Journal of clinical monitoring and computing
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J Clin Monit Comput · Feb 2014
Randomized Controlled TrialUse of a decision support system improves the management of hemodynamic and respiratory events in orthopedic patients under propofol sedation and spinal analgesia: a randomized trial.
Decision support systems (DSSs) have been successfully implemented into clinical practice offering clinical suggestions and treatment options with excellent results in various clinical settings. Although their results appeared promising, showing that DSSs can increase anesthesiologists' vigilance and patient safety during surgery, DSSs have never been used before to help anesthesiologists in identifying critical events in patients under spinal analgesia with sedation. We have developed and clinically evaluated a DSS for this specific task. ⋯ The number of critical events/h occurring and the duration of surgery were similar in both groups. The number of hypoxemia episodes was significantly less (P = 0.036) in the DSS group (0.7 ± 1.0 vs. 1.4 ± 2.2 for the Control Group). The DSS tested in this trial could help the clinician to detect and treat critical events more efficiently and in a shorter length of time.
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J Clin Monit Comput · Feb 2014
Case ReportsUSCOM-window to the circulation: utility of supra-sternal Doppler in an elderly anaesthetized patient for a robotic cystectomy.
Supra-sternal Doppler (USCOM Ltd., Sydney, Australia) can be used during anaesthesia to measure cardiac output (CO) and related flow parameters. However, before the USCOM can be used routinely, its utility and limitations need to be fully understood and critical information about its use disseminated. In "Window to the Circulation" we use the example of an elderly man undergoing major urological robotic surgery to highlight the utility and limitations of intra-operative USCOM use. ⋯ However, achieving a good quality scan is important as it improves the reliability of USCOM data. The supra-sternal route is rich in flow signals and identifying the aortic valve signal is paramount. Recognizing the other characteristic waveforms in the signal helps greatly.
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Mechanical ventilation is a sophisticated technique with very narrow therapeutic ranges i.e. highly efficient and able to keep alive the most severe patients, but with considerable side effects and unwanted complications if not properly and timely used. Computerized protocols, closed loop systems, decision support, all terms which need to be defined, may help making mechanical ventilation safer and more efficient. The present paper will provide a short overview on technical and engineering considerations regarding closed loop controlled ventilation as well as tangible clinical evidences supporting the previous statement.
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J Clin Monit Comput · Feb 2014
Observational StudyCardiac output assessed by non-invasive monitoring is associated with ECG changes in children with critical asthma.
The primary aim of this study was to determine changes in CI and SI, if any, in children hospitalized with status asthmatics during the course of treatment as measured by non-invasive EC monitoring. The secondary aim was to determine if there is an association between Abnormal CI (defined as <5 or >95 % tile adjusted for age) and Abnormal ECG (defined as ST waves changes) Non-invasive cardiac output (CO) recordings were obtained daily from admission (Initial) to discharge (Final). Changes in CI and SI measurements were compared using paired t tests or 1-way ANOVA. ⋯ In children that required a prolonged course of treatment, there was also a significant decrease in SI. Abnormal CI at Initial CO recording was associated with ST waves changes on ECG during hospitalization. Future studies are required to determine whether non-invasive CO monitoring can predict which patients are at risk for developing abnormal ECG.
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J Clin Monit Comput · Feb 2014
Bench test assessment of mainstream capnography during high frequency oscillatory ventilation.
To assess the feasibility, stability and predictability of pCO2 measurement (PETCO2) using a main stream capnograph in a high frequency oscillatory ventilation circuit. A commercially available capnograph was mounted into a high frequency oscillatory ventilator patient circuit, adjustable CO2 flow was introduced into an artificial lung and the output of the CO2 sensor assessed under varying ventilator settings. Influence of oxygen content, pressures, heat and moisture were recorded. ⋯ From this bench test, we conclude it is feasible to measure PETCO2 using a main stream capnograph during high frequency oscillatory conditions, these measurements were stable during the experiment. Changes in CO2 production or output can be detected. The system may prove to be of clinical value, but further in vivo measurements are warranted.