Articles: closed-circuit-anesthesia.
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Case Reports
[Faulty internal tube in a co-axial ventilation tube system: cause of a massive postoperative hypercapnia].
This article presents the case of a patient with massive postoperative hypercapnia during mechanical ventilation in the intensive care unit (ICU). With normal tidal volumes and clearly visible chest movements, adequate findings with regard to auscultation, oxygenation and correct respirator settings, no cause for the increasing hypercapnia was initially found; however, replacement of the respirator led to a return to normal carbon dioxide levels. When checking the replaced respirator a service technician found the cause of the respirator failure: the internal tube of the co-axial ventilation system was faulty leading to an increased dead space and rebreathing of carbon dioxide.
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Minimally invasive measurement of cardiac output as a central component of advanced haemodynamic monitoring has been increasingly recognised as a potential means of improving perioperative outcomes in patients undergoing major surgery. Methods based upon pulmonary carbon dioxide elimination are among the oldest techniques in this field, with comparable accuracy and precision to other techniques. ⋯ The accuracy and precision of this approach to cardiac output measurement has been shown to be similar to other minimally invasive techniques. This paper reviews the underlying principles and evolution of the method, and future directions including recent adaptations designed to deliver continuous breath-by-breath monitoring of cardiac output.
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J. Cardiothorac. Vasc. Anesth. · Oct 2012
Comparative StudyIntraoperative stroke volume optimization using stroke volume, arterial pressure, and heart rate: closed-loop (learning intravenous resuscitator) versus anesthesiologists.
The authors compared the performance of a group of anesthesia providers to closed-loop (Learning Intravenous Resuscitator [LIR]) management in a simulated hemorrhage scenario using cardiac output monitoring. ⋯ Despite the roughly similar volumes of fluid given, the closed-loop maintained more stable hemodynamics than the practitioners primarily because the fluid was given earlier in the protocol and CO optimized before the hemorrhage began, whereas practitioners tended to resuscitate well but only after significant hemodynamic change indicated the need. Overall, these data support the potential usefulness of this closed-loop algorithm in clinical settings in which dynamic predictors are not available or applicable.