AVAILABLE TOOLS FOR NON-INVASIVE MONITORING

ARE THEY RELIABLE AND INFORMATIVE?

Non-invasive monitoring is all the rage… and every clinician has their favourite amongst the various tools available. This morning session led by Xavier Monnet and Azriel Perel asks the question "Are these devices reliable and informative?" Learn alongside the experts in this eye-opening session featuring a variety of monitoring tools…

Skin perfusion monitoring  

What non-invasive tools do we have to assess the perfusion status of the peripheral/skin perfusion. What is their prognostic value and how can it be used in clinical practice?

“Abnormal peripheral perfusion in critically ill patients is associated with an excess mortality irrespective of the admission diagnosis”

~ Jan Bakker, Rotterdam, Netherlands

Non-invasive analysis of the arterial pressure waveform 

Questions that will be answered in this presentation:

–What technologies for the continuous noninvasive analysis of the arterial pressure waveform are available? What are the measurement principles of these technologies?

-How should we interpret the validation studies testing these innovative technologies in comparison with established reference technologies?

-In which patients can these technologies be applied for haemodynamic management?  

~ Bernd Saugel, Hamburg, Germany

Haemodynamic monitoring by transoesophageal approach  

Echocardiography is probably the best haemodynamic device allowing to diagnose the different mechanisms of shock, as hypovolemia, left ventricular systolic dysfunction and right ventricular failure, all independently. Compared to transthoracic echocardiography (TTE), transoesophageal echocardiography (TOE/TEE) is minimally-invasive, can only be recommended in the critically-ill patients when mechanically ventilated. It is also much less operator-dependent and more reproducible than TTE, which renders this technique perfectly suitable for monitoring. As recommended by experts, TOE/TEE is able to give relevant informations for guiding therapy, perfectly adapted for functional haemodynamic monitoring. However, the main limitation is the actual absence of evidence-based data demonstrating that using TOE/TEE for haemodynamic monitoring improves prognosis, even though indirect results in the field of ARDS, septic shock may suggest it. The lecture will illustrate all of these points with images and videos recorded by the speaker in “true” patients at the bedside, and will also do a summary of the current medical literature in the field.         

~ Antoine Vieillard-Baron (Boulogne, France)

Monitoring big data to predict haemodynamic collapse

Identification of patients with overt cardiorespiratory insufficiency (CRI) or at high risk of impending CRI is often difficult. Absolute alterations in fixed physiologic measures and their dynamic changes over time are often used to define CRI, but these are impeded by questions of data accuracy (artifacts), missing data and misunderstandings of the complex interactions of the various independent measures. Recent data support the statement that integrated monitoring systems (IMS) that created derived fused parameters of stability or instability using machine learning algorithms, accurately identify CRI and can predict their occurrence beforehand.

In his presentation, Michael Pinsky will discuss IMS based on established machine learning analysis using various established tools, including artificial neural networks (ANN), k-nearest neighbor, support vector machine, random forest classifier and others on routinely acquired non-invasive and invasive haemodynamic measures to identify CRI and display them in real-time with a high degree of precision.

The implications of these approaches for all healthcare monitoring across the spectrum of in-patient to chronic care is clear, even though the need may appear more pressing for the acute care setting to those of us whose daily life is centered there. The underlying assumption of these approaches is that measured changes in easily acquired physiologic variables reflect complex patient-specific interactions amongst multiple regulatory autonomic, hormonal and metabolic systems. Accordingly, simple algorithm approaches to such interactions, like the use of the existing severity scoring systems or computer-based treatment protocols, are unlikely to improve outcomes other than by standardising therapies. Potentially, by using Functional Heamodynamic Monitoring (FHM) principles, as described in Pinsky's keynote lecture at LIVES 2016, we can predict with a high degree of accuracy volume responsiveness and central arterial tone in all patients. But one needs to identify who is unstable or going to be unstable before applying these FHM approaches.

Also in this Session:

Sublingual microcirculation monitoring    
Can Ince, Amsterdam, Netherlands

THEMATIC SESSION ~ AVAILABLE TOOLS FOR NON-INVASIVE MONITORING: ARE THEY RELIABLE AND INFORMATIVE?

05.10.2016, 08:30 – 10:00, room Vienna      

#cardio #haem