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PubMedDate not supplied

The weight of the cortical inflow against medullary reflexes as enlightened by spectral analysis of HR and SP waves.

Components of the autonomic drive to the heart were studied in 5 young normals subjected to: 1. sustained lung inflation (SLI) in various postures; 2. mental loading by concentration of attention; 3. face immersion (FI) in cold water under SLI or snorkel breathing, when sitting; 4. superpositions of 1-3 experimental interventions. Recorded were: cardiotachogram (CTG as RR interval) and T-wave amplitude from ECG, ear-lobe photo-plethysmogram, digital impedance rheogram, thermistor pneumogram (PNG). Heart rate (HR) and systolic pressure (SP) data were treated using the Fourier analysis on a M118B microcomputer. Preliminary data-exploration, reported in a previous paper, has verified the capability of the Fourier spectrum to spot in short quasistationary data-series known marks of single interventions and has pointed to the amphotrop nature of SLI and FI maneuvers. Present work approaches the same data from the point of view of the competition between various regulatory menus under combined interventions. The "cortico-cardiac reflex"--HR stabilizing under mental loading versus rest based upon balanced reduction in both respiratory and vasomotor sinus arrhythmia (RSA and VSA, respectively)--appeared now as a middle size actor upon medullary areas; it is overridden, yet not put to silence by the powerful orthostatic reflex; it is comparable (SLI) or major (FI) vis-a-vis of synergic vagal reflexes whose more easily approachable mechanisms could offer it meaningful models. Capacitating this "reflex" in the containment of intricated arrhythmias with extrinsic involvement or in "educating" the benefic vagal prevalence upon the heart should observe these precisions.

Adult↗
PubMed2005

Pre-excimer laser and post-excimer laser refractive surgery measurements of scotopic pupil diameter using 2 pupillometers.

PURPOSE: To compare a digital infrared pupillometer with a handheld light amplification pupillometer for measuring scotopic pupil size and to evaluate if the postoperative refractive changes of the cornea can influence pupil measurements. DESIGN: Prospective noncomparative interventional case series. PARTICIPANTS: One hundred eyes, 50 myopic (mean spherical equivalent [SE] refraction [+/- standard deviation], -4.32+/-2.44 diopters [D]) and 50 hyperopic (mean SE refraction, +2.95+/-0.99 D), of 50 otherwise healthy subjects underwent photorefractive keratectomy or LASIK. INTERVENTION: The preoperative and postoperative scotopic pupil sizes were measured by 2 examiners (E1, E2) with both a handheld light amplification pupillometer (Colvard, Oasis Medical, Glendora, CA) and a digital infrared pupillometer (Eye World Pupillometer [EWP], Oculus Keratograph, Oculus Opikgerate GmbH, Wetzlar, Germany). The agreement and interrater repeatability were determined using the comparison method described by Bland and Altman. The paired Student's t test was used to evaluate the difference between the preoperative and postoperative measurements. MAIN OUTCOME MEASURES: Scotopic pupil diameter, topographic corneal refractive power, uncorrected visual acuity (VA), best spectacle-corrected VA, and manifest spectacle refraction. RESULTS: The preoperative mean scotopic pupil diameter was 6.12+/-0.90 mm with the EWP and 6.18+/-0.91 mm with the Colvard. After the surgery, mean SE refractions were -0.22+/-0.98 D (myopic patients) and +0.19+/-0.40 D (hyperopic patients). Postoperative mean scotopic pupil diameters were 6.12+/-0.89 mm (EWP) and 6.17+/-0.90 mm (Colvard). There was no statistically significant difference between preoperative and postoperative mean scotopic pupil sizes in either patient group. The limits of agreement between the 2 devices ranged from 2.24 mm (E1) to 2.12 mm (E2) preoperatively and from 2.27 mm (E1) to 2.08 mm (E2) postoperatively. The coefficient of interrater repeatability ranged from 0.56 mm (EWP) to 1.12 mm (Colvard) preoperatively and from 0.62 mm (EWP) to 1.14 mm (Colvard) postoperatively. CONCLUSIONS: The digital infrared pupillometer showed better preoperative and postoperative repeatability than the handheld light amplification pupillometer. In the present study, a mean correction of <3 D of the corneal refractive power did not seem to modify the preoperative scotopic pupil size measurements.

Adult↗
PubMed2002

Three-dimensional analysis of morphological changes in the maxilla of patients with cleft lip and palate.

OBJECTIVE: Three-dimensional (3-D) morphological changes in the maxilla of patients with cleft lip and palate (CLP) have been recorded, mainly using two-dimensional cast analyses. Although these seem to be insufficient, no standardized 3-D method has been developed until now. In this study, accuracy, precision, and validity of a newly developed 3-D digital computer-aided procedure to visualize and metrically analyze the growth of the edentulous maxilla of infants with CLP have been evaluated. PATIENTS: The method was applied to 10 infants with complete unilateral CLP. INTERVENTIONS: Consecutive casts of the maxilla (1 week and 3, 6, and 12 months) of each patient were optically measured with a 3-D laser scanner. Following digitizing, the casts were computer reconstructed, aligned, and superimposed using specialized computer software. The distances between the surfaces were measured. Additionally, the surfaces were segmented perpendicular to the alveolar crest, the reference points being C1, C1', C2, C2', and I. The volumes of the resulting segments were determined and compared with one another. RESULTS: The newly developed analysis enables a visualization of the extent and direction of morphological changes in the maxilla of infants with CLP. With this method it is possible to quantify these changes of the volume of defined alveolar segments. CONCLUSIONS: The 3-D analysis developed is an ideal tool for the examination of 3-D morphological changes in the edentulous maxilla of patients with CLP. The results will serve as the starting point for a longitudinal study on the efficacy of different methods, not only of presurgical infant orthopedics but also of surgical procedures.

Alveolar Process↗
PubMedDate not supplied

[The scientific videotape with digital processing in surgery. The new opportunities offered surgery for videotape recording and postprocessing with the use of information and digital technologies].

The facility of the tape recording of a surgical operation, by means of simple manageable apparatuses and at low costs, especially in comparison with the former cinematography, makes it possible for all surgeons to record their own operative activity. Therefore at present the demonstration in video of surgical interventions is very common, but very often the video-tapes show surgical events only in straight chronological succession, as for facts of chronicle news. The simplification of the otherwise sophisticated digital technology of informatics elaboration of images makes more convenient and advisable to assemble the more meaningful sequences for a final product of higher scientific value. The digital technology gives at the best its contribution during the phase of post-production of the video-tape, where the surgeon himself can assemble an end product of more value because aimed to a scientific and rational communication. Thanks to such an elaboration the video-tape can aim not simply to become a good documentary, but also to achieve an educational purpose or becomes a truly scientific film. The initial video will be recorded following a specific project, the script, foreseeing and programming what has to be demonstrated of the surgical operation, establishing therefore in advance the most important steps of the intervention. The sequences recorded will then be assembled not necessarily in a chronological succession but integrating the moving images with static pictures, as drawings, schemes, tables, aside the picture-in picture technique, and besides the vocal descriptive comment. The cinema language has accustomed us to a series of passages among the different sequences as fading, cross-over, "flash-back", aiming to stimulate the psychological associative powers and encourage those critical. The video-tape can be opportunely shortened, paying attention to show only the essential phases of the operation for demonstrate only the core of the problem and utilize at the best the physiological period of active attention of the observer. The informatic digital elaboration has become so easy that the surgeon himself can be able to elaborate personally on his personal computer, with professional and scientific attitude, the sequences of his surgical activity in a product of more general value. His personal engagement also in the phase of post-production gives him the possibility to demonstrate uprightly with images the complex surgical experience of science, skill and ability to communicate, perhaps better than he is able to do with words.

Humans↗
PubMed1995

Implementation of region-of-interest fluoroscopy by using the road mapping mode of a real-time digital radiographic unit.

In region-of-interest (ROI) fluoroscopy, a filter is used to greatly attenuate the x-ray beam outside the ROI and digital image processing is used to equalize the displayed brightness. The method is applicable to real-time imaging procedures such as vascular interventions for which a high-quality image is essential only over an ROI (eg, near the catheter tip), whereas the noise-degraded periphery may be acceptable for visualizing landmarks. Use of ROI fluoroscopy can greatly reduce radiation exposure to the patient and to staff while image quality in the ROI is maintained or improved. Exposure reduction factors greater than 5 were demonstrated for coil placement in a canine aneurysm model by using standard digital angiographic equipment operating in the road mapping mode. Potential applications for which future work will determine the clinical acceptability of ROI fluoroscopy include many of the highest-dose interventional procedures, in addition to general gastrointestinal fluoroscopy.

Animals↗
PubMed1987

Automated quantitative coronary arteriography: morphologic and physiologic validation in vivo of a rapid digital angiographic method.

Quantitative coronary arteriography has been shown to be useful in assessing the extent of coronary disease, its functional significance, and its response to therapeutic interventions. Most current methods rely either on hand-drawn arterial contours or automatic edge-detection algorithms applied to 35 mm cineangiograms. To assess the performance in vivo of a new, fully automatic, rapid coronary quantitation program, dogs were instrumented with precision-drilled, plastic cylinders to create intraluminal stenoses in the left anterior descending and/or circumflex arteries, as well as with high-fidelity micromanometers and electromagnetic flow probes. Stenosis diameters ranged from 0.83 to 1.83 mm. Biplane, on-line, digital coronary angiograms and cineangiograms were recorded during standard selective coronary arteriography in the closed-chest preparation. The on-line digital images were analyzed in nonsubtracted and subtracted modes. Cineangiograms were digitized to allow coronary quantitation by the same computer program. There was an excellent correlation between known and measured minimal diameter stenoses (r = .87 to .98, SEE = 0.09 to 0.24 mm). Interobserver and intraobserver variability analysis showed high reproducibility (r = .90 to .97, SEE = 0.12 to 0.23 mm). The best results in both analyses were achieved by nonsubtracted digital imaging and the worst by cineradiography. Measures of percent diameter stenosis, percent area stenosis (geometric and videometric), and absolute minimal cross-sectional area (geometric and videometric) were all significantly correlated with independent measures of actual coronary flow reserve. This study provides direct anatomic and physiologic validation in vivo of a new and rapid coronary quantitation method suitable for analysis of both digital angiograms and cineangiograms.

Angiography↗
PubMed2026

Effectiveness of a digi-physical tool and working method for paediatric obesity treatment in Abu Dhabi: a non-inferiority intervention study using an external historical comparator.

BACKGROUND: Effective paediatric obesity treatment requires high intensity, scalable interventions. A digi-physical tool for paediatric obesity treatment has shown positive results in Stockholm, Sweden. This study evaluates whether the same treatment method is effective in a different cultural setting. METHODS: This non-inferiority intervention study, using an external historical comparator, included 60 consecutively recruited children aged 6-15.9 years with obesity who initiated treatment at Sheikh Shakhbout Medical City in Abu Dhabi between June and December 2023. Patients were treated with Evira, a digi-physical tool and working method enabling high intensity individualized care, real-time monitoring, and interactive patient-clinician communication. The primary outcome was BMI z-score change at 26 weeks. Non-inferiority was assessed using a predefined margin of 0.10 BMI z-score, with outcomes compared to a prior published trial in Stockholm (n&#x2009;=&#x2009;107). RESULTS: A total of 112 children were included in the analysis (Abu Dhabi cohort, n&#x2009;=&#x2009;35; Stockholm cohort, n&#x2009;=&#x2009;77). The adjusted mean change in BMI z-score was -&#x2009;0.20 (95% CI: -&#x2009;0.28, -&#x2009;0.12) in the Abu Dhabi cohort and -&#x2009;0.20 (- 0.26, -&#x2009;0.14) in the Stockholm cohort (p&#x2009;=&#x2009;0.88). Non-inferiority was confirmed, (predefined margin 0.10 was not exceeded). A clinically significant BMI z-score reduction (&#x2265;&#x2009;0.20 units) was achieved by 45.7% of participants in Abu Dhabi and 36.4% in Stockholm (p&#x2009;=&#x2009;0.35). Non-retention rates at 26 weeks were 41.7% vs. 28.0%, respectively (p&#x2009;=&#x2009;0.07). CONCLUSIONS: The findings provide promising evidence that treatment outcomes achieved with the digi-physical treatment tool were comparable in the Abu Dhabi and Stockholm cohorts, supporting its feasibility in a second cultural and healthcare setting.

Humans↗
PubMedDate not supplied

[New aspects of radiologic pelvimetry. Digital image intensification radiography: preliminary results of validation possibilities and results in various types of pelvic disproportion].

Within 1 year with 1325 births 54 cases necessitated operative obstetric intervention due to a disproportion between fetal head and maternal pelvis. In 40 cases radiologic pelvimetry was performed, using the conventional technique. 75% of cases turned out to be due to a midplane or outlet contraction. As, on the one hand, this type of pelvic disproportion seems to be of increasing importance, on the other hand generously adoperated radiologic diagnosis is not well accepted by the patients due to X-ray burden, Digital Image Intensifier Radiography (DIR) has been introduced for pelvimetry. X-ray burden amounts to only 5% of that of the conventional technique. Enhanced postprocessing and interactive measurement possibilities are further advantages of DIR. Using the appropriate softwear, interactive measurement results are characterized by the lack of mistakes due to X-ray divergence, if only the distance between measurement level and desk surface is known. By analyzing 30 computer tomograms measurement levels of the most important pelvic distances could be calculated in relation to the position of the anterior iliac spine. These relations show a very low interindividual variation. Thus, possible errors in measurement amount to a maximum of only 3.5%. The evaluation of our cases reveals the necessity to reassess the normal ranges for pelvic parameters, for the use of those deriving from conventional pelvimetry failed to describe correctly the anatomy of birth channel. For this sake, additional measurements, esp. of sacral and pelvic outlet anatomy have to be performed. Based upon these measurements, a computer aided modelling of the birth channel and a simulation of the birth could be achieved.(ABSTRACT TRUNCATED AT 250 WORDS)

Computer Simulation↗
PubMed2003

Presacral arteriovenous fistula: case report.

OBJECTIVE AND IMPORTANCE: We describe a case of arteriovenous fistula in front of the sacrum. Drainage induced epidural venous dilation in the sacral spinal canal. The fistula was embolized endoarterially with n-butyl-2-cyanoacrylate via its iliac arterial feeders. In follow-up digital subtraction angiography 1 month later, the fistula was found to be totally closed. The patient was followed up clinically for 2.5 years. She has remained symptom-free. CLINICAL PRESENTATION: A previously healthy 43-year-old woman presented with severe gluteal and perineal pain and a local sensation of hyperesthesia. The primary computed tomographic scan of the lumbosacral spine was normal, and emergency laparoscopy showed no signs of any pathological lesions. Magnetic resonance imaging discovered an unidentified mass in the sacral spinal canal, and the patient was hospitalized for neurosurgery. However, surgery on this mass had to be discontinued because of profuse bleeding, and the patient was referred for angiography. INTERVENTION: Diagnostic catheter angiography revealed a high-flow arteriovenous fistula anterior to the sacrum, and the mass detected earlier by magnetic resonance imaging seemed to be a dilated epidural vein draining the fistula. The feeders of the fistula originated in both internal iliac arteries, and the fistula was occluded via these arteries in two angiographic sessions. CONCLUSION: A paraspinal arteriovenous fistula may have venous drainage through the epidural venous plexus, and the ectatic veins may induce radicular symptomology. To the best of our knowledge, a paraspinal fistula at such a presacral location has not been documented previously. An unidentified mass in the sacral spinal canal should be suspected of being a dilated vascular structure. Prompt angiographic examinations with an option for embolization should be performed, and open surgical intervention should be avoided.

Adult↗
PubMed1996

Arteriovenous fistula of the internal mammary artery (combat injury): transcatheter intravascular coil occlusion.

A case of arteriovenous fistula of the left internal mammary artery occluded by Gianturco coil is reported. A 26-year-old male suffered multiple explosive injuries. Right heart failure developed postoperatively. Digital subtraction angiography demonstrated arteriovenous fistulas between the left internal mammary artery and left subclavian and innominate veins. Considering previous multiple surgical interventions and severe general condition of the patient, both arteriovenous fistulas were successfully occluded by transcatheter placement of a Gianturco coil.

Adult↗
PubMed1984

Assessment of left ventricular function in coronary artery disease with the nuclear probe during intervention studies.

The nuclear probe was used for measuring left ventricular function in 11 normal subjects and the results compared with those using a digital gammacamera. The probe was then used to measure left ventricular function in patients with coronary artery disease during dynamic exercise and stress atrial pacing. The ability of the probe to detect changes induced by glyceryl trinitrate was also evaluated in separate parallel studies. In the 11 normal subjects there was a good correlation between the left ventricular ejection fraction measured by the gammacamera and the nuclear probe both at rest and during exercise. Exercise increased this value by at least 5% in all normal subjects during measurements with both the gammacamera and the nuclear probe. The mean (SD) difference was -0.3% (2.60) at rest and 2.3% (5.02) at peak exercise. Both exercise and pacing produced angina in the patient group and the mean (SEM) value fell from 52% (3.5) to 28% (2.6) and from 46% (5.1) to 34% (3.2) respectively. Glyceryl trinitrate prolonged the exercise and pacing times, and the corresponding falls in ejection fraction were significantly reduced. The non-imaging nuclear probe is a cheap and portable instrument capable of assessing left ventricular function in patients with cardiac disease. It is designed for high count rate acquisition over a short period of time and can thus provide both beat to beat and summated left ventricular time activity curves suitable for quantitative analysis. It therefore has important advantages in the clinical setting and during controlled interventions compared with the gammacameras.

Adult↗
PubMed2006

Nonhepatic arteries originating from the hepatic arteries: angiographic analysis in 250 patients.

PURPOSE: To investigate the prevalence and patterns of origin of nonhepatic arteries originating from the proper hepatic artery (PHA) or its distal branches and to assess their relation to anatomic variations. MATERIALS AND METHODS: Digital subtraction celiac arteriography and selective left hepatic arteriography was performed in 250 patients with hepatocellular carcinoma. Three interventional radiologists interpreted the angiograms on the monitor by consensus. If necessary, further superselective arteriography was performed. The prevalence of nonhepatic arteries, their sites of origin, and the influence of underlying anatomic variants were analyzed. RESULTS: Nonhepatic arteries were found in 205 patients. The most common nonhepatic artery was the right gastric artery (RGA; n = 196), followed by the hepatic falciform artery (HFA; n = 129), accessory left gastric artery (LGA; n = 43), posterior superior pancreaticoduodenal artery (PSPDA; n = 18), and left inferior phrenic artery (LIPA; n = 5). The left hepatic artery (LHA) was the most frequent origin of nonhepatic arteries (170 of 250). Regardless of anatomic variation, the most common origins of the RGA and HFA were the PHA and the segment IV hepatic artery, respectively. In patients with an aberrant LHA from the LGA, no accessory LGAs or LIPAs were found. PSPDAs preferentially arose from variant hepatic arteries arising from the gastroduodenal artery. CONCLUSIONS: Nonhepatic arteries commonly arise from the hepatic arteries, especially the LHA and PHA. Moreover, variants of the celiac and hepatic arteries influence the prevalence and sites of origin of nonhepatic arteries.

Adult↗
PubMed2002

Gadolinium as an alternative contrast agent for diagnostic and interventional angiographic procedures in patients with impaired renal function.

BACKGROUND: The study was designed to investigate the safety and feasibility of gadopentetate dimeglumine, a gadolinium-based contrast medium, as an alternative angiographic contrast agent in patients with impaired renal function and high risk for iodinated contrast-induced nephropathy. METHODS: Gadopentetate dimeglumine was used as the radiographic contrast agent in 32 diagnostic or interventional angiographic procedures in 29 patients (59% diabetics) with severe renal insufficiency (average serum creatinine of 3.6+/-1.4 mg/dl). The average dose of gadopentetate dimeglumine was 0.34+/-0.06 mmol/kg body weight. Gadopentetate dimeglumine was used either alone (n=20) or in conjunction with carbon dioxide (n=12). RESULTS: Thirty-two angiographic procedures (24 diagnostic angiographies and 8 interventional procedures) were performed in 29 patients. For diagnostic purposes, eleven selective renal arteriographies, six angiographies of the iliac arteries and lower extremities, and seven venous angiographies of the upper extremity and central veins were performed. Interventional procedures consisted of two percutaneous transluminal renal angioplasties with stenting, four percutaneous peripheral vascular interventions, and two balloon angioplasties of a dialysis fistula. None of the patients, except one, had evidence of post-procedure contrast material-induced renal failure (increase in serum creatinine >0.5 mg/dl within 72 h) or other complications. This patient had a clinically important increase in serum creatinine level after percutaneous transluminal renal angioplasty and stenting, probably due to cholesterol embolism. Gadopentetate dimeglumine had sufficient radiographic density to allow adequate diagnostic visualization with digital subtraction equipment in all cases. CONCLUSIONS: Gadopentetate dimeglumine is an alternative and safe radiographic contrast agent for angiography and interventional procedures in patients with severe pre-existing renal impairment. In this population with high risk for contrast-induced acute renal failure, it is obviously less nephrotoxic than iodinated contrast media.

Adult↗
PubMed1997

The concept of archiving unedited and edited digital coronary angiograms.

Digital image data acquired during cardiac catheterization will soon be archived on standardized digital storage media. However, with the enormous amount of generated data, considerable time will be wasted at later reviewing or at conferences, or when performing additional quantitative studies. As a result major advantages of a digital acquisition and archiving technique will be lost. The concept of two way archiving includes an unedited (primary) digital archive as well as a (secondary) archive edited by operator guided "intelligent" data reduction (IDR). IDR is based upon the elimination of useless and redundant frame sequences (FS), documentation of coronary interventions on one representative single frame (F) and on the reduction of relevant FS and physiological data to and ECG-controlled representative cardiac cycle (CC). With a heart rate of 72/min and an acquisition rate of 12.5 F/s a documentation of each FS may be obtained with only 10 F. A redundancy-free set of 130 F of a diagnostic study as well as only 41-85 F of an interventional study will be archived on an individual 3.5" MOD or on a CD-R. Two cardiologists and two cardiosurgeons studied independently 24 IDR-edited and the corresponding unedited digital angiograms and found no significant differences in the diagnostically relevant coronary morphology and left ventricular function. IDR provides an edited digital coronary angiogram, e.g. a set of images free of redundance and without loss of relevant information. Uneditable FS can be archived in their unedited (primary) form. IDR is managed on-line by an operator interacting with the angiographer.

Angiography, Digital Subtraction↗
PubMed2003

[Improved evaluation of stenoses of hemodialysis fistulas by B-flow ultrasound].

PURPOSE: To evaluate the new technique of B-flow ultrasound in assessing stenoses of hemodialysis fistulas. MATERIALS AND METHODS: 50 patients (mean age 58 years) with Brescia-Cimino-Shunts (27 shunts of the radial and 23 of the cubital artery) were prospectively assessed with intraarterial DSA and vascular ultrasound by independent examiners. Eligibility for the study was a shunt-volume of less than 400 ml/min and an angiographically suspected hemodynamically significant stenosis of the anastomosis or of shunt veins. Sonography was performed with a multifrequency ultrasound probe (5 to 10 MHz, Logic 700, GE) using B-mode, color coded Doppler sonography (CCDS) and B-flow technique. RESULTS: Anastomotic stenosis and stenosis of the shunt veins were equally distributed, found in 25 patients each. The measurements of the residual lumen of the 25 anastomotic stenoses were 1.47 to 3.43 mm (average: 2.3 mm) for intraarterial DSA, 1.57 to 3.73 mm (average: 2.6 mm) for B-mode ultrasound, 1.97 to 4.17 mm (average: 2.9 mm) for CCDS, 1.43 to 3.47 mm (average: 2.3 mm) for B-flow technique in the brightness mode and 1.6 to 3.47 mm (average: 2.4 mm) for B-flow technique in the B-mode. The brightness mode of the B-flow correlated best with intraarterial DSA (r=0.994), with a significantly lower correlation between CCDS and intraarterial DSA. B-flow displays less vascular distortion within the stenosis and fewer flow artifacts. Even in angulated stenoses, the detected intra- and poststenotic flow was markedly less angle-dependent in comparison with CCDS. B-flow clearly facilitates the visualization of hypoechoic plaques and intima proliferation. Furthermore, eccentric cicatricial stenoses, intima flaps or hypoechoic thrombi, which were not seen with DSA or B-mode, showed improved visualization in comparison with CCDS. CONCLUSION: Ultrasound B-flow makes it easier to assess the morphology and the local degree of stenotic hemodialysis fistulas. Flow detection is achieved with fewer artifacts and reduced angle dependence. This opens the way for better planning of interventional therapy.

Aged↗
PubMed2000

Pulse oximeter-induced digital injury: frequency rate and possible causative factors.

OBJECTIVE: To study the frequency rate of and factors associated with pulse oximeter-induced digital injury (PIDI). DESIGN: Prospective descriptive study. SETTING: Surgical intensive care unit of a university hospital. PATIENTS: All patients with a length of stay of >2 days. INTERVENTIONS AND MAIN RESULTS: We monitored 125 patients by using a pulse oximeter with a nondisposable clip-on probe changed every 3-4 hrs from one finger to another. Daily inspection was performed with special attention to digital injury. Factors implicated in the pathogenesis of PIDI, such as vasopressor therapy, hypotension, hypoxia, hypothermia, and arterial cannulation of the radial or ulnar artery were recorded daily. A total of 22 patients received norepinephrine and dopamine, 34 patients were given dopamine, and 69 patients did not receive vasoactive drugs. PIDI developed in 6 of 125 patients, five in the norepinephrine/dopamine group, one in the dopamine group, and none in the patients not receiving vasopressors. When comparing the frequency rate of PIDI in patients receiving norepinephrine (5 of 22) with patients not receiving norepinephrine (1 of 103) the relationship between the use of norepinephrine and PIDI is significant (p < .001). However, this relationship may also be explained by the fact that patients in the norepinephrine group were more severely ill than patients not requiring norepinephrine were. This is reflected by a higher median severity of illness score (Simplified Acute Physiology Score II) (p = .001), median duration of hypotension (p < .001), median number of saturation drops (p < .001), and higher mortality rate (p < .001). Hypothermia did not occur in any of the patients. There was no significant difference between the median right-left difference in duration of arterial cannulation between the two subgroups (p = .8). In all surviving patients, PIDI healed without permanent damage. CONCLUSIONS: In the studied population of critically ill patients in a surgical intensive care unit, the frequency rate of PIDI was 5% (6 of 125). Although an association with the use of norepinephrine was found, this small number of cases does not allow definite statistical conclusions concerning a relationship between the possible causative factors and PIDI. However, severely ill patients, as indicated by their need for more aggressive vasopressors, are more likely to develop PIDI. In survivors, PIDI healed without sequelae.

APACHE↗