Journal of clinical monitoring and computing
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J Clin Monit Comput · Apr 2017
FLOW-i ventilator performance in the presence of a circle system leak.
Recently, the FLOW-i anaesthesia ventilator was developed based on the SERVO-i intensive care ventilator. The aim of this study was to test the FLOW-i's tidal volume delivery in the presence of a leak in the breathing circuit. We ventilated a test lung model in volume-, pressure-, and pressure-regulated volume-controlled modes (VC, PC, and PRVC, respectively) with a FLOW-i. ⋯ Interestingly, VT did not differ appreciably from 6 to 0.3 L/min of fresh air flow among the 3 ventilatory modes. In the absence of leakage, peak inspiratory pressures were similar, while they were 35-45 % smaller in PRVC and VC than in PC mode in the presence of leaks. In conclusion, FLOW-i maintained VT (down to fresh gas flows of 0.3 L/min) to 90 % of its preset value in PC mode, which was 4-5 times greater than in VC or PRVC modes.
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J Clin Monit Comput · Apr 2017
Agreement in hemodynamic monitoring during orthotopic liver transplantation: a comparison of FloTrac/Vigileo at two monitoring sites with pulmonary artery catheter thermodilution.
To study agreement in cardiac index (CI), systemic vascular resistance index (Systemic VRI) and stroke volume variation (SV variation) between the FloTrac/Vigileo at radial and femoral arterial cannulation sites, and pulmonary artery catheter (PAC) thermodilution, in patients undergoing orthotopic liver transplantation. A prospective observational study of 25 adult patients with liver failure. Radial and femoral arteries were cannulated with standardised FloTrac/Vigileo arterial transducer kits and a PAC was inserted. ⋯ Agreement in SV variation between radial and femoral measurement sites approached a clinically acceptable threshold [mean difference (SD) 0.68 (2.44) %), LOA ±4.78 %]. FloTrac/Vigileo CI cannot substitute for PAC thermodilution CI, regardless of measurement site. SV variation measurements may be interchangeable between radial and femoral sites for determining fluid responsiveness.
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J Clin Monit Comput · Apr 2017
Observational StudyHeart rate time series characteristics for early detection of infections in critically ill patients.
It is difficult to make a distinction between inflammation and infection. Therefore, new strategies are required to allow accurate detection of infection. Here, we hypothesize that we can distinguish infected from non-infected ICU patients based on dynamic features of serum cytokine concentrations and heart rate time series. ⋯ There was no significant additional value of adding static cytokine levels or cytokine time series information to the generated decision tree model. The results suggest that heart rate is a better marker for infection than information captured by cytokine time series when the exact stage of infection is not known. The predictive value of (expensive) biomarkers should always be weighed against the routinely monitored data, and such biomarkers have to demonstrate added value.
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J Clin Monit Comput · Apr 2017
One operator's experience of ultrasound guided lumbar plexus block for paediatric hip surgery.
Lumbar plexus block has been shown to be effective for providing postoperative analgesia after major hip surgeries in children. The goal of the study was to evaluate the feasibility of ultrasound guidance during lumbar plexus block in children undergoing hip surgery for congenital hip dislocation. After obtaining local institutional ethical committee approval and parental informed consent, ASA I or II, 1-6 years old children undergoing hip surgery were included into the study. ⋯ Mean time for the first analgesic is found as 10 h after surgery. Only one patient required morphine in the recovery unit and 23 patients received paracetamol. US guided lumbar plexus block using Shamrock Method is an effective technique for providing postoperative analgesia after hip surgeries in children and it's effect lasts for 8-12 h after surgery.
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J Clin Monit Comput · Apr 2017
Hypoxic events and concomitant factors in preterm infants on non-invasive ventilation.
Automated control of inspired oxygen for newborn infants is an emerging technology, currently limited by reliance on a single input signal (oxygen saturation, SpO2). This is while other signals that may herald the onset of hypoxic events or identify spurious hypoxia are not usually utilised. We wished to assess the frequency of apnoea, loss of circuit pressure and/or motion artefact in proximity to hypoxic events in preterm infants on non-invasive ventilation. ⋯ Hypoxic events are frequently accompanied by respiratory pauses and/or motion artefact. Real-time monitoring and input of respiratory waveform may thus improve the function of automated oxygen controllers, allowing pre-emptive responses to respiratory pauses. Furthermore, use of motion-resistant oximeters and plethysmographic waveform assessment procedures will help to optimise feedback control of inspired oxygen delivery.