Journal of clinical monitoring and computing
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J Clin Monit Comput · Apr 2017
To characterize the incidence of airway misplacement of nasogastric tubes in anesthetized intubated patients by using a manometer technique.
This study characterized the incidence of airway misplacement of nasogastric (NG) tubes in surgical patients, and the benefit of using a manometer to discriminate gastric placement from airway placement of NG tubes. Subjects included adult patients scheduled for abdominal surgery. After tracheal intubation, a 16 Fr. ⋯ For confirmation of gastric placement, the auscultation technique had a sensitivity of 100.0 % and a specificity of 79.3 %. In contrast, the manometer technique had a sensitivity of 100.0 % and a specificity of 100.0 % in the discrimination of gastric placement from airway placement of NG tubes. Airway misplacement of NG tubes is not uncommon in surgical patients, and the manometer technique may be a reliable and safe method to discriminate gastric placement from airway placement of NG tubes.
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J Clin Monit Comput · Apr 2017
Hypoxic events and concomitant factors in preterm infants on non-invasive ventilation.
Automated control of inspired oxygen for newborn infants is an emerging technology, currently limited by reliance on a single input signal (oxygen saturation, SpO2). This is while other signals that may herald the onset of hypoxic events or identify spurious hypoxia are not usually utilised. We wished to assess the frequency of apnoea, loss of circuit pressure and/or motion artefact in proximity to hypoxic events in preterm infants on non-invasive ventilation. ⋯ Hypoxic events are frequently accompanied by respiratory pauses and/or motion artefact. Real-time monitoring and input of respiratory waveform may thus improve the function of automated oxygen controllers, allowing pre-emptive responses to respiratory pauses. Furthermore, use of motion-resistant oximeters and plethysmographic waveform assessment procedures will help to optimise feedback control of inspired oxygen delivery.
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J Clin Monit Comput · Apr 2017
ReviewJournal of Clinical Monitoring and Computing 2016 end of year summary: respiration.
This paper reviews 16 papers or commentaries published in Journal of Clinical Monitoring and Computing in 2016, within the field of respiration. Papers were published covering peri- and post-operative monitoring of respiratory rate, perioperative monitoring of CO2, modeling of oxygen gas exchange, and techniques for respiratory monitoring.
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J Clin Monit Comput · Apr 2017
A risk stratification algorithm using non-invasive respiratory volume monitoring to improve safety when using post-operative opioids in the PACU.
Late detection of respiratory depression in non-intubated patients compromises patient safety. SpO2 is a lagging indicator of respiratory depression and EtCO2 has proven to be unreliable in non-intubated patients. A decline in minute ventilation (MV) is the earliest sign of respiratory depression. ⋯ At discharge, 29/150 patients had Low MV and those receiving opioids were 50 % more likely to display Low MV (23 vs. 16 %). The RVM can identify patients at-risk for opioid-induced respiratory depression and/or experiencing POA. Monitoring of MV can guide opioid-dosing regimens and may increase patient safety across the continuum of care.
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J Clin Monit Comput · Apr 2017
Observational StudyUtility of stroke volume variation measured using non-invasive bioreactance as a predictor of fluid responsiveness in the prone position.
The aim of this prospective study was to evaluate the usefulness of stroke volume variation (SVV) derived from NICOM® to predict fluid responsiveness in the prone position. Forty adult patients undergoing spinal surgery in the prone position were included in this study. We measured SVV from NICOM® (SVVNICOM) and FloTrac™/Vigileo™ systems (SVVVigileo), and pulse pressure variation (PPV) using automatic (PPVauto) and manual (PPVmanual) calculations at four time points including supine and prone positions, and before and after fluid loading of 6 ml kg-1 colloid solution. ⋯ The optimal cut-off values were 12 % for SVVNICOM, SVVVigileo, and PPVauto, and 10 % for PPVmanual. SVV from NICOM® successfully predicts fluid responsiveness during surgery in the prone position. This totally non-invasive technique for assessing individual functional intravenous volume status would be useful in a wide range of surgeries performed in the prone position.