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Journal of Clinical Monitoring and Computing

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https://www.readbyqxmd.com/read/29789999/assessing-the-correct-inflation-of-the-endotracheal-tube-cuff-a-larger-pilot-balloon-increases-the-sensitivity-of-the-finger-pressure-technique-but-it-remains-poorly-reliable-in-clinical-practice
#1
Antonio Pisano, Luigi Verniero, Nicola Galdieri, Antonio Corcione
The pilot balloon palpation (or 'finger-pressure') method is still widely used to assess the endotracheal tube cuff inflation, despite consistent evidence of its poor sensitivity in recognizing cuff overinflation. It was recently speculated that this may be related to the lower wall tension (due to the smaller radius) of the pilot balloon as compared with the cuff, according to Laplace's law. To verify this hypothesis and, secondarily, to assess whether the use of a 'large' pilot balloon (identical to the cuff) increases the reliability of this technique, 62 anesthetists (41 experienced anesthesiologists and 21 residents) were asked to estimate the pressure of a cuff inflated to 88 mmHg into a simulated trachea by feeling both a usual and a modified 'large' pilot balloon...
May 22, 2018: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/29785552/suppression-of-pupillary-unrest-by-general-anesthesia-and-propofol-sedation
#2
Matthias Behrends, Merlin D Larson, Andrew E Neice, Michael P Bokoch
The pupil undergoes irregular oscillations when exposed to light. These oscillations, known as pupillary unrest in ambient light, originate from oscillatory activity within the Edinger-Westphal nucleus in the midbrain. The midbrain and upper pons also contain nuclei known to be very sensitive to the effects of anesthetics that play a central role in maintaining wakefulness. We hypothesized that anesthetics may display similar effects on wakefulness and pupillary unrest. Repeat measurements of pupillary unrest using infrared pupillometry were performed in 16 patients undergoing general anesthesia and 8 patients undergoing propofol sedation...
May 21, 2018: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/29779129/practical-impact-of-a-decision-support-for-goal-directed-fluid-therapy-on-protocol-adherence-a-clinical-implementation-study-in-patients-undergoing-major-abdominal-surgery
#3
Alexandre Joosten, Reda Hafiane, Marco Pustetto, Luc Van Obbergh, Thierry Quackels, Alexis Buggenhout, Jean-Louis Vincent, Brigitte Ickx, Joseph Rinehart
The purpose of this study was to assess the effects of using a real time clinical decision-support system, "Assisted Fluid Management" (AFM), to guide goal-directed fluid therapy (GDFT) during major abdominal surgery. We compared a group of patients managed using the AFM system with a historical cohort of patients (control group) who had been managed using a manual GDFT strategy. Adherence to the protocol was defined as the relative intraoperative time spent with a stroke volume variation (SVV) < 13%...
May 19, 2018: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/29777332/influence-of-tetanic-stimulation-on-the-staircase-phenomenon-and-the-acceleromyographic-time-course-of-neuromuscular-block-a-randomized-controlled-trial
#4
Guido Mazzinari, Carlos L Errando, Oscar Díaz-Cambronero, Manuel Martin-Flores
During neuromuscular monitoring, repeated electrical stimulation evokes muscle responses of increasing magnitude ('staircase phenomenon', SP). We aimed to evaluate whether SP affects time course and twitches' values of an acceleromyographic assessed neuromuscular block with or without previous tetanic stimulation. Fifty adult patients were randomized to receive a 50 Hz tetanic stimulus (S group) or not (C group) before monitor calibration. After 20 min of TOF ratio (TOFr) stimulation rocuronium was administered...
May 18, 2018: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/29770895/implementation-of-goal-directed-therapy-needs-a-boost-and-it-is-called-assisted-fluid-management
#5
EDITORIAL
Paul A van Beest
No abstract text is available yet for this article.
May 16, 2018: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/29752666/lung-water-assessment-from-gravimetry-to-wearables
#6
Frederic Michard
Several techniques are now available to detect and quantify pulmonary edema, from the laboratory postmortem method (gravimetry) to non-invasive wearable sensors. In critically ill patients with adult respiratory distress syndrome (ARDS), computed tomography scans are often performed to visualize lung lesions and quantify lung aeration, but their value seems somewhat limited to quantify pulmonary edema on a routine basis and of course to track changes with therapy. In this context, transpulmonary thermodilution is a convenient technique...
May 11, 2018: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/29749570/validation-of-a-photoplethysmography-device-for-detection-of-obstructive-sleep-apnea-in-the-perioperative-setting
#7
Philipp Faßbender, Ali Haddad, Silja Bürgener, Jürgen Peters
Obstructive sleep apnea (OSA) is a risk factor for perioperative complications, but many OSA patients present undiagnosed. While polysomnography (PSG) is the "gold standard" for diagnosis, its application is technology-intense, time-consuming, expensive, and requires specialists, often delaying surgery. Thus, miniaturized devices were developed for OSA screening aimed at ruling out major OSA while measuring a lesser number of biological signals. We evaluated the accuracy of a photoplethysmography (PPG)-based device for OSA detection...
May 10, 2018: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/29744774/performance-and-applications-of-bedside-visual-inspection-of-airway-pressure-time-curve-profiles-for-estimating-stress-index-in-patients-with-acute-respiratory-distress-syndrome
#8
Phunsup Wongsurakiat, Nadwipa Yuangtrakul
To determine the performance of bedside visual inspection of airway pressure-time (Paw-t) curve profiles (VI) for estimating stress index (SI) in patients with acute respiratory distress syndrome (ARDS). A prospective study in 30 subjects with ARDS receiving mechanical ventilation at two peak inspiratory flow (PIF) settings: 60 or 40 L/min. For each study session, two physicians inspected real-time Paw-t waveforms from mechanical ventilator's monitoring screens at bedside for 30 s and interpreted which of the three patterns (tidal recruitment, noninjurious ventilation or tidal overdistension) the Paw-t curve profile was compatible with...
May 9, 2018: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/29740730/a-comparison-of-ventricular-systolic-function-indices-provided-by-volumeview-ev1000%C3%A2-and-left-ventricular-ejection-fraction-by-echocardiography-among-septic-shock-patients
#9
Nitchakan Nakwan, Ply Chichareon, Bodin Khwannimit
The aim of this study was to compare the cardiac function index (CFI) and global ejection fraction (GEF) obtained by VolumeView/EV1000™, with the left ventricular ejection fraction (LVEF) by echocardiography in septic shock patients. A prospective observational study was conducted in a medical intensive care unit of a tertiary, teaching university hospital. Thirty-two, mechanical-ventilated septic shock patients were included in this study. We simultaneously measured CFI and GEF with LVEF. The correlation of CFI, GEF along with LVEF and ability of CFI and GEF to predict LVEF ≥ 40, 50 and 60% were evaluated...
May 8, 2018: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/29725795/a-low-dose-of-three-local-anesthetic-solutions-for-interscalene-blockade-tested-by-thermal-quantitative-sensory-testing-a-randomized-controlled-trial
#10
Luc A Sermeus, Tom Schepens, Guy H Hans, Stuart G Morrison, Kristien Wouters, Margaretha B Breebaart, Carine J Smitz, Marcel P Vercauteren
This randomized double-blind controlled trial compared the block characteristics of three low-dose local anesthetics at different roots in an ultrasound-guided interscalene block, using thermal quantitative sensory testing for assessing the functioning of cutaneous small nerve fibres. A total of 37 adults scheduled to undergo shoulder arthroscopy were randomized to receive 5 mL of either 0.5% levobupivacaine with and without epinephrine 1/200,000 or 0.75% ropivacaine in a single-shot interscalene block. Thermal quantitative sensory testing was performed in the C4, C5, C6 and C7 dermatomes...
May 3, 2018: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/29725794/cardiac-output-measurement-in-liver-transplantation-patients-using-pulmonary-and-transpulmonary-thermodilution-a-comparative-study
#11
Luigi Vetrugno, Elena Bignami, Federico Barbariol, Nicola Langiano, Francesco De Lorenzo, Carola Matellon, Giuseppe Menegoz, Giorgio Della Rocca
During liver transplantation surgery, the pulmonary artery catheter-despite its invasiveness-remains the gold standard for measuring cardiac output. However, the new EV1000 transpulmonary thermodilution calibration technique was recently introduced into the market by Edwards LifeSciences. We designed a single-center prospective observational study to determine if these two techniques for measuring cardiac output are interchangeable in this group of patients. Patients were monitored with both pulmonary artery catheter and the EV1000 system...
May 3, 2018: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/29705865/real-time-spectral-analysis-of-the-arterial-pressure-waveform-using-a-wirelessly-connected-tablet-computer-a-pilot-study
#12
David Andrew Pybus
Spectral analysis of the arterial pressure waveform, using specialized hardware, has been used for the retrospective calculation of the 'Spectral Peak Ratio' (SPeR) of the respiratory and cardiac arterial spectral peaks. The metric can quantify the cardiovascular response to volume loading by analysing the effect of changing tidal volume (indexed to body weight) (VTI ) on pulse pressure variability. In this pilot study, the feasibility of real-time SPeR calculation, using a mobile computer which was wirelessly connected to the patient monitor, was evaluated by examining the determinants of SPeR in 60 cardiac-surgical patients...
April 28, 2018: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/29700664/halving-the-volume-of-anaconda-initial-clinical-experience-with-a-new-small-volume-anaesthetic-reflector-in-critically-ill-patients-a-quality-improvement-project
#13
Hagen Bomberg, Franziska Meiser, Sarah Zimmer, Martin Bellgardt, Thomas Volk, Daniel I Sessler, Heinrich V Groesdonk, Andreas Meiser
AnaConDa-100 ml (ACD-100, Sedana Medical, Uppsala, Sweden) is well established for inhalation sedation in the intensive care unit. But because of its large dead space, the system can retain carbon dioxide (CO2 ) and increase ventilatory demands. We therefore evaluated whether AnaConDa-50 ml (ACD-50), a device with half the internal volume, reduces CO2 retention and ventilatory demands during sedation of invasively ventilated, critically ill patients. Ten patients participated in this cross-over protocol. After sedation with isoflurane via ACD-100 for 24 h, the 5-h observation period started...
April 26, 2018: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/29680878/quantitative-computed-tomography-in-comparison-with-transpulmonary-thermodilution-for-the-estimation-of-pulmonary-fluid-status-a-clinical-study-in-critically-ill-patients
#14
Bernd Saugel, Moritz Wildgruber, Albrecht Staudt, Michael Dieckmeyer, Konstantin Holzapfel, Georgios Kaissis, Mikhail Y Kirov, Vsevolod V Kuzkov, Roland M Schmid, Wolfgang Huber
Extravascular lung water (index) (EVLW(I)) can be estimated using transpulmonary thermodilution (TPTD). Computed tomography (CT) with quantitative analysis of lung tissue density has been proposed to quantify pulmonary edema. We compared variables of pulmonary fluid status assessed using quantitative CT and TPTD in critically ill patients. In 21 intensive care unit patients, we performed TPTD measurements directly before and after chest CT. Based on the density data of segmented CT images we calculated the tissue volume (TV), tissue volume index (TVI), and the mean weighted index of voxel aqueous density (VMWaq)...
April 21, 2018: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/29667097/an-elevated-respiratory-quotient-predicts-complications-after-cardiac-surgery-under-extracorporeal-circulation-an-observational-pilot-study
#15
J Piot, A Hébrard, M Durand, J F Payen, P Albaladejo
Following cardiac surgery, hyperlactatemia due to anaerobic metabolism is associated with an increase in both morbidity and mortality. We previously found that an elevated respiratory quotient (RQ) predicts anaerobic metabolism. In the present study we aimed to demonstrate that it is also associated with poor outcome following cardiac surgery. This single institution, prospective, observational study includes all those patients that were consecutively admitted to the intensive care unit (ICU) after cardiac surgery with cardiopulmonary bypass, that had also been monitored using pulmonary artery catheter...
April 17, 2018: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/29667096/evaluation-of-the-novel-non-invasive-zero-heat-flux-tcore%C3%A2-thermometer-in-cardiac-surgical-patients
#16
José A Sastre, María J Pascual, Teresa López
Tcore™ Sensor is a novel zero-heat-flux thermometer that estimates core temperature from skin over forehead. We tested the hypothesis that this system estimates core temperature to an accuracy within 0.5 °C. 40 cardiac surgical patients were enrolled (960 measurements). Reference core temperatures were measured in nasopharynx, pulmonary artery and the arterial branch of the oxygenator of the cardiopulmonary bypass (CPB) circuit. 95% Bland-Altman limits of agreement for repeated measurement data was used to study the agreement between Tcore™ thermometer and the reference methods...
April 17, 2018: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/29667095/can-postoperative-deltoid-weakness-after-cervical-laminoplasty-be-prevented-by-using-intraoperative-neurophysiological-monitoring
#17
Muneharu Ando, Tetsuya Tamaki, Takuji Matsumoto, Kazuhiro Maio, Masatoshi Teraguchi, Noboru Takiguchi, Hiroki Iwahashi, Makiko Onishi, Yukihiro Nakagawa, Hiroshi Iwasaki, Shunji Tsutsui, Masanari Takami, Hiroshi Yamada
Laminoplasty, frequently performed in patients with cervical myelopathy, is safe and provides relatively good results. However, motor palsy of the upper extremities, which occurs after decompression surgery for cervical myelopathy, often reduces muscle strength of the deltoid muscle, mainly in the C5 myotome. The aim of this study was to investigate prospectively whether postoperative deltoid weakness (DW) can be predicted by performing intraoperative neurophysiological monitoring (IONM) during cervical laminoplasty and to clarify whether it is possible to prevent palsy using IONM...
April 17, 2018: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/29663179/the-impact-of-obesity-on-pulmonary-deterioration-in-patients-undergoing-robotic-assisted-laparoscopic-prostatectomy
#18
Sebastian Blecha, Marion Harth, Florian Zeman, Timo Seyfried, Matthias Lubnow, Maximilian Burger, Stefan Denzinger, Michael T Pawlik
Obesity affects respiratory and hemodynamic function in anesthetized patients. The aim of this study was to evaluate the influence of the body mass index (BMI) on pulmonary changes in a permanent 45° steep Trendelenburg position (STP) during robotic-assisted laparoscopic prostatectomy (RALP). 51 patients undergoing RALP under standardized anesthesia were included. Perioperative pulmonary function and oxygenation were measured in awake patients (T0 ), 20 min after the induction of anesthesia (T1 ), after insufflation of the abdomen in supine position (T2 ), after 30 min in STP (T3 ), when controlling Santorini's plexus in STP (T4 ), before awakening while supine (T5 ), and after 45 min in the recovery room (T6 )...
April 16, 2018: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/29644558/finger-and-forehead-photoplethysmography-derived-pulse-pressure-variation-and-the-benefits-of-baseline-correction
#19
Shaoxiong Sun, Wouter H Peeters, Rick Bezemer, Xi Long, Igor Paulussen, Ronald M Aarts, Gerrit J Noordergraaf
To non-invasively predict fluid responsiveness, respiration-induced pulse amplitude variation (PAV) in the photoplethysmographic (PPG) signal has been proposed as an alternative to pulse pressure variation (PPV) in the arterial blood pressure (ABP) signal. However, it is still unclear how the performance of the PPG-derived PAV is site-dependent during surgery. The aim of this study is to compare finger- and forehead-PPG derived PAV in their ability to approach the value and trend of ABP-derived PPV. Furthermore, this study investigates four potential confounding factors, (1) baseline variation, (2) PPV, (3) ratio of respiration and heart rate, and (4) perfusion index, which might affect the agreement between PPV and PAV...
April 11, 2018: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/29633099/use-of-the-mirus%C3%A2-system-for-general-anaesthesia-during-surgery-a-comparison-of-isoflurane-sevoflurane-and-desflurane
#20
Martin Bellgardt, Dominik Drees, Vladimir Vinnikov, Livia Procopiuc, Andreas Meiser, Hagen Bomberg, Philipp Gude, Heike Vogelsang, Thomas Peter Weber, Jennifer Herzog-Niescery
The MIRUS™ system enables automated end-expired control of volatile anaesthetics. The device is positioned between the Y-piece of the breathing system and the patient's airway. The system has been tested in vitro and to provide sedation in the ICU with end-expired concentrations up to 0.5 MAC. We describe its performance in a clinical setting with concentrations up to 1.0 MAC. In 63 ASA II-III patients undergoing elective hip or knee replacement surgery, the MIRUS™ was set to keep the end-expired desflurane, sevoflurane, or isoflurane concentration at 1 MAC while ventilating the patient with the PB-840 ICU ventilator...
April 9, 2018: Journal of Clinical Monitoring and Computing
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