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BACKGROUND: Fibromyalgia (FM) is a chronic disorder with high morbidity and significant health service utilization costs. Few studies have reported on the phenotypic overlap of FM and bipolar disorder (BD). The aim of this review is to qualitatively and quantitatively summarize the results and clinical implications of the extant literature on the co-occurrence of FM and BD. METHODS: A systematic search of PubMed/Medline, Cochrane, PsycINFO, CINAHL and Embase was conducted to search for relevant articles. Articles were included if incidence and/or prevalence of BD was determined in the FM sample. Results of prevalence were pooled from all studies. Pooled odds ratio (OR) was calculated based on case-control studies using standard meta-analytic methods. RESULTS: A total of nine studies were included. The pooled rate of BD comorbidity in samples of FM patients was 21% (n=678); however, results varied greatly as a function of study methodology. Case-controlled studies revealed a pooled OR of 7.55 of BD co-morbidity in samples of FM patients [95% Confidence Interval (CI)=3.9-14.62, FM n=268, controls n=413] with low heterogeneity (I(2)=0%). LIMITATIONS: The current study was limited by the low number of available studies and heterogeneity of study methods and results. CONCLUSIONS: These data strongly suggest an association between BD and FM. Future studies employing a validated diagnostic screen are needed in order to more accurately determine the prevalence of BD in FM. An adequate psychiatric assessment is recommended in FM patients with suspected symptoms consistent with BD prior to administration of antidepressants in the treatment of FM.

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Following a bloodstream infection in June 2011 with Ralstonia mannitolilytica in a premature infant treated with a humidifying respiratory therapy device, an investigation was initiated at the Hadassah Medical Centres in Jerusalem. The device delivers a warmed and humidified mixture of air and oxygen to patients by nasal cannula. The investigation revealed colonisation with R. mannitolilytica of two of 15 patients and contamination of components of five of six devices deployed in the premature units of the Hadassah hospitals. Ten isolates from the investigation were highly related and indistinguishable from isolates described in an outbreak in 2005 in the United States (US). Measures successful in containing the US outbreak were not included in user instructions provided to our hospitals by the distributor of the device.

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BACKGROUND: Neuraxial analgesia significantly increases the success rate of external cephalic version (ECV) among nulliparae. The study objective was to compare ECV success among multiparae with and without spinal analgesia. METHODS: Prospective randomized controlled trial performed over a pre-defined 6 yr period in a tertiary referral delivery suite. Healthy multiparae at term requesting ECV for breech presentation, without fetal or uterine anomaly, were enrolled after written informed consent. Women were randomized to receive either spinal analgesia (bupivacaine 7.5 mg) or no analgesia before the ECV. The primary outcome was successful conversion from breech to vertex presentation, confirmed by ultrasound. Visual analogue pain score and adverse outcomes (complications of anaesthesia or ECV) were recorded. Statistical analysis was performed according to intention to treat using two-sided tests. RESULTS: Among 265 multiparae who underwent ECV, 65 consented to enrol, one subsequently refused ECV; therefore, data from 64 women were analysed. ECV was successful in 27 of 31 patients (87.1%) receiving spinal analgesia vs 19 of 33 (57.5%) with no analgesia (P=0.009; 95% CI of difference: 0.075-0.48). ECV with spinal analgesia reduced visual analogue pain score, mean (sd) 1.7 (2.4) vs 5.5 (2.9) without (P<0.0001). Maternal hypotension was seen after spinal analgesia in 10 of 31 (32%) (P=0.0003) and easily treated without adverse outcome. No complications were noted after the ECV. CONCLUSIONS: Administration of spinal analgesia significantly increased the rate of successful ECV among multiparae at term with increased patient comfort. The trial was registered at the National Institute of Health Trials Registry, NCT00119184, www.clinicaltrials.gov.

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BACKGROUND: No therapy is currently available to improve the reduced uteroplacental blood flow (UPBF) that characterizes pre-eclampsia. We hypothesized that sympathectomy induced by epidural local anaesthesia reduces uterine vascular resistance (which is inversely correlated with UPBF) in pre-eclampsia. METHODS: Ten pregnant women between 24 and 32 weeks of gestation with pre-eclampsia and uterine artery flow abnormalities were randomized to antepartum continuous epidural therapy (ACET) or control. ACET was initiated by a 5 day dose-ranging trial (ACET-1) of 0.04, 0.06, 0.08, and 0.1% ropivacaine and saline placebo, each at 10 ml h(-1) for 24 h. Doses were randomized and double-blind. Doppler ultrasound indices of vascular resistance were assessed at baseline and after each 24 h dosing period in both uterine arteries. Subsequently, these ACET patients were administered 0.1% ropivacaine until delivery (ACET-2), with one additional randomized double-blind placebo day. RESULTS: Five patients were randomized to ACET. In each patient, one uterine artery exhibited a dose-dependent reduction in vascular resistance (P=0.035), a response that returned to baseline following placebo (P<0.001). The contralateral uterine artery exhibited either increased vascular resistance or no change. In all cases, the uterine artery that responded to ACET had higher baseline resistance than its pair (P=0.043). Baseline right-left difference in resistance between paired uterine arteries was greatly diminished following ACET. Although ACET patients had a mean (sd) duration to delivery of 19 (9) days compared with control 2 (1) days (P=0.008), this should be interpreted with caution because of demographic differences between groups. CONCLUSIONS: ACET reduces uterine artery resistance in pre-eclampsia <32 weeks. Uteroplacental re-distribution is a novel observation and warrants further investigation.

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A parturient (grand multipara) developed arrested labour complicated by severe fetal heart rate decelerations. Senior physicians explained the need for a caesarean section, but she chose to deliver vaginally since rabbinical blessing could not be obtained. Forcing the mother to have a cesarean section without consent is considered "civil battery." The dilemma faced by medical staff and the implications of her refusal for the treating medical staff are described.

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Placenta accreta may be suspected prior to surgery, but the actual diagnosis is only confirmed at surgery. This prospective and observational study was performed to assess whether preparations should be made for potential massive blood loss prior to Caesarean surgery in all patients with suspected placenta accreta. Patients were classified as high or low suspicion for placenta accreta based on ultrasonography and clinical factors. Among 28 suspected cases of placenta accreta, diagnosis was confirmed at surgery in 50% (12/17 high and 2/11 low suspicion) cases. Hysterectomy was only performed in the 12 high suspicion patients with placenta accreta (p < 0.001). High suspicion patients required more blood transfusions: mean(SD) 6.5 (7.0) units vs 1.09 (1.1) units, p = 0.017. Anaesthetists should be prepared for major haemorrhage in all cases of suspected placenta accreta, although use of a system to grade level of suspicion may identify those at greater risk.

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Since the mid-1980s, murine retroviral vectors have been used extensively by a number of investigators to clonally mark and genetically modify primitive hematopoietic stem cells (HSC) (1,2). During this period, both vectors and packaging systems used to generate virus have undergone considerable modification. This has led to increased production of high-titer, replication-defective retrovirus that is more resistant to gene inactivation following integration into hematopoietic cells. Current approaches to murine HSC transduction have become increasingly more standardized, although there remain numerous variations on a theme (see Chapter 15). This "classical" method utilizes preconditioned bone-marrow cells (typically from 5-fluorouracil [5-FU]-treated animals) and coculture of these cells with virus-producing packaging cells in the presence of exogenous cytokines. This approach generally yields high proportions of transduced cells that can repopulate lethally irradiated recipient mice for long periods of time, indicating that self-renewal activity is maintained-at least to some extent-in conditions that promote stem-cell cycling. With this approach, it is difficult to re-isolate transduced cells from packaging cells and from nontransduced bone marrow, which would be desirable in some clinically relevant cases.

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BACKGROUND: A previous report using a partial sciatic nerve ligation (PSL) model for neuropathic pain in rats demonstrated that consumption of soy-containing diets preoperatively and postoperatively suppressed development of mechanical and heat allodynia, as well as hyperalgesia. The current study examined whether dietary soy suppresses these neuropathic sensory disorders when consumed either before or after PSL injury. METHODS: Male Wistar rats were grouped into seven different feeding regimens. These rats were fed SOY (RMH-1000, PMI Feeds, St. Louis, MO), a diet containing 85% soy protein since weaning, and were then switched to noSOY (Bio-Serv Co., Frenchtown, NJ), a diet devoid of soy at certain time points before PSL injury (14, 7, 1 days, or 15 and 0 h). Postoperatively, these rats were fed SOY or noSOY diets. Levels of mechanical and heat allodynia and hyperalgesia were determined preoperatively and 3, 8, and 14 days after PSL injury. RESULTS: Compared with groups fed preoperative noSOY, consumption of SOY before PSL injury significantly blunted postoperative levels of allodynia and hyperalgesia. Administering the SOY diet both before and after PSL injury provided no additional suppression of neuropathic pain. No pain suppression was noted in rats fed a noSOY diet preoperatively and SOY diet after PSL injury. Switching from SOY to noSOY feeding within 15 h of PSL injury was sufficient to allow for the full development of allodynia and hyperalgesia. CONCLUSIONS: Consumption of a soy-containing diet suppressed the development of neuropathic pain after PSL injury. The pain-suppressing properties of dietary soy were the result of a preemptive effect (i.e., when consumed preoperatively), but not a palliative effect (i.e., when consumed postoperatively). This effect of soy-containing diets appears to be short-lived, since switching to a noSOY diet 15 h before ligation abrogated the suppressive effect of soy.

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OBJECTIVE: To assess in vitro the performance of five mechanical ventilators-Siemens 300 and 900C (Siemens-Elma; Solna, Sweden), Puritan Bennett 7200 (Nellcor Puritan Bennett; Pleasanton, CA), Evita 4 (Dragerwerk; Lubeck, Germany), and Bear 1000 (Bear Medical Systems; Riverside CA)-and a bedside sidestream spirometer (Datex CS3 Respiratory Module; Datex-Ohmeda; Helsinki, Finland) during ventilation with helium-oxygen mixtures. DESIGN: In vitro study. SETTING: ICUs of two university-affiliated hospitals. METHODS AND MEASUREMENTS: Each ventilator was connected to 100% helium through compressed air inlets and then tested at three to six different tidal volume (VT) settings using various helium-oxygen concentrations (fraction of inspired oxygen [FIO(2)] of 0.2 to 1.0). FIO(2) and VT were measured with the Datex CS3 spirometer, and VT was validated with a water-displacement spirometer. MAIN RESULTS: The Puritan Bennett 7200 ventilator did not function with helium. With the other four ventilators, delivered FIO(2) was lower than the set FIO(2). For the Siemens 300 and 900C ventilators, this difference could be explained by the lack of 21% oxygen when helium was connected to the air supply port, while for the other two ventilators, a nonlinear relation was found. The VT of the Siemens 300 ventilator was independent of helium concentration, while for the other three ventilators, delivered VT was greater than the set VT and was dependent on helium concentration. During ventilation with 80% helium and 20% oxygen, VT increased to 125% of set VT for the Siemens 900C ventilator, and more than doubled for the Evita 4 and Bear 1000 ventilators. Under the same conditions, the Datex CS3 spirometer underestimated the delivered VT by about 33%. CONCLUSIONS: At present, no mechanical ventilator is calibrated for use with helium. This investigation offers correction factors for four ventilators for ventilation with helium.

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OBJECTIVES: The goal of this study was to investigate the nature of the association between silent ischemia and postoperative myocardial infarction (PMI). BACKGROUND: Silent ischemia predicts cardiac morbidity and mortality in both ambulatory and postoperative patients. Whether silent stress-induced ischemia is merely a marker of extensive coronary artery disease or has a closer association with infarction has not been determined. METHODS: In 185 consecutive patients undergoing vascular surgery, we correlated ischemia duration, as detected on a continuous 12-lead ST-trend monitoring during the period 48 h to 72 h after surgery, with cardiac troponin-I (cTn-I) measured in the first three postoperative days and with postoperative cardiac outcome. Postoperative myocardial infarction was defined as cTn-I >3.1 ng/ml accompanied by either typical symptoms or new ischemic electrocardiogram (ECG) findings. RESULTS: During 11,132 patient-hours of monitoring, 38 patients (20.5%) had 66 transient ischemic events, all but one denoted by ST-segment depression. Twelve patients (6.5%) sustained PMI; one of those patients died. All infarctions were non-Q-wave and were detected by a rise in cTn-I during or immediately after prolonged, ST depression-type ischemia. The average duration ofischemia in patients with PMI was 226+/-164 min (range: 29 to 625), compared with 38+/-26 min (p = 0.0000) in 26 patients with ischemia but not infarction. Peak cTn-I strongly correlated with the longest, as well as cumulative, ischemia duration (r = 0.83 and r = 0.78, respectively). Ischemic ECG changes were completely reversible in all but one patient who had persistent new T wave inversion. All ischemic events culminating in PMI were preceded by an increase in heart rate (delta heart rate = 32+/-15 beats/min), and most (67%) of them began at the end of surgery and emergence from anesthesia. CONCLUSIONS: Prolonged, ST depression-type ischemia progresses to MI and is strongly associated with the majority of cardiac complications after vascular surgery.

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BACKGROUND: A large proportion of patients with critical limb ischemia have advanced, often asymptomatic coronary artery disease which is associated with increased perioperative risk and decreased long-term survival. METHODS: We evaluated retrospectively the short and long-term effect of routine dipyridamole-thallium cardiac scanning (DTS) and selective coronary revascularization in 113 consecutive patients who were scheduled for revascularization of the lower extremity. RESULTS: DTS was abnormal in 60 (53.1%) patients and demonstrated a moderate-severe reversible defect in 26 (23.0%) patients. On the basis of DTS and clinical evaluation 33 (29.2%) patients were referred for coronary catheterization. Of these, 9 underwent PTCA and 4 underwent coronary artery bypass, without complications. Surgical revascularization of the limbs was performed in all but two patients. Two (1.8%) patients died postoperatively, three (2.7%) sustained nonfatal postoperative myocardial infarctions. None of the patients who underwent preoperative coronary revascularization suffered a cardiac complication after the peripheral vascular operation. During mean follow-up of 31.7 months, 30 (28.0%) patients died. A moderate-severe reversible defect on DTS was the strongest predictor for shortened survival (Exp(b)=0.61, CI 95%=0.42-0.88; p=0.006). Patients who underwent preoperative coronary revascularization followed a survival curve approaching those without a reversible defect on DTS (mean survival 61+/-8 vs 63+/-4 months; NS) which was significantly better than those with such a defect who did not undergo coronary revascularization (mean survival 34+/-5 months; p=0.03). CONCLUSIONS: While the perioperative benefits of routine preoperative DTS screening in patients with critical limb ischemia, remain debatable, it provides an opportunity for identification and treatment of life-limiting coronary artery disease and improving survival.

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OBJECTIVE: To establish ways of defining long-term ICU patients and to develop methods of quantifying their impact on bed utilization. DESIGN: Retrospective analysis of prospectively collected sample data. SETTING: Two university hospital adult surgical ICUs. PATIENTS: 6,588 consecutive patients admitted over 8 years to ICU 1 and 2,913 patents admitted over 5 years to ICU 2. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: Patients with uncommon but expected long stays were designated as long-term patients and those with exceptional and unexpected long stays were designated as outliers. Visualization of the length-of-stay frequency distributions revealed that the "tail" of the distributions began at a stay of about 10 days, and this was chosen as the threshold for long-term patients. A threshold of 30 days was chosen as the outlier threshold since only isolated patients stayed longer. The impact (long-term patients/total admissions) of long-term patients on bed utilization was assessed and year-to-year differences examined. Long-term patients staying at least 10 days used 2.7-5.0 bed-years. CONCLUSIONS: Long-term patients can have a major impact on ICU bed utilization. With 23-45% of the beds occupied by long-term patients, the availability of beds for short-stay patients is reduced. This is important in ICUs where efficient patient throughput is vital, so that beds are availability for both elective and emergency admissions.

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PURPOSE: 1) to investigate whether leukotriene B(4) (LTB(4)) is a factor in the inflammatory reaction following chorioretinal laser injury in rabbits; 2) to study its relationship with the cyclooxygenase (COX) metabolic pathway; 3) to study the influence of Nordihydroguaiaretic acid (NDGA), an inhibitor; of the lipoxygenase (LOX) cascade, on both COX and LOX metabolism. METHODS: Prostaglandin E(2) (PGE(2)) and LTB(4) synthesis by incubated samples of chorioretina obtained from rabbits' eyes exposed to Neodymium:Yag laser along with these eicosanoids accumulation in the vitreous were measured over one week follow-up period. The effect of NDGA pre-treatment on the COX and the LOX pathways in the laser-injured chorioretina was also assessed. PGE(2) and LTB(4) levels in the vitreous and in the chorioretina incubation medium were quantified using the radioimmunoassay technique with the appropriate antibodies. RESULTS: LTB(4) in vitro production by rabbits' chorioretina subjected to ND; YAG laser was significantly elevated compared to control, peaking on day 7 to levels 2.45 fold greater than baseline (p < 0.01). PGE(2) formation, following a different pattern, was also enhanced and its maximal level (5.2 fold higher than control, p < 0.01) was achieved at the initial phase (day 1 post laser). Laser irradiation caused also an increase in the two eicosanoids accumulation in the vitreous, which was however not proportional to their production levels. NDGA treatment was associated with a sustained decrease in LTB(4) content in the vitreous, but had no effect on PGE(2) vitreal levels. CONCLUSIONS: Laser irradiation of the rabbits' retina induces an alteration in the LOX metabolic pathway, which is dissociated from the influence on the COX cascade, pointing for the first time to a possible role played by LTB( 4) as a mediator in the chorioretinal inflammatory reaction, with no connection to the role played by PGE(2). NDGA selectively inhibited LOX activity without affecting COX activity.

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PURPOSE: Stealth liposomal doxorubicin (Alzal Corp, Palo Alto, CA) has a slower clearance rate than free doxorubicin, resulting in sustained serum levels. Liposomal encapsulation also leads to increased concentration of drug in tumor tissue. Meta-analysis of previous studies has shown that doxorubicin has activity in epithelial ovarian cancer. The current study was developed to examine the activity of Stealth liposomal doxorubicin in platinum- and paclitaxel-refractory ovarian cancer. PATIENTS AND METHODS: Patients had epithelial ovarian cancer that either progressed on or recurred within 6 months of completion of platinum and paclitaxel chemotherapy. All patients had measurable disease. Stealth liposomal doxorubicin was administered at 50 mg/m(2) every 4 weeks as a 1-hour infusion. RESULTS: Eighty-nine patients were treated and included in an intent-to-treat analysis. There were 82 patients who were platinum and paclitaxel refractory and met all study criteria. There was one complete response and 14 partial responses, for a total response rate of 16.9% (95% confidence interval [CI], 9.1% to 24.6%). For platinum- and paclitaxel-refractory patients, the response rate was 18.3% (95% CI, 9.9% to 26.7%). Median time to progression was 19. 3 weeks for the entire population. Ten patients (11.2%) withdrew because of adverse events related to the drug (palmar-plantar erythrodysesthesia [PPE], n = 3; asthenia, n = 2; cardiac, n = 2; neutropenia, n = 1; stomatitis, n = 1; and edema, n = 1). There were no drug-related fatal events. There were only eight grade 4 adverse events attributable to the drug. Stomatitis, PPE, and skin lesions were managed with dose reductions and delays in most cases. CONCLUSION: Stealth liposomal doxorubicin has activity in refractory epithelial ovarian cancer. PPE and stomatitis can usually be managed by dose adjustment. The ease of administration makes this an attractive agent.

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OBJECTIVES: To determine the factors that cause changes in surgical intensive care unit (ICU) utilization. The aim was to uncover the causes of these changes and examine whether any could have been predicted statistically. DESIGN: Retrospective analysis of prospectively collected representative data. SETTING: University hospital adult surgical ICU. PATIENTS: A total of 6,571 consecutive patients admitted over 8 yrs. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Changes in annual admission rates and lengths of stay were examined to determine their causes, whether they were because of structural changes caused by alterations of physical facilities, functional changes caused by changes in personnel or policies, or clinical changes caused by alterations in clinical practice. The medical literature was examined to determine whether these changes reflected medical trends. During the 8 yrs there was a steady increase in the number of admissions and a steady reduction in the length of stay. These changes in unit utilization were often not predictable statistically and were attributable to a combination of clinical, structural, and functional factors. CONCLUSIONS: Surgical ICU utilization was notable for continual, and not predictable, changes. Clinical issues included new surgical techniques and anesthetic practices; structural causes included changes in bed capacity and opening an intermediate care unit; and functional factors involved changes in surgical personnel, policy revisions, and pressures to reduce ICU length of stay. This was further complicated by the observation that changes in the number of admissions were often not paralleled by similar changes in the number of patient days. This complex situation demonstrated the problems of basing predictions of future utilization on previous experiences.

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PURPOSE: To study the ocular hypotensive effect of a nonpsychotropic cannabinoid, HU-211 (11 -hydroxy-delta8-tetra-hydrocannabinol, dimethylheptyl), an N-methyl-D-aspartate (NMDA) agonist, in normotensive rabbits. METHODS: The cannabinoid HU-211, being lipophilic, was incorporated into a stable oil-in-water submicron sterile emulsion, consisting of 0.12% (w/w) HU-211. A single- dose, randomized and double-masked study was designed, using a Digilab 30R pneumotonometer to measure intraocular pressure (IOP) in normotensive rabbits. RESULTS: Application of a single dose of HU-211 ophthalmic preparation resulted in an IOP reduction of 5.3 mmHg (24% of baseline), first evident at 1.5 h post application and persisting for over 6 h. A small but significant lowering of pressure (12.5% of baseline) occurred in the contralateral eyes of HU-211 treated rabbits, lasting for 4 h post treatment. CONCLUSION: Our work demonstrated that HU-211, incorporated into submicron emulsion, caused a 6-h-long reduction in IOP in the treated eye, with a lesser reduction in the contralateral untreated eye.

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Cardiac and thoracic surgery cause alterations in ventilatory function that can lead to significant postoperative pulmonary complications. These complications often occur among patients with pre-existing pulmonary dysfunction and cause significantly longer hospital stays. This review explores some of the recent literature concerning this issue, including the effects of lung reduction surgery.

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STUDY OBJECTIVE: To illustrate the influence of anesthetic gases on respiratory flow measurements and to correct this influence. DESIGN: In vitro evaluation. SETTING: Laboratory. MEASUREMENTS AND MAIN RESULTS: An in vitro method using a 120-L Tissot water-seal spirometer was used along with a Bicore CP-100, designed for use in intensive care units, and a Datex Ultima, designed for use in the operating room. The flow transducer of one of the instruments being tested was placed in the gas inlet of the Tissot so that simultaneous measurements could be made. Timed flows (2 to 60 L/min) of various gases (O2 and air) and gas mixtures (halothane-O2, isoflurane-O2, N2O-O2, and N2O-O2-isoflurane) were used and the measurements made by the Tissot and the test instrument compared. The Datex Ultima, which includes software corrections for anesthetics, was able to accurately measure gas flows (2 to 60 L/min) of air, 100% oxygen, and anesthetic gas mixtures to within +/- 10% of measurements made by the Tissot. The Bicore CP-100, intended for use with mechanically ventilated patients, accurately measured air and 100% oxygen flow rate to within +/- 8% of the measurements made by the Tissot, but there were large errors (up to 40%) when anesthetics were used. CONCLUSIONS: This study illustrates the effects of anesthetic gases on measurements of ventilatory flow and the need to ascertain whether corrections are needed to improve the accuracy of flow transducers.

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OBJECTIVES: To characterize the decreases in pulmonary artery temperature that coincide with the inflation cycle of pneumatic calf compression stockings and to examine their effects on the thermodilution measurement of cardiac output. DESIGN: Three-part observational study. SETTING: University hospital surgical intensive care unit. PATIENTS: Postoperative patients with indwelling pulmonary artery catheters. INTERVENTION: Thermodilution cardiac output measurements with and without pneumatic calf compression. MEASUREMENTS AND MAIN RESULTS: Phase 1 (n = 18) examined the effects of pneumatic compression on pulmonary artery temperature. There was no effect on pulmonary artery temperature (device off, 37.468+/-0.008 degrees C; device on, 37.458+/-0.014 degrees C), but the difference between the maximum and minimum pulmonary artery temperatures was increased (off, 0.031+/-0.006 degrees C; on, 0.055+/-0.012 degrees C [p < .001]). Phase 2 (n = 12) found that the mean thermodilution cardiac output with 10 mL of cold (0-5 degrees C) injectate was unchanged by pneumatic compression (off, 7.00+/-2.28 L/min; on, 6.89+/-2.22 L/min). However, when the compression devices were operating, the variability between the individual measurements was increased, as reflected by larger coefficients of variation (off, 3.19+/-1.96; on, 8.72+/-6.56 [p < .02]). Similar results were obtained during phase 3 (n = 5), when cardiac output was measured with room temperature Injectate. CONCLUSIONS: Intermittent pneumatic calf compression increased lower limb venous return, causing acute but transient decreases in pulmonary artery blood temperature. This did not affect the accuracy of thermodilution cardiac output measurements that were made using 10 mL of either cold or room temperature injectate.

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