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{ "pk": 8109, "title": "Noninvasive Hemodynamic Monitoring in Emergency Patients with Suspected Heart Failure, Sepsis and Stroke: The Premium Registry", "subtitle": null, "abstract": "Introduction: \nNoninvasive hemodynamic (HD) assessments in the emergency department (ED) might assist in the diagnosis, therapeutic plan development and risk stratification of acutely ill patients. This multinational observational study was designed to initiate noninvasive HD measurements prior to any ED patient therapeutic interventions and broadly evaluate them for potential diagnostic, therapeutic and predictive value.\nMethods: \nWe enrolled patients with suspected acute heart failure (AHF), sepsis or stroke. Continuous noninvasive HD monitoring was begun using the Nexfin finger cuff device (Edwards LifeSciences, BMEYE, Amsterdam, Netherlands). Beat-to-beat HD measurements were averaged for the initial 15 minutes, prior to therapeutic intervention. We performed suspected disease group comparisons and evaluated HD predictors of 30-day mortality.\nResults: \nOf 510 patients enrolled: 185 (36%) AHF, 194 (38%) sepsis and 131 (26%) stroke. HD variables were significantly different (p<0.05) amongst the groups. Cardiac output and index and stroke volume index (SVI) were highest in sepsis (6.5, 3.5, 36), followed by stroke (5.5, 2.7, 35.8), and lowest in AHF (5.4, 2.7, 33.6). The in-group HD standard deviations and ranges measurements were large, indicating heterogeneous underlying HD profiles. Presenting SVI predicted 30-day mortality for all groups.\nConclusion:\n Presenting ED noninvasive HD data has not been previously reported in any large patient population. Our data suggest a potential role for early noninvasive HD assessments aiding in diagnosing of patients, individualizing therapy based on each person’s unique HD values and predicting 30-day mortality. Further studies and analyses are needed to determine how HD assessments should be best used in the ED. [West J Emerg Med. 2014;15(7):-0.]", "language": "en", "license": { "name": "Creative Commons Attribution-NonCommercial 4.0", "short_name": "CC BY-NC 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNonCommercial — You may not use the material for commercial purposes.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by-nc/4.0" }, "keywords": [ { "word": "noninvasive continuous hemodynamic monitoring, Emergency Medicine, acutely ill patients" } ], "section": "Critical Care", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/6j4174gk", "frozenauthors": [ { "first_name": "Richard", "middle_name": "M.", "last_name": "Nowak", "name_suffix": "", "institution": "Henry Ford Health System, Department of Emergency Medicine, Detroit, Michigan", "department": "None" }, { "first_name": "Prabath", "middle_name": "", "last_name": "Nanayakkara", "name_suffix": "", "institution": "VU University Medical Center, Department of Emergency Medicine, Amsterdam, Netherlands", "department": "None" }, { "first_name": "Salvatore", "middle_name": "", "last_name": "DiSomma", "name_suffix": "", "institution": "Sant’ Andrea Hospital, Department of Emergency Medicine, Rome, Italy", "department": "None" }, { "first_name": "Phil", "middle_name": "", "last_name": "Levy", "name_suffix": "", "institution": "Wayne State University, Department of Emergency Medicine and Cardiovascular", "department": "None" }, { "first_name": "Edmée", "middle_name": "", "last_name": "Schrijver", "name_suffix": "", "institution": "VU University Medical Center, Department of Emergency Medicine, Amsterdam, Netherlands", "department": "None" }, { "first_name": "Rebecca", "middle_name": "", "last_name": "Huyghe", "name_suffix": "", "institution": "Henry Ford Health System, Department of Emergency Medicine, Detroit, Michigan", "department": "None" }, { "first_name": "Alessandro", "middle_name": "", "last_name": "Autunno", "name_suffix": "", "institution": "Sant’ Andrea Hospital, Department of Emergency Medicine, Rome, Italy", "department": "None" }, { "first_name": "Robert", "middle_name": "", "last_name": "Sherwin", "name_suffix": "", "institution": "Wayne State University, Department of Emergency Medicine and Cardiovascular Research Institute, Detroit, Michigan", "department": "None" }, { "first_name": "George", "middle_name": "", "last_name": "Divine", "name_suffix": "", "institution": "Henry Ford Health System, Department of Biostatistics, Detroit, Michigan", "department": "None" }, { "first_name": "Michele", "middle_name": "", "last_name": "Moyer", "name_suffix": "", "institution": "Henry Ford Health System, Department of Emergency Medicine, Detroit, Michigan", "department": "None" } ], "date_submitted": "2014-01-23T01:34:06Z", "date_accepted": "2014-01-23T01:34:06Z", "date_published": "2014-09-23T23:28:59Z", "render_galley": null, "galleys": [ { "label": "", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/8109/galley/4678/download/" } ] }