Journal of clinical monitoring and computing
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J Clin Monit Comput · Jun 2023
Randomized Controlled TrialIntubation using video laryngeal mask airway SaCoVLM and laryngeal mask airway Ambu® Aura-i in anesthetized children with microtia: a randomized controlled study.
The Ambu Aura-i laryngeal mask is considered to be a device for blind intubation as well as for fiberoptic guided intubation. The novel video laryngeal airway mask SaCoVLM is a supraglottic airway device that allows intubation under direct vision. We hypothesized that success rates for device placement and tracheal intubation with the SaCoVLM would be comparable with the Ambu Aura-i mask. A prospective, randomized clinical trial was conducted from March 2021 to December 2021. ⋯ The time for removal was slower in the SaCoVLM group than in the Ambu Aura-i group (20.8 s ± 0.8 versus 14.7 s ± 6.1; p < 0.01). The airway leak pressure was higher in the SaCoVLM group than in the Ambu Aura-i group (27.0 s ± 1.0 versus 22.3 s ± 3.6; p < 0.01), and the incidence of blood staining was higher in the SaCoVLM group (16.7%). The SaCoVLM has an overall comparable performance to the Ambu Aura-i mask. However, the SaCoVLM is better relative to direct intubation without the assistance of a flexible intubation scope, which reduces the device's demand.
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J Clin Monit Comput · Jun 2023
Clinical TrialChanges of the nociceptive flexion reflex threshold in patients undergoing cardiac surgery-a prospective clinical pilot study.
Opioid dosage for general anaesthesia and sedation relies on surrogate parameters such as heartrate and blood pressure. This implies the risk of both under- and overdosing. A promising tool to provide target-oriented opioid dosing is measuring the nociceptive flexion reflex threshold (NFRT). ⋯ Unless measurements are not prevented by technical issues NFRT-assessment appears to be a future tool to target analgesics in patients not able to self-report pain. Trial registration Study registration: DRKS00021617. https://www.drks.de/drks_web/navigate.do?navigationId=trial. HTML&TRIAL_ID=DRKS00021617 (registered retrospectively).
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J Clin Monit Comput · Jun 2023
Randomized Controlled TrialEvaluation of a new insertion site for arterial pressure line in intensive care unit management: a prospective study.
The arterial pressure line (A-line) is primarily inserted through the radial artery. However, accidental removal due to joint movement can be problematic in the intensive care unit (ICU). This study aimed to evaluate the safety and effectiveness of A-line insertion in the ICU through the distal radial approach (DRA), which is used in cardiac catheterization. ⋯ Guidewire use during insertion was significantly more common in the DRA group (P < 0.01) and post-puncture splint fixation was significantly more common in the TRA group (P < 0.01). Accidental removal, the primary endpoint, was observed in 10 patients with TRAs and 11 patients with DRAs, with no significant difference between the two groups (P > 0.99). DRA is as safe and effective as the TRA, suggesting that it is useful as a new A-line insertion site.
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J Clin Monit Comput · Jun 2023
Evaluation of patient state index, bispectral index, and entropy during drug induced sleep endoscopy with dexmedetomidine.
Multiple electroencephalographic (EEG) monitors and their associated EEG markers have been developed to aid in assessing the level of sedation in the operating room. While many studies have assessed the response of these markers to propofol sedation and anesthetic gases, few studies have compared these markers when using dexmedetomidine, an alpha-2 agonist. Fifty-one patients underwent drug induced sleep endoscopy with dexmedetomidine sedation. ⋯ Lightening secondary to RASS score assessment is significantly captured by all three commercial EEG metrics (p < 0.001). Commercial EEG monitors can capture changes in the brain state associated with the RASS score during dexmedetomidine sedation. PSI and Entropy were highly correlated and may be better suited for assessing deeper levels of sedation.
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J Clin Monit Comput · Jun 2023
Clinical TrialNoninvasive intracranial pressure waveforms for estimation of intracranial hypertension and outcome prediction in acute brain-injured patients.
Analysis of intracranial pressure waveforms (ICPW) provides information on intracranial compliance. We aimed to assess the correlation between noninvasive ICPW (NICPW) and invasively measured intracranial pressure (ICP) and to assess the NICPW prognostic value in this population. In this cohort, acute brain-injured (ABI) patients were included within 5 days from admission in six Intensive Care Units. Mean ICP (mICP) values and the P2/P1 ratio derived from NICPW were analyzed and correlated with outcome, which was defined as: (a) early death (ED); survivors on spontaneous breathing (SB) or survivors on mechanical ventilation (MV) at 7 days from inclusion. ⋯ Similar results were observed when decompressive craniectomy patients were excluded. In this study, P2/P1 derived from noninvasive ICPW assessment was well correlated with IHT. This information seems to be as associated with ABI patients outcomes as ICP. Trial registration: NCT03144219, Registered 01 May 2017 Retrospectively registered, https://www.clinicaltrials.gov/ct2/show/NCT03144219 .