Journal of clinical monitoring and computing
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J Clin Monit Comput · Apr 2014
A novel airway device with tactile sensing capabilities for verifying correct endotracheal tube placement.
We present a new device for verifying endotracheal tube (ETT) position that uses specialized sensors intended to distinguish anatomical features of the trachea and esophagus. This device has the potential to increase the safety of resuscitation, surgery, and mechanical ventilation and decrease the morbidity, mortality, and health care costs associated with esophageal intubation and unintended extubation by potentially improving the process and maintenance of endotracheal intubation. ⋯ It is intended to detect the presence or absence of tracheal rings immediately upon inflation of the airway occlusion cuff. The initial study detailed here verifies that a prototype device can detect contours similar to tracheal rings in a tracheal model.
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J Clin Monit Comput · Apr 2014
Review Case ReportsGlideScope video laryngoscopy use tracheal intubation in patients with ankylosing spondylitis: a series of four cases and literature review.
Airway management in patients with ankylosing spondylitis (AS) is a challenging problem for anesthesiologists. The GlideScope video laryngoscope (GVL) is designed to assist tracheal intubation for patients with a difficult airway. The aim of the study was to report the successful intubation by GVL of four AS patients, and to discuss the use of GVL for tracheal intubation in patients with AS by performing a review of the literature. ⋯ As with any challenging airway management, it is essential to have a rescue strategy. We believe that GVL can be a good alternative for oral endotracheal intubation in patients with AS. This series is very small and the reader should be very cautious about drawing broad conclusions regarding the GVL and patients with AS.
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J Clin Monit Comput · Apr 2014
Reliable real-time calculation of heart-rate complexity in critically ill patients using multiple noisy waveform sources.
Heart-rate complexity (HRC) has been proposed as a new vital sign for critical care medicine. The purpose of this research was to develop a reliable method for determining HRC continuously in real time in critically ill patients using multiple waveform channels that also compensates for noisy and unreliable data. Using simultaneously acquired electrocardiogram (Leads I, II, V) and arterial blood pressure waveforms sampled at 360 Hz from 250 patients (over 375 h of patient data), we evaluated a new data fusion framework for computing HRC in real time. ⋯ Furthermore, the fusion of waveform sources produced better error density distributions than those derived from individual waveforms. The data fusion framework was shown to provide in real-time a reliable continuously streamed HRC value, derived from multiple waveforms in the presence of noise and artifacts. This approach will be validated and tested for assessment of HRC in critically ill patients.
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J Clin Monit Comput · Apr 2014
Practice guidelines for the supervising professional: intraoperative neurophysiological monitoring.
The American Society of Neurophysiological Monitoring (ASNM) was founded in 1988 as the American Society of Evoked Potential Monitoring. From the beginning, the Society has been made up of physicians, doctoral degree holders, technologists, and all those interested in furthering the profession. The Society changed its name to the ASNM and held its first Annual Meeting in 1990. ⋯ Adherence to a literature-based, formalized process characterizes the construction of all ASNM guidelines. The guidelines covering the Professional Practice of intraoperative monitoring were established by a committee of nearly 30 total participants and ultimately endorsed by the Board of Directors of ASNM on January 24th 2013. That document follows.
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J Clin Monit Comput · Apr 2014
Controlled Clinical TrialEnd-tidal versus manually-controlled low-flow anaesthesia.
During low-flow manually-controlled anaesthesia (MCA) the anaesthetist needs constantly adjust end-tidal oxygen (EtO2) and anaesthetic concentrations (EtAA) to assure an adequate and safe anaesthesia. Recently introduced anaesthetic machines can automatically maintain those variables at target values, avoiding the burden on the anaesthetist. End-tidal-controlled anaesthesia (EtCA) and MCA provided by the same anaesthetic machine under the same fresh gas flow were compared. ⋯ In MCA patients the number of manual adjustments to stabilize EtAA and EtO2 were 137 and 107, respectively; no adjustment was required in EtCA. Low-flow anaesthesia delivered with an anaesthetic machine able to automatically control EtAA and EtO2 provided the same clinical stability and avoided the continuous manual adjustment of delivered sevoflurane and oxygen concentrations. Hence, the anaesthetist could dedicate more time to the patient and operating room activities.