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Introduction In sepsis, the reduced systemic vascular resistance (SVR) can lead to a compensatory increase in cardiac output (CO). This may mimic a normal cardiac function although there is already a sepsis-induced myocardial depression. On a cohort of patients with septic multi-organ dysfunction syndrome, we have recently developed a method to correlate the actual CO to the afterload (estimated by SVR) and introduced the parameter “afterload-related cardiac performance” (ACP), which indicates if the rise of CO is adequate for the particular SVR. In this present study it was to be investigated, if ACP can reveal septic cardiomyopathy in patients with community-acquired sepsis in the early state soon after admission to the emergency department (ED), and if there is a prognostic relevance of septic cardiomyopathy defined by ACP. Results were compared to cardiac index (CI) and cardiac power index (CPI). Methods Adults presenting at the ED with sepsis were included. ACP, CI and CPI were calculated at the time of admission, after 24, and 72 h. They were correlated to severity of disease and the prognostic values were analyzed. Results A total of 141 patients were included. Only ACP was significantly influenced by severity of sepsis, whereas CI and CPI were not. ACP was the only hemodynamic parameter predicting mortality: nonsurvivors had lower ACP values at the time of admission to the ED (66.9 vs. 88.9 %, p  < 0.05) and ACP predicted non-survival with an AUC value of 0.72, p  = 0.003. Cardiac impairment defined by an ACP value of 80 % or below determined worse prognosis. Conclusions Septic cardiomyopathy occurs already at the early stage of disease and is of prognostic relevance. It might be recognized best, if cardiac function is correlated to afterload.

Background Septic patients with cardiac impairment are with high mortality. Afterload-related cardiac performance (ACP), as a new tool for diagnosing septic cardiomyopathy (SCM), still needs to be evaluated for its impact on the prognosis for patients with septic shock. Methods In this retrospective study, 100 patients with septic shock undertaken PiCCO monitoring were included. The ability of ACP, cardiac index (CI), and cardiac power index (CPI) to discriminate between survivors and non-survivors was tested by comparing the area under the receiver operating characteristic curve (AUROC) analysis. Cox proportional hazards regression analyses were performed to assess the associations of ACP with day-28 mortality. Curve estimation was used to describe the relationship between the hazard ratio (HR) of death and ACP. Results ACP had a strong linear correlation with CI and CPI ( P < 0.001). ACP demonstrated significantly greater discrimination for day-28 mortality than CI before adjusted [AUROC 0.723 (95% CI 0.625 to 0.822) vs. 0.580 (95% CI 0.468 to 0.692), P = 0.007] and CPI after adjusted [AUROC 0.693 (95% CI 0.590 to 0.797) vs . 0.448 (0.332 to 0.565), P < 0.001]. Compared with ACP > 68.78%, HR for ACP ≤ 68.78% was 3.55 (1.93 to 6.54) ( P < 0.001). When adjusted with age, APACHE-II score, Vasoactive Inotropic Score, Lactate, CRRT, day-1 volume, fibrinogen and total bilirubin as possible confounders, and decrease ACP are still associated with increasing day-28 mortality ( P < 0.05). An exponential relationship was observed between ACP12h and HR of day-28 death. Conclusions Our results suggested thatACP could improve mortality predictions when compared to CI and CPI. Decreased ACP was still an independent risk factor for increased day-28 mortality.

The aim of this study was to investigate whether continuous renal replacement therapy (CRRT) influences the global end-diastolic volume index (GEDVI), cardiac index (CI), and extravascular lung water index (EVLWI) measured by Pulse Index Continuous Cardiac Output (PICCO) in febrile patients. Fifteen fever patients were included in this study. CI, GEDVI, EVLWI, heart rate (HR), and mean arterial pressure (MAP) were measured at five time-points: before CRRT (T0), immediately after CRRT started (T1), 15 min after CRRT started (T2), immediately after CRRT stopped (T3), and 15 min after CRRT stopped (T4). Results have shown that CI and GEDVI were decreased significantly in T1 (CI: 4.09 ± 0.72 vs 2.81 ± 0.58 L/min m , = 0.000 and GEDVI: 727.86 ± 63.47 vs 531.07 ± 66.63 mL/m , = 0.000). However, CI and GEDVI were significantly increased in T3 (CI: 4.09 ± 0.72 vs 7.23 ± 1.32 L/min m , = 0.000 and GEDVI 727.86 ± 63.47 vs 1339.17 ± 121.52 mL/m , = 0.000). There were no significant differences in T2 and T4. Among the five-time points, no measurement errors were observed with regards to HR, MAP, and EVLWI. Therefore, the data herein contained suggests that PICCO measurements should begin 15 min after the start or stop of CRRT.

Occupational therapy often uses craft activities as therapeutic tools, but their therapeutic effectiveness has not yet been adequately demonstrated. The aim of this study was to examine changes in frontal midline theta rhythm (Fmθ) and autonomic nervous responses during craft activities, and to explore the physiological mechanisms underlying the therapeutic effectiveness of occupational therapy. To achieve this, we employed a simple craft activity as a task to induce Fmθ and performed simultaneous EEG and ECG recordings. For participants in which Fmθ activities were provoked, parasympathetic and sympathetic activities were evaluated during the appearance of Fmθ and rest periods using the Lorenz plot analysis. Both parasympathetic and sympathetic indices increased with the appearance of Fmθ compared to during resting periods. This suggests that a relaxed-concentration state is achieved by concentrating on craft activities. Furthermore, the appearance of Fmθ positively correlated with parasympathetic activity, and theta band activity in the frontal area were associated with sympathetic activity. This suggests that there is a close relationship between cardiac autonomic function and Fmθ activity.

Background A passive leg raising (PLR) test is positive if the cardiac index (CI) increased by > 10%, but it requires a direct measurement of CI. On the oxygen saturation plethysmographic signal, the perfusion index (PI) is the ratio between the pulsatile and the non-pulsatile portions. We hypothesised that the changes in PI could predict a positive PLR test and thus preload responsiveness in a totally non-invasive way. Methods In patients with acute circulatory failure, we measured PI (Radical-7) and CI (PiCCO2) before and during a PLR test and, if decided, before and after volume expansion (500-mL saline). Results Three patients were excluded because the plethysmography signal was absent and 3 other ones because it was unstable. Eventually, 72 patients were analysed. In 34 patients with a positive PLR test (increase in CI ≥ 10%), CI and PI increased during PLR by 21 ± 10% and 54 ± 53%, respectively. In the 38 patients with a negative PLR test, PI did not significantly change during PLR. In 26 patients in whom volume expansion was performed, CI and PI increased by 28 ± 14% and 53 ± 63%, respectively. The correlation between the PI and CI changes for all interventions was significant ( r  = 0.64, p  < 0.001). During the PLR test, if PI increased by > 9%, a positive response of CI (≥ 10%) was diagnosed with a sensitivity of 91 (76–98%) and a specificity of 79 (63–90%) (area under the receiver operating characteristics curve 0.89 (0.80–0.95), p  < 0.0001). Conclusion An increase in PI during PLR by 9% accurately detects a positive response of the PLR test. Trial registration ID RCB 2016-A00959-42. Registered 27 June 2016.

Previous research has reported that different coping types (active or passive) are required depending on the stress-inducing task. The aim of this study was to examine the autonomic nervous response during speech tasks that require active coping, by using Lorenz plot analysis. Thirty-one university students participated in this study ( = 21.03 years, = 2.27). This study included 3 phases: (1) resting phase, (2) silent reading phase, and (3) reading aloud phase. Autonomic nervous system responses were recorded in each phase. We asked participants to evaluate their subjective states (arousal, valence, and mood) after the silent reading phase and the reading aloud phase. We observed that the cardiac sympathetic index (CSI) for the sympathetic nervous response was significantly higher during the reading aloud phase than during the silent reading phase. In contrast, the cardiac vagal index (CVI) for the parasympathetic nervous response was significantly higher during the reading aloud phase than during the resting phase. There were no significant differences between the resting phase and the silent reading phase in both cardiac sympathetic and CVIs. We also observed that the degree of arousal was significantly higher after the reading aloud phase than after the silent reading phase. Our findings indicate that the psychological load during silent reading is ineffective for activating the sympathetic nervous system. The sympathetic nervous response was activated in the reading aloud phase. Also, the parasympathetic nervous response in the reading aloud phase was activated compared with the resting phase. Reading aloud is necessary to adequately activate the parasympathetic nervous system by requiring participants to respire (i.e., expiration) more than during resting and silent reading tasks. The increase in the CVI likely stems from activating the parasympathetic nervous system during expiration. Although the speech task required participants to perform active coping, it was designed to activate both the sympathetic and parasympathetic nervous systems during expiration.

BACKGROUND With the increasing use of quality of life measures in evaluations of cardiac interventions, criteria are needed for selecting appropriate quality of life measures. An important criterion is the sensitivity of a measure for detecting clinically important changes. OBJECTIVES To compare the sensitivity of four measures when used in a group of cardiac patients undergoing the same intervention. METHODS The short form 36 (SF-36), the quality of life index–cardiac version (QLI), the quality of life after myocardial infarction questionnaire (QLMI), and the schedule for the evaluation of individual quality of life (SEIQoL) were used to evaluate quality of life in a group of 22 patients after myocardial infarction or coronary artery bypass graft (CABG), at the beginning of rehabilitation and six weeks later. Analysable data were obtained from 16 patients. RESULTS A significant improvement over time was only observed for the SF-36 subscale, vitality (p < 0.05). Five of the eight SF-36 subscales and one of the four QLMI subscales showed modest sensitivity (index: > 0.2 and < 0.5), while all other subscales showed poor sensitivity (index: < 0.2). Using SEIQoL, family was most often nominated as an area of importance to quality of life (n = 13), followed by health (n = 10), leisure/hobbies (n = 8), marriage (n = 8), and work (n = 6). CONCLUSIONS All four QOL measures used in this study were found to lack sensitivity to change. Further research is needed using other cardiac populations and interventions in order to verify these findings, with a view to developing more sensitive quality of life scales.

Intradialytic cardiac output (CO) decline normally occurs during hemodialysis (HD) and results in short-term intradialytic hypotension to longer-term increased cardiovascular morbidity and mortality in chronic HD patients. Enhanced external counter pulsation (EECP) is a novel non-invasive device that has been demonstrated to improve coronary blood flow and maintain systemic hemodynamics in patients without kidney dysfunction. This study is the first to explore the efficacy and safety of EECP application during HD on intradialytic changes of CO and other hemodynamic parameters. Stable chronic HD patients without recent cardiovascular events were randomly allocated to the EECP group (n = 7) receiving a single session of 60-min EECP therapy at the early period of 4-h online hemodiafiltration (HDF), and the control group (n = 7) obtaining standard 4-h online HDF without EECP. Interval measurements of intradialytic CO by Transonic HD03 device, intradialytic central aortic blood pressure (BP) by AtCor Medical SphygmoCor-XCEL device, and heart rate (HR) in the mid-week HD sessions were conducted. Changes in these parameters were compared with a linear mixed model. CO of the patients in the EECP group was maintained throughout the HDF session compared to a significant CO decline of 2.4 L/min after 4-h HDF in the control group (p-value 0.007). Cardiac index (CI) also changed in the same direction as CO. Central systolic BP, central diastolic BP, central mean arterial pressure, and HR were indifferent between the two groups. In 9 patients continuing the study in the subsequent 36 HDF sessions, there was a trend to prevent the increase in high-sensitivity cardiac troponin I by long-term EECP treatment. No intolerable adverse events related to EECP were reported. EECP application during online HDF could maintain CO, CI, and might reduce the risk of HD-related myocardial ischemia through various proposed mechanisms, including promoting coronary perfusion. However, larger studies on other cardiovascular outcomes are warranted.

PurposeClinical examination is often the first step to diagnose shock and estimate cardiac index. In the Simple Intensive Care Studies-I, we assessed the association and diagnostic performance of clinical signs for estimation of cardiac index in critically ill patients.MethodsIn this prospective, single-centre cohort study, we included all acutely ill patients admitted to the ICU and expected to stay > 24 h. We conducted a protocolised clinical examination of 19 clinical signs followed by critical care ultrasonography for cardiac index measurement. Clinical signs were associated with cardiac index and a low cardiac index (< 2.2 L min−1 m2) in multivariable analyses. Diagnostic test accuracies were also assessed.ResultsWe included 1075 patients, of whom 783 (73%) had a validated cardiac index measurement. In multivariable regression, respiratory rate, heart rate and rhythm, systolic and diastolic blood pressure, central-to-peripheral temperature difference, and capillary refill time were statistically independently associated with cardiac index, with an overall R2 of 0.30 (98.5% CI 0.25–0.35). A low cardiac index was observed in 280 (36%) patients. Sensitivities and positive and negative predictive values were below 90% for all signs. Specificities above 90% were observed only for 110/280 patients, who had atrial fibrillation, systolic blood pressures < 90 mmHg, altered consciousness, capillary refill times > 4.5 s, or skin mottling over the knee.ConclusionsSeven out of 19 clinical examination findings were independently associated with cardiac index. For estimation of cardiac index, clinical examination was found to be insufficient in multivariable analyses and in diagnostic accuracy tests. Additional measurements such as critical care ultrasonography remain necessary.