Noninvasive cardiac output monitoring in a porcine model using the inspired sinewave technique: a proof-of-concept study.

BACKGROUND: Cardiac output (Q˙) monitoring can support the management of high-risk surgical patients, but the pulmonary artery catheterisation required by the current 'gold standard'-bolus thermodilution (Q˙T)-has the potential to cause life-threatening complications. We present a novel noninvasive and fully automated method that uses the inspired sinewave technique to continuously monitor cardiac output (Q˙IST). METHODS: Over successive breaths the inspired nitrous oxide (N2O) concentration was forced to oscillate sinusoidally with a fixed mean (4%), amplitude (3%), and period (60 s). Q˙IST was determined in a single-compartment tidal ventilation lung model that used the resulting amplitude/phase of the expired N2O sinewave. The agreement and trending ability of Q˙IST were compared with Q˙T during pharmacologically induced haemodynamic changes, before and after repeated lung lavages, in eight anaesthetised pigs. RESULTS: Before lung lavage, changes in Q˙IST and Q˙T from baseline had a mean bias of -0.52 L min-1 (95% confidence interval [CI], -0.41 to -0.63). The concordance between Q˙IST and Q˙T was 92.5% as assessed by four-quadrant analysis, and polar plot analysis revealed a mean angular bias of 5.98° (95% CI, -24.4°-36.3°). After lung lavage, concordance was slightly reduced (89.4%), and the mean angular bias widened to 21.8° (-4.2°, 47.6°). Impaired trending ability correlated with shunt fraction (r=0.79, P<0.05). CONCLUSIONS: The inspired sinewave technique provides continuous and noninvasive monitoring of cardiac output, with a 'marginal-good' trending ability compared with cardiac output based on thermodilution. However, the trending ability can be reduced with increasing shunt fraction, such as in acute lung injury.

Lieb-Robinson bounds on n-partite connected correlation functions.

Lieb and Robinson provided bounds on how fast bipartite connected correlations can arise in systems with only short-range interactions. We generalize Lieb-Robinson bounds on bipartite connected correlators to multipartite connected correlators. The bounds imply that an n-partite connected correlator can reach unit value in constant time. Remarkably, the bounds also allow for an n-partite connected correlator to reach a value that is exponentially large with system size in constant time, a feature which stands in contrast to bipartite connected correlations. We provide explicit examples of such systems.

Genuine Multipartite Entanglement without Multipartite Correlations.

Nonclassical correlations between measurement results make entanglement the essence of quantum physics and the main resource for quantum information applications. Surprisingly, there are n-particle states which do not exhibit n-partite correlations at all but still are genuinely n-partite entangled. We introduce a general construction principle for such states, implement them in a multiphoton experiment and analyze their properties in detail. Remarkably, even without multipartite correlations, these states do violate Bell inequalities showing that there is no classical, i.e., local realistic model describing their properties.