Journal of clinical monitoring and computing
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J Clin Monit Comput · Oct 2013
Case ReportsAssessment and confirmation of tracheal intubation when capnography fails: a novel use for an USB camera.
A 62 year old male with a right pyriform fossa lesion extending to the right arytenoid and obscuring the glottic inlet was planned for laser assisted excision. Direct laryngoscopic assessment after topicalization of the airway, showed a Cormack Lehane grade 3 view. ⋯ Capnography may not be reliable as a sole indicator of confirmation of correct endotracheal tube placement. Video laryngoscopy may provide additional confirmation of endotracheal intubation.
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J Clin Monit Comput · Oct 2013
Review Meta AnalysisHeart rate variability indices for very short-term (30 beat) analysis. Part 1: survey and toolbox.
Heart rate variability (HRV) analysis over very short (<60 s) periods may be useful for monitoring dynamic changes in autonomic nervous system activity where steady-state conditions are not maintained (e.g. during drug administration, or the start or end of exercise). From the 1980s there has been a wealth of HRV indices produced in the quest for better measures of the change in parasympathetic and sympathetic activity. Many of the indices have been sparingly used and have not been investigated for application to short-term use. ⋯ The survey identified a comprehensive list of 115 indices that were subsequently coded and screened. Of these, 70 were unique and produced a finite number with 60 s data, so are included in the Toolbox. These indices require validation against physiological data before they can be applied to short-term HRV analysis of cardiac autonomic nervous system activity.
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J Clin Monit Comput · Oct 2013
Randomized Controlled TrialUmesh's intubation detector (UID) for rapid and reliable identification of tracheal intubation by novices in anaesthetised, paralysed adult patients.
Oesophageal intubation can lead to life threatening complications if left undetected. Several devices and techniques are available to confirm tracheal intubation and for early detection of oesophageal intubation. This study was carried out to evaluate the utility of the Umesh's intubation detector device for rapid and reliable differentiation of tracheal from oesophageal intubation by novice users. ⋯ Out of the total 100 oesophageal intubations, 99 were correctly identified. There were no complications related to the study. Umesh's intubation detector device can be used by novices for rapid and reliable differentiation of tracheal from oesophageal intubation in healthy adult patients.
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J Clin Monit Comput · Oct 2013
Randomized Controlled TrialRespiratory parameters as a surrogate marker for duration of intubation: potential application of automated vital sign collection.
Prolonged time during endotracheal tube placement has been associated with poor outcomes, including cardiac arrest and death. For this reason, the accurate measurement of the duration of intubation time is an important metric in studies that evaluate interventions to improve airway outcomes. In the current study we correlated the gaps in routinely measured ventilatory parameters with duration of the intubation procedure to determine if these intervals could be used to accurately calculate the intubation time. ⋯ The gap in measured tidal volume of 39 ± 53 s most closely approximated the actual duration of intubation of 38 ± 28 s, (R(2) = 0.85, y = x - 0.87). During intubation, the disappearance gaps in tidal volume, and the airway pressure and flow waveforms highly correlate with the duration of the intubation procedure and may be useful in the evaluation of airway management interventions. However, just as there are limitations to a labor-intensive method of recording airway management timing, there are limitations to using an automated method.
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J Clin Monit Comput · Oct 2013
Case ReportsErroneous continuous cardiac output by calibrated pulse contour analysis.
Pulse contour analysis techniques are used for beat-to-beat tracking of cardiac output in critically ill patients. However, an adequate pulse pressure waveform signal and identification of the appropriate (i.e. systolic) part of the waveform by the monitor are crucial for correct calculation of continuous cardiac output. ⋯ We would like to emphasize the importance of visually checking the waveform for any irregularities that may cause erroneous calculations before initiating a therapy based on these values. One advantage of the system used here is that the part of the pressure curve used for analysis is automatically indicated.