Journal of clinical monitoring and computing
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J Clin Monit Comput · Apr 2014
Review Case ReportsGlideScope video laryngoscopy use tracheal intubation in patients with ankylosing spondylitis: a series of four cases and literature review.
Airway management in patients with ankylosing spondylitis (AS) is a challenging problem for anesthesiologists. The GlideScope video laryngoscope (GVL) is designed to assist tracheal intubation for patients with a difficult airway. The aim of the study was to report the successful intubation by GVL of four AS patients, and to discuss the use of GVL for tracheal intubation in patients with AS by performing a review of the literature. ⋯ As with any challenging airway management, it is essential to have a rescue strategy. We believe that GVL can be a good alternative for oral endotracheal intubation in patients with AS. This series is very small and the reader should be very cautious about drawing broad conclusions regarding the GVL and patients with AS.
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J Clin Monit Comput · Apr 2014
Oxygenation advisor recommends appropriate positive end expiratory pressure and FIO2 settings: retrospective validation study.
A decision support, rule-based oxygenation advisor that provides guidance for setting positive end expiratory pressure (PEEP) and fractional inhaled oxygen concentration (FIO2) for patients with respiratory failure is described. The target oxygenation goal is to achieve and maintain pulse oximeter oxygen saturation (SpO2) ≥ 88 and ≤ 95%, as posited by the Acute Respiratory Distress Syndrome Network, by recommending appropriate combinations of PEEP and FIO2. For patient safety, the oxygenation advisor monitors mean arterial blood pressure (MAP) to ensure it is ≥ 65 mmHg for hemodynamic stability and inspiratory plateau pressure (Pplt) so it is ≤ 30 cm H2O for lung protection. ⋯ A novel oxygenation advisor provided continuous and automatic recommendations for setting PEEP and FIO2 that were shown to be as good as the clinical judgment of experienced attending physicians. For all patients, the target oxygenation goal was achieved. Concerning patient safety, the oxygenation advisor detected those occasions when MAP and Pplt were in potentially unsafe ranges.
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J Clin Monit Comput · Apr 2014
Controlled Clinical TrialEntropy correlates with Richmond Agitation Sedation Scale in mechanically ventilated critically ill patients.
Sedation is routinely used in intensive care units. However due to absence of objective scoring systems like Bispectral Index and entropy our ability to regulate the degree of sedation is limited. This deficiency is further highlighted by the fact that agitation scores used in intensive care units (ICU) have no role in paralyzed patients. ⋯ There was a statistically significant correlation between the state entropy (SE) and RASS [Spearman's rho/rs = 0.334, p\0.0001]; response entropy (RE) and RASS [Spearman's rho/rs = 0.341, p\0.0001]). For adequate sedation as judged by a RASS value of 0 to -3, the mean SE was 57.86 ± 16.50 and RE was 67.75 ± 15.65. The present study illustrates that entropy correlates with RASS (between scores 0 and -3) when assessing the level of sedation in mechanically ventilated critically ill patients.
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J Clin Monit Comput · Apr 2014
A novel airway device with tactile sensing capabilities for verifying correct endotracheal tube placement.
We present a new device for verifying endotracheal tube (ETT) position that uses specialized sensors intended to distinguish anatomical features of the trachea and esophagus. This device has the potential to increase the safety of resuscitation, surgery, and mechanical ventilation and decrease the morbidity, mortality, and health care costs associated with esophageal intubation and unintended extubation by potentially improving the process and maintenance of endotracheal intubation. ⋯ It is intended to detect the presence or absence of tracheal rings immediately upon inflation of the airway occlusion cuff. The initial study detailed here verifies that a prototype device can detect contours similar to tracheal rings in a tracheal model.
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J Clin Monit Comput · Apr 2014
Comparative StudyPeripheral tissue oximetry: comparing three commercial near-infrared spectroscopy oximeters on the forearm.
Estimation of regional tissue oxygenation (rStO2) by near infrared spectroscopy enables non-invasive end-organ oxygen balance monitoring and could be a valuable tool in intensive care. However, the diverse absolute values and dynamics of different devices, and overall poor repeatability of measurements are a problem. The aim of the present study is to test the hypothesis that INVOS 5100C, FORE-SIGHT and NONIN EQUANOX 7600 have similar properties concerning absolute values, repeatability, and sensitivity to changes in rStO2. ⋯ Two measures of signal-to-noise were similar among devices. This suggests that good repeatability comes at the expense of low sensitivity to changes in oxygenation. Values of rStO2 on the forearm from INVOS, NONIN and FORE-SIGTH cannot be used interchangeably.