Femoral indicator injection for transpulmonary thermodilution using the EV1000/VolumeView®: do the same criteria apply as for the PiCCO®?

Objective

Comparison of global end-diastolic volume index (GEDVI) obtained by femoral and jugular transpulmonary thermodilution (TPTD) indicator injections using the EV1000/VolumnView® device (Edwards Lifesciences, Irvine, USA).

Methods

In an 87-year-old woman with hypovolemic shock and equipped with both jugular and femoral vein access and monitored with the EV1000/VolumeView® device, we recorded 10 datasets, each comprising duplicate TPTD via femoral access and duplicate TPTD (20 ml cold saline) via jugular access.

Results

Mean femoral GEDVI ((674.6±52.3) ml/m²) was significantly higher than jugular GEDVI ((552.3±69.7) ml/m²), with P=0.003. Bland-Altman analysis demonstrated a bias of (+122±61) ml/m², limits of agreement of ?16 and +260 ml/m², and a percentage error of 22%. Use of the correction-formula recently suggested for the PiCCO® device significantly reduced bias and percentage error. Similarly, mean values of parameters derived from GEDVI such as pulmonary vascular permeability index (PVPI; 1.244±0.101 vs. 1.522±0.139; P<0.001) and global ejection fraction (GEF; (24.7±1.6)% vs. (28.1±1.8)%; P<0.001) were significantly different in the case of femoral compared to jugular indicator injection. Furthermore, the mean cardiac index derived from femoral indicator injection ((4.50±0.36) L/(min·m²)) was significantly higher (P=0.02) than that derived from jugular indicator injection ((4.12±0.44) L/(min·m²)), resulting in a bias of (+0.38±0.37) L/(min·m²) and a percentage error of 19.4%.

Conclusions

Femoral access for indicator injection results in markedly altered values provided by the EV1000/VolumeView®, particularly for GEDVI, PVPI, and GEF.

     

Evaluating test validity: reprise and progress

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Effects of kindergarten retention at the end of first grade

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Supporting the Learning Process with Collaborative Concept Mapping Using Computer-Based Communication Tools and Processes

University students are too often challenged by their limited skills in application, investigation, relational thinking, and communication of ideas. In this study, we have combined 3 tools that potentially can support and foster students’ development in the above mentioned areas through student collaboration, concept mapping, and electronic technologies. The participants in this study were 26 students in two intact classes in learning theories. In groups of 3 to 5 students, they were asked to generate 3 concept maps and accompanying prose over the term on 3 major issues in the field of learning. Through the use of interviews, questionnaires, and student generated concept maps, students reportedly enjoyed concept mapping for its organizational and relational properties but preferred sharing their concept maps and dialoguing with one another in a synchronous mode where immediate feedback and flow of thinking could be maintained when involved in constructing maps. Moreover, they did not like the redundancy offered by both prose and concept map outputs, suggesting that while concept mapping can be an arena for generating and generally structuring ideas, prose can be a means of communicating such ideas in a form that is common to most people. This is particularly important for teachers and students who have difficulty navigating through maps alone.     

Networking From the Inside Out: Understanding Learners' Processes,Activities, and Experiences

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