Cardiovascular

Dear Clinician,

In the new Clinical Window Web Journal (CWWJ), we have now focused on the cardiovascular system and monitoring technology. This issue continues our cardiology series of informative articles, and in a few instances, we may be a bit provocative, too. Having first visited our current articles, it may be worth your while to revisit our September 2001 issue of Cardiology and - why not - the critical care issue of April 2002, as well. On the left side of the CWWJ page, there is a link which lists all ten of the previous issues.

In the comprehensive review on Emerging Technologies in Cardiac Output Monitoring, Dr. Alexander Mittnacht and Dr. David L. Reich (Dept. of Anesthesiology, Mount Sinai Medical Center, New York, USA) provide an overview of the state of the art of cardiac output monitoring technology. The traditional gold standard technique is based on pulmonary artery catheterization. However, today there is a trend towards less invasive procedures in cardiac output monitoring. Having both a clinical as well as a scientific viewpoint, the authors review other available cardiac output monitoring techniques, including transesophageal echocardiography (TEE), thoracic bioimpedance, and gas based rebreathing methods. An extensive list of references is also included.

Gastric tonometry in cardiogenic shock: Case report by Dr. Jannssen (Univ. of Aachen Germany). This is a report of a patient with a severe cardiovascular condition due to an acute myocardial infarction. Resistant ventricular tachycardia (VT) has resulted in patient’s intubation and admission to critical care.

This case demonstrates how monitoring can assist in clinical decision making, particularly when one has to select between various invasive techniques of care. Pulmonary artery measurements, TEE, and gastric tonometry all reflected the severity of cardiogenic shock in this patient. The trend graphs of the monitored variables nicely demonstrated the effect of the treatment, which this time was emergency catheter ablation, and the delivery of RF energy to the left ventricle to cure the VT.

Prof. Pekka Meriläinen, PhD (Tech) has been Datex-Ohmeda’s Chief Scientist for many years. In his column, he takes a critical perspective with a topic Monitoring Cardiac Output: Science and Challenges. "When facing the technical challenge of measuring basic physiological processes like circulation and ventilation for the first time, bright young biomedical engineers, physicists, and mathematicians usually start by modeling the systems", Dr. Meriläinen starts. Maintaining a critical viewpoint throughout the article, he then makes a realistic point stating, " after some experience, intellectual frustration will inevitably set in. Applying basic models using linear elements may sometimes work in a healthy body – where monitoring is seldom needed – but not in the critically ill where it would be most beneficial."

Then, he reviews today’s noninvasive technologies, some of which have been claimed as modern innovations. Interestingly, the basic principles of many noninvasive techniques have been published years ago. Just a few equations have been added to nourish those who are mathematically oriented. Throughout, his article remains very practical and even provocative. I believe this column will be excellent food for thought for may our readers, and your feedback is most welcome.

Many thanks to our authors for their great contributions.

Ilkka S. Kalli MD, PhD, MBA
Anesthesiologist, Editor-in-Chief
Datex-Ohmeda’s Clinical Window Web Journal

Last updated: 1 December 2002Created
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