Journal of clinical monitoring and computing
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J Clin Monit Comput · Feb 2020
Observational StudyA simplified quantitative acid-base approach for patients with acute respiratory diseases.
The Stewart-Figge acid-base model has been criticized for being mathematically complex. We aimed to develop simpler formalisms, which can be used at the bedside. The following simplifications were used: (1) [Ca2+] and [Mg2+] are replaced by their mid-reference concentrations (2) pH is set to 7.4. ⋯ A [SIDa, adj] < 50.4 meq/l had an accuracy of 0.995 (p < 0.001) for the diagnosis of strong ion (SI) acidosis, while a [SIDa, adj] > 52.5 meq/l had an accuracy of 0.997 (p < 0.001) for the diagnosis of SI alkalosis. A [BICgap] > 11.6 meq/l predicted unmeasured ion (UI) acidosis with an accuracy of 0.997 (p < 0.001), while an [AGc] > 19.88 meq/l predicted UI acidosis with an accuracy of 0.994 (p < 0.001). The "[BICgap] model" is a reliable tool for the assessment of acid-base disorders in patients with acute respiratory diseases. [BICgap] is not inferior to [AGc] in the diagnosis of UI acidosis.
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J Clin Monit Comput · Feb 2020
ReviewClinical use of volumetric capnography in mechanically ventilated patients.
Capnography is a first line monitoring system in mechanically ventilated patients. Volumetric capnography supports noninvasive and breath-by-breath information at the bedside using mainstream CO2 and flow sensors placed at the airways opening. ⋯ Volumetric capnography goes one step forward standard respiratory mechanics and provides a new dimension for monitoring of mechanical ventilation. The article discusses the role of volumetric capnography for the clinical monitoring of mechanical ventilation.
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This end of the year summary reviews anesthesia related manuscripts that have been published in the Journal of Clinical Monitoring and Computing in 2019. Anesthesia is currently defined as being composed of unconsciousness, immobility, and autonomic nervous system (ANS) control (Br J Anaesth;122:e127-e135135, Egan 2019). ⋯ Regaining consciousness has to be accompanied by pain control, and it is important to ensure that the patient regains baseline cognitive function. Anesthesia machine equipment, drug administration, and airway related topics make up the rest of published manuscripts.
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J Clin Monit Comput · Feb 2020
Randomized Controlled TrialHypoventilation patterns during bronchoscopic sedation and their clinical relevance based on capnographic and respiratory impedance analysis.
Capnography involves the measurement of end-tidal CO2 (EtCO2) values to detect hypoventilation in patients undergoing sedation. In a previous study, we reported that initiating a flexible bronchoscopy (FB) examination only after detecting signs of hypoventilation could reduce the risk of hypoxemia without compromising the tolerance of the patient for this type of intervention. We hypothesize that hypoventilation status could be determined with greater precision by combining thoracic impedance-based respiratory signals, RESP, and EtCO2 signals obtained from a nasal-oral cannula. ⋯ Hypoventilation status (as revealed by EtCO2 levels) could be further classified by RESP into central-predominant or non-central-predominant types. It appears that patients with central-predominant hypoventilation are more sensitive to propofol during the induction of sedation. RESP values could be used to tailor sedation management specifically to individual patients.