Journal of clinical monitoring and computing
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J Clin Monit Comput · Dec 2022
Randomized Controlled TrialEvaluation of indigenously developed closed-loop automated blood pressure control system (claps): a preliminary study.
Closed-loop systems have been designed to assist anesthetists in controlling anesthetic drugs and also maintaining the stability of various physiological variables in the normal range. In the present study, we describe and clinically evaluated a novel closed-loop automated blood pressure control system (CLAPS) in patients undergoing cardiac surgery under cardiopulmonary bypass. Forty ASA II-IV adult patients undergoing elective cardiac surgery were randomly allocated to receive adrenaline, noradrenaline, phenylephrine and nitroglycerine (NTG) adjusted either through CLAPS (CLAPS group) or manually (Manual group). ⋯ The cardiac index and left ventricular end-diastolic area were comparable between the groups. Automated infusion of vasoactive drugs using CLAPS is feasible and also better than manual control for controlling hemodynamics during cardiac surgery. Trial registration number and date This trial was registered in the Clinical Trial Registry of India under Registration Number CTRI/2018/01/011487 (Retrospective; registration date; January 23, 2018).
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J Clin Monit Comput · Dec 2022
Randomized Controlled TrialAn optimal tracheal tube preshaping strategy for endotracheal intubation using video laryngoscopy: a randomized controlled trial.
Although video laryngoscopy solves the problem of glottis exposure, it is difficult to deliver the tube to the glottic opening when the tracheal tube is unevenly shaped. This study aimed to compare the effects of different tube shapes on the first-pass success (FPS) rate in patients undergoing video laryngoscopy-assisted tracheal intubation. Three hundred patients above 18 years of age who underwent general anaesthesia and required endotracheal intubation were included in the study. ⋯ And the time to tracheal intubation in Group C was significantly less than that in Group A and Group B (22.21 ± 4.01 vs. 19.92 ± 4.11 vs. 17.71 ± 3.47; P < 0.001). The straight-to-cuff stylet preshape angulation of curvature of the blade could provide a higher FPS rate and shorter time to tracheal intubation during video laryngoscopy-assisted endotracheal intubation. Trial registration: Chinese Clinical Trial Registry, ChiCTR1900026019.
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J Clin Monit Comput · Dec 2022
Randomized Controlled TrialComparing ventilation modes by electrical impedance segmentography in ventilated children.
Electrical impedance segmentography offers a new radiation-free possibility of continuous bedside ventilation monitoring. The aim of this study was to evaluate the efficacy and reproducibility of this bedside tool by comparing synchronized intermittent mandatory ventilation (SIMV) with neurally adjusted ventilatory assist (NAVA) in critically-ill children. In this prospective randomized case-control crossover trial in a pediatric intensive care unit of a tertiary center, including eight mechanically-ventilated children, four sequences of two different ventilation modes were consecutively applied. ⋯ During NAVA children showed a shift of impedance towards caudal lung segments, compared to SIMV. Electrical impedance segmentography enables dynamic monitoring of transthoracic impedance. The immediate benefit of personalized ventilatory strategies can be seen when using this simple-to-apply bedside tool for measuring lung impedance.
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J Clin Monit Comput · Dec 2022
Randomized Controlled TrialEffect of intraoperative personalized goal-directed hemodynamic management on acute myocardial injury in high-risk patients having major abdominal surgery: a post-hoc secondary analysis of a randomized clinical trial.
Acute myocardial injury is common after noncardiac surgery and associated with mortality. Impaired intraoperative cardiovascular dynamics are a risk factor for acute myocardial injury. Optimizing intraoperative cardiovascular dynamics may thus reduce acute myocardial injury. ⋯ Acute myocardial injury occurred in 4 of 90 patients (4%) in the personalized goal-directed hemodynamic management group and in 12 of 90 patients (13%) in the routine hemodynamic management group (relative risk: 0.33, 95% confidence interval: 0.11 to 0.99, P = 0.036; absolute risk reduction: - 9%, 95% confidence interval: - 17% to - 0.68%, P = 0.034). In this post-hoc secondary analysis, intraoperative personalized goal-directed hemodynamic management reduced the incidence of acute myocardial injury compared to routine hemodynamic management in high-risk patients having major abdominal surgery. This needs to be confirmed in larger prospective trials.
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J Clin Monit Comput · Dec 2022
Randomized Controlled TrialThe effect of head position on glottic visualization with video laryngoscope and intubation success in obese patients who are not expected to have a difficult airway: a prospective randomized clinical study.
Intubation is required to maintain anesthesia in patients who are planned to undergo surgery under general anesthesia. One of the most important steps for successful intubation is to position head and neck appropriately. Sniffing position, head extension position, and neutral head position are the most known and used head and neck positions. ⋯ IDS score was found to be statistically significantly higher in the neutral head position compared to the other positions (p < 0.001, p < 0.001, respectively). In addition, the IDS score was statistically significantly higher in head extension position than in sniffing position (p = 0.016). This study is a randomized controlled trial of 150 patients investigating the impact of head position on glottic visualization and intubation success in obese patients when using Macintosh-like VL. The results show that sniffing position may be favored.