Journal of clinical monitoring and computing
-
The Systolic pressure variation (SPV) is known to be a sensitive indicator of hypovolemia. However, the SPV may be elevated due to other reasons, such as changes in lung compliance or tidal volumes. Using the SPV to monitor the hemodynamic status of patients in the prone position may, therefore, be problematic due to possible effects of increased abdominal pressure on both venous return and lung compliance. The purpose of this study is to examine whether or not the SPV changes significantly when placing the patient in the prone position. ⋯ This study is important because it shows for the first time that the SPV does not change significantly in the prone position, and may therefore continue to be used as an indicator of the volume status. It also would appear to indicate that our methods for protecting the chest and abdomen in the prone position are effective.
-
J Clin Monit Comput · Oct 2009
Monitoring of reactive hyperemia using photoplethysmographic pulse amplitude and transit time.
Peripheral arterial tonometry and Ultrasound measurement of flow mediated dilation have been the widely reported noninvasive techniques to assess vasodilation during reactive hyperemia (RH). ⋯ Results suggests that PTT response reflects the myogenic components in the early part of RH and PPG amplitude response reflects the metabolic component reinforcing the later course of RH. PPG amplitude and PTT can be used to quantify the changes in diameter and tone of the vessel wall, respectively during RH. The collective responses of PPG amplitude and PTT can be more appropriate to facilitate PPG technique for monitoring of vasodilation caused by RH.
-
J Clin Monit Comput · Oct 2009
ReviewSpinal cord stimulation: principles of past, present and future practice: a review.
Electric energy have been in use for the treatment of various ailments, including pain, since the time of Pharaohs. The theoretical basis of electrotherapy of pain was provided by the Gate Control Theory of Melzak and Wall. ⋯ The indications for SCS is growing and the technology involved in this is rapidly advancing, however, high level of scientific evidence is still lacking to support this form of therapy due to difficulties in blinding and comparing with control groups. Future developments in SCS could include, combined SCS-drug delivery system, bio feedback and closed loop systems.
-
J Clin Monit Comput · Oct 2009
Comparative StudyThe mean machine; accurate non-invasive blood pressure measurement in the critically ill patient.
Accurate indirect prehospital blood pressure measurement in the critically ill patient remains an important challenge to both patient management and prehospital research. Ambulatory blood pressure measuring devices have not been trialled for prehospital use in critically ill patients. Prior to prehospital validation where conditions are suboptimal, we aimed to test under favourable conditions in the Intensive Care Unit, a selection of ambulatory devices that may be suitable for use in the field. ⋯ In the Intensive Care Unit, the performance of one device, the Oscar 2, surpassed the others and fulfilled the AAMI protocol criteria for mean pressure measurement. This device is suitable for prehospital validation.
-
J Clin Monit Comput · Oct 2009
Clinical TrialA novel electronic algorithm for detecting potentially insufficient anesthesia: implications for the prevention of intraoperative awareness.
A recent clinical trial compared a minimum alveolar concentration (MAC)-based protocol to an electroencephalography (EEG)-based protocol for the prevention of intraoperative awareness. One limitation of this study design is that MAC-based protocols are not sensitive to the use of intravenous agents, while EEG-based protocols are. Our objective was to develop a MAC alert that incorporates intravenous agents. ⋯ Our novel electronic alerting system incorporates both age-adjusted MAC and intravenous anesthesia, and triggers with a higher frequency in cases of awareness. These data suggest the potential for our system to alert clinicians to insufficient anesthesia.