Journal of clinical monitoring and computing
-
Many of the complications related to prolonged ventilation are related to inappropriate handling of endotracheal tube (ETT) cuff. This article reviews the possible complications associated with the ETT cuff, and the landmark development made in that field. The article challenges the present paradigm of cuff use and reviews the current clinical practice in that area.
-
J Clin Monit Comput · Feb 2012
New airway device for ventilation and monitoring in pediatric patients undergoing MRI study.
A method of administering continuous positive airway pressure via a new airway device to prevent upper airway obstruction and preserve spontaneous respiration under total intravenous anesthesia has been adapted for children undergoing deep sedation for MRI studies. Presented herein is a retrospective study of 45 pediatric patients, ages 5 months to 7 years, who underwent an MRI study under general anesthesia using a modified nasal vestibule airway (NVA®), a pressure-sealing nasal cannula that can be used in conjunction with an anesthesia circuit to deliver nasal-CPAP during anesthesia. After inhalation induction of anesthesia with sevoflurane, an intravenous infusion of propofol was used to maintain anesthesia. ⋯ A new approach is offered to maintain airway patency, monitoring and spontaneous respirations in pediatric patients undergoing MRI study. This pressure-sealing nasal cannula can deliver CPAP under anesthesia while avoiding the requirement of an invasive airway and facilitating additional monitoring and control not possible with an ordinary nasal cannula. This NVA may be used in other locations in pediatric patients where endotracheal intubation is not necessary or impossible.
-
The authors evaluated an analyser for the determination of propofol concentrations in whole blood. The Pelorus 1000 (Sphere Medical) measures propofol concentrations in around 5 min without the requirement for sample preparation. The performance of the analyser was characterised with respect to linearity, precision in control solutions and whole blood and method comparison to an HPLC based reference method. ⋯ The only cross interference of note is to a highly elevated level of conjugated bilirubin, while low haematocrit levels lead to a 0.13 μg/ml under reading with respect to the HPLC reference. The system fulfils the requirements for measurement of propofol concentrations in whole blood samples with precision and accuracy suitable for elucidating propofol pharmacokinetics at clinically relevant concentrations. With no requirement for sample preparation and a fast time to results, the analyser opens up the possibility of studies to measure and respond to blood propofol concentrations in patients in close to real time.
-
J Clin Monit Comput · Feb 2012
Validation of indirect calorimetry for measurement of energy expenditure in healthy volunteers undergoing pressure controlled non-invasive ventilation support.
The aim of this validation study was to assess the reliability of gas exchange measurement with indirect calorimetry among subjects who undergo non-invasive ventilation (NIV). Oxygen consumption (VO2) and carbon dioxide production (VCO2) were measured in twelve healthy volunteers. Respiratory quotient (RQ) and resting energy expenditure (REE) were then calculated from the measured VO2 and VCO2 values. ⋯ The change of sampling air flow had no statistically significant effect on any of the above parameters. We found that REE can be accurately measured with an indirect calorimeter also during NIV-supported breathing and the change of sampling air flow does not distort the gas exchange measurement. A higher sampling air flow in indirect calorimetry decreases the possibility for air leakages in the measurement system and increases the reliability of REE measurement.
-
J Clin Monit Comput · Feb 2012
Case ReportsProtection of the remaining spinal cord function with intraoperative neurophysiological monitoring during paraparetic scoliosis surgery: a case report.
To demonstrate the usefulness of rectus femoris muscle MEPs monitoring in a paraparetic neuromuscular scoliosis case. ⋯ Intraoperative neurophysiological monitoring should be used for neuromuscular scoliosis cases with paraparesis if proximal function, such as the rectus femoris muscle, exists.