Anaesthesia
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Randomized Controlled Trial Comparative Study
Emergency capnography monitoring: comparing ergonomic design of intensive care unit ventilator interfaces and specific training of staff in reducing time to activation.
Modern ventilators provide capnography monitoring in patients with tracheal tubes, in compliance with national and international recommendations. This technology is often not used when patients' lungs are non-invasively ventilated; however, it should be accessed immediately following tracheal intubation to confirm tube placement. This study assessed the effect of ventilation interface design on the speed with which capnography can be activated by comparing the Dräger Evita 4 and Dräger V500 before and after a specific training episode. ⋯ We used a randomised crossover design, measuring time to monitoring activation, and repeated the study after 3 months. Survival analysis showed significantly quicker activation associated with ventilator choice (V500, p < 0.0001) and training (p = 0.0058). The training improved activation speed with both machines, though this was only significant for the Evita 4 (p = 0.0097).
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We compared the work needed to retract a non-lubricated and a lubricated stylet from a tracheal tube over 24 h. Stylets were lubricated with sterile water, silicone fluid, lidocaine spray, lidocaine gel, MedPro(®) lubricating gel or Lacri-Lube(®). ⋯ Where a tracheal tube is pre-loaded with a stylet for use at an indeterminate time, silicone fluid was the best choice of lubricant as it performed consistently well up to 24 h. At 24 h only silicone fluid (0.49 (0.01)) outperformed no lubrication (0.77 (0.24); p = 0.04).
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We report laboratory and clinical evaluations of a blood propofol concentration analyser. Laboratory experiments used volunteer blood spiked with known propofol concentrations over the clinically relevant concentrations from 0.5 to 16 μg.ml(-1) to assess linearity and the influence of haematocrit and concurrent drug administration. Analyser concentrations demonstrated excellent linearity (R(2) = 0.999). ⋯ Clinical performance of the analyser was assessed using 80 arterial blood samples from 72 patients receiving propofol infusions during cardiac surgery. Samples were processed using the propofol analyser, and high performance liquid chromatography (HPLC) used as a gold-standard comparator. These data demonstrated excellent agreement between the propofol analyser and HPLC with a bias of 0.13 μg.ml(-1) and precision of -0.16 to 0.42 μg.ml(-1).