Journal of clinical monitoring and computing
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J Clin Monit Comput · Apr 2019
Assessing the correct inflation of the endotracheal tube cuff: a larger pilot balloon increases the sensitivity of the 'finger-pressure' technique, but it remains poorly reliable in clinical practice.
The pilot balloon palpation (or 'finger-pressure') method is still widely used to assess the endotracheal tube cuff inflation, despite consistent evidence of its poor sensitivity in recognizing cuff overinflation. It was recently speculated that this may be related to the lower wall tension (due to the smaller radius) of the pilot balloon as compared with the cuff, according to Laplace's law. To verify this hypothesis and, secondarily, to assess whether the use of a 'large' pilot balloon (identical to the cuff) increases the reliability of this technique, 62 anesthetists (41 experienced anesthesiologists and 21 residents) were asked to estimate the pressure of a cuff inflated to 88 mmHg into a simulated trachea by feeling both a usual and a modified 'large' pilot balloon. ⋯ Moreover, 89% of participants (85% of experienced anesthesiologists and 95% of residents) believed that pressure was higher in the 'large' balloon than in the normal one. However, only 32% of participants (51% of experienced anesthesiologists and none of residents) recognized slight overinflation (40 mmHg) after feeling the 'large' balloon. The pilot balloon size affects the sensitivity of the 'finger-pressure' technique, but it remains poorly reliable with a larger pilot balloon.
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J Clin Monit Comput · Apr 2019
Measurement of blood-oxygen saturation using a photoacoustic technique in the rabbit hypoxemia model.
The golden standard method to obtain accurate blood oxygen saturation is blood gas analysis that needs invasive procedure of blood sampling. Photoacoustic technique enables us to measure real-time blood oxygen saturation without invasive procedure. The aim of this study is to use the photoacoustic technique, an optical method, for accurately determining oxygen saturation in vivo. ⋯ The oxygen saturation calculated using calibration curves 1 and 2 showed strong correlations with the reference standard in regression analysis (R = 0.965, 0.964, respectively). The Bland-Altman analysis revealed better agreement and precision with calibration curve 2, whereas there was significant underestimation of values obtained using calibration curve 1. Photoacoustic measurement of oxygen saturation using calibration curve 2 provided an accurate estimate of oxygen saturation, which was similar to that obtained using a portable blood-gas analyzer.
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J Clin Monit Comput · Apr 2019
Comment LetterIn response: Blood CO2 exchange monitoring, Haldane effect and other calculations in sepsis and critical illness.
Abstract
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Clinical monitoring and technology are at the heart of anesthesiology, and new technological developments will help to define how anesthesiology will evolve as a profession. Anesthesia related research published in the JCMC in 2018 mainly pertained to ICU sedation with inhaled agents, anesthesia workstation technology, and monitoring of different aspects of depth of anesthesia.
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J Clin Monit Comput · Apr 2019
Randomized Controlled TrialComparison of conventional fluid management with PVI-based goal-directed fluid management in elective colorectal surgery.
Intraoperative fluid management is quite important in terms of postoperative organ perfusion and complications. Different fluid management protocols are in use for this purpose. Our primary goal was to compare the effects of conventional fluid management (CFM) with the Pleth Variability Index (PVI) guided goal-directed fluid management (GDFM) protocols on the amount of crystalloids administered, blood lactate, and serum creatinine levels during the intraoperative period. ⋯ The length of hospital stay was found to be similar in both group. PVI-guided GDFM might be an alternative to CFM in ASA I-II patients undergoing elective colorectal surgery. However, further studies need to be carried out to search the efficiency and safety of PVI.