Journal of clinical monitoring and computing
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J Clin Monit Comput · May 1998
Transcutaneous renal function monitor: precision during unsteady hemodynamics.
Hospital acquired renal dysfunction, most commonly caused by renal hypoperfusion, dramatically increases mortality in intensive care patients. Glomerular filtration rate (GFR) is rapidly altered during renal hypoperfusion, and a more rapid means of GFR measurement may prompt institution of renal-specific therapy. We hypothesized that a transcutaneous renal function monitor can rapidly and accurately assess acute changes in GFR within a time frame much shorter than the 2-4 hours currently available. ⋯ TC monitoring provides prompt indication of directional changes in GFR and may provide the clinician warning of inadequate resuscitation. Prospective analysis of the specificity, sensitivity, and TC guided renal-specific resuscitation is needed.
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We have previously shown in a mechanical lung model [1] that bronchial flap-valve expiratory obstruction results in sequential lung expiration, best detected by prolonged and low magnitude tracheal expired flow (V) from the obstructed lung. However, the normal expiratory resistance of clinical ventilation circuits might also generate prolonged, low value exhaled V, that could be confused with bronchial flap-valve obstruction. We reasoned that bronchial flap-valve obstruction would also cause sequential CO2 unloading from each lung and result in a biphasic tracheal capnogram. ⋯ During moderate or severe left bronchial flap-valve obstruction, left bronchial V was delayed so that the left lung anatomical dead space (devoid of CO2) mixed with normal right exhalate to depress the expiratory upstroke or early plateau of the tracheal capnogram. During severe obstruction, decreased perfusion of the left lung caused lower alveolar PCO2. Then, prolonged low V from the left bronchus also resulted in depression of the end of the tracheal alveolar plateau. In general, the low magnitude of bronchial V from the obstructed lung limited its effect on the tracheal capnogram and the best marker of sequential lung emptying during bronchial flap-valve obstruction may be late exhaled V without reduction in total tidal volume.
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J Clin Monit Comput · May 1998
A cross-validated multifactorial index of perioperative risks in adults undergoing anaesthesia for non-cardiac surgery. Analysis of perioperative events in 26907 anaesthetic procedures.
To develop a severity index of anaesthetic risk that predicts relevant perioperative adverse events in adults. ⋯ The index seems to reflect the risk of relevant perioperative incidents. It can be used for audit purposes. In daily routine, the index could focus our attention on patients with increased perioperative risk. However, it is limited in detecting particular constellations of factors which interact on each other with regard to perioperative risk.
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J Clin Monit Comput · May 1998
Adaptive lung ventilation (ALV) during anesthesia for pulmonary surgery: automatic response to transitions to and from one-lung ventilation.
Adaptive lung ventilation is a novel closed-loop-controlled ventilation system. Based upon instantaneous breath-to-breath analyses, the ALV controller adjusts ventilation patterns automatically to momentary respiratory mechanics. Its goal is to provide a preset alveolar ventilation (V'A) and, at the same time, minimize the work of breathing. Aims of our study were (1) to investigate changes in respiratory mechanics during transition to and from one-lung ventilation (OLV), (2) to describe the automated adaptation of the ventilatory pattern. ⋯ Respiratory mechanics during transition to and from OLV are characterized by marked changes in R and C into opposite directions, leaving TC unaffected. The ALV controller manages these transitions successfully, and maintains V'A reliably without intervention by the anesthesiologist. VT during OLV was found to be consistently lower than recommended in the literature.
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J Clin Monit Comput · May 1998
Nocturnal body movements and hypoxemia in middle-aged females after lower abdominal surgery under general anesthesia: a study with the static-charge-sensitive bed (SCSB).
The aim of this study was to evaluate the feasibility of the static-charge-sensitive-bed (SCSB) combined with pulse oximetry (SpO2) for postoperative monitoring and to determine variables which could be used for evaluating the quality of postoperative sleep and breathing. ⋯ Postoperative periodic movement activity was suppressed, but sleep remained fragmented with frequent body movements. In our middle-aged non-obese females (ASA I-II), no severe postoperative hypoxemia was observed during the three-nights postoperative survey. Perioperative movement monitoring with the SCSB was a valuable tool in rejecting movement artefacts of SpO2 and in evaluating general sleep quality.