Journal of clinical monitoring and computing
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J Clin Monit Comput · Dec 2016
Comparative StudyPerformance of computer simulated inhalational anesthetic uptake model in comparison with real time isoflurane concentration.
Gas Man software was developed to enhance our understanding of the pharmacokinetics of inhalational anaesthetics. To date the Gas Man software has not been validated in humans. In this study we compared the Gas Man software with real time measured end tidal isoflurane concentrations while using a semi closed circle system in anesthetised patients. ⋯ The end-tidal concentration values of isoflurane in real patients are very close to those predicted by Gas Man software. The pharmocokinetics of inhalational anesthetic administration in patients can be taught accurately using Gas Man technology. This technology may also help in developing different kinetic models of inhalational agents in the body.
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J Clin Monit Comput · Dec 2016
Case ReportsMassive pulmonary embolism leading to cardiac arrest: one pathology, two different ECMO modes to assist patients.
Massive acute pulmonary embolism (MAPE) represents a significant risk for morbidity and mortality. The potential for sudden and fatal deterioration highlights the need for a prompt diagnosis and appropriate intervention. Using two cases reports, we describe two different modes of successful ECMO implantation (VA-ECMO vs. ⋯ A VV-ECMO was successfully implemented, leading to a rapid improvement in both oxygenation and RV function. ECMO can provide lifesaving hemodynamic and respiratory support in critically ill patients with a MAPE who are too unstable to tolerate other interventions or have failed other therapies. An important determinant of success in the use of ECMO for MAPE is the return of adequate RV function, which allows physicians to appropriately identify which type of ECMO to implant.
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J Clin Monit Comput · Dec 2016
Multi-parameter vital sign database to assist in alarm optimization for general care units.
Continual vital sign assessment on the general care, medical-surgical floor is expected to provide early indication of patient deterioration and increase the effectiveness of rapid response teams. However, there is concern that continual, multi-parameter vital sign monitoring will produce alarm fatigue. The objective of this study was the development of a methodology to help care teams optimize alarm settings. ⋯ Plots of vital sign distributions in the cloud-hosted database were similar to other large databases published by different authors. The cloud-hosted database can be used to run simulations for various alarm thresholds and annunciation delays to predict the total alarm burden experienced by nursing staff. This methodology might, in the future, be used to help reduce alarm fatigue without sacrificing the ability to continually monitor all vital signs.
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J Clin Monit Comput · Dec 2016
Effect-site concentrations of remifentanil causing bradycardia in hypnotic and non-hypnotic patients.
Although the induction of anaesthesia with remifentanil often causes bradycardia, the relationship between the effect-site concentration (Ce) of remifentanil and instantaneous heart rate (HR) has remained unclear. The present study examined the relationship between instantaneous HR and remifentanil Ce at the induction of anaesthesia with and without propofol hypnosis, to facilitate safe management of anaesthesia induction with remifentanil. Instantaneous HR was calculated every 5 s using an electrocardiographic real-time analysis system (MemCalc/Makin2; GMS, Tokyo, Japan). ⋯ In the hypnosis group, HR was significantly lower than basal HR when remifentanil Ce was increased to 3.5 ng ml(-1) (p < 0.05), whereas no significant HR reduction was found in the non-hypnosis group until remifentanil Ce reached >5 ng ml(-1) (p < 0.05). The induction of anaesthesia using remifentanil with propofol hypnotics significantly reduces HR even in a low remifentanil Ce insufficient to suppress the cardiovascular response at tracheal intubation. Preparations to treat bradycardia are recommended for the safe management of anaesthesia induction when remifentanil is combined with hypnotics.
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J Clin Monit Comput · Dec 2016
Editorial CommentCardiac output monitoring: less invasiveness, less accuracy?