Journal of clinical monitoring and computing
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To place in context the potential value of isolated plasma strong ion difference (SID) calculations and strong ion gap (SIG) calculations versus suggested cut-down versions such as SIDa adj and the BICgap respectively. ⋯ Clinicians are unlikely to find SID calculations or cut-down versions such as the SIDa adj clinically useful. The albumin corrected anion gap is in current use and easily determined by mental arithmetic from point of care anion gap printouts plus recent plasma albumin measurements. Any slight advantage of the BICgap would be offset by the complexity of its calculation.
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J Clin Monit Comput · Feb 2020
Case ReportsThe value of acoustic respiratory rate monitoring in a patient with postoperative hemorrhage after thyroidectomy: a case report.
Acoustic respiratory rate (RRa) monitoring is a non-invasive method of monitoring respiratory rate in spontaneously breathing individuals. The aim of this report is to highlight the clinical utility of this monitoring system in post-thyroidectomy patients by presenting a case of respiratory compromise due to post-thyroidectomy hematoma, in which the alarm of the respiratory rate monitor alerted the nursing staff about the complication. A 61-year-old woman who uneventfully underwent right thyroid lobectomy for adenomatous goiter under general anesthesia with endotracheal intubation was being monitored postoperatively using the RRa monitoring system. ⋯ Thereafter, after anesthesia induction, the hematoma was drained, hemostasis was achieved, and the wound was closed after surgical drain insertion. The patient was extubated postoperatively without any further respiratory events. The information on respiratory rate disorders provided by RRa monitoring, including the tachypnea alarm, can contribute to early detection of postoperative respiratory complications and to avoiding life-threatening situations following certain operations, such as thyroidectomy.
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J Clin Monit Comput · Feb 2020
Philips Intellivue NMT module: precision and performance improvements to meet the clinical requirements of neuromuscular block management.
The variability or inaccuracy of acceleromyographic measurements could interfere with the interpretation of the train-of-four (TOF) ratio during neuromuscular block (NMB) recovery. This study evaluated the precision and performance of the Philips Intellivue NMT module (NMT) before (part 1) and after (part 2) several technical upgrades (i.e., firmware upgrade, new cable, and hand adapter) that were recently available. Two cohorts of 30 patients who were scheduled to undergo rhino/septoplasty under general anesthesia were included in the study. ⋯ Initially, the NMT significantly overestimated NMB recovery at every stage. Conversely, in the second part of the study, no difference reached statistical significance. With the recent upgrades and the new hand adapter, the NMT provided similar results compared with the TWX, Their implementation should be recommended in clinical practice.
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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.