Journal of clinical monitoring and computing
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J Clin Monit Comput · Dec 2012
Multicenter StudyThe ability of a new continuous cardiac output monitor to measure trends in cardiac output following implementation of a patient information calibration and an automated exclusion algorithm.
A new non-invasive continuous cardiac output (esCCO) monitoring system solely utilizing a routine cardiovascular monitor was developed, even though a reference cardiac output (CO) is consistently required. Subsequently, a non-invasive patient information CO calibration together with a new automated exclusion algorithm was implemented in the esCCO system. We evaluated the accuracy and trending ability of the new esCCO system. ⋯ The percentage error was 69.6 %. Polar plots analysis showed that the mean polar angle was -1.6° and radial limits of agreement were ±53.3°. This study demonstrates that the patient information calibration is clinically useful as ICO, but trending ability of the new esCCO system is not clinically acceptable as judged by percentage error and polar plots analysis, even though it's trending ability is comparable with currently available arterial waveform analysis methods.
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J Clin Monit Comput · Dec 2012
Airway management practices in adult intensive care units in Israel: a national survey.
Timely and adequate management of normal and compromised airway is a crucial task facing medical teams taking care of patients in intensive care units. We investigated the airway management practices in the Israeli intensive care units (ICUs). A postal survey was sent to the 20 main ICUs in Israel. ⋯ Equipment and medications necessary for airway management are available in most of the units. Difficult airways in ICUs are mainly managed by anesthesiologists and ENT surgeons. Few ICUs have quality assurance meetings.
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J Clin Monit Comput · Dec 2012
Combination of continuous pulse pressure variation monitoring and cardiac filling pressure to predict fluid responsiveness.
To assess if combining central venous pressure (CVP) and/or pulmonary capillary wedge pressure (PCWP) information with arterial pulse pressure variation can increase the ability to predict fluid responsiveness in patients under general anesthesia. This study is a retrospective analysis of patients scheduled for coronary artery bypass surgery and monitored with a pulmonary artery catheter who underwent a volume expansion after induction of general anesthesia. Among the 46 patients studied, 31 were responders to volume expansion. ⋯ Combining information on right and/or left cardiac filling pressures with PPV did not increase the ability to predict whether a patient will be a responder or a non-responder to volume expansion. The ability to identify a potentially fluid responsive patient was no better using PPV plus cardiac filling pressures when compared to using PPV alone. Therefore, if PPV values are being monitored in a patient, CVP and PCWP values do not provide additional information to predict fluid responsiveness.
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J Clin Monit Comput · Dec 2012
The reliability of manual reporting of clinical events in an anesthesia information management system (AIMS).
Manual incident reports significantly under-report adverse clinical events when compared with automated recordings of intraoperative data. Our goal was to determine the reliability of AIMS and CQI reports of adverse clinical events that had been witnessed and recorded by research assistants. ⋯ AIMS yielded a sensitivity of 38 % (95 % confidence interval [CI] 8.5-75.5 %), while the sensitivity of CQI reporting was 13 % (95 % CI 0.3-52.7 %). The low sensitivities of the AIMS and CQI reports suggest that user-reported AIMS and CQI data do not reliably include significant clinical events.
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J Clin Monit Comput · Dec 2012
Case ReportsTranscranial Doppler monitoring of middle cerebral flow velocity in a patient with a ventriculoperitoneal shunt undergoing laparoscopy.
Laparoscopic surgery is possibly associated with a risk of intracranial pressure (ICP) increase due to pneumoperitoneum in patients with ventriculoperitoneal shunts (VPS). Invasive techniques for shunt pressure monitoring are not routinely used because of the possible complications. Transcranial Doppler (TCD) is a non-invasive, safe method which gives accurate information about blood-flow velocities in basal cerebral arteries and indirectly about the ICP. ⋯ We report the use of TCD for middle cerebral flow velocity monitoring in a patient with a VPS who underwent laparoscopic surgery. In the case we present, during 60 min of pneumoperitoneum, TCD showed a sustained, but not clinically significant increase of the Pulsatility Index, with a recorded maximum change of 31 %. We consider that the use of TCD may increase the safety of laparoscopic procedures in patients with preexisting VPS.