Journal of clinical monitoring and computing
-
J Clin Monit Comput · Dec 2018
ReviewQuantitative measures of EEG for prediction of outcome in cardiac arrest subjects treated with hypothermia: a literature review.
Cardiac arrest (CA) is the leading cause of death and disability in the United States. Early and accurate prediction of CA outcome can help clinicians and families to make a better-informed decision for the patient's healthcare. Studies have shown that electroencephalography (EEG) may assist in early prognosis of CA outcome. ⋯ Given these potential benefits, there have been an increasing interest over the last few years in the development and employment of EEG quantitative measures to predict CA outcome. This paper extensively reviews the definition and efficacy of various measures that have been employed for the prediction of outcome in CA subjects undergoing hypothermia (a neuroprotection method that has become a standard of care to improve the functional recovery of CA patients after resuscitation). The review details the State-of-the-Art and provides some perspectives on what seems to be promising for the early and accurate prognostication of CA outcome using the quantitative measures of EEG.
-
J Clin Monit Comput · Oct 2018
ReviewAssessment of liver perfusion and function by indocyanine green in the perioperative setting and in critically ill patients.
Indocyanine green (ICG) is a water-soluble dye that is bound to plasma proteins when administered intravenously and nearly completely eliminated from the blood by the liver. ICG elimination depends on hepatic blood flow, hepatocellular function and biliary excretion. ICG elimination is considered as a useful dynamic test describing liver function and perfusion in the perioperative setting, i.e., in liver surgery and transplantation, as well as in critically ill patients. ICG plasma disappearance rate (ICG-PDR) which can be measured today by transcutaneous systems at the bedside is a valuable method for dynamic assessment of liver function and perfusion, and is regarded as a valuable prognostic tool in predicting survival of critically ill patients, presenting with sepsis, ARDS or acute liver failure.
-
Inhaled anesthetics have been utilized mostly for general anesthesia in the operating room and oftentimes for sedation and for treatment of refractory status epilepticus and status asthmaticus in the intensive care unit. These contexts in the ICU setting are related to potential for prolonged administration wherein potential organ toxicity is a concern. ⋯ High dose inhaled agents are associated with postoperative cognitive dysfunction (POCD) and other situations. However, thus far no strong indication of problematic neuro or organ toxicity has been demonstrated after prolonged use of low dose volatile anesthesia.
-
J Clin Monit Comput · Aug 2018
Review Historical ArticleA technical review of the history, development and performance of the anaesthetic conserving device "AnaConDa" for delivering volatile anaesthetic in intensive and post-operative critical care.
There is a shift in critical care to adopt volatile anaesthetics as sedatives for certain patients using mechanical ventilation. Accompanying this shift is a growing body of literature describing the advantages or disadvantages of using isoflurane or sevoflurane for long term sedation. This practise requires a cost effective, efficient and safe means to deliver these drugs that can simultaneously operate with modern critical care ventilators and ventilation protocols while protecting the care environment and care workers from excessive exposure to the drugs. ⋯ This reflection reduces the total amount of anaesthetic needed, reducing that which is exhausted or scavenged upon exhalation. It can be used for 24 h of sedation, and fits into current critical care ventilator circuits almost without modifications. This article will describe the physical characteristics of the device, how it works, its development history and the performance parameters under which it can be used.
-
J Clin Monit Comput · Aug 2018
ReviewInhaled anesthetic agent sedation in the ICU and trace gas concentrations: a review.
There is a growing interest in the use of volatile anesthetics for inhalational sedation of adult critically ill patients in the ICU. Its safety and efficacy has been demonstrated in various studies and technical equipment such as the anaesthetic conserving device (AnaConDa™; Sedana Medical, Uppsala, Sweden) or the MIRUS™ system (Pall Medical, Dreieich, Germany) have significantly simplified the application of volatile anesthetics in the ICU. ⋯ In this review, benefits, risks, and technical aspects of inhalational sedation in the ICU are discussed. Further, the potential health effects of occupational long-term low-concentration agent exposure, the staffs' exposure levels in clinical practice, and strategies to minimize the individual gas exposure are reviewed.