Journal of clinical monitoring and computing
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J Clin Monit Comput · Apr 2016
ReviewJournal of Clinical Monitoring and Computing 2015 end of year summary: cardiovascular and hemodynamic monitoring.
Hemodynamic monitoring is essential in critically ill patients. In this regard, the Journal of Clinical Monitoring and Computing (JCMC) has become an ideal platform for publishing cardiovascular and hemodynamic monitoring-related research, as reflected by an increasing number of articles related to this topic and published in the recent years. To highlight this new progress, every New Year the journal prints a descriptive review on some important papers published last year in the JCMC and related to blood, cardiovascular function and hemodynamic monitoring.
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Low flow anesthesia increases the use of CO2 absorbents, but independent data that compare canister life of the newest CO2 absorbents are scarce. Seven different pre-packed CO2 canisters were tested in vitro: Amsorb Plus, Spherasorb, LoFloSorb, Medisorb, Medisorb EF, LithoLyme, and SpiraLith. CO2 (160 mL min(-1)) flowed into the tip of a 2 L breathing bag that was ventilated with a tidal volume of 500 mL, a respiratory rate of 10/min, and an I:E ratio of 1:1 using the controlled mechanical ventilation mode of the Aisys (®) (GE, Madison, WI, USA). ⋯ The most important factors that determine canister life of prepacks in a circle breathing system are the chemical composition of the canister, the absolute amount of absorbent present in the canister, and the FICO2 replacement threshold. The use of the fractional canister usage allows cost comparisons among different prepacks. Results should not be extrapolated to prepacks that fit onto other anesthesia machines.
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J Clin Monit Comput · Apr 2016
Comparative StudyCardiac output method comparison studies: the relation of the precision of agreement and the precision of method.
Cardiac output (CO) plays a crucial role in the hemodynamic management of critically ill patients treated in the intensive care unit and in surgical patients undergoing major surgery. In the field of cardiovascular dynamics, innovative techniques for CO determination are increasingly available. Therefore, the number of studies comparing these techniques with a reference, such as pulmonary artery thermodilution, is rapidly growing. ⋯ But as the actual CO of a subject changes from assessment to assessment, there is no real repetition of a measurement. This situation equals a scenario in which single measurements are given for multiple true values per subject. In such a case it is not possible to assess the precision of method.
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J Clin Monit Comput · Apr 2016
Near-infrared spectroscopy determined cerebral oxygenation with eliminated skin blood flow in young males.
We estimated cerebral oxygenation during handgrip exercise and a cognitive task using an algorithm that eliminates the influence of skin blood flow (SkBF) on the near-infrared spectroscopy (NIRS) signal. The algorithm involves a subtraction method to develop a correction factor for each subject. For twelve male volunteers (age 21 ± 1 yrs) +80 mmHg pressure was applied over the left temporal artery for 30 s by a custom-made headband cuff to calculate an individual correction factor. ⋯ With the use of both source-detector distances, handgrip exercise and a cognitive task increased O2Hb (P < 0.01) but O2Hb was reduced when SkBF became eliminated by pressure on the temporal artery for 5 s. However, when the estimation of cerebral oxygenation was based on the algorithm developed when pressure was applied to the temporal artery, estimated O2Hb was not affected by elimination of SkBF during handgrip exercise (P = 0.666) or the cognitive task (P = 0.105). These findings suggest that the algorithm with the individual correction factor allows for evaluation of changes in an accurate cerebral oxygenation without influence of extracranial blood flow by NIRS applied to the forehead.
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Respiratory rate has been shown to be an important predictor of cardiac arrest, respiratory adverse events and intensive care unit admission and has been designated a vital sign. However it is often inadequately monitored in hospitals. We test the hypothesis that RespiraSense, a piezoelectric-based novel respiratory rate (RR) monitor which measures the differential motion of the chest and abdomen during respiratory effort, is not inferior to commonly used methods of respiratory rate measurement. ⋯ The 95 % confidence interval for the difference in average RR between RespiraSense and ECG was calculated to be [-3.9, 3.1]. The 95 % confidence interval for the difference in average RR between RespiraSense and nurses' evaluation was [-5.5, 4.3]. We demonstrate a clinically relevant agreement between RR monitored by the RespiraSense device with both ECG-derived and manually observed RR in 48 post-surgical patients in a PACU environment.