Anesthesia and analgesia
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Anesthesia and analgesia · May 2017
Higher Fresh Gas Flow Rates Decrease Tidal Volume During Pressure Control Ventilation.
We observed that increasing fresh gas flow (FGF) decreased exhaled tidal volume (VT) during pressure control ventilation (PCV). A literature search produced no such description whereby unintended VT changes occur with FGF changes during PCV. ⋯ FGF has a significant effect on VT during PCV in the Aestiva bellows ventilator, suggesting caution when changing FGF during PCV in infants. Our hypothesis is that at higher FGF rates, an inadvertent PEEP is developed by the flow resistance of the ventilator relief valve that is not recognized by the ventilator. In turn, less change in pressure is needed to reach the set inspiratory pressure, resulting in lower VT delivery at higher FGF rates. This underappreciated FGF-VT interaction during PCV with a bellows ventilator may be clinically significant in pediatric patients; prospective data collection in patients is needed for further evaluation.
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Anesthesia and analgesia · May 2017
Development of a Pediatric Risk Assessment Score to Predict Perioperative Mortality in Children Undergoing Noncardiac Surgery.
Although there have been numerous attempts to predict perioperative mortality in adults, an objective model to predict mortality in children has not been developed. In this study, we aimed to develop a Pediatric Risk Assessment (PRAm) score to predict perioperative mortality in children undergoing noncardiac surgery. ⋯ In this study, we developed a simplified PRAm tool (PRAm score) as a predictor of perioperative mortality in children undergoing noncardiac surgery. The PRAm score has excellent accuracy. In patients assigned American Society of Anesthesiologists physical status classification ≥4, there is wide variability in objectively obtained PRAm scores.
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Anesthesia and analgesia · May 2017
Comparative StudyCreation and Validation of an Automated Algorithm to Determine Postoperative Ventilator Requirements After Cardiac Surgery.
In medical practice today, clinical data registries have become a powerful tool for measuring and driving quality improvement, especially among multicenter projects. Registries face the known problem of trying to create dependable and clear metrics from electronic medical records data, which are typically scattered and often based on unreliable data sources. The Society for Thoracic Surgery (STS) is one such example, and it supports manually collected data by trained clinical staff in an effort to obtain the highest-fidelity data possible. As a possible alternative, our team designed an algorithm to test the feasibility of producing computer-derived data for the case of postoperative mechanical ventilation hours. In this article, we study and compare the accuracy of algorithm-derived mechanical ventilation data with manual data extraction. ⋯ There is a significant appeal to having a computer algorithm capable of calculating metrics such as total ventilator times, especially because it is labor intensive and prone to human error. By incorporating 3 different sources into our algorithm and by using preprogrammed clinical judgment to overcome common errors with data entry, our results proved to be more comprehensive and more accurate, and they required a fraction of the computation time compared with manual review.
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Anesthesia and analgesia · May 2017
ReviewDrug Infusion Systems: Technologies, Performance, and Pitfalls.
This review aims to broadly describe drug infusion technologies and raise subtle but important issues arising from infusion therapy that can potentially lead to patient instability and morbidity. Advantages and disadvantages of gravity-dependent drug infusion are described and compared with electromechanical approaches for precise control of medication infusion, including large-volume peristaltic and syringe pumps. This review discusses how drugs and inert carriers interact within infusion systems and outlines several complexities and potential sources of drug error. ⋯ All of these potential sources for adverse events relating to the infusion system dead volume illustrate the need for continuing education of clinical personnel in the complexities of drug delivery by infusion. This review concludes with an outline of future technologies for managing drug delivery by continuous infusion. Automated systems based on physiologic signals and smart systems based on physical principles and an understanding of dead volume may mitigate against adverse patient events and clinical errors in the complex process of drug delivery by infusion.
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Anesthesia and analgesia · May 2017
Randomized Controlled Trial Comparative StudyGenerative Retrieval Improves Learning and Retention of Cardiac Anatomy Using Transesophageal Echocardiography.
Transesophageal echocardiography (TEE) is a valuable monitor for patients undergoing cardiac and noncardiac surgery as it allows for evaluation of cardiovascular compromise in the perioperative period. It is challenging for anesthesiology residents and medical students to learn to use and interpret TEE in the clinical environment. A critical component of learning to use and interpret TEE is a strong grasp of normal cardiovascular ultrasound anatomy. ⋯ Medical students and anesthesiology residents inexperienced in the use of TEE showed both improved learning and retention of basic cardiovascular ultrasound anatomy with the incorporation of GR into the educational experience.