Welcome!

News Feed Item

Classic Textbook on Critical Care, the ICU book by Paul Marino, M.D., PhD., Recommends Direct Measurement of Blood Volume in Evaluating Critically Ill Patients

NEW YORK, NY -- (Marketwired) -- 01/07/14 -- Daxor Corporation (NYSE MKT: DXR)

The most widely read textbook in critical care medicine is the ICU book (intensive care unit) by Paul Marino, M.D. The fourth edition of this book has just been published by Lippincott Williams & Wilkins, and has important information about blood volume measurement. Dr. Marino, who is on the staff of Cornell Medical School, is an internationally recognized authority on critical care medicine.

The previous third edition was published in 2007. The fourth edition has important new information about the use of blood volume measurement. In a chapter on hypovolemia (low blood volume) Dr. Marino writes "Blood volume measurements have traditionally required too much time to perform to be clinically useful in an ICU setting, but this has changed with the introduction of a semi-automated blood volume analyzer (Daxor Corporation, New York, NY) that provides blood volume measurements in less than an hour. Blinded measurements of blood, red cell, and plasma volumes were performed in patients with circulatory shock who were managed with pulmonary artery catheters, and the results show that blood and plasma volumes were considerably higher than normal. When blood volume measurements were made available for patient care, 53% of the measurements led to a change in fluid management, and this was associated with a significant decrease in mortality rate (from 24% to 8%). These results will require corroboration, but they highlight the limitations of the clinical assessment of blood volume, and the potential for improved outcomes when blood volume measurements are utilized for fluid management." Dr. Marino's book cited a study by Dr. Mihae Yu and included a graph of her research which was published in Shock (A Prospective Randomized Trial Using Blood Volume Analysis in Addition to Pulmonary Artery Catheter, Compared with Pulmonary Artery Catheter Alone, to Guide Shock Resuscitation in Critically Ill Surgical Patients; Shock, Vo. 35, No. 3, pp 220-228, 2011). This landmark study by Dr. Yu studied 100 critically ill patients in the ICU. 50 of them were treated on the basis of a blood volume measurement plus PAC, and 50 were treated on the basis of PAC without knowledge of the blood volume measurement. The patients who were treated on the basis of a blood volume measurement had an 8% survival rate vs. a 20% death rate in the patients who were treated without knowledge of the blood volume measurement.

The most common laboratory tests to evaluate a patient's blood volume are the hematocrit and hemoglobin tests. These tests only measure the concentration of red blood cells, not the volume of the patient's blood. Dr. Marino's book contains the following statement "The use of the hematocrit (and hemoglobin concentration) to evaluate the presence and severity of acute blood loss is both common and inappropriate. Changes in hematocrit show a poor correlation with blood volume deficits and erythrocyte deficits in acute hemorrhage. Acute blood loss involves the loss of whole blood, which results in proportional decreases in the volume of plasma and erythrocytes. As a result, acute blood loss results in a decrease in blood volume but not a decrease in hematocrit. (There is a small dilutional effect from transcapillary refill in acute blood loss, but this is usually not enough to cause a significant decrease in hematocrit.) In the absence of volume resuscitation, the hematocrit will eventually decrease because hypovolemia activates the rennin-angiotensin-aldosterone system, and the renal retention of sodium and water that follows will have a dilutional effect on the hematocrit. This process begins 8 to 12 hours after acute blood loss, and can take a few days to become fully established." That statement is based on original research by Drs. S. Oohashi and H. Endoh, who examined physicians' assessments of patients' blood volumes with actual blood volume measurements and found them to be extremely disparate. Previously, studies from Columbia Presbyterian Medical Center also demonstrated that physicians treating heart failure patients were only correct 51% of the time using the usual clinical parameters and laboratory tests in evaluating the blood volume status of a patient.

Dr. Marino's chapter focused particularly on the detection of hypovolemia (low blood volume). He cited studies which used invasive procedures such as pulmonary artery catheterization (PAC) and central venous pressure to assess a patient's blood volume. Previous studies have demonstrated, in situations where blood volume measurements were actually made, that such assessments are frequently wrong.

Dr. Feldschuh, the president of Daxor, a board certified cardiologist, noted that it is truly tragic that the overwhelming majority of patients treated in intensive care units are not treated based on actual blood volume measurements. Instead, they are treated on the basis of inaccurate tests such as hematocrits and hemoglobins, and invasive procedures such as pulmonary artery catheterization, which multiple studies have shown to be inaccurate for evaluating a patient's blood volume.

Dr. Feldschuh stated that it is unfortunate that thousands of patients die every year because they are not treated correctly due to inaccurate assessments of blood volume. These tests only measure the concentration of red blood cells in a patient, they do not measure a patient's total blood volume. The BVA-100 can measure blood volume to an accuracy of 98%.

Dr. Marino closed this particular chapter with the following comments: "The clinical evaluation of intravascular volume, including the use of central venous pressure (CVP) measurements, is so flawed it has been called a 'comedy of errors'" and "Direct measurements of blood volume are clinically feasible, but are underutilized."

The past week extensive publicity was given to the case of a 13 year old girl in California who had a tonsillectomy and was said to have bled extensively. Unfortunately her blood loss was not properly replaced and she was pronounced brain dead. This is the type of case that occurs by the thousands every year. In addition to patients who die from inadequate treatment, thousands more suffer heart attacks and strokes. Many patients with lack of brain oxygen ultimately develop dementia. Lack of oxygen to the brain is well known to destroy and irreversibly damage brain cells. The knowledge of how to perform accurate blood volume measurement has been known for more than 70 years. An automated blood volume measurement instrument has been available for more than 10 years. The excuse for not performing blood volume measurement has always been that the test is too difficult to perform accurately and takes 4 to 8 hours. The BVA-100 has automated most of the procedure and enables the blood volume measurement to be done in under an hour. Inability to obtain rapid blood volume measurements should no longer be an excuse for treating critically ill patients with blood volume derangements on the basis of tests which are known to be inaccurate and may result in irreversible damage and even death to patients.

Dr. Feldschuh will be attending the annual meeting of Critical Care Medicine in San Francisco January 8 - 13, 2014. This is the main annual meeting of physicians specializing in intensive care unit medicine.

More Stories By Marketwired .

Copyright © 2009 Marketwired. All rights reserved. All the news releases provided by Marketwired are copyrighted. Any forms of copying other than an individual user's personal reference without express written permission is prohibited. Further distribution of these materials is strictly forbidden, including but not limited to, posting, emailing, faxing, archiving in a public database, redistributing via a computer network or in a printed form.

Latest Stories
In most cases, it is convenient to have some human interaction with a web (micro-)service, no matter how small it is. A traditional approach would be to create an HTTP interface, where user requests will be dispatched and HTML/CSS pages must be served. This approach is indeed very traditional for a web site, but not really convenient for a web service, which is not intended to be good looking, 24x7 up and running and UX-optimized. Instead, talking to a web service in a chat-bot mode would be muc...
SYS-CON Events announced today that Column Technologies will exhibit at SYS-CON's @DevOpsSummit at Cloud Expo, which will take place on June 7-9, 2016, at the Javits Center in New York City, NY. Established in 1998, Column Technologies is a global technology solutions provider with over 400 employees, headquartered in the United States with offices in Canada, India, and the United Kingdom. Column Technologies provides “Best of Breed” technology solutions that automate the key DevOps principal...
More and more companies are looking to microservices as an architectural pattern for breaking apart applications into more manageable pieces so that agile teams can deliver new features quicker and more effectively. What this pattern has done more than anything to date is spark organizational transformations, setting the foundation for future application development. In practice, however, there are a number of considerations to make that go beyond simply “build, ship, and run,” which changes ho...
SYS-CON Events announced today that AppNeta, the leader in performance insight for business-critical web applications, will exhibit and present at SYS-CON's @DevOpsSummit at Cloud Expo New York, which will take place on June 7-9, 2016, at the Javits Center in New York City, NY. AppNeta is the only application performance monitoring (APM) company to provide solutions for all applications – applications you develop internally, business-critical SaaS applications you use and the networks that deli...
Fortunately, meaningful and tangible business cases for IoT are plentiful in a broad array of industries and vertical markets. These range from simple warranty cost reduction for capital intensive assets, to minimizing downtime for vital business tools, to creating feedback loops improving product design, to improving and enhancing enterprise customer experiences. All of these business cases, which will be briefly explored in this session, hinge on cost effectively extracting relevant data from ...
When building large, cloud-based applications that operate at a high scale, it’s important to maintain a high availability and resilience to failures. In order to do that, you must be tolerant of failures, even in light of failures in other areas of your application. “Fly two mistakes high” is an old adage in the radio control airplane hobby. It means, fly high enough so that if you make a mistake, you can continue flying with room to still make mistakes. In his session at 18th Cloud Expo, Lee...
SYS-CON Events announced today that (ISC)²® (“ISC-squared”) will exhibit at SYS-CON's 18th International Cloud Expo®, which will take place on June 7-9, 2016, at the Javits Center in New York City, NY. Two leading non-profits focused on cloud and information security, (ISC)² and Cloud Security Alliance (CSA), developed the Certified Cloud Security Professional (CCSP) certification to address the increased demand for cloud security expertise due to rapid growth in cloud. Recently named “The Next...
The Art of DevOps provides a fun overview to help teams understand DevOps. Written in the style of the famous 6th century Chinese manuscript “The Art of War,” this eBook describes DevOps in the form of a mission to continuously deliver assets to the operational battlegrounds safely, securely, and quickly. It’s a fun read with valuable insights.
SYS-CON Events announced today that iDevices®, the preeminent brand in the connected home industry, will exhibit at SYS-CON's 18th International Cloud Expo®, which will take place on June 7-9, 2016, at the Javits Center in New York City, NY. iDevices, the preeminent brand in the connected home industry, has a growing line of HomeKit-enabled products available at the largest retailers worldwide. Through the “Designed with iDevices” co-development program and its custom-built IoT Cloud Infrastruc...
There will be new vendors providing applications, middleware, and connected devices to support the thriving IoT ecosystem. This essentially means that electronic device manufacturers will also be in the software business. Many will be new to building embedded software or robust software. This creates an increased importance on software quality, particularly within the Industrial Internet of Things where business-critical applications are becoming dependent on products controlled by software. Qua...
As enterprises work to take advantage of Big Data technologies, they frequently become distracted by product-level decisions. In most new Big Data builds this approach is completely counter-productive: it presupposes tools that may not be a fit for development teams, forces IT to take on the burden of evaluating and maintaining unfamiliar technology, and represents a major up-front expense. In his session at @BigDataExpo at @ThingsExpo, Andrew Warfield, CTO and Co-Founder of Coho Data, will dis...
WebSocket is effectively a persistent and fat pipe that is compatible with a standard web infrastructure; a "TCP for the Web." If you think of WebSocket in this light, there are other more hugely interesting applications of WebSocket than just simply sending data to a browser. In his session at 18th Cloud Expo, Frank Greco, Director of Technology for Kaazing Corporation, will compare other modern web connectivity methods such as HTTP/2, HTTP Streaming, Server-Sent Events and new W3C event APIs ...
The Quantified Economy represents the total global addressable market (TAM) for IoT that, according to a recent IDC report, will grow to an unprecedented $1.3 trillion by 2019. With this the third wave of the Internet-global proliferation of connected devices, appliances and sensors is poised to take off in 2016. In his session at @ThingsExpo, David McLauchlan, CEO and co-founder of Buddy Platform, will discuss how the ability to access and analyze the massive volume of streaming data from mil...
The cloud competition for database hosts is fierce. How do you evaluate a cloud provider for your database platform? In his session at 18th Cloud Expo, Chris Presley, a Solutions Architect at Pythian, will give users a checklist of considerations when choosing a provider. Chris Presley is a Solutions Architect at Pythian. He loves order – making him a premier Microsoft SQL Server expert. Not only has he programmed and administered SQL Server, but he has also shared his expertise and passion w...
Advances in technology and ubiquitous connectivity have made the utilization of a dispersed workforce more common. Whether that remote team is located across the street or country, management styles/ approaches will have to be adjusted to accommodate this new dynamic. In his session at 17th Cloud Expo, Sagi Brody, Chief Technology Officer at Webair Internet Development Inc., focused on the challenges of managing remote teams, providing real-world examples that demonstrate what works and what do...