Comparison of the Pulse Wave Transit Time Method and an Arterial Pressure-Based Cardiac Output System for Measuring Cardiac Output Trends During Laparotomy Without Postural Change

Objective: Perioperative intravascular volume can be optimised by identifying predictors of fluid responsiveness. This study compared the estimated continuous cardiac output (esCCO) system for non- invasive measurement and an arterial pressure-based cardiac output (APCO) system for detecting exact changes in cardiac output (CO) among patients undergoing laparotomy without postural change. Methods: This study was performed at Toho University Omori Medical Centre in Japan from April 2016 to July 2016 and included 26 adult patients undergoing elective laparotomy lasting > 2 h without postural change. We evaluated both interchangeability and dynamic trend. After entering the biometric data (age, sex, height, weight, heart rate, pulse wave transit time, and blood pressure), the esCCO device was calibrated. All patients were also monitored with the APCO system. Data were analysed and compared for 12 adult patients using Bland­Altman analysis and polar plots. Results: The CO value obtained with esCCO was 0.75 ± 0.86 L/min (percentage error: 41%) lower than that obtained with the APCO system. Polar plotting revealed that the mean angular bias was 3.5°, and the radial limit of agreement was 28.3°. Conclusion: This study demonstrated that data obtained using esCCO are not interchangeable with those obtained using the APCO system. The trending ability of the esCCO device was deemed good among patients undergoing laparotomy without postural change.

Treatment for delirium with risperidone: results of a prospective open trial with 10 patients.

Delirium is a common psychiatric illness among medically compromised patients. There is an increasing opportunity to use atypical antipsychotics to treat delirium. The effects of these drugs on delirium, however, the most appropriate way to use them, and the associated adverse effects remain unclear. To clarify these points, a prospective open trial on risperidone was carried out in 10 patients with delirium. At a low dose of 1.7 mg/d, on average, risperidone was effective in 80% of patients, and the effect appeared within a few days. There were no serious adverse effects. However, sleepiness (30%) and mild drug-induced parkinsonism (10%) were observed; the symptom of sleepiness was a reason for not increasing the dose. One patient responded to a dose as low as 0.5 mg/d, so it is recommended that treatment start at a low dose, which may then be increased gradually. This trial is a preliminary open study with a small sample size, and further controlled studies will be necessary.