1. 3 rd iFAD 29/11/2013 Non-invasive hemodynamic monitoring 1 P16: Non-invasive hemodynamic monitoring with Nexfin in critically ill patients: a preliminary study 30th November 2013 3rd iFAD– Maltron Satellite Symposium Ester Philipse

2. 3 rd iFAD 29/11/2013 Non-invasive hemodynamic monitoring 2 2 nd iFAD 17/11/2012Should I bother about Ebb and Flow phase of shock 2 Introduction Nexfin monitor (BMEYE, Amsterdam, the Netherlands) Non-invasive hemodynamic monitoring tool Finger blood pressure waveform – Volume-clamp principle of Penaz – Physiological and physical criteria of Wesseling

3. 3 rd iFAD 29/11/2013 Non-invasive hemodynamic monitoring 3 Nexfin (BMEYE, Amsterdam, the Netherlands)

4. 3 rd iFAD 29/11/2013 Non-invasive hemodynamic monitoring 4 Aim Validation of the Nexfin in a mixed population of medical ICU patients

5. 3 rd iFAD 29/11/2013 Non-invasive hemodynamic monitoring 5 Methods Prospective study in ICU patients Comparing parameters obtained by Nexfin with PICCO monitoring, radial line or NIBP measurement by armcuff Statistical analysis: Student t-test, Pearson correlation and Bland-Altman analysis,

6. 3 rd iFAD 29/11/2013 Non-invasive hemodynamic monitoring 6 Results 77 medical ICU patients were included In 7 patients measurement with Nexfin was not possible (excluded) Patient characteristics Age (y)65,6 ± 15,9 BMI (kg/m 2 )25,6 ± 4,8 Sex (male/female)1/1 Mechanycally ventilated46/70 Vasopressor use24/70 Inotropica20/70 APACHE - II22,9 ± 10,9 SAPS - II48 ± 20,1 SOFA7,5 ± 4,5 ICU mortality26/70

7. 3 rd iFAD 29/11/2013 Non-invasive hemodynamic monitoring 7 Results – cardiac output

8. 3 rd iFAD 29/11/2013 Non-invasive hemodynamic monitoring 8 Results – MAP

9. 3 rd iFAD 29/11/2013 Non-invasive hemodynamic monitoring 9 Results – hemoglobin (Massimo-technique)

10. 3 rd iFAD 29/11/2013 Non-invasive hemodynamic monitoring 10 Conclusion MAP could be monitored non-invasively with Nexfin CO measured by Nexfin is not correlating well with golden standard Hemoglobin measured by Nexfin is not correlating well with hemoglobin obtained by blood analysis The exact patient profile still had to be determined