Journal of clinical monitoring and computing
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J Clin Monit Comput · Jul 2002
Comparative StudyActivated clotting time systems vary in precision and bias and are not interchangeable when following heparin management protocols during cardiopulmonary bypass.
Our aim was to test the hypothesis that new activated clotting time (ACT) technology, with modifications to instruments and reagents designed to detect earlier clot formation, would be associated with more precise but lower results. A secondary objective was to evaluate the potential impact of any change in ACT measurement on heparin requirements during cardiopulmonary bypass (CPB). ⋯ Our results support the hypothesis that the modified technology (Actalyke) is associated with more precise but lower ACT results. We estimated these lower values would lead to increased heparin dosing during CPB. The impact of this increase on bleeding after cardiac surgery with CPB is controversial and requires further study.
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J Clin Monit Comput · Jul 2002
Bispectral Index in ICU: correlation with Ramsay Score on assessment of sedation level.
The assessment of sedation level in critically ill patient remains a challenge for the intensivists in order to avoid over- or under-sedation phenomena. Scoring systems commonly used still show some limitation; the introduction of Bispectral Index (an EEG parameter) could bring potential advantages in monitoring sedation. According to the reports, Bispectral Index correlates with levels of sedation on the Ramsay Scale. We report our personal experience in this topic. ⋯ The results of the study are consistent with those found in the literature on this topic of study. In fact, this study demonstrates the utility of BIS to track levels of consciousness in ICU patients while still maintaining the use of the score systems to care for ICU patients.
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J Clin Monit Comput · Jul 2002
Pulmonary blood flow (cardiac output) and the effective lung volume determined from a short breath hold using the differential Fick method.
This work attempts to show how pulmonary blood flow (Qp), cardiac output (CO(Fick)) and the lung volume of effective gas exchange (ELV) can be determined from breath-by-breath measurements of the tidal exhaled CO2 elimination V (litre/min) and the end tidal CO2 concentration P (%) using the differential Fick method. The measurements are made during steady state ventilation and when the CO2 balance in the lungs changes subsequent to a perturbation of the gas exchange conditions. ⋯ With a single breath perturbation, the differential Fick method can yield cardiopulmonary information using 2-3 breaths only and with a minimum of interference with the patient. Complete data analysis results in multiple determinations of the Qp and ELV values which improve the attainable precision. Our investigation points to the possibility to determine Qp, CO(Fick) and ELV also during spontaneous breathing, by using the natural tidal variations of V and P.
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J Clin Monit Comput · Jul 2002
Diagnosis of anesthetic-induced upper airway obstruction in children using respiratory inductance plethysmography.
Upper airway obstruction is the most rapid and clinically relevant cause of hypoxia during sedation and anesthesia. This study was designed to determine if respiratory inductance plethysmography (RIP) could quantify the degree of upper airway obstruction caused by induction of general anesthesia. ⋯ We investigated two methods for analyzing RIP tracings during varying degrees of upper airway obstruction in anesthetized children. We found that neither technique was sufficiently accurate for predicting the severity of upper airway obstruction and would not be useful as a predictor of upper airway obstruction in the clinical or research settings.
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J Clin Monit Comput · Jul 2002
Learning about new anesthetics using a model driven, full human simulator.
New pharmacological agents are introduced into medical practice at an ever-increasing pace. Teaching how to use new medications in the clinical setting presents educational challenges and puts patients at risk. ⋯ Patient simulation is a novel method of introducing new drugs to the medical community and is perceived by anesthesia providers as a valuable addition to available teaching methods.