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Determination of optimal implantation site in central venous system for wireless hemodynamic monitoring.

ABSTRACT: Background/purpose:In recent years, treatment of heart failure patients has proved to benefit from implantation of pressure sensors in the pulmonary artery. Despite this, pulmonary artery pressure is related to the left ventricle, and cannot provide information on the right side of the heart. By contrast, pressure in the central venous system is directly connected to the right atrium and could potentially predict a wider range of heart failure conditions. The purpose of this work is to find an optimal site for implantation in the central venous system of a hemodynamic wireless sensor for heart failure monitoring. Since all previous hemodynamic sensors were located in the pulmonary artery, there is no existing information about an optimal site in the central venous system. Methods:This study analysed data obtained from CT scans of most relevant anatomical features in the inferior vena cava. The most important parameters of the sites of interest were extracted, analysed statistically and compared, with the purpose to select an optimal site of implantation. Results:The results obtained show that the area comprised between the iliac bifurcation and the lower renal vein (and between the second and third lumbar veins) is the most suitable site of implantation for a hemodynamic sensor. Parameters such as its straight anatomy, diameter (21 mm) and link distance (106 mm) present it as a convenient location for implantation. Its procedure appears relatively easy, as access from the femoral vein is close to the site of interest. In addition, there are not major delicate structure in its surroundings that may pose a risk to the patient. Conclusion:This study concludes that the area between the iliac join and the lower renal vein (and the 2nd and 3rd lumbar veins) is an optimal site for the accommodation of a hemodynamic sensor.

SUBMITTER: Manavi T

PROVIDER: S-EPMC7132147 | biostudies-literature | 2020 Apr

REPOSITORIES: biostudies-literature

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Determination of optimal implantation site in central venous system for wireless hemodynamic monitoring.

Manavi Tejaswini T Vazquez Patricia P Tubassam Muhammad M Zafar Junaid J Sharif Faisal F Zafar Haroon H

International journal of cardiology. Heart & vasculature 20200403

<h4>Background/purpose</h4>In recent years, treatment of heart failure patients has proved to benefit from implantation of pressure sensors in the pulmonary artery. Despite this, pulmonary artery pressure is related to the left ventricle, and cannot provide information on the right side of the heart. By contrast, pressure in the central venous system is directly connected to the right atrium and could potentially predict a wider range of heart failure conditions. The purpose of this work is to f ...[more]

PMID: 32274418

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Project description:Major abdominal surgery is associated with significant risk of morbidity and mortality in the perioperative period. Optimising intraoperative fluid administration may result in improved outcomes. Our aim was to compare the effects of central venous pressure (CVP), and central venous oxygen saturation (ScvO2)-assisted fluid therapy on postoperative complications in patients undergoing high risk surgery.Patients undergoing elective major abdominal surgery were randomised into control and ScvO2 groups. The target level of mean arterial pressure (MAP) was???60 mmHg in both groups. In cases of MAP?<?60 mmHg patients received either a fluid or vasopressor bolus according to the CVP?<?8 mmHg in the control group. In the ScvO2 group, in addition to the MAP, an ScvO2 of <75% or a >3% decrease indicated need for intervention, regardless of the actual MAP. Data are presented as mean?±?standard deviation or median (interquartile range).We observed a lower number of patients with complications in the ScvO2 group compared to the control group, however it did not reach statistical significance (ScvO2 group: 10 vs.19; p?=?0.07). Patients in the ScvO2 group (n?=?38) received more colloids compared to the control group (n?=?41) [279(161) vs. 107(250) ml/h; p?<?0.001]. Both groups received similar amounts of crystalloid (1126?±?471 vs. 1049?±?431 ml/h; p?=?0.46) and norepinephrine [37(107) vs. 18(73) mcg/h; p?=?0.84]. Despite similar blood loss in both groups, the ScvO2 group received more blood transfusions (63% vs. 37%; p?=?0.018). More patients in the control group had a postoperative PaO2/FiO2?<?200 mmHg (23 vs. 10, p?<?0.01). Twenty eight day survival was significantly higher in the ScvO2 group (37/38 vs. 33/41 p?=?0.018).ScvO2-assisted intraoperative haemodynamic support provided some benefits, including significantly better postoperative oxygenation and 28 day survival rate, compared to CVP-assisted therapy without a significant effect on postoperative complications during major abdominal surgery.ClinicalTrials.gov NCT02337010.

Dataset Information

Determination of optimal implantation site in central venous system for wireless hemodynamic monitoring.

Publications

Determination of optimal implantation site in central venous system for wireless hemodynamic monitoring.

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