Journal of clinical monitoring and computing
-
J Clin Monit Comput · Feb 2019
The impact of obesity on pulmonary deterioration in patients undergoing robotic-assisted laparoscopic prostatectomy.
Obesity affects respiratory and hemodynamic function in anesthetized patients. The aim of this study was to evaluate the influence of the body mass index (BMI) on pulmonary changes in a permanent 45° steep Trendelenburg position (STP) during robotic-assisted laparoscopic prostatectomy (RALP). 51 patients undergoing RALP under standardized anesthesia were included. Perioperative pulmonary function and oxygenation were measured in awake patients (T0), 20 min after the induction of anesthesia (T1), after insufflation of the abdomen in supine position (T2), after 30 min in STP (T3), when controlling Santorini's plexus in STP (T4), before awakening while supine (T5), and after 45 min in the recovery room (T6). ⋯ Changes in PIP, Pdriv and LC during RALP may be predicted in relation to patient's BMI for consideration in the preoperative setting. Trial registration number Z-2014-0387-6. Registered on 8 July 2014.
-
J Clin Monit Comput · Feb 2019
Observational StudyEvaluation of the novel non-invasive zero-heat-flux Tcore™ thermometer in cardiac surgical patients.
Tcore™ Sensor is a novel zero-heat-flux thermometer that estimates core temperature from skin over forehead. We tested the hypothesis that this system estimates core temperature to an accuracy within 0.5 °C. 40 cardiac surgical patients were enrolled (960 measurements). Reference core temperatures were measured in nasopharynx, pulmonary artery and the arterial branch of the oxygenator of the cardiopulmonary bypass (CPB) circuit. 95% Bland-Altman limits of agreement for repeated measurement data was used to study the agreement between Tcore™ thermometer and the reference methods. ⋯ The proportion of differences within 0.5 °C was 54.40% (95% CI 48.80-60.00%). LCCC was 0.74 (0.69-0.79). Cutaneous forehead zero-flux temperatures were not sufficiently accurate for routine clinical use in the cardiac surgical population.
-
J Clin Monit Comput · Feb 2019
Letter Case ReportsIntubation in prone position using AirTraq Avant videolaryngoscope.
Abstract
-
Several techniques are now available to detect and quantify pulmonary edema, from the laboratory postmortem method (gravimetry) to non-invasive wearable sensors. In critically ill patients with adult respiratory distress syndrome (ARDS), computed tomography scans are often performed to visualize lung lesions and quantify lung aeration, but their value seems somewhat limited to quantify pulmonary edema on a routine basis and of course to track changes with therapy. In this context, transpulmonary thermodilution is a convenient technique. ⋯ Echo probes are about to replace the stethoscope in our pocket and, if B lines (aka comet tails) do not allow a real quantification of pulmonary edema, they are useful to detect an increase in lung water. Finally, wireless and wearable sensors are now available to monitor patients on hospital wards and beyond (home monitoring). They should enable the detection of pulmonary congestion at a very early stage, and if combined with a proactive therapeutic strategy, have potential to improve outcome.
-
J Clin Monit Comput · Dec 2018
Observational StudyFeasibility of continuous sedation monitoring in critically ill intensive care unit patients using the NeuroSENSE WAVCNS index.
Sedation in the intensive care unit (ICU) is challenging, as both over- and under-sedation are detrimental. Current methods of assessment, such as the Richmond Agitation Sedation Scale (RASS), are measured intermittently and rely on patients' behavioral response to stimulation, which may interrupt sleep/rest. A non-stimulating method for continuous sedation monitoring may be beneficial and allow more frequent assessment. ⋯ Significant EEG suppression was detected in 3/15 (20%) participants. Observed RASS matched RASS goals in 36/89 (40%) assessments. The WAVCNS variability, and incidence of EEG suppression, highlight the limitations of using RASS as a standalone sedation measure, and suggests potential benefit of adjunct continuous brain monitoring.