Journal of clinical monitoring and computing
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J Clin Monit Comput · Jun 2015
Randomized Controlled TrialEarly goal-directed therapy based on endotracheal bioimpedance cardiography: a prospective, randomized controlled study in coronary surgery.
The objective was to compare the impact of an early goal-directed hemodynamic therapy based on cardiac output monitoring (Endotracheal Cardiac Output Monitor, ECOM) with a standard of care on postoperative outcome following coronary surgery. This prospective, controlled, parallel-arm trial randomized 100 elective primary coronary artery bypass grafting patients to a study group (ECOM; n = 50) or a control group (control; n = 50). In the ECOM group, hemodynamic therapy was guided by respiratory stroke volume variation and cardiac index given by the ECOM system. ⋯ The time to reach extubation was reduced in the ECOM group: 510 min [360-1,110] versus 570 min [320-1,520], P = 0.005. No significant differences were found between both groups for possible hospital discharge [Hazard Ratio = 0.96 (95 % CI 0.64-1.45)] and hospital discharge [Hazard Ratio = 1.20 (95 % CI 0.79-1.81)]. A mini-invasive early goal-directed hemodynamic therapy based on ECOM can reduce the time to reach extubation but fails to significantly reduce the length of stay in hospital and the rate of major cardiac morbidity.
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J Clin Monit Comput · Jun 2015
Case ReportsFall in inspired oxygen and anaesthetic agent concentrations during change of soda lime absorber.
Following an episode of reduction in inspired oxygen concentration (FiO(2)) and inhalational agent concentration (Fi agent) during the changing of a soda lime absorber, We conducted an in vitro experiment to understand the impact of disconnection of the absorber on inspired gas dilution at different fresh gas flows. We found that both in Dräger Fabius GS and Primus anaesthesia work stations, disconnection of the absorber caused progressive reduction in FiO(2) and Fi agent as the FGF was decreased. The operating principle of fresh gas decoupling (FGD) valve is a potential source of this complication, which must be kept in mind while changing the soda lime during the course of surgery where an anaesthetic work stations utilizing FGD valves are used.
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J Clin Monit Comput · Jun 2015
Observational StudyCan short-term heart rate variability be used to monitor fentanyl-midazolam induced changes in ANS preceding respiratory depression?
Opioids have an occasional but high-risk side effect of respiratory depression. The detection of critical respiratory depression usually occurs after the event. Earlier detection would be beneficial in preventing increased morbidity and mortality of 0.01 % patients receiving analgesic opioids. ⋯ No significant change before critical respiratory events was observed in traditional, spectral power, respiratory or other indices. One index, PolVar20, indicated a burst of sympathetic activity preceding respiratory depression similar to sleep apnoea arousals that restore airway patency. Before its usefulness in early detection of airway tone can be determined, PolVar20 requires further work: a statistical method for highly skewed distributions, auto adjustment for baseline variability, and detecting a range of sympathetic responses to apnea.
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J Clin Monit Comput · Jun 2015
Observational StudyAccuracy of the transpulmonary ultrasound dilution method for detection of small anatomic shunts.
The purpose of this study was to investigate the qualitative and quantitative accuracy of transpulmonary ultrasound dilution (UD) (COstatus™, Transonic Systems) for the detection of small anatomic shunts. It was a prospective, observational study in a multi-disciplinary pediatric intensive care unit. Seventy-three critically ill children (67 post cardiac surgery), with a median (IQR) age of 10 (3-50.3) months and a median (IQR) weight of 8 (3.43-13) kg were enrolled. ⋯ Shunt was detected by UD alone in eight children; six of these had clinical conditions known to compromise dilution curve analysis (valve regurgitation, asymmetric pulmonary blood flow). Shunt was detected by echocardiography alone in two children; in both cases the shunt was tiny. UD is an accurate method for the detection of small anatomical shunts, both qualitatively and quantitatively.