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Anil Srivastava
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Cardiac output is one of the most important parameters for cardiac function monitoring, providing an estimate of whole body perfusion oxygen delivery and allowing for an understanding of the causes of high blood pressure.
Over the past many years, the market for haemodynamic monitoring products has changed, and growth in this market is being fueled by several factors. One of the major factors is ageing population with an increasing number of cardiac disorders. Because of many factors and other conditions that could benefit from hemodynamic monitoring, growth is also being driven by the demand for less invasive and noninvasive technologies that measure cardiac output continuously, stroke volume and other global parameters of oxygen delivery. Nowadays, volumetric information for fluid management or monitoring cardiac function is getting more and more attention worldwide.
There are many methods of monitoring the haemodynamic status of patients, both invasive and non-invasive. The invasive methods are the Fick method and thermodilution, whereas the non-invasive methods are esophageal Doppler, trans-esophageal echocardiography, lithium dilution, pulse contour, partial CO2 rebreathing and thoracic electrical bio-impedance. All of them have their advantages and disadvantages; of these techniques, thermodilution technique is considered to be gold standard for obtaining Cardiac output, although the usage of this technology is on decline due to its invasiveness and associated complexities.
The ideal system for continuous cardiac output monitoring would be non-invasive, easy to use, reliable and compatible in all kinds of patients. A number of research studies have been carried out in clinical care settings for the purpose of finding a technique of measurement which is non-invasive, cost effective and with clinically acceptable accuracy.
Emphasis is on non-invasive techniques to measure important parameters like Continuous Cardiac Output (CCO) is growing. Recent reports show that usage of the pulmonary artery catheter declined 65 per cent from 1993 to 2004 in the US* (*Wiener RS, Welch HG. Trend in the use of the pulmonary artery catheter in the United states, 1993-2004, JAMA 2007; 298: 423-9).
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Nihon Kohden recently launched the esCCO, a novel technology to non-invasively measure continuous cardiac output from ECG and SpO2. esCCO is a new technology to determine the cardiac output –Continuously using Pulse Wave Transit Time (PWTT) which is obtained by the pulse oximetry and ECG-signals from each cycle of the ECG and peripheral pulse wave. esCCO provides real-time, continuous and non-invasive cardiac output measurement along with esCCI (Continuous Cardiac Index). Ease of operating andease of access to the technology will be the key in future.
The ambition in research and development though, was the provision of volumetric information, especially for mid and low care levels, to improve patient care and enhance treatment outcome. With that, the challenge was to avoid any kind of invasive or minimal-invasive calibration. By only entering patient information such as age, gender, height and weight, and an initial NIBP measurement, esCCO determines a reference value for calibration and is ready for start the measurement. Additionally, a cardiac output value obtained by other CO devices such as by pulmonary artery catheter can be used for calibration. Both calibration modes reliably track changes in cardiac output and provide advanced monitoring of a patient’s hemodynamic status, thus helping clinicians in better patient care.
For quality patient care, comprehensive management of different hemodynamic parameters is crucial. Both restrictive and excessive fluid management increase risk of morbidity and mortality. Hemodynamics Graph provides a more intuitive approach to diagnostic and therapeutic decision making in hemodynamic management during Sepsis management.
Nihon Kohden has introduced a new monitoring tool of plotting the trend of changes in various hemodynamic parameters of preload, afterload and output indicating the cardiac functionality. Hemodynamics graph helps clinicians easily see the direction and trend of hemodynamic change while imaging the Frank-Starling curve, and help to objectively determine the optimal therapeutic strategy based on the Forrester Classification.
Blood pressure and Central Venus Pressure (CVP) target graphs can support therapy according to the guidelines for initial resuscitation of sever sepsis and septic shock.
Much evidence supports the idea that goal-directed fluid management guided by several hemodynamic parameters will reduce postoperative hospital stay and complications.
Contact Details:
Anil Srivastava
National Sales Manager
Head – Sales & Marketing- Medical Equipment
Nihon Kohden India
308, Spaze Tower-A, Spazedge
Sector-47, Sohna Road
Gurgaon -122002. India
Tel: (0124) 4931000
Mob: 9810699223
Toll free No.: 1800 103 8182
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