Journal of clinical monitoring and computing
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J Clin Monit Comput · Dec 2019
Barriers to ultrasound guidance for central venous access: a survey among Dutch intensivists and anaesthesiologists.
Accumulating evidence shows that ultrasound (US) guidance improves effectiveness and safety of central venous catheter (CVC) placement. Several international guidelines therefore recommend the use of US for placement of CVCs. However, surveys show that the landmark-based technique is still widely used, while the percentage of physicians using US is increasing less than expected. ⋯ Personality traits most likely do not play a major role in the acceptance of US guidance for central venous catheterization. A potential intervention to increase US use could be formalizing local hospital policies mandating compliance with US guidance. Future research can perhaps focus on cognitive biases that currently limit more widespread use of US guidance.
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J Clin Monit Comput · Dec 2019
Predicting postoperative delirium and postoperative cognitive decline with combined intraoperative electroencephalogram monitoring and cerebral near-infrared spectroscopy in patients undergoing cardiac interventions.
Studies have associated electroencephalogram (EEG) suppression with postoperative delirium (POD) and postoperative cognitive decline (POCD). Otherwise, improving cerebral tissue oxygen saturation (rScO2) seems beneficial. No study has evaluated the impact of EEG suppression and decreased rScO2 on the incidence of POD and POCD when the intraoperative management of patients is performed with a depth-of-anesthesia (DOA) monitor and a cerebral oximetry. ⋯ Having experienced high magnitudes of EEG suppression (fourth quartile of AUCEEGSR>0s) was significantly associated with POD (OR = 2.247; 95% CI = 1.414-3.571; P = 0.001). Low rScO2 at the end of surgery was statistically associated with POCD (OR = 0.981; 95% CI = 0.965-0.997; P = 0.018). The results of our study show that the degree of intraoperative EEG suppression on one hand, and low rScO2 at the end of procedure on the other hand, are associated with respectively POD and POCD in patients undergoing cardiac interventions.
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J Clin Monit Comput · Dec 2019
Comparative StudyIn vitro efficiency of 16 different Ca(OH)2 based CO2 absorbent brands.
Data directly comparing CO2 absorbents tested in identical and clinically relevant conditions are scarce or non-existent. We therefore tested and compared the efficiency of 16 different brands of Ca(OH)2 based CO2 absorbents used as loose fill or a cartridge in a refillable canister under identical low flow conditions. CO2 absorbents efficiency was tested by flowing 160 mL/min CO2 into the tip of a 2 L balloon that was ventilated with an ADU anesthesia machine (GE, Madison, WI, USA) with a tidal volume of 500 mL and a respiratory rate of 10/min while running an O2/air FGF of 300 mL/min. ⋯ The efficiency of Ca(OH)2 based CO2 absorbent differs up to 100% on a volume basis. Macroscopic arrangement (cylindrical wrap with preformed channels versus granules), chemical composition (NaOH content), and granular shape all affect efficiency per volume of product. The data can be used to compare costs of the different products.
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J Clin Monit Comput · Dec 2019
Comparative StudyEconomic and operational impact of an improved pathway using rapid molecular diagnostic testing for patients with influenza-like illness in a German emergency department.
To evaluate the economic and operational effects of implementing a shorted diagnostic pathway during influenza epidemics. This retrospective study used emergency department (ED) data from the 2014/2015 influenza season. Alere i influenza A & B rapid molecular diagnostic test (RDT) was compared with the polymerase chain reaction (PCR) pathway. ⋯ In patients with a negative diagnosis, the RDT was also estimated to reduce the total diagnostic costs by 41.52 € per patient compared with PCR. The total cost difference was projected to be 31,892 € across a 14-week influenza season. The improved process and earlier diagnosis with the RDT pathway compared with conventional PCR resulted in considerable savings in ED, inpatient room occupancy time and cost across the influenza season.
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J Clin Monit Comput · Dec 2019
Near-real-time pulmonary shunt and dead space measurement with micropore membrane inlet mass spectrometry in pigs with induced pulmonary embolism or acute lung failure.
The multiple inert gas elimination technique (MIGET) using gas chromatography (GC) is an established but time-consuming method of determining ventilation/perfusion (VA/Q) distributions. MIGET-when performed using Micropore Membrane Inlet Mass Spectrometry (MMIMS)-has been proven to correlate well with GC-MIGET and reduces analysis time substantially. We aimed at comparing shunt fractions and dead space derived from MMIMS-MIGET with Riley shunt and Bohr dead space, respectively. ⋯ MM-S and MM-VD correlated and agreed well with Riley shunt and with Bohr dead space. MM-S increased significantly after lung injury only in the lavage group, whereas MM-VD increased significantly in both groups. This is the first work evaluating and demonstrating the feasibility of near real-time VA/Q distribution measurements with the MIGET and the MMIMS methods.