Journal of clinical monitoring and computing
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Current hypoxic guards systems fail to maintain the inspired O2 concentration (FIO2) ≥ 21 % across the entire fresh gas flow (FGF) range when a second carrier gas is used (N2O or air). We examined the performance of the Maquet O2 Guard(®), a smart hypoxic guard that increases O2 delivery if an inspired hypoxic mixture is formed. After obtaining IRB approval and informed consent, 12 ASA I-II patients were enrolled. ⋯ FDO2 was increased to 60 % and FGF to 1 L min(-1) (the latter only if it was lower than 1 L min(-1) prior to activation of the O2 Guard). FIO2 increased to 25 % within 55 s after O2 Guard activation in all patients. The O2 Guard(®), an active inspired hypoxic guard, rapidly reverses and limits the duration of inspired hypoxic episodes when the delivered hypoxic guard fails to do so.
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J Clin Monit Comput · Feb 2016
ReviewJournal of Clinical Monitoring and Computing 2015 end of year summary: anesthesia.
Clinical monitoring is an essential part of the profession of anesthesiology. It would therefore be impossible to review all articles published in the Journal of Clinical Monitoring and Computing that are relevant to anesthesia. Because other reviews will address monitoring of the respiratory and cardiovascular system, the current review will limit itself to topics uniquely related to anesthesia. The topics are organized according to the chronological order in which an anesthetic proceeds: secure the airway; ventilate and deliver anesthetic gases; monitor vital organ function and anesthetic depth; and ensure analgesia during/after emergence from anesthesia (locoregional anesthesia and pain control).
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J Clin Monit Comput · Feb 2016
In-line positioning of ultrasound images using wireless remote display system with tablet computer facilitates ultrasound-guided radial artery catheterization.
Ultrasound-guided procedures may be easier to perform when the operator's eye axis, needle puncture site, and ultrasound image display form a straight line in the puncture direction. However, such methods have not been well tested in clinical settings because that arrangement is often impossible due to limited space in the operating room. We developed a wireless remote display system for ultrasound devices using a tablet computer (iPad Mini), which allows easy display of images at nearly any location chosen by the operator. ⋯ Success rate was significantly higher (100 vs. 70 %, P = 0.02) and catheterization time significantly shorter (28.5 ± 7.5 vs. 68.2 ± 14.3 s, P < 0.001) with the tablet method as compared to the conventional method. An ergonomic straight arrangement of the image display is crucial for successful and quick completion of ultrasound-guided arterial catheterization. The present remote display system is a practical method for providing such an arrangement.
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J Clin Monit Comput · Feb 2016
Randomized Controlled TrialImpact of early haemodynamic goal-directed therapy in patients undergoing emergency surgery: an open prospective, randomised trial.
Haemodynamic goal-directed therapies (GDT) may improve outcome following elective major surgery. So far, few data exist regarding haemodynamic optimization during emergency surgery. In this randomized, controlled trial, 50 surgical patients with hypovolemic or septic conditions were enrolled and we compared two algorithms of GDTs based either on conventional parameters and pressure pulse variation (control group) or on cardiac index, global end-diastolic volume index and stroke volume variation as derived from the PiCCO monitoring system (optimized group). ⋯ Likewise, SOFA scores were higher in the optimized group on POD1 (10.2 ± 2.5 versus 6.6 ± 2.2 in the control group, P = 0.001), POD2 (8.4 ± 2.6 vs 5.0 ± 2.4 in the control group, P = 0.002) and POD 3 (5.2 ± 3.6 and 2.2 ± 1.3 in the control group, P = 0.01). There was no significant difference in hospital mortality (13 % in the control group and 25 % in the optimized group). Haemodynamic optimization based on volumetric and flow PiCCO-derived parameters was associated with a less favorable postoperative outcome compared with a conventional GDT protocol during emergency surgery.