Journal of clinical monitoring and computing
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J Clin Monit Comput · Jun 2014
Clinical TrialVariations in the pre-ejection period induced by deep breathing do not predict the hemodynamic response to early haemorrhage in healthy volunteers.
Monitoring that can predict fluid responsiveness is an unsettled matter for spontaneously breathing patients. Mechanical ventilation induces cyclic variations in blood pressure, e.g. pulse pressure variation, whose magnitude predicts fluid responsiveness in mechanically ventilated patients. In this study, we hypothesised that a deep breathing manoeuvre with its effect on heart rate variability (HRV) could induce similar cyclic variations in blood pressure in spontaneously breathing healthy subjects and that the magnitude of these variations could predict the hemodynamic response to controlled haemorrhage. 37 blood donors were instructed to perform two simple deep breathing manoeuvres prior to blood donation; one manoeuvre with a respiratory cycle every 10 s (0.1 Hz) and one every 6 s (0.167 Hz). ⋯ At none of the respiratory manoeuvres was ∆PEP nor ∆PEP/RMSSD prior to haemorrhage correlated to changes in cardiac output following haemorrhage. Deep breathing induces cyclic changes in blood pressure that are strongly dependent on HRV. These blood pressure variations do, however, not predict the cardiac output response to controlled haemorrhage.
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J Clin Monit Comput · Jun 2014
Clinical TrialIntraoperative flash VEPs are reproducible in the presence of low amplitude EEG.
Flash visual evoked potentials (FVEPs) are often irreproducible during surgery. We assessed the relationship between intraoperative FVEP reproducibility and EEG amplitude. Left then right eyes were stimulated by goggle light emitting diodes, and FVEPs were recorded from Oz–Fz′ (International 10-20 system) in 12 patients. ⋯ Raising the low cut filter to 10 and 30 Hz (in two patients) progressively reduced EEG and FVEP amplitude, reduced amplifier blocking time and improved FVEP reproducibility. FVEPs were more reproducible in the presence of low amplitude EEG than high amplitude EEG. This is the first report describing the effect of EEG amplitude on FVEP reproducibility during surgery
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J Clin Monit Comput · Jun 2014
Randomized Controlled TrialEffect of preloading epidural space with normal saline on the incidence of complications of epidural catheter placement and spinal anesthesia for cesarean section.
To evaluate the effect of preloading the epidural space with normal saline (NS) on the incidence of complications of epidural catheter placement and spinal anesthesia for cesarean section. Two hundred and ninety parturients at full term, who were scheduled for cesarean section under combined spinal-epidural anesthesia were randomly divided into two groups: group control (I) and group NS (II). The epidural puncture was performed at the estimated L3-4 interspace with a Tuohy needle attached to a 5 ml syringe. ⋯ Blood vessel trauma in group II was significantly lower than in group I, P < 0.05. However, the incidence of paraesthesia was similar between the two groups, P > 0.05. Preloading the epidural space with NS can decrease the incidence of clinically apparent injury to blood vessels during epidural catheter placement, and can improve the effects of spinal analgesia, but does not reduce the incidence of paraesthesia.
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J Clin Monit Comput · Jun 2014
An active one-lobe pulmonary simulator with compliance control for medical training in neonatal mechanical ventilation.
Mechanical ventilation is a current support therapy for newborns affected by respiratory diseases. However, several side effects have been observed after treatment, making it mandatory for physicians to determine more suitable approaches. High fidelity simulation is an efficient educational technique that recreates clinical experience. ⋯ An innovative software-based simulator for training neonatologists and nurses within the continuing medical education program on respiratory disease management was validated. Following the clinical needs, three friendly graphic user interfaces were implemented for simulating three different clinical scenarios (spontaneous breathing, controlled breathing and triggered/assisted ventilation modalities) thus providing physicians with an active experience. The proposed pulmonary simulator has the potential to be included in the range of computer-driven technologies used in medical training, adding novel functions and improving simulation results.
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J Clin Monit Comput · Jun 2014
Application of internal electrodes to the oesophageal and tracheal tube in an animal trial: evaluation of its clinical and technical potentiality in electrical impedance tomography.
Electrical impedance tomography (EIT) is of potential medical interest e.g., to optimize ventilator settings during mechanical ventilation. Nevertheless there are still several challenges. Although electrode belts are commonly used and promoted, they are not necessarily adequate for the long-term monitoring of patients in intensive-care units (ICU). ⋯ Distinguishability of lungs was improved in reconstructed frames. The resulting sensitivity of measured electrical impedance was enhanced around the mediastinal region and even cardiac-related activity was significantly increased by a factor of up to 6. In conclusion the application of internal electrodes appears to be beneficial for diverse clinical purposes and should be addressed in further studies.