Journal of clinical monitoring and computing
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J Clin Monit Comput · Feb 2020
Two-site regional oxygen saturation and capnography monitoring during resuscitation after cardiac arrest in a swine pediatric ventricular fibrillatory arrest model.
To investigate the use of two-site regional oxygen saturations (rSO2) and end tidal carbon dioxide (EtCO2) to assess the effectiveness of resuscitation and return of spontaneous circulation (ROSC). Eight mechanically ventilated juvenile swine underwent 28 ventricular fibrillatory arrests with open cardiac massage. Cardiac massage was administered to achieve target pulmonary blood flow (PBF) as a percentage of pre-cardiac arrest baseline. ⋯ The AUCs for sudden increase of EtCO2, C-rSO2, and R-rSO2 at ROSC were 0.86 [95% CI, 0.77-0.94], 0.87 [95% CI, 0.8-0.94], and 0.98 [95% CI, 0.96-1.00] respectively. Measurement of continuous EtCO2 and rSO2 may be used during CPR to ensure effective chest compressions. Moreover, both rSO2 and EtCO2 may be used to detect ROSC in a swine pediatric ventricular fibrillatory arrest model.
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J Clin Monit Comput · Feb 2020
Trending algorithm discriminates hemodynamic from injury related TcMEP amplitude loss.
Jasiukaitis and Lyon (J Clin Monit Comput, https://doi.org/10.1007/s10877-018-0181-9, 2018) described an motor evoked potential (MEP)amplitude trending system to detect MEP amplitude loss against a background of MEP variability. They found that the end of case value of a running R2 triggered by a set MEP amplitude loss criterion appeared to discriminate new injury from non-injury in a small sample of three patients. The present study examines the predictive capability of the running R2 in a larger sample of patients (21 injured and 19 non-injured). ⋯ End-of-case R2 values greater than 60% appeared to be highly predictive of new post-operative deficit, while values less than 40% appeared to insure no new deficit. The proposed trending system can discriminate injury from non-injury outcomes when compressive radicular injury during correction for lumbar deformity is involved. This discrimination appears to be successful even when MEP amplitude loss for non-iatrogenic reasons (i.e., hemorrhage) is also occurring.
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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.