Journal of clinical monitoring and computing
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J Clin Monit Comput · Dec 2012
Airway management practices in adult intensive care units in Israel: a national survey.
Timely and adequate management of normal and compromised airway is a crucial task facing medical teams taking care of patients in intensive care units. We investigated the airway management practices in the Israeli intensive care units (ICUs). A postal survey was sent to the 20 main ICUs in Israel. ⋯ Equipment and medications necessary for airway management are available in most of the units. Difficult airways in ICUs are mainly managed by anesthesiologists and ENT surgeons. Few ICUs have quality assurance meetings.
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J Clin Monit Comput · Dec 2012
Case ReportsTranscranial Doppler monitoring of middle cerebral flow velocity in a patient with a ventriculoperitoneal shunt undergoing laparoscopy.
Laparoscopic surgery is possibly associated with a risk of intracranial pressure (ICP) increase due to pneumoperitoneum in patients with ventriculoperitoneal shunts (VPS). Invasive techniques for shunt pressure monitoring are not routinely used because of the possible complications. Transcranial Doppler (TCD) is a non-invasive, safe method which gives accurate information about blood-flow velocities in basal cerebral arteries and indirectly about the ICP. ⋯ We report the use of TCD for middle cerebral flow velocity monitoring in a patient with a VPS who underwent laparoscopic surgery. In the case we present, during 60 min of pneumoperitoneum, TCD showed a sustained, but not clinically significant increase of the Pulsatility Index, with a recorded maximum change of 31 %. We consider that the use of TCD may increase the safety of laparoscopic procedures in patients with preexisting VPS.
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J Clin Monit Comput · Dec 2012
Randomized Controlled TrialValidation of the new intubation detector device: a manikin study.
This study was done to validate the utility of Umesh's intubation detector in detection of tracheal or oesophageal intubation in manikin using volunteers with different levels of experience in tracheal intubation (including novices). The Sim Man II, (Laerdal Medical AS, Norway) manikin was used. Two cuffed tracheal tubes of size 6.5 mm ID were used. ⋯ Out of a total 100 performances, 99 were correctly identified. On one instance, a tube placed in trachea was incorrectly interpreted to be in the oesophagus by a novice. Umesh's intubation detector helps in rapid and reliable confirmation of tracheal intubation in manikin irrespective of the experience level of the assessor in tracheal intubation.
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J Clin Monit Comput · Dec 2012
Randomized Controlled TrialA beat-by-beat, on-line, cardiovascular index, CARDEAN, to assess circulatory responses to surgery: a randomized clinical trial during spine surgery.
Automated assessment of circulatory response to surgical stimuli is unsolved. Would detection of cardiac baroreflex inhibition assess adequacy of intra-operative anti-nociception upon incision, as performed on-line on a beat-by-beat basis by a cardiovascular index, CARDEAN™? 18 ASA I-II patients undergoing spinal disc repair were studied, in a prospective randomized single-blinded trial (observational study). During infusion of propofol to maintain bispectral index between 40 and 60, patients were allocated to receive an effect site target-controlled infusion of remifentanil at Ce = 2 or 4 ng ml(-1). ⋯ Upon skin incision, CARDEAN increased in the remifentanil Ce = 2 ng ml(-1) group (n = 7, P < 0.05), while it did not increase in the remifentanil Ce = 4 ng ml(-1) group (n = 7, P = 0.18). During surgery, retrospectively, CARDEAN > 60 was associated with tachycardia and hypertension (P (k) = 0.81 ± 0.10). Changes in CARDEAN appeared linked to adequacy of anti-nociception.
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J Clin Monit Comput · Dec 2012
Randomized Controlled TrialThe utility of bispectral index monitoring for sedated patients treated with low-dose remifentanil.
The aim of the present study was to determine the effect of low-dose remifentanil on the monitoring quality of the Bispectral index for mechanically ventilated patients. Twelve patients who underwent elective surgery and required mechanical ventilation post-operatively were enrolled in this study with written informed consent. Eligible patients were divided into two groups. ⋯ These values were assessed by single regression analysis and a P value of <0.05 was considered significant. There was a significant correlation between RASS and BIS values (P = 3 × 10(-12), R (2) = 0.67) in the remifentanil group, but not in the control group (P = 0.50, R (2) = 0.057). The administration of low-dose remifentanil makes BIS a more precise tool for sedated patients under mechanical ventilation in the ICU.