Numerous cardiac output (CO) monitors have been produced that provide continuous rather than intermittent readings. Bland and Altman has become the standard method for validating their performance against older standards. However, the Bland and Altman method only assesses precision and does not assess how well a device detects serial changes in CO (trending ability). Currently, there is no consensus on how trending ability, or trend analysis, should be performed. Therefore, we performed a literature review to identify articles published between 1997 and 2009 that compared methods of continuous CO measurement. Identified articles were grouped according to measurement technique and statistical methodology. Articles that analyzed trending ability were reviewed with the aim of finding an acceptable statistical method. Two hundred two articles were identified. The most popular methods were pulse contour (69 articles), Doppler (54), bioimpedance (38), and transpulmonary or continuous thermodilution (27). Forty-one articles addressed trending, and of these only 23 provided an in-depth analysis. Several common statistical themes were identified: time plots, regression analysis, Bland and Altman using change in CO (ΔCO), and the 4-quadrant plot, which used direction of change of ΔCO to determine the concordance. This plot was further refined by exclusion of data when values were small. Receiver operating characteristic curves were used to define the exclusion zone. In animal studies, a reliable reference standard such as an aortic flowprobe was frequently used, and regression or time plots could be used to show trending. Clinical studies were more problematic because data collection points were fewer (8-10 per subject). The consensus was to use the 4-quadrant plot with exclusion zones and apply concordance analysis. A concordance rate of >92% when using a 15% zone indicated good trending. A new method of presenting trend data (ΔCO) on a polar plot is proposed. Agreement was shown by the angle with the horizontal axis and ΔCO by the distance from the center. Trending can be assessed by the vertical limits of the data, similar to the Bland and Altman method.

A critical review of the ability of continuous cardiac output monitors to measure trends in cardiac output.

Bacterial adhesion on PEG modified polyurethane surfaces

Vascular catheters are the most frequently used indwelling medical devices and' have become necessary tools for the successful treatment of patients with chronic or critical illness. It is estimated that vascular catheters are inserted in more than 20 million patients who are admitted to hospitals in the United States each year [1]. Several complications, however, prevent the prolonged maintenance of vascular catheters. Infection is one of the leading complications, and catheter-related septicemia represents the most frequent lifethreatening complication of vascular catheters [2-4].

Infectious complications of indwelling vascular catheters.

The word sepsis originated from the old Greek word meaning “putrefaction”. Nowadays, this term is used to describe the host systemic response to infectious stimuli that is characterised by clinical, haemodynamic, biochemical and inflammatory responses [1]. Sepsis is still one of the leading causes of death in the critically ill [2]. Despite all the research performed over the last two decades, few specific treatments have been shown to improve outcome. In daily practice, clinicians are often faced with two dilemmas: whether a patient is infected or not, and whether the antibiotic therapy being given is effective. The distinction between infection and sepsis is frequently difficult to make. Infection without sepsis can occur if the process remains localised. A sepsis-like syndrome without infection is also a frequent finding in conditions such as trauma and pancreatitis [3]. The attention of the clinician must be directed towards the early diagnosis of infection [4]. However, bacteriological confirmation may be difficult to obtain and negative cultures do not exclude the presence of infection. In addition, manifestations of sepsis such as fever, leukocytosis and tachycardia are neither specific nor sensitive for infection, nor for monitoring the response to therapy [5]. Increasing understanding of the various inflammatory cascade mechanisms has given new insights and provided several markers that, in conjunction with other manifestations of sepsis, can be useful as indicators of infection. C-reactive protein (CRP) is one such marker.

https://courses.washington.edu/pharm522/Week2/C-reactive%20protein-%20A%20valuable%20marker%20of%20sepsis%20(ICM%202002).pdf

C-reactive protein: a valuable marker of sepsis.

Objective:To provide current information related to central venous catheterization.Design:Review of literature relevant to central venous catheterization and its indications, insertion techniques, and prevention of complications.Results:Central venous catheterization can be lifesaving but is associa

http://medical-mastermind-community.com/uploads/Central-Venous-Catheters1.pdf

Central venous catheterization

Thoracic electrical bioimpedance measurement of cardiac output--not ready for prime time.

Pulmonary Manifestations of the Eosinophilia-Myalgia Syndrome Associated with Tryptophan Ingestion

The evaluation of fever in the intensive care unit.

Infectious complications of indwelling long-term central venous catheters.

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Thoracic electrical bioimpedance measurement of cardiac output--not ready for prime time.

Pulmonary Manifestations of the Eosinophilia-Myalgia Syndrome Associated with Tryptophan Ingestion

The evaluation of fever in the intensive care unit.

Infectious complications of indwelling long-term central venous catheters.