Journal of clinical monitoring and computing
-
J Clin Monit Comput · Dec 2018
Letter Case ReportsMagnetic resonance imaging (MRI) induced 'hypoxia artifacts' on pulse oximetry: how reliable are MRI compatible monitoring devices?
Distinguishing a monitoring artifact requires expertise and adeptness. This can be practically challenging during the course of an anesthetic. We report a case, wherein we experienced episodes of aberrant pulse-oximeter values suggestive of desaturation with normal waveforms, occurring during a particular sequence of magnetic resonance imaging (MRI) performed under general anesthesia, which in fact was an artifact induced by the 3 T MRI during the diffusion tensor imaging sequence.
-
J Clin Monit Comput · Dec 2018
Editorial CommentBoosting systemic pressure with phenylephrine: arterial or venous modulation?
Abstract
-
J Clin Monit Comput · Dec 2018
Observational StudyNon-invasive bladder volume measurement for the prevention of postoperative urinary retention: validation of two ultrasound devices in a clinical setting.
Ultrasound scanning of bladder volume is used for prevention of postoperative urinary retention (POUR). Accurate assessment of bladder volume is needed to allow clinical decision-making regarding the need for postoperative catheterization. Two commonly used ultrasound devices, the BladderScan® BVI 9400 and the newly released Prime® (Verathon Medical®, Bothell, WA, USA), with or without the 'pre-scan' option, have not been validated in clinical practice. ⋯ The Prime® without pre-scan underestimated by - 4.1% (95% CI - 8.8 to + 0.5%) and the Prime® with pre-scan underestimated by - 6.3% (95% CI - 11.6 to - 1.1%). This study shows that while both ultrasound devices were able to approximate current bladder volume, both BVI 9400® and Prime®-with and without pre-scan-were not able to measure the actual bladder volume within our predefined limit of ± 5%. Using the pre-scan feature of the Prime® did not further improve accuracy.
-
J Clin Monit Comput · Dec 2018
Randomized Controlled TrialComparison of cardiac output optimization with an automated closed-loop goal-directed fluid therapy versus non standardized manual fluid administration during elective abdominal surgery: first prospective randomized controlled trial.
An intraoperative automated closed-loop system for goal-directed fluid therapy has been successfully tested in silico, in vivo and in a clinical case-control matching. This trial compared intraoperative cardiac output (CO) in patients managed with this closed-loop system versus usual practice in an academic medical center. The closed-loop system was connected to a CO monitoring system and delivered automated colloid fluid boluses. ⋯ There was no significant impact on the primary study endpoint, but this was found in a context of unexpected lower initial CI in the closed-loop group. Trial registry number ID-RCB/EudraCT: 2013-A00770-45. ClinicalTrials.gov Identifier NCT01950845, date of registration: 17 September 2013.
-
J Clin Monit Comput · Dec 2018
Comparative StudyVolumetric and reflective device dead space of anaesthetic reflectors under different conditions.
Inhalation sedation is increasingly performed in intensive care units. For this purpose, two anaesthetic reflectors, AnaConDa™ and Mirus™ are commercially available. However, their internal volume (100 ml) and possible carbon dioxide reflection raised concerns. ⋯ Et-CO2 showed similar effects. In addition to volumetric dead space, reflective dead space was determined as 198 ± 6/58 ± 6/35 ± 0/25 ± 0 ml under ATP/BTPS/ISO-0.4/ISO-1.2 conditions for AnaConDa, and 92 ± 6/25 ± 0/25 ± 0/25 ± 0 ml under the same conditions for MIRUS, respectively. Under BTPS conditions and with the use of moderate inhaled agent concentrations, reflective dead space is small and similar between the two devices.