Journal of clinical monitoring and computing
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J Clin Monit Comput · Apr 2016
Comparative StudyAccuracy of CO2 monitoring via nasal cannulas and oral bite blocks during sedation for esophagogastroduodenoscopy.
Esophagogastroduodenoscopy procedures are typically performed under conscious sedation. Drug-induced respiratory depression is a major cause of serious adverse effects during sedation. Capnographic monitoring of respiratory activity improves patient safety during procedural sedation. ⋯ The two nasal cannulas without oral cups failed to provide sufficient CO2 for breath detection when the mouth was fully open and oxygen was delivered at 10 L/min. Our simulation found that respiratory rate can be accurately monitored during the procedure using a CO2 sampling bite block or a nasal cannula with oral cup. The accuracy of PETCO2 measurements depends on the device used, the amount of supplement oxygen, the amount of oral breathing and the patient's minute ventilation.
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Low flow anesthesia increases the use of CO2 absorbents, but independent data that compare canister life of the newest CO2 absorbents are scarce. Seven different pre-packed CO2 canisters were tested in vitro: Amsorb Plus, Spherasorb, LoFloSorb, Medisorb, Medisorb EF, LithoLyme, and SpiraLith. CO2 (160 mL min(-1)) flowed into the tip of a 2 L breathing bag that was ventilated with a tidal volume of 500 mL, a respiratory rate of 10/min, and an I:E ratio of 1:1 using the controlled mechanical ventilation mode of the Aisys (®) (GE, Madison, WI, USA). ⋯ The most important factors that determine canister life of prepacks in a circle breathing system are the chemical composition of the canister, the absolute amount of absorbent present in the canister, and the FICO2 replacement threshold. The use of the fractional canister usage allows cost comparisons among different prepacks. Results should not be extrapolated to prepacks that fit onto other anesthesia machines.
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J Clin Monit Comput · Apr 2016
Comparative StudyCardiac output method comparison studies: the relation of the precision of agreement and the precision of method.
Cardiac output (CO) plays a crucial role in the hemodynamic management of critically ill patients treated in the intensive care unit and in surgical patients undergoing major surgery. In the field of cardiovascular dynamics, innovative techniques for CO determination are increasingly available. Therefore, the number of studies comparing these techniques with a reference, such as pulmonary artery thermodilution, is rapidly growing. ⋯ But as the actual CO of a subject changes from assessment to assessment, there is no real repetition of a measurement. This situation equals a scenario in which single measurements are given for multiple true values per subject. In such a case it is not possible to assess the precision of method.
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Respiratory rate has been shown to be an important predictor of cardiac arrest, respiratory adverse events and intensive care unit admission and has been designated a vital sign. However it is often inadequately monitored in hospitals. We test the hypothesis that RespiraSense, a piezoelectric-based novel respiratory rate (RR) monitor which measures the differential motion of the chest and abdomen during respiratory effort, is not inferior to commonly used methods of respiratory rate measurement. ⋯ The 95 % confidence interval for the difference in average RR between RespiraSense and ECG was calculated to be [-3.9, 3.1]. The 95 % confidence interval for the difference in average RR between RespiraSense and nurses' evaluation was [-5.5, 4.3]. We demonstrate a clinically relevant agreement between RR monitored by the RespiraSense device with both ECG-derived and manually observed RR in 48 post-surgical patients in a PACU environment.
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J Clin Monit Comput · Apr 2016
The effects of oxygen induced pulmonary vasoconstriction on bedside measurement of pulmonary gas exchange.
In patients with respiratory failure measurements of pulmonary gas exchange are of importance. The bedside automatic lung parameter estimator (ALPE) of pulmonary gas exchange is based on changes in inspired oxygen (FiO2) assuming that these changes do not affect pulmonary circulation. This assumption is investigated in this study. ⋯ Changes were immediately reversed on returning FiO2 towards baseline. In this study changes in MPAP and PVR are small and immediately reversible consistent with small changes in pulmonary gas exchange. This indicates that mild deoxygenation induced pulmonary vasoconstriction does not have significant influences on the ALPE parameters in patients after CABG.