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BMEYE

BMEYE specializes in noninvasive advanced hemodynamic monitoring. BMEYE provides a unique noninvasive solution for the measurement of cardiac output (CO)—the next standard vital sign—and other advanced hemodynamic parameters. Its monitors are safe, precise and easy to use, making hemodynamic monitoring a reality in daily clinical practice.

The Clinical Need

It is well known that patients may respond in a variable and sometimes unpredictable manner to surgery, fluids, anesthetic agents, vasoactive drugs and other interventions. All of these factors may induce significant and rapid changes in CO, which is the main determinant of oxygen delivery (DO₂) to the tissues. However, the parameters that are routinely monitored today during surgery, like blood pressure (BP) and heart rate, are neither sensitive nor specific enough for the timely identification of hemodynamic deterioration (i.e., a decrease in cardiac output). This is why it is evident that non-invasive continuous CO must become the next standard vital sign.

The Noninvasive Solution

The ^ccNexfin monitor (Figure 1) connects to the patient by simply wrapping an inflatable cuff around the middle phalanx of the finger (Figure 2). The pulsating finger artery is “clamped” by applying equivalent counter pressure that results in a pressure waveform. This is how ^ccNexfin provides beat-to-beat continuous BP in a totally noninvasive manner, without the need for arterial cannulation. The resulting BP waveform serves as the basis for the measurement of continuous CO.

^ccNexfin measures real-time continuous CO and other hemodynamic parameters (Table) by a novel pulse contour method (Nexfin CO-Trek), which is based on the systolic pressure area and a physiologic three-element Windkessel model. In order to better guide hemodynamic management, ^ccNexfin also includes advanced algorithms to compute dynamic fluid responsiveness parameters, i.e., stroke volume variation and pulse pressure variation.

Table. Monitored Parameters  Type Parameters Label Hemodynamics Cardiac output/cardiac index CO/CI Systolic/diastolic blood pressures Sys/Dia Mean arterial pressure MAP Heart rate HR Stroke volume SV Systemic vascular resistance SVR Contractility index dP/dt Fluid responsiveness Pulse pressure variation PPV Stroke volume variation SVV Oxygen transport Oxygen delivery index DO2I Oxygen saturation SpO2 Total hemoglobin SpHb Perfusion index PI

In addition to these essential hemodynamic parameters, ^ccNexfin has integrated pulse CO-oximetry measurements with the Masimo Rainbow^® SET technology, allowing clinicians to get real-time, continuous and non-invasive values of oxygen saturation and hemoglobin content. These values in combination with cardiac output, allow ^ccNexfin to also provide oxygen delivery DO₂.

With ^ccNexfin you will be able to:

• Evaluate within minutes your patient’s CO—the next standard vital sign
• Extend the scope of your hemodynamic management by monitoring patients at risk who don’t need invasive lines
• Identify occult hemodynamic instability
• Optimize your patient’s hemodynamic status prior to induction of anesthesia
• Determine the need and bridge the time for invasive hemodynamic monitoring
• See the immediate effect of diagnostic and therapeutic interventions
• Improve patient convenience during long monitoring periods

The Applications

For which patients?

^ccNexfin is perfectly suited for all surgical patients who are at risk for developing hemodynamic instability, or who may benefit from perioperative hemodynamic optimization. The populations who may benefit greatly from ^ccNexfin include:

• The elderly
• The obese
• Pregnant women
• Cardiac patients
• Diabetic patients
• Patients with other significant comorbidities

For which procedures?

^ccNexfin has benefits over the whole range of low-, moderate- and high-risk procedures including:

• Major general surgery—including oncologic procedures
• Cardiac surgery
• Thoracic surgery—one-lung ventilation, induced pneumothorax
• Orthopedic surgery—fractured hip, joint replacement, spine
• Bariatric surgery
• Obstetric and extensive gynecologic surgery
• Urology—radical and/or high risk for bleeding procedures

Where in the hospital can ^ccNexfin be used?

^ccNexfin is a light, small monitor and can be used in many parts of the hospital (Figure 3):

• Operating room, intensive care unit and emergency department
• Step-down and intermediate care unit
• Outpatient cardiology and preoperative anesthesia clinics
• Patient ward—where events such as orthostatic hypotension can be easily diagnosed

This corporate profile was reviewed and approved by BMEYE.

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