Articles: monitoring.
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Anesthesia and analgesia · Aug 1989
Randomized Controlled Trial Clinical TrialIntraoperative temperature monitoring sites in infants and children and the effect of inspired gas warming on esophageal temperature.
This study tested the hypotheses that 1) temperatures of "central" sites are similar in infants and children undergoing noncardiac surgery and 2) airway heating and humidification increases distal esophageal temperature. Twenty children were randomly assigned to receive 1) active airway humidification using an airway heater and humidifier set at 37 degrees C (N = 8), 2) passive airway humidification using a heat and moisture exchanger (N = 6), or 3) no airway humidification and/or heating (control, N = 6). There were no statistically significant differences between tympanic membrane, esophageal, rectal, and axillary temperatures. ⋯ Although esophageal and tympanic membrane temperatures in the entire group were similar, esophageal temperatures in patients receiving active and passive airway humidification were about 0.35 degrees C above tympanic temperatures after induction of anesthesia. In contrast, esophageal temperatures in patients without airway humidification were 0.25 degrees C below tympanic temperatures after induction of anesthesia. Esophageal-tympanic membrane temperature differences in the patients given active and passive humidification differed significantly from the corresponding sum in the control group at all times, but not from each other.
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of interposed abdominal compression CPR and standard CPR by monitoring end-tidal PCO2.
Interposed abdominal compression CPR (IAC-CPR) has been demonstrated to significantly improve blood flow compared with standard (S)-CPR in animal and electrical models. Studies with IAC-CPR in human beings have not reported data regarding cardiac output. Animal and clinical studies have correlated end-tidal PCO2 (ETPCO2) with cardiac output produced with precordial compressions. ⋯ In patients arriving in cardiac arrest, return of spontaneous circulation was observed in six patients (30%) during IAC-CPR and in one patient (6%) during S-CPR (P = .07). Our study strongly suggests that cardiac output may be significantly increased in human beings with IAC-CPR as evidenced by the significantly greater increases in ETPCO2 with IAC-CPR compared with S-CPR. In addition, IAC-CPR appeared to demonstrate a trend toward increasing the return of spontaneous circulation.
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Critical care medicine · Feb 1989
Randomized Controlled Trial Clinical TrialAnalysis of the effects of continuous on-line monitoring of mixed venous oxygen saturation on patient outcome and cost-effectiveness.
Continuous measurement of mixed venous oxygen saturation (Sv-O2) has recently been introduced as a monitoring and management technique in critical care patients. To determine the impact of Sv-O2 monitoring on patient management and cost-effectiveness, we conducted a prospective, randomized clinical trial of 99 consecutive patients receiving pulmonary artery (PA) catheters in the ICU. One group (n = 49) received an Edwards quadruple-lumen flow-directed PA catheter. ⋯ Statistical analysis by step-deletion multiple regression analysis and the unpaired Student's t-test demonstrated that use of the Opticath was not associated with a decrease in potentially adverse hemodynamic events, length of ICU stay, or mortality. In terms of cost-effectiveness, mixed venous oximetry is economically favorable in a charge-based reimbursement system, but economically unfavorable in a fixed-cost-based reimbursement system. Although continuous Sv-O2 monitoring has been shown to be accurate and reliable, it does not appear to be beneficial in all patients requiring PA catheterization.
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison between a conventional and a fiberoptic flow-directed thermal dilution pulmonary artery catheter in critically ill patients.
Invasive hemodynamic monitoring is frequently required in the management of patients in intensive care units. A fiberoptic flow-directed thermal dilution pulmonary artery catheter capable of continuously monitoring the mixed venous saturation, while more expensive than a conventional pulmonary artery catheter, theoretically could result in better patient care, and might be cost-effective if it resulted either in fewer blood tests being ordered or in less time in the intensive care unit. To test this hypothesis, we designed a randomized trial in our Medical Intensive Care Unit to compare a standard pulmonary artery catheter with a fiberoptic catheter. ⋯ There were no statistical differences between the groups in age, time in the intensive care unit, number of tests ordered, hours of mechanical ventilator therapy, hours of vasoactive drug therapy, or mortality rate. The only statistically significant differences between the groups were that (1) the fiberoptic catheter required a longer insertion time and (2) there were more technical problems in consistently obtaining the wedge pressure in the patients with the fiberoptic catheters. We conclude that routine substitution of a fiberoptic catheter for the standard pulmonary artery catheter is not indicated.
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Randomized Controlled Trial Clinical Trial
Use of the post-tetanic count to monitor recovery from intense neuromuscular blockade in children.
The post-tetanic count was investigated as a method of monitoring intense neuromuscular blockade in children. One of five myoneural blockers (atracurium, vecuronium, pancuronium, tubocurarine or alcuronium) was given to groups of six children during nitrous oxide-oxygen-halothane anaesthesia. ⋯ The interval between the appearance of the first post-tetanic response and the first train-of-four response was typically 5-10 min for the intermediate-acting agents vecuronium and atracurium, and 20-30 min for the long-acting agents pancuronium, alcuronium and tubocurarine. A post-tetanic count of 6 with alcuronium and tubocurarine, or 7 with vecuronium, atracurium and pancuronium indicated that recovery of the first train-of-four response was imminent.