Journal of clinical monitoring and computing
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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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J Clin Monit Comput · Apr 2010
Comparative Study Controlled Clinical TrialChanges in R-Wave amplitude in DII lead is less sensitive than pulse pressure variation to detect changes in stroke volume after fluid challenge in ICU patients postoperatively to cardiac surgery.
The amplitude of R-wave in DII lead (RDII) has been shown to correlate to central blood volume in animal and healthy volunteers. The aim of this study was to assess if change in RDII (DeltaRDII) after passive leg rise (PLR) and fluid loading would allow detecting preload dependence in intensive care ventilated patients. This parameter was compared to concomitant changes in pulse arterial pressure (DeltaPP). ⋯ DeltaRDII in response to PLR does not successfully help identifying preload dependent patients contrarily to DeltaPP or change in stroke volume.
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J Clin Monit Comput · Apr 2010
Index of consciousness and bispectral index values are interchangeable during normotension and hypotension but not during non pulsatile flow state during cardiac surgical procedures: a prospective study.
Awareness under anesthesia is an avoidable complication during general anesthesia. Anesthetic depth monitors assist anesthesiologists in providing appropriate levels of anesthesia. Index of consciousness monitoring is a recently introduced monitor in the array of anesthesia depth monitors. The objective of this study was to assess the interchangeability of bispectral index, which is already in clinical use and the recently introduced index of consciousness techniques. The other objective was to assess this interchangeability during normotension, hypotension and during pulseless state in patients undergoing coronary artery bypass graft surgery. This study is a prospective observational study, conducted in a tertiary referral hospital. ⋯ The bispectral index and index of consciousness values may be interchangeable. The interchangeability is better appreciated during normotension and hypotension but not during non pulsatile state of cardiopulmonary bypass.
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J Clin Monit Comput · Apr 2010
Case ReportsLeak in the breathing circuit: CO2 absorber and human error.
A couple of reports in literature have mentioned CO2 absorbers to be the cause for breathing circuit leak during anesthesia. Defective canister, failure to close the absorber chamber and overfilling of the chamber with sodalime were the problems in these reports. Among these, the last two are reports of human error resulting in problems. We report a case where despite taking precautions in this regard, we experienced a significant leak in the system due to a problem with the CO2 absorber, secondary to human error.
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J Clin Monit Comput · Apr 2010
A novel laparoscopic pulse oximeter device. An easy, efficient and cost- effective way of detecting arterial structures.
The introduction of laparoscopy has revolutionized surgery. However, these new techniques have brought new problems into the surgical field. ⋯ Therefore, there is still a strong need for developing additional tools to help mapping the anatomy. We designed a laparoscopic pulse oximeter device, which offers an easy, efficient and cost- effective way of using pulse oximetry in combination with a standard laparoscopic clamp in order to identify arterial structures.