Journal of clinical monitoring and computing
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J Clin Monit Comput · Oct 2021
Pulse rate as an alternative, real-time feedback indicator for chest compression rate: a porcine model of cardiac arrest.
Feedback indicators can improve chest compression quality during cardiopulmonary resuscitation (CPR). However, the application of feedback indicators in the clinic practice is rare. Pulse oximetry has been widely used and reported to correlate spontaneous circulation restoration during CPR. ⋯ Interclass correlation coefficients and Bland-Altman analysis revealed reliable agreement between pulse rates and synchronous chest compression rates. Similarly, compression interruption and synchronous pulse interruption times obtained also showed high agreement. Pulse rate can be used as an alternative indicator of chest compression rate during CPR in a porcine model of cardiac arrest. Pulse interruption time also can be used to reflect compression interruption time precisely in this model.
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J Clin Monit Comput · Oct 2021
Motor evoked potential monitoring can evaluate ischemic tolerance to carotid artery occlusion during surgery.
Balloon test occlusion (BTO) is a useful examination for evaluating ischemic tolerance to internal carotid artery (ICA) occlusion. The aim of this study was to investigate the relationships between intraoperative motor evoked potential (MEP) monitoring and the results of preoperative BTO. Between 2013 and 2017, 32 patients undergoing surgery under general anesthesia with intraoperative MEP monitoring, in whom preoperative BTO was performed, were identified. ⋯ Thus, the sensitivity and specificity for BTO-positive were significantly higher for MEP than for EEG (100% and 72.0%, p = 0.02) in 28 patients, but they were not significantly different compared with SEP (33.3% and 100%, p = 0.48) in 21 patients. MEP monitoring might be one of the alternatives for evaluating ischemic tolerance to ICA occlusion during surgery. The cutoff value of MEP amplitude was a > 80% reduction.
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J Clin Monit Comput · Oct 2021
A simple method of mechanical power calculation: using mean airway pressure to replace plateau pressure.
The reference method for mechanical power (MP) calculation proposed by Gattinoni et al. is based on plateau pressure (Pplat) which needs an inspiratory hold. This study aims to introduce and validate a simple surrogate for MP calculation without any intervention in ventilated patients with or without acute respiratory distress syndrome (ARDS). The introduced equation is as:[Formula: see text]where Pmean is mean airway pressure, VE is minute ventilation, PEEP is positive end-expiratory pressure, and Te/Ti is expiratory-to-inspiratory ratio. 50 patients with ARDS and 50 post-operative patients without ARDS were enrolled. ⋯ At both Tplat levels, the Pmean-derived MP correlated well with the reference MP both in patients with or without ARDS (non-ARDS: slopes = 1.05, 0.94, R2 = 0.95, 0.93, bias + 0.76, + 0.51; ARDS: slopes = 1.03, 0.95, R2 = 0.96, 0.96, bias + 0.97, + 0.78. P < 0.0001 for all). In patients with or without ARDS, Pmean-derived MP allows rapid and dynamic estimation of mechanical power without any intervention at the bedside.
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J Clin Monit Comput · Oct 2021
LetterEndotracheal tube inflation tubing defect: an unusual cause of intraoperative volume leak.
Loss of endotracheal cuff pressure can lead to airway compromise and loss of volume delivery in mechanical ventilation requiring immediate intervention. A 40 years old male posted for bilateral interpositional arthroplasty was intubated nasally with 7.5 mm flexometallic endotracheal tube. In the intraoperative period airway leak was detected due to loss of cuff pressure even after repeated attempt of cuff inflation. After changing endotracheal tube, leak was detected from the inflation tubing distal to the cuff, which was apparent only when cuff pressure was increased above 30 cm of H2O.
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J Clin Monit Comput · Oct 2021
The effect of compliance with a perioperative goal-directed therapy protocol on outcomes after high-risk surgery: a before-after study.
Perioperative goal-directed therapy is considered to improve patient outcomes after high-risk surgery. The association of compliance with perioperative goal-directed therapy protocols and postoperative outcomes is unclear. The purpose of this study is to determine the effect of protocol compliance on postoperative outcomes following high-risk surgery, after implementation of a perioperative goal-directed therapy protocol. ⋯ The number of complications was higher in the before-group compared to the after-group (n = 414 vs. 282; p = 0.031). In the after-group, patients with high protocol compliance for stroke volume variation or stroke volume index had less complications compared to patients with low protocol compliance for stroke volume variation or stroke volume index (n = 187 vs. 90; p = 0.01). Protocol compliance by the attending clinicians is essential and should be monitored to facilitate an improvement in postoperative outcomes desired by the implementation of perioperative goal-directed therapy protocols.