Journal of clinical monitoring and computing
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J Clin Monit Comput · Feb 2020
Randomized Controlled TrialPositive end-expiratory pressure increases arterial oxygenation in elderly patients undergoing urological surgery using laryngeal mask airway in lithotomy position.
Elderly patients undergoing urological surgery in the lithotomy position may be vulnerable to perioperative hypoxemia. Positive end-expiratory pressure (PEEP) can improve arterial oxygenation. Although laryngeal mask airway (LMA) is widely utilized in urological surgery, it is not known how PEEP affects arterial oxygenation in these patients. ⋯ Atelectasis score at T2 was lower in group P than in group Z (5.3 ± 1.7 vs. 8.4 ± 2.3, P < 0.001). However, the incidence of a significant leak and complications associated with LMA insertion did not significantly differ between the two groups. PEEP can improve arterial oxygenation and reduce atelectasis in elderly patients using sLMA during urological surgery in the lithotomy position, suggesting that PEEP may be useful for elderly patients with an increased risk of perioperative hypoxemia when using sLMA.
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J Clin Monit Comput · Feb 2020
Effect of transpulmonary pressure-guided positive end-expiratory pressure titration on lung injury in pigs with acute respiratory distress syndrome.
To investigate the effect of positive end-expiratory pressure (PEEP) guided by transpulmonary pressure or with maximum oxygenation-directed PEEP on lung injury in a porcine model of acute respiratory distress syndrome (ARDS). The porcine model of ARDS was induced in 12 standard pigs by intratracheal infusion with normal saline. The pigs were then randomly divided into two groups who were ventilated with the lung-protective strategy of low tidal volume (VT) (6 ml/kg), using different methods to titrate PEEP level: transpulmonary pressure (TP group; n = 6) or maximum oxygenation (MO group; n = 6). ⋯ The pulmonary vascular permeability index and the extravascular lung water index in the TP group were significantly lower than those in the MO group (P < 0.05). The TP group had a lower lung wet to dry weight ratio, lung injury score, and MPO, TNF-, and IL-8 concentrations than the MO group (P < 0.05). In summary, in a pig model of ARDS, ventilation with low VT and transpulmonary pressure-guided PEEP adjustment was associated with improved compliance, reduced dead space ventilation, increased cardiac output, and relieved lung injury, as compared to maximum oxygenation-guide PEEP adjustment.
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J Clin Monit Comput · Feb 2020
Forehead electrodes sufficiently detect propofol-induced slow waves for the assessment of brain function after cardiac arrest.
In a recent study, we proposed a novel method to evaluate hypoxic ischemic encephalopathy (HIE) by assessing propofol-induced changes in the 19-channel electroencephalogram (EEG). The study suggested that patients with HIE are unable to generate EEG slow waves during propofol anesthesia 48 h after cardiac arrest (CA). Since a low number of electrodes would make the method clinically more practical, we now investigated whether our results received with a full EEG cap could be reproduced using only forehead electrodes. ⋯ The results received with forehead electrodes were similar to those of the full EEG cap. With the experimental pilot study data, the forehead electrodes were as capable as the full EEG cap in capturing the effect of HIE on propofol-induced slow wave activity. The finding offers potential in developing a clinically practical method for the early detection of HIE.
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J Clin Monit Comput · Feb 2020
Observational StudyMeasuring the accuracy of propofol target-controlled infusion (TCI) before and after surgery with major blood loss.
Target-controlled infusion (TCI) is based on pharmacokinetic models designed to achieve a desired drug level in the blood. TCI's predictive accuracy of plasma propofol levels at the end of surgery with major blood loss has not been well established. This prospective observational study included adult patients (BMI 20-35 kg/m2) undergoing surgery with expected blood loss ≥ 1500 mL. ⋯ Propofol TCI allows clinically unproblematic conduct of general anaesthesia. In cases of major blood loss, the probability of propofol TCI overestimating plasma levels increases. Trial registration German Clinical Trials Register (DRKS; DRKS00009312).