Journal of clinical monitoring and computing
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J Clin Monit Comput · Aug 2021
Ultrasound prediction for vocal cord dysfunction in patients scheduled for anterior cervical spine surgeries: a prospective cohort study.
Prediction of vocal cord dysfunction is essential after anterior cervical spine surgeries. This study aimed to detect the validity of transcutaneous laryngeal ultrasonography by both anterior and novel lateral approaches for prediction of vocal cord edema and paralysis after anterior cervical spine surgeries. A prospective cohort study conducted on 90 patients scheduled for anterior cervical spine surgeries underwent consecutive pre and postoperative vocal cord examination for edema and paralysis by both anterior and lateral approaches laryngeal ultrasonography. ⋯ Overall incidence of vocal cord paralysis was 16.6%. Risk of vocal cord paralysis was statistically significant more in female, multiple disc herniation, lower and mixed disc levels, Langenbeck retractor, cage and plate and duration of surgery ≥ 1.5 h. Transcutaneous Laryngeal ultrasound is a valid comfortable tool for prediction of vocal cord edema and paralysis after anterior cervical spine surgeries with superiority of the novel lateral over anterior approach.
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J Clin Monit Comput · Aug 2021
Assessment of spontaneous breathing during pressure controlled ventilation with superimposed spontaneous breathing using respiratory flow signal analysis.
Integrating spontaneous breathing into mechanical ventilation (MV) can speed up liberation from it and reduce its invasiveness. On the other hand, inadequate and asynchronous spontaneous breathing has the potential to aggravate lung injury. During use of airway-pressure-release-ventilation (APRV), the assisted breaths are difficult to measure. ⋯ In the mechanical subgroup the values for RRspont and MVspont the EVITA® showed higher values compared to Breath-Sep. We developed a computerized method for respiratory flow-curve based differentiation of breathing cycle components during mechanical ventilation with superimposed spontaneous breathing. Further studies in humans and optimizing of this technique is necessary to allow for real-time use at the bedside.
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J Clin Monit Comput · Aug 2021
Observational StudyPredictive value of the respiratory exchange ratio for the occurrence of postoperative complications in laparoscopic surgery: a prospective and observational study.
Indirect measurement of the respiratory exchange ratio (RER) has been shown to predict the occurrence of postoperative complications after major open non-cardiac surgery. Our main objective was to demonstrate the ability of the RER, indirectly measured by the anaesthesia respirator, to predict the occurrence of postoperative complications following laparoscopic surgery. We performed an observational, prospective and monocentric study. ⋯ One hour after insufflation, the FiO2-FetO2 difference was significantly lower and the RER was significantly higher in the complications subgroup than in the subgroup without complications (4.4/- 1.6% vs 5.8/- 1.2%, p = 0.001 and 0.95 [0.85-1.04] vs 0.83 [0.75-0.92], p = 0.04, respectively). The RER measured during laparoscopic surgery can predict the occurrence of postoperative complications. Trial registration The objectives and procedures of the study was registered at Clinicaltrials.gov (NCT03751579); date: November 23, 2018.
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J Clin Monit Comput · Aug 2021
Unexpected deposits in the anesthetic circuit: a possible cause of PEEP/Pmax valve malfunction.
PEEP is regulated by the internal PEEP/maximum peak inspiratory pressure limit (Pmax) valve. Malfunctioning of the PEEP/Pmax valve can result in the creation of unintentional or unstable PEEP, and a reduction of inspired tidal volume. Some of our Dräger Fabius® anesthesia machines were noted to exhibit changes in expiratory waveforms and unstable PEEP during general anesthesia. ⋯ The build-up of deposits occurred within a year after the previous regular inspection. Our troubleshooting process determined the issue with the PEEP/Pmax valve, which could go unnoticed because the valve is encased inside the breathing circuit, and requires disassembly for close inspection. Our findings should raise awareness regarding the importance of the preventive maintenance cycle as a safety precaution to keep the anesthetic circuit free of unexpected contamination.
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J Clin Monit Comput · Aug 2021
Observational StudyCardiovascular dynamics during peroral endoscopic myotomy for esophageal achalasia: a prospective observational study using non-invasive finger cuff-derived pulse wave analysis.
Peroral endoscopic myotomy (POEM) is natural orifice transluminal endoscopic surgery to treat esophageal achalasia. During POEM, cardiovascular dynamics can be impaired by capnoperitoneum, capnomediastinum, and systemic carbon dioxide accumulation. We systematically investigated changes in cardiovascular dynamics during POEM. ⋯ HR (median at baseline: 67 (60;72) bpm), CI (2.8 (2.5;3.2) L/min/m2), SVI (42 (34;51) mL/m2), and SVRI (1994 (1652; 2559) dyn × s × cm-5 × m-2) remained stable during POEM. Mixed model-derived 95% confidence limits of hemodynamic variables during POEM were 72 to 106 mmHg for MAP, 65 to 79 bpm for HR, 2.7 to 3.3 L/min/m2 for CI, 37 and 46 mL/m2 for SVI, and 1856 and 2954 dyn × s × cm-5 × m-2 for SVRI. POEM is a safe procedure with regard to cardiovascular dynamics as it does not markedly impair MAP, HR, CI, SVI, or SVRI.