Journal of clinical monitoring and computing
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Capnography has become a standard of perioperative monitoring in pediatric anesthesiology. It has also begun to find application in a variety of situations outside the perioperative setting. While the use of capnography has been increasing, the dissemination and acceptability of capnography in all areas of pediatrics has been variable. The purpose of this study was to describe all the applications and interpretations of capnography that have been reported in children. ⋯ Capnography has been proven to be a useful non-invasive perioperative monitor of the physiology and safety of the child. This list of the clinical applications and interpretations of capnography could find use in teaching and simulation in pediatrics.
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J Clin Monit Comput · Apr 2010
Review Meta AnalysisVentilator-associated pneumonia: current status and future recommendations.
Ventilator-associated pneumonia (VAP) is a common hazardous complication in ICU patients. The aim of the current review is to give an update on the current status and future recommendations for VAP prevention. ⋯ EBPG consensus includes: elevation of the head of the bed, use of daily "sedation vacations" and decontamination of the oropharynx. Technological solutions should aim to use the most comprehensive combination of subglottic suction of secretions, optimization of ETT cuff pressure and ultrathin cuffs. VAP is a type of hospital-acquired pneumonia that develops more than 48 h after endotracheal intubation. Its incidence is estimated to be 9-27%, with a mortality of 25-50% [Am J Respir Crit Care Med 171:388-416 (2005), Am J Med 85:499-506 (1988), Chest 122:2115-2121 (2002), Intensive Care Med 35:9-29 (2009)]. The most important target in VAP handling is its prevention. The aim of this article is to review the pathogenesis, epidemiology and the different strategies/technologies for prevention of VAP.
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Monitoring of aortic blood flow, conducting large portions of the cardiac output (CO), allows conclusions on the global hemodynamic status of patients. For this purpose, transesophageal Doppler (TED) devices have been developed, which interrogate the descending aorta and calculate aortic blood flow velocity using the Doppler principle. The recorded velocity-time curve can be used to estimate CO as well other advanced hemodynamic parameters such as preload, afterload and myocardial contractility. ⋯ However, several assumptions are needed to translate the measured Doppler frequency shift to hemo- dynamic variables and discrepancies between the assumed and the actual condition may introduce a considerable risk for erroneous calculations. A correct interpretation of the displayed parameters requires profound knowledge on the technical basis of this method as well as its technical limitations. Our review focuses on these technical aspects which the clinician should be familiar with to allow proper use of TED monitoring devices.
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J Clin Monit Comput · Oct 2009
ReviewSpinal cord stimulation: principles of past, present and future practice: a review.
Electric energy have been in use for the treatment of various ailments, including pain, since the time of Pharaohs. The theoretical basis of electrotherapy of pain was provided by the Gate Control Theory of Melzak and Wall. ⋯ The indications for SCS is growing and the technology involved in this is rapidly advancing, however, high level of scientific evidence is still lacking to support this form of therapy due to difficulties in blinding and comparing with control groups. Future developments in SCS could include, combined SCS-drug delivery system, bio feedback and closed loop systems.
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J Clin Monit Comput · Feb 2008
ReviewEvaluations of physiological monitoring displays: a systematic review.
The purpose of this paper is to present the findings from a systematic review of evaluation studies for physiologic monitoring displays, centered on empirical assessments across all available settings and samples. The findings from this review give readers the opportunity to examine past work across studies and set the stage for the design and conduct of future evaluations. ⋯ The advent of integrated graphical displays ushered a new era into physiological monitoring display designs. All but one study reported significant differences between traditional, numerical displays and novel displays; yet we know little about which graphical displays are optimal and why particular designs work. Future authors should use a theoretical model or framework to guide the study design, focus on other clinical study participants besides anesthesiologists, employ additional research methods and use more realistic and complex tasks and settings to increase external validity.