Journal of clinical monitoring and computing
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J Clin Monit Comput · Aug 2019
Selection of cuffed endotracheal tube for children with congenital heart disease based on an ultrasound-based linear regression formula.
It remains to be discovered whether a formula predicting the subglottic transverse diameter measured by ultrasound (SGDformula) for the selection of an appropriate endotracheal tube (ETT) for children without congenital heart disease (CHD) is useful for children with CHD. A formula for predicting SGD was established after assessing 60 children ≤ 8 years without CHD and validated on 60 children with CHD. We selected the cuffed ETT size based on the SGD by ultrasound (SGDultra). ⋯ And the mean bias (SGDformula-ETT size and SGDultra-ETT size) was 0.21 mm (95% confidence interval, - 0.59 to 1.01 mm) and 0.00 mm (- 0.79 to 0.84 mm). For the CHD group, the ultrasound-based method yielded a 78% success rate of ETT size choice, while the formula-based method permitted an appropriate ETT size in only 32% of subjects (P < 0.001). Our analysis showed that measuring the SGDultra was more accurate in predicting the correct OD of the ETT in children with CHD undergoing cardiovascular surgery, based on the correlation and agreement with ETT OD.
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J Clin Monit Comput · Aug 2019
Mathematical arterialisation of peripheral venous blood gas for obtainment of arterial blood gas values: a methodological validation study in the clinical setting.
Arterial blood gas (ABG) analysis is an essential tool in the clinical assessment of acutely ill patients. Venous to arterial conversion (v-TAC), a mathematical method, has been developed recently to convert peripheral venous blood gas (VBG) values to arterialized VBG (aVBG) values. The aim of this study was to test the validity of aVBG compared to ABG in an emergency department (ED) setting. ⋯ Bland-Altman plot revealed clinically acceptable mean difference and limits-of-agreement intervals between ABG and aVBG pH and pCO2, but not between ABG and aVBG pO2. Arterialization of VBG using v-TAC is a valid method for measuring pH and pCO2, but not for pO2. Larger clinical studies are required to evaluate the applicability of v-TAC in different patient subpopulations.
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J Clin Monit Comput · Aug 2019
Can variable practice habits and injection port dead-volume put patients at risk?
Injection ports used to administer medications and draw blood samples have inherent dead-volume. This volume can potentially lead to inadvertent drug administration, contribute to erroneous laboratory values by dilution of blood samples, and increase the risk of vascular air embolism. We sought to characterize provider practice in management of intravenous (IV) and arterial lines and measure dead-volumes of various injection ports. ⋯ Mean (SD) dead-volume in microliters ranged from 0.1 (0.0) to 5.6 (1.0) in 1-way injection ports and from 54.1 (2.8) to 126.5 (8.3) in 4-way injection ports. The practices of our providers when giving medications and drawing blood samples are variable. The dead-volume associated with injection ports used at our institution may be clinically significant, increasing errors in medication delivery and laboratory analysis.
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J Clin Monit Comput · Jun 2019
Thoracic fluid content: a novel parameter for detection of pulmonary edema in parturients with preeclampsia.
Acute pulmonary oedema is a serious complication of preeclampsia. Early detection of pulmonary edema in preeclampsia would improve fluid management and would also allow earlier detection of severe cases. The aim of this work is to evaluate the ability of thoracic fluid content measured by electrical cardiometry for early detection of pulmonary edema in parturients with preeclampsia. ⋯ In parturients with preeclampsia, both lung ultrasound score and thoracic fluid content showed excellent properties for detection pulmonary edema. The high negative predictive value of both tests makes them useful screening tests to rule out pulmonary edema. The excellent correlation between both measures suggests that electrical cardiometry could be a promising surrogate to ultrasound for assessment of extravascular lung water.
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J Clin Monit Comput · Jun 2019
Change in staff anesthesiologists' opinions of an Anesthesia Information Management System (AIMS).
Following introduction of an Anesthesia Information Management System (AIMS) at a tertiary care, academic health sciences centre, a quality assurance initiative was conducted to assess staff opinions of the AIMS using a previously published, anonymous survey tool at 1 and 5 years following AIMS introduction. At 5 years compared to 1 year after implementation of AIMS, the majority (18 of 24, 75%) of responses to the survey questions had a statistically significant change (P < 0.05) in the proportion of respondents favoring AIMS compared to the 1 year survey. Domains noted to be more favorable 5 years compared to 1 year after AIMS introduction included patient safety in the Operating Rooms and Post-Anesthesia Care Unit, quality of handover and overall documentation, and communication amongst healthcare workers. The ideal time period at which to assess AIMS after introduction is not clear.