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      A Novel Non-Invasive Device for the Assessment of Central Venous Pressure in Hospital, Office and Home

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          Abstract

          Background

          Venous congestion can be quantified by central venous pressure (CVP) and its monitoring is crucial to understand and follow the hemodynamic status of patients with cardio-respiratory diseases. The standard technique for CVP measurement is invasive, requiring the insertion of a catheter into a jugular vein, with potential complications. On the other hand, the current non-invasive methods, mainly based on ultrasounds, remain operator-dependent and are unsuitable for use in the home environment. In this paper, we will introduce a novel, non-invasive device for the hospital, office and home assessment of CVP.

          Methods

          After describing the measurement concept, we will report a preliminary experimental study enrolling 5 voluntary healthy subjects to evaluate the VenCoM measurements’ repeatability, and the system’s capability in measuring small elicited venous pressure variations (2 mmHg), as well as an induced venous hypertension within a pathological range (12÷20 mmHg).

          Results

          The experimental measurements showed a repeatability of ±1mmHg. The VenCoM device was able to reliably detect the elicited venous pressure variations and the simulated congestive status.

          Discussion and Conclusion

          The proposed non-invasive VenCoM device is able to provide a fast and repeatable CVP estimate, having a wide spectrum of potential clinical applications, including the monitoring of venous congestion in heart failure patients and in subjects with renal and hepatic dysfunction, as well as pulmonary hypertension (PH) that can be extended to pneumonia COVID-19 patients even after recovery. The device needs to be tested further on a large sample size of both healthy and pathological subjects, to systematically validate its reliability and impact in clinical setting.

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          Most cited references77

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          Heart Disease and Stroke Statistics—2020 Update

          Circulation
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            Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography.

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              Immune mechanisms of pulmonary intravascular coagulopathy in COVID-19 pneumonia

              Summary The lung pathology seen in patients with coronavirus disease 2019 (COVID-19) shows marked microvascular thrombosis and haemorrhage linked to extensive alveolar and interstitial inflammation that shares features with macrophage activation syndrome (MAS). We have termed the lung-restricted vascular immunopathology associated with COVID-19 as diffuse pulmonary intravascular coagulopathy, which in its early stages is distinct from disseminated intravascular coagulation. Increased circulating D-dimer concentrations (reflecting pulmonary vascular bed thrombosis with fibrinolysis) and elevated cardiac enzyme concentrations (reflecting emergent ventricular stress induced by pulmonary hypertension) in the face of normal fibrinogen and platelet levels are key early features of severe pulmonary intravascular coagulopathy related to COVID-19. Extensive immunothrombosis over a wide pulmonary vascular territory without confirmation of COVID-19 viraemia in early disease best explains the adverse impact of male sex, hypertension, obesity, and diabetes on the prognosis of patients with COVID-19. The immune mechanism underlying diffuse alveolar and pulmonary interstitial inflammation in COVID-19 involves a MAS-like state that triggers extensive immunothrombosis, which might unmask subclinical cardiovascular disease and is distinct from the MAS and disseminated intravascular coagulation that is more familiar to rheumatologists.
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                Author and article information

                Journal
                Med Devices (Auckl)
                Med Devices (Auckl)
                mder
                mder
                Medical Devices (Auckland, N.Z.)
                Dove
                1179-1470
                13 May 2021
                2021
                : 14
                : 141-154
                Affiliations
                [1 ]eDIMES Lab-Laboratory of Bioengineering, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna , Bologna, Italy
                [2 ]Ars Medica: Associazione Medico-Chirurgica Della Gallura , Olbia, Italy
                [3 ]Villa Laura Ospedale Privato Accreditato , Bologna, Italy
                [4 ]Abcardio Cardiological Center , Bologna, Italy
                [5 ]TRE ESSE Progettazione Biomedica S.r.l ., Bologna, 40138, Italy
                Author notes
                Correspondence: Laura Cercenelli Laboratory of Bioengineering, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna , c/o S. Orsola Malpighi-Hospital, via Massarenti 9, Bologna, 40138, ItalyTel +39 0516364603Fax +39 0516364603 Email laura.cercenelli@unibo.it
                [*]

                These authors contributed equally to this work

                Author information
                http://orcid.org/0000-0001-7818-1356
                Article
                307775
                10.2147/MDER.S307775
                8128499
                732dc387-9535-477f-924b-6036a60522ac
                © 2021 Marcelli et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                History
                : 26 February 2021
                : 14 April 2021
                Page count
                Figures: 12, References: 78, Pages: 14
                Categories
                Original Research

                Biotechnology
                central venous pressure,pulmonary artery pressure,heart failure,non-invasive device,home monitoring,covid-19,cardiovascular measurements

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