org/10.1093/med/9780199609956.003.0002.
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This chapter includes a summary of respiratory physiology, respiratory mechanics (pressure-volume relationships and compliance, airway resistance and the work of breathing) and the pulmonary circulation (pulmonary vascular resistance, shunt and lung zones). Measurement of respiratory flow, lung volumes and diffusion capacity is summarized, as well as measurement and interpretation of arterial blood gases. The physics behind capnography and pulse oximetry are explained with abnormalities related to clinical contexts. The common clinical scenarios of respiratory failure and asthma are discussed with initial management and resuscitation.
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Kreit, John W. Physiological Assessment of the Mechanically Ventilated Patient. Redaktor John W. Kreit. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190670085.003.0009.
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This chapter reviews the tests that can be used to determine the type and severity of respiratory failure and the extent to which one or more of the components of normal ventilation and gas exchange have been compromised by disease. Physiological Assessment of the Mechanically Ventilated Patient describes the bedside procedures, measurements, and calculations that allow the assessment of gas exchange and respiratory mechanics in mechanically ventilated patients. Topics include co-oximetry and pulse oximetry, arterial blood gas measurements, venous admixture and shunt fraction, the dead space to tidal volume ratio, time- and volume-capnography, measurement of peak and plateau pressures, and calculation of respiratory system compliance and resistance.
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Kipnis, Eric, i Benoit Vallet. Tissue perfusion monitoring in the ICU. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0138.
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Resuscitation endpoints have shifted away from restoring normal values of routinely assessed haemodynamic parameters (central venous pressure, mean arterial pressure, cardiac output) towards optimizing parameters that reflect adequate tissue perfusion. Tissue perfusion-based endpoints have changed outcomes, particularly in sepsis. Tissue perfusion can be explored by monitoring the end result of perfusion, namely tissue oxygenation, metabolic markers, and tissue blood flow. Tissue oxygenation can be directly monitored locally through invasive electrodes or non-invasively using light absorbance (pulse oximetry (SpO2) or tissue (StO2)). Global oxygenation may be monitored in blood, either intermittently through blood gas analysis, or continuously with specialized catheters. Central venous saturation (ScvO2) indirectly assesses tissue oxygenation as the net balance between global O2 delivery and uptake, decreasing when delivery does not meet demand. Lactate, a by-product of anaerobic glycolysis, increases when oxygenation is inadequate, and can be measured either globally in blood, or locally in tissues by microdialysis. Likewise, CO2 (a by-product of cellular respiration) and PCO2 can be measured globally in blood or locally in accessible mucosal tissues (sublingual, gastric) by capnography or tonometry. Increasing PCO2 gradients, either tissue-to-arterial or venous-to-arterial, are due to inadequate perfusion. Metabolically, the oxidoreductive status of mitochondria can be assessed locally through NADH fluorescence, which increases in situations of inadequate oxygenation/perfusion. Finally, local tissue blood flow may be measured by laser-Doppler or visualized through intravital microscopic imaging. These perfusion/oxygenation resuscitation endpoints are increasingly used and studied in critical care.
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Prout, Jeremy, Tanya Jones i Daniel Martin. Cardiovascular system. Oxford University Press, 2014. http://dx.doi.org/10.1093/med/9780199609956.003.0001.
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This chapter covers the assessment and investigation of perioperative cardiac risk, the principles of perioperative haemodynamic monitoring and physiological changes in cardiac comorbidity with their relevance to anaesthetic management. Perioperative cardiovascular risk includes assessment of cardiac risk factors, functional capacity and evidence-based guidelines for preassessment. Cardiovascular investigations such as cardiopulmonary exercise testing and scoring systems for cardiac risk are included. Management of the cardiac patient for non-cardiac surgery is detailed. Invasive monitoring with arterial, central venous and pulmonary artery catheters is described. Cardiac output measurement systems including dilution techniques, pulse contour analysis and Doppler are compared. The physiological changes, management and implications for anaesthesia of common cardiac comorbidity including ischaemic heart disease, heart failure, valvular heart disease, pacemakers and pulmonary hypertension are described.
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Kahn, S. Lowell. Directional AngioJet Thrombectomy with Guide Catheter Helical Spin Technique. Redaktorzy S. Lowell Kahn, Bulent Arslan i Abdulrahman Masrani. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199986071.003.0037.
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The presence of thrombus in the central veins is associated with a higher risk of development post-thrombotic syndrome. The AngioJet Solent Proxi (90 cm) and Omni (120 cm) catheters are commonly used peripheral thrombectomy devices indicated for acute arterial and venous thrombus removal. Both catheters are 6 Fr sheath/8 Fr guide catheter compatible, and both offer the Power Pulse feature, allowing the direct infusion of tissue plasminogen activator into the thrombus. The catheters are indicated for use in vessels greater than 3 mm, with an optimal vessel range between 6 and 20 mm. Their use in the removal of iliac vein and inferior vena cava thrombus is frequent. Although the system is purported to provide effective thrombectomy capabilities in larger vessels, incomplete thrombus removal is common with larger vessels. This chapter proposes a simple modification in the standard use of the AngioJet Solent Proxi and Omni catheters.
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Chaloner, E. Combined vascular and orthopaedic injuries. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780199550647.003.012009.
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♦ Early diagnosis of an arterial injury is critical in reducing the risk of limb loss♦ Don’t assume that missing pulses are due to arterial ‘spasm’♦ Don’t assume that presence of distal pulses rules out a proximal vascular injury – arterial intimal tears can occlude the vessel many hours after the initial injury♦ After an arterial repair has been completed there is still a risk of subsequent compartment syndrome from reperfusion♦ Arterial shunts can procure some time for skeletal fixation prior to definitive arterial repair or grafting.
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Staitieh, Bashar S., i Greg S. Martin. Therapeutic goals of fluid resuscitation. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0070.
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Optimizing tissue perfusion by administering intravenous fluids presents a special challenge to the intensive care unit (ICU) clinician. Recent studies have drastically altered how we assess a patient’s fluid responsiveness, particularly with regard to upstream surrogates of tissue perfusion. Central venous pressure and pulmonary capillary wedge pressure have been found to be inaccurate markers of fluid responsiveness and have given way to methods such as cardiac output as assessed by echocardiography and the various forms of arterial waveform analysis. These newer techniques, such as stroke volume variation, systolic pressure variation, and pulse pressure variation, have been found to better delineate which patients will respond to a fluid challenge with an increase in cardiac output, and which will not. In addition, traditional methods of assessing the consequences of excessive fluid administration, such as pulmonary oedema and the non-anion gap acidosis of saline administration, have given way to more sophisticated measurements of extravascular lung water, now available at the bedside. Downstream markers of tissue perfusion, such as base deficit, central venous oxygen saturations, and lactic acid, continue to be useful in particular clinical settings, but are all relatively non-specific markers, and are therefore difficult to use as resuscitation targets for ICU patients in general. Finally, recent data on septic shock and ARDS have demonstrated the importance of conservative fluid strategies, while data in surgical populations have emphasized the need for judicious fluid administration and attention to the balance of blood products used in resuscitation efforts.
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Rady, Mohamed Y., i Ari R. Joffe. Non-heart-beating organ donation. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0390.
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The transplantation community endorses controlled and uncontrolled non-heart-beating organ donation (NHBD) to increase the supply of transplantable organs at end of life. Cardiac arrest must occur within 1–2 hours after the withdrawal of life-support in controlled NHBD. Uncontrolled NHBD is performed after failed cardiopulmonary resuscitation in an unexpected witnessed cardiac arrest. Donor management aims to protect transplantable organs against warm ischaemic injury through the optimization of haemodynamics and mechanical ventilation. This also requires antemortem instrumentation and systemic anticoagulation for organ perseveration in controlled NHBD. Interval support with extracorporeal membrane oxygenation or cardiopulmonary bypass is generally required for optimal organ perfusion and oxygenation in uncontrolled NHBD, which remains a controversial medical practice. There are several unresolved ethical challenges. The circulatory criterion of 2–10 minutes of absent arterial pulse does not comply with the uniform determination of death criterion of the irreversible cessation of functions of the cardiovascular or central nervous systems. There are no robust safeguards in clinical practice that can prevent faulty prognostication, and premature withdrawal of treatment or termination of cardiopulmonary resuscitation. Unmanaged conflicting interests of increasing the supply of transplantable organs can have serious consequences on the medical care of potentially salvageable patients. Perimortem interventions can interfere with the delivery of an optimal quality of end-of-life care. The lack of disclosure of these NHBD ethical controversies does not uphold the moral obligation for an informed consent.
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Chappell, Michael, Bradley MacIntosh i Thomas Okell. ASL Acquisition Principles. Oxford University Press, 2017. http://dx.doi.org/10.1093/oso/9780198793816.003.0002.
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A variety of acquisition methods for arterial spin labeling (ASL) perfusion MRI exist, often with different names referring to broadly similar approaches. This chapter outlines the main flavors of ASL in common use, along with their strengths and weaknesses, before finally presenting the current consensus of the community on good acquisition parameters for general use. The chapter considers the choice of labeling (e.g. pseudo-continuous versus pulsed), readout (e.g. 2D versus 3D), the choice of post-label delay, and a number of other solutions to correct for artifacts such as arterial contamination. Avoiding extensive technical details, this chapter seeks to inform the ASL user when making choices about acquisition parameters for the use of ASL and also provides enough terminology to help a new user understand the key parameters that they need to know when presented with a new ASL dataset.
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Llarich, Kyle W. Cardiac Examination, Valvular Heart Disease, and Congenital Heart Disease. Oxford University Press, 2012. http://dx.doi.org/10.1093/med/9780199755691.003.0042.
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Despite tremendous technologic advances in medical testing and imaging, physicians must be able to assess patients accurately at the bedside; this assessment allows appropriate, cost-effective, and efficient ordering of tests. Part I of this chapter outlines the salient features of a thorough physical examination, cardiac imaging techniques, and valvular and congenital heart disease. A thorough physical examination includes assessment of jugular venous pressure, arterial pulses, apical impulses, additional cardiac palpitations, and appropriate imaging techniques. Cardiac imaging techniques include contrast angiography, echocardiography, radionuclide imaging, magnetic resonance imaging, electron beam computed tomography and positron emission tomography. Different types of valvular and congenital heart disease are examined.
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Júnior, José Roberto Zaffalon, Adriano Marin de Abreu, Ricardo Bueno Lunelli i Pedro Bruno Lobato Cordovil. SISTEMA NERVOSO AUTÔNOMO DE MULHERES PRATICANTES DE GINÁSTICA AERÓBICA E HISTÓRICO FAMILIAR DE HIPERTENSÃO. Bookerfield Editora, 2021. http://dx.doi.org/10.53268/bkf21060101.
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O Sistema Nervoso Autônomo (SNA) modula a Frequência Cardíaca (FC), que pode ser estimulada e melhorada por meio da atividade física. A prática regular de exercícios aeróbicos como Ginástica Aeróbica (GA) propicia mudanças e adaptações ao sistema cardíaco capazes de resultar em melhoria da saúde e diminuição de riscos de doenças cardiovasculares como a Hipertensão Arterial Sistêmica (HAS). Nesta perspectiva, o presente estudo teve como objetivo analisar a modulação do sistema nervoso autônomo por meio da variabilidade da frequência cardíaca (VFC) em mulheres com e sem histórico familiar positivo de HAS praticantes de ginástica aeróbica. Participaram 65 mulheres com idade entre 18 e 35 anos, separados em dois grupos: filhas de normotenso (FN) e filhas de hipertensos (FH). A modulação autonômica cardíaca foi avaliada utilizando o registro do intervalo R-R (ms) pelo período de 15 minutos. Quanto aos valores encontrados, no que diz respeito ao intervalo de pulso (IP), o grupo FN apresentou aumento quando comparado à do grupo FH (p=0,045). Não foram observadas diferenças significativas em nenhuma outra variável (pressão arterial, SD, BF, AF, %BF, %AF e BF/AF). Nossos achados indicam que a prática de exercícios aeróbicos como a GA proporciona melhoria nas funções vasomotora e FC gerando boas adaptações do SNA do grupo FH, ao suscitar similaridades com o grupo FN como consequência.