Journal of clinical monitoring and computing
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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
Postoperative desaturation and bradypnea after general anesthesia in non-ICU patients: a retrospective evaluation.
Respiratory depression, presenting as desaturation and bradypnea, is common during the early postoperative period. However, it has not been evaluated by appropriate monitoring. The purpose of the present study was to identify the incidence and predictors of desaturation and bradypnea following general anesthesia, using a continuous and centralized monitoring system, in non-ICU patients who did not have serious complications and did not undergo major surgery. ⋯ Age (OR 1.04, 95% CI 1.01-1.07; p = 0.010) and postoperative opioid administration (OR 3.16, 95% CI 1.22-7.87; p = 0.019) showed a significant association with the occurrence of both desaturation and bradypnea. This study demonstrated the incidence and predictors of postoperative desaturation and bradypnea, and suggests the need for monitoring oxygen saturation and respiratory rate for at least 8 h after surgery in non-ICU patients. Use of monitoring systems might provide a safety net for postoperative patients.