Journal of clinical monitoring and computing
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J Clin Monit Comput · Dec 2023
Case ReportsRecording of a left ventricle assist device electrical current with a neurally adjusted ventilation assist (NAVA) catheter: a small case series.
Neurally Adjusted Ventilatory Assist (NAVA) is an adaptive ventilation mode that recognizes electromyographic diaphragmatic activation as a sensory input to control the ventilator. NAVA may be of interest in prolonged mechanical ventilation and weaning, as it provides effort-adapted support, improves patient-ventilator synchronization, and allows additional monitoring of neuromuscular function and drive. Ventricular assist devices (VAD), especially for the left ventricle (LVAD), are increasingly entering clinical practice, and intensivists are faced with distinct challenges such as the interaction between the system and other measures of organ support. ⋯ An implanted LVAD can render the NAVA signal unusable for ventilatory support because the LVAD signal can interfere with the recording of electromyographic activation of the diaphragm. Therefore, patients with implanted LVAD may need other modes of ventilation than NAVA for advanced weaning strategies.
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J Clin Monit Comput · Dec 2023
True intratracheal oxygen concentration delivered by SentriO Oxy™ masks under various respiratory conditions: a bench study.
SentriO Oxy™ is a newly available, Food and Drug Administration-approved oxygenation mask system that provides high oxygenation, even on low-flow (5-10 L/min) oxygen. This study aimed to accurately measure the intratracheal fraction of inspired oxygen (FiO2) using SentriO Oxy™ masks under relatively low oxygen flow rates. A manikin-ventilator-test lung simulation system was used. ⋯ In addition, using linear regression analysis, we found that TV, RR, and oxygen flow were all significant factors influencing the measured FiO2. Our experiment proposed two prediction equations considering the oxygen flow rate, TV, and RR. The results of our study may provide information and prediction of FiO2 for clinicians to use SentriO Oxy™ masks during sedative anesthetic procedures under low oxygen flow rates.
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J Clin Monit Comput · Dec 2023
Editorial CommentPerioperative monitoring of the oxygen reserve: where do we stand?
The Oxygen Reserve Index (ORi) is an advanced plethysmography-derived variable that may help to quantify the degree of hyperoxia in patients receiving supplemental oxygen administration. ORi is a (relative) indicator of the actual partial pressure of oxygen dissolved in arterial blood (PaO2). ⋯ Within the moderate hyperoxic range (100-200 mmHg PaO2), there is a sound correlation between ORi and PaO2. This editorial discusses the clinical implications of this validation study and elaborates on the possible role of ORi monitoring in addition to SpO2 (peripheral arterial oxygen saturation) monitoring alone.
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J Clin Monit Comput · Dec 2023
Observational StudyEffectiveness of substantial shortening of the endotracheal tube for decreasing airway resistance and increasing tidal volume during pressure-controlled ventilation in pediatric patients: a prospective observational study.
The endotracheal tubes (ETTs) used for children have a smaller inner diameter. Accordingly, the resistance across ETT (RETT) is higher. Theoretically, shortening the ETTs can decrease total airway resistance (Rtotal), because Rtotal is sum of RETT and patient's airway resistance. ⋯ The laboratory experiment showed that ETT length and the pressure gradient across ETT are linearly related under a certain flow rate, and approximately 40% of the pressure gradient across the ETT at its original length was generated by the slip joint. Median RETT/Rtotal ratio were calculated as 0.69. The effectiveness of ETT shortening on Rtotal and TV was very limited, because the resistance of the slip joint was very large.
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J Clin Monit Comput · Dec 2023
Cardiac surgery-associated acute kidney injury and perioperative plasma viscosity: is there a relationship?
Plasma viscosity (PV) is a key factor in microcirculatory flow resistance and capillary perfusion during hemodilution, we hypothesized a possible relationship between cardiac surgery-associated acute kidney injury (CSA-AKI) and PV. We conducted a prospective, observational, single-center study on 50 adult cardiac surgery patients with cardiopulmonary bypass (age 64 years, male sex 80%, baseline serum creatinine 1.04 mg/dL). We assessed perioperative characteristics, management, short-term outcomes, blood analysis, PV, serum creatinine, and diuresis. ⋯ However, CSA-AKI was related to increased BMI, lower hemoglobin and hematocrit levels, and pre-existing CKD. The present study found no significant association between PV and CSA-AKI. Nevertheless, more research is needed to validate this finding and to investigate the role of PV in other clinical settings.