This study is an observational prospective pilot trial that utilizes finger cuff non invasive hemodynamic monitoring (NexfinHD Monitor) to assess 4 different groups (CHF/COPD, Trauma, Sepsis, Stroke) of patients on arrival to the Emergency Department and to document the changes seen in these hemodynamics with acute therapies.
There has been little very early (after Emergency Department presentation) hemodynamic monitoring of acutely ill or injured patients secondary to the lack of non invasive technologies that could be reliably applied to this patient population.Thus all assessments of hemodynamics have been made by physicians on clinical information including intermittent pulse and blood pressure measurements. It is not known what the underlying continuous cardiac output, systemic vascular resistance, etc are in these patients and how these change with current Emergency Medicine therapeutic interventions. Currently there is available a finger cuff devise (NexfinHD Monitor, BMEYE, Amsterdam) that can measure these hemodynamics on a beat to beat basis and that can be easily applied to acutely ill individuals. This prospective pilot study of 48 patients (4 groups of 12 each) will document the hemodynamics of patients on arrival and continuously for 2 hours, blinded to the treating physician. Treating physicians will be asked to estimate these hemodynamic parameters at various time points. The study will characterize the hemodynamics of patients, compare them to the estimates of treating physicians and determine whether they predict the need for life saving interventions.
- NexfinHD Monitor Device
Other Names: Transcient Ischemic Attack Intervention Desc: Finger cuff device (NexfinHD Monitor, BMEYE, Amsterdam) that can measure hemodynamics on a beat to beat basis and that can be easily applied to acutely ill individuals. ARM 1: Kind: Experimental Label: Acute CHF/COPD Description: Patients presenting with shortness of breath secondary to acute exacerbation of CHF/COPD ARM 2: Kind: Experimental Label: Acute Trauma Description: Acute trauma patients with a trauma ISS>15 ARM 3: Kind: Experimental Label: Sepsis Description: Patients presenting with a suspicion of acute sepsis (fever, tachycardia, tachypnea) ARM 4: Kind: Experimental Label: Stroke Description: Patients presenting with symptoms and signs of acute stroke (thrombotic or hemorrhagic)
- Observation: Cohort
- Perspective: Prospective
- Sampling: Non-Probability Sample
Acutely ill or injured Emergency Department patients
|Type||Measure||Time Frame||Safety Issue|
|Primary||To elucidate the hemodynamics of the cohort of four different groups of patients in the early hours of their presentation||Emergency Department (ED) arrival to 2 hours||No|
|Secondary||Comparison of clinical estimation of hemodynamics and values estimated by the NexfinHD on arrival and for up to 6 hours||ED arrival to 6 hours||No|
|Secondary||To compare if abnormal hemodynamics as measured by the NexfinHD and clinical assessment after arrival to the ED in the 4 groups predicts life saving interventions within 2 hours||ED arrival to 2 hours||No|
|Secondary||To calculate short term hemodynamic variability parameters and their prediction of life saving interventions within 2 hours and subjective/objective estimation of clinical improvement||ED arrival to 2 hours||No|
|Secondary||Estimation of bias and precision of the non invasive hemodynamic trends in unselected patient group by assessing the validity of measurements with invasive measurements if used||ED arrival to 2 hours||No|