Journal of clinical monitoring and computing
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J Clin Monit Comput · Dec 2012
Randomized Controlled TrialA beat-by-beat, on-line, cardiovascular index, CARDEAN, to assess circulatory responses to surgery: a randomized clinical trial during spine surgery.
Automated assessment of circulatory response to surgical stimuli is unsolved. Would detection of cardiac baroreflex inhibition assess adequacy of intra-operative anti-nociception upon incision, as performed on-line on a beat-by-beat basis by a cardiovascular index, CARDEAN™? 18 ASA I-II patients undergoing spinal disc repair were studied, in a prospective randomized single-blinded trial (observational study). During infusion of propofol to maintain bispectral index between 40 and 60, patients were allocated to receive an effect site target-controlled infusion of remifentanil at Ce = 2 or 4 ng ml(-1). ⋯ Upon skin incision, CARDEAN increased in the remifentanil Ce = 2 ng ml(-1) group (n = 7, P < 0.05), while it did not increase in the remifentanil Ce = 4 ng ml(-1) group (n = 7, P = 0.18). During surgery, retrospectively, CARDEAN > 60 was associated with tachycardia and hypertension (P (k) = 0.81 ± 0.10). Changes in CARDEAN appeared linked to adequacy of anti-nociception.
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J Clin Monit Comput · Dec 2012
Randomized Controlled TrialThe utility of bispectral index monitoring for sedated patients treated with low-dose remifentanil.
The aim of the present study was to determine the effect of low-dose remifentanil on the monitoring quality of the Bispectral index for mechanically ventilated patients. Twelve patients who underwent elective surgery and required mechanical ventilation post-operatively were enrolled in this study with written informed consent. Eligible patients were divided into two groups. ⋯ These values were assessed by single regression analysis and a P value of <0.05 was considered significant. There was a significant correlation between RASS and BIS values (P = 3 × 10(-12), R (2) = 0.67) in the remifentanil group, but not in the control group (P = 0.50, R (2) = 0.057). The administration of low-dose remifentanil makes BIS a more precise tool for sedated patients under mechanical ventilation in the ICU.
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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
Evaluation of an integrated intensive care unit monitoring display by critical care fellow physicians.
In the past two far-view displays, which showed vital signs, trends, alarms, infusion pump status, and therapy support indicators, were developed and assessed by critical care nurses (Görges et al. in Dimens Crit Care Nurs. 30(4):206-17, 2011). The aim of the current study is to assess the generalizability of these findings to physicians. The first aim is to test whether an integrated far-view display, designed to be readable from 3 to 5 m, enables critical care physicians to more rapidly and accurately (1) recognize a change in patient condition; (2) identify alarms; and (3) identify near-empty infusion pumps, than a traditional patient monitor and infusion pump. ⋯ Displays that present patient data in a redesigned format enables critical care clinicians to more rapidly identify changes in patient conditions and to more accurately decide which patient needs their attention. In a clinical setting, this could improve patient safety. In future work, an evaluation of the display using live patient data from an ICU should be performed.
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J Clin Monit Comput · Dec 2012
Case ReportsDetection of positional brachial plexus injury by radial arterial line during spinal exposure before neuromonitoring confirmation: a retrospective case study.
To demonstrate the potential usefulness of radial arterial line monitoring in detection of brachial plexus injury in spinal surgery. Multiple neuromonitoring modalities including SEPs, MEPs and EMG were performed for a posterior thoracicolumbar surgery. Radial arterial line (A-line) was placed on the right wrist for arterial blood pressure monitoring. ⋯ Loss of ulnar nerve SEPs and hand muscle MEPs with a cold hand on the right was noticed when neuromonitoring resumed after spine exposure. SEPs, MEPs, A-line readings and hand temperature returned after modification of the right arm position. Radial arterial line monitoring may help detect positional brachial plexus injury in spinal surgery when continuous neuromonitoring is interrupted during spine exposure in prone position.