Journal of clinical monitoring and computing
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J Clin Monit Comput · Oct 2017
Randomized Controlled TrialCentral venous catheter tip migration due to tracheal extubation: a prospective randomized study.
Considerable numbers of patients undergo central venous catheterization (CVC) under mechanical ventilation. We hypothesized that the return of spontaneous breathing and tracheal extubation could be associated with distal CVC tip migration towards intracardiac positions due to decreasing intrathoracic pressures and subsequent readjustment of mediastinal organs. Patients scheduled for cardiac surgery were randomized for right or left internal jugular vein (IJV) CVC placement under general anesthesia and mechanical ventilation. ⋯ A CXR using CVC tip to carina distances revealed no significant tip migrations in the time between postoperative assessment and following tracheal extubation (5.1 ± 1.7 vs. 5.3 ± 1.5 cm; P = 0.196). In patients with CVCs positioned at the cavoatrial junction, tracheal extubation was not associated with significant postoperative CVC tip malposition, but tended to undergo proximal migration. This trend should be considered particularly in left-sided thoracocervical puncture approaches to avoid unfavorable CVC tip positions.
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J Clin Monit Comput · Oct 2017
Randomized Controlled TrialMicrocirculation measured by vascular occlusion test during desflurane-remifentanil anesthesia is superior to that in propofol-remifentanil anesthesia in patients undergoing thoracic surgery: subgroup analysis of a prospective randomized study.
General anesthesia can affect microcirculatory properties. However, differential effects on the microcirculation according to the anesthetic technique used during thoracoscopic surgery have not been well documented. We conducted a randomized clinical trial in which the effects of desflurane and propofol, both with remifentanil, on systemic arterial oxygenation during one-lung ventilation were compared in patients undergoing thoracoscopic surgery. ⋯ Tissue oxygen saturation was higher in the desflurane than the propofol group (mean ± standard deviation, 83 ± 6 vs. 80 ± 9, 84 ± 6 vs. 76 ± 10, and 87 ± 7 vs. 77 ± 10 % at 30 and 60 min of one-lung ventilation and at two-lung ventilation; adjusted p = 0.026, <0.001, and <0.001, respectively). The recovery slope during the vascular occlusion test, reflecting microvascular reperfusion adequacy, was higher in the desflurane than the propofol group during surgery (mean difference, 0.5 %/s; 95 % CI 0.0-0.9 %/s; p = 0.037). Desflurane-remifentanil anesthesia is associated with better microcirculation than propofol-remifentanil anesthesia in patients undergoing thoracoscopic surgery.
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J Clin Monit Comput · Oct 2017
Evaluation of a non-invasive multisensor accelerometer for calculating energy expenditure in ventilated intensive care patients compared to indirect calorimetry and predictive equations.
Continuous measurement of resting energy expenditure (REE) in critically ill patients remains challenging but is required to prevent malnutrition. SenseWear Pro 3 Armband (SWA) is a research grade accelerometer for assessment of REE with the advantage of easy handling. In a prospective study we compared SWA with indirect calorimetry (IC) and predictive equations in critically ill, ventilated patients. ⋯ Differences were also noted when SWA was compared to predictive formulas. At present, SWA cannot be regarded as an alternative to indirect calorimetry. Individual measurements are often inaccurate and should be used with caution until improved algorithms, based on the results of this study, have been implemented.
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J Clin Monit Comput · Oct 2017
Patterns of intra-arterial blood pressure monitoring for patients undergoing total shoulder arthroplasty under general anesthesia: a retrospective analysis of 23,073 patients.
Total shoulder arthroplasty (TSA) is typically performed in the beach-chair position. Maintenance of adequate mean arterial pressure is required to provide appropriate cerebral perfusion pressure and prevent cerebral ischemia. Placement of an arterial line to facilitate invasive monitoring is discretionary, based on clinical judgment. ⋯ Compared to university hospitals, arterial line placement was more likely in attached or freestanding surgical centers (OR 2.01, CI 1.37-2.96) and less likely in medium sized community hospitals (OR 0.62, CI 0.42-0.93), small community hospitals (OR 0.11, CI 0.03-0.34) and facilities performing less than 100 TSAs per year (OR 0.19, CI 0.12-0.31). Utilization of arterial line monitoring for TSA has associations with both institutional and patient factors. This study demonstrates the national patterns for the use of arterial lines for TSA and may serve as a resource to aid in clinical judgment.
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J Clin Monit Comput · Oct 2017
Detection of spine structures with Bioimpedance Probe (BIP) Needle in clinical lumbar punctures.
Lumbar puncture is a relatively safe procedure, but some serious, even fatal, complications can occur. Needle guidance can increase puncture accuracy, decrease the number of attempts, and make the procedure easier. We tested the feasibility of a bioimpedance-based tissue-sensing technology for needle guidance in clinical use. ⋯ It can make the puncture procedure smoother, as repeated CSF flow tests are avoided. The correct needle tip location is immediately detected, thus unnecessary needle movements close to spinal nerves are prevented. Physicians could benefit from the information provided by the BIP Needle, especially in patients with obesity or anatomic alterations.