Journal of clinical monitoring and computing
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J Clin Monit Comput · Apr 2022
Effects of PEEP on the relationship between tidal volume and total impedance change measured via electrical impedance tomography (EIT).
Electrical impedance tomography (EIT) is used in lung physiology monitoring. There is evidence that EIT is linearly associated with global tidal volume (VT) in clinically healthy patients where no positive end-expiratory pressure (PEEP) is applied. This linearity has not been challenged by altering lung conditions. ⋯ The variance in VTEIT was best described by peak inspiratory pressure (PIP) and PEEP (adjusted R2 0.82) while variance in VTSpiro was best described by PIP and airway deadspace (adjusted R2 0.76). The relationship between VTEIT and VTSpiro remains linear with changes in tidal volume, and stable across altered lung conditions. This may have application for monitoring and assessment in vivo.
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J Clin Monit Comput · Apr 2022
Pupillary unrest, opioid intensity, and the impact of environmental stimulation on respiratory depression.
Opioid-induced respiratory depression (OIRD) confers significant morbidity, but its onset can be challenging to recognize. Pain or stimulation effects of conversation may mask or attenuate common clinical manifestations of OIRD. We asked whether pupillary unrest could provide an objective signal of opioid exposure, and whether this signal would be independent from the confounding influence of extrinsic stimulation. ⋯ PUAL is a consistent indicator of opioid effect, and distinguishes higher opioid concentrations independently of the stimulating effects of conversational interaction. Under equivalent opioid exposure, conversational interaction delayed the onset and minimized the severity of OIRD. Clinical trial registration: NCT04301895.
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J Clin Monit Comput · Apr 2022
LetterUse of flexible video bronchoscope for verification of nasogastric tube position in the intubated patient.
We propose a novel method for verifying the nasogastric tube (NGT) position and tip localization using flexible video bronchoscopy in anesthetized and intubated adult patients. The length of the scope used is 65 cm and can thus, track the NGT up to the pyloric canal. We have used this technique in patients with success. ⋯ The stomach is identified by the red mucosa and random tortuous folds (Fig. 1b). The pyloric canal can be identified by the convergence of gastric mucosal folds leading to the pyloric opening (Fig. 1c). In each case, the subdiaphragmatic position of NGT was verified with radiography, which is a routine practice in our institute.
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J Clin Monit Comput · Apr 2022
Non-invasive electrical cardiometry cardiac output monitoring during prehospital helicopter emergency medical care: a feasibility study.
Introducing advanced hemodynamic monitoring might be beneficial during Helicopter Emergency Medical Service (HEMS) care. However, it should not increase the on-scene-time, it should be easy to use and should be non-invasive. The goal of this study was to investigate the feasibility of non-invasive cardiac output measurements by electrical cardiometry (EC) and the quality of the EC signal during pre-hospital care provided by our HEMS. ⋯ Cardiac output measurements are feasible during prehospital HEMS care with good quality of the EC signal. Monitoring was easy to use and quick to install. In our view it is an promising candidate for the prehospital setting. Further research is needed to determine its clinical value during clinical decision making.
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J Clin Monit Comput · Apr 2022
ReviewPropofol detection for monitoring of intravenous anaesthesia: a review.
This paper presents a review of established and emerging methods for detecting and quantifying the intravenous anaesthetic propofol in solution. There is growing evidence of numerous advantages of total intravenous anaesthesia using propofol compared to conventional volatile-based anaesthesia, both in terms of patient outcomes and environmental impact. However, volatile-based anaesthesia still accounts for the vast majority of administered general anaesthetics, largely due to a lack of techniques for real-time monitoring of patient blood propofol concentration. Herein, propofol detection techniques that have been developed to date are reviewed alongside a discussion of remaining challenges.