Journal of clinical monitoring and computing
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J Clin Monit Comput · Aug 2009
Yet another cause for blocked sidestream capnogram--beware of the non-threaded cap mount in heat and moisture exchangers.
Heat and moisture exchangers (HME) are commonly used during general anaesthesia and intensive care of patients on mechanical ventilators. Some of the HME manufacturers provide HMEs with a Luer lock fitting for connecting side stream CO(2) monitoring line, Luer lock cap, and a non-threaded cap mount. ⋯ This can create confusion to the clinicians and can result in inadvertent connection of the CO(2) monitoring line to the non-threaded cap mount resulting in blocked CO(2) monitoring line and leak in the circuit. We caution all the anaesthesiologists and intensivists regarding this possibility while using HMEs from different manufacturers.
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J Clin Monit Comput · Jun 2009
Low minimum alveolar concentration alarm: a standard for prevention of awareness during general anaesthesia maintained by inhalational anaesthetics.
Awareness during general anaesthesia is a rare but significant problem that can be frightening to the patients. We suggest that newer generation monitors should include this facility to provide a low alarm limit to MAC settings so as to improve the quality of patient care. Also we suggest that a "near empty" alarm be incorporated into vaporizers which can warn the anaesthesiologist prior to development of possible light plane of anaesthesia. We hope that adopting these two features can help enhance patient safety and can further aid in quality assurance.
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J Clin Monit Comput · Jun 2009
Randomized Controlled TrialImproved accuracy of cardiac output estimation by the partial CO2 rebreathing method.
This study investigated the accuracy of the NICO monitor equipped with the newer software. Additionally, the effects of the increased dead space produced by the NICO monitor on ventilatory settings were investigated. ⋯ This study demonstrated the improved performance of the NICO monitor with updated software. The performance of the NICO monitor with ver. 4.2 or later software is similar to CCO. However, the cardiac output measurement did not fulfill the criteria of interchangeability to the cardiac output measurement by bolus thermodilution. Updates to ver. 5.0 attenuated the effects of rebreathing introduced by the NICO monitor without compromising the accuracy of the cardiac output measurement.
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J Clin Monit Comput · Jun 2009
A poor correlation exists between oscillometric and radial arterial blood pressure as measured by the Philips MP90 monitor.
In anesthesia and critical care, invasive arterial blood pressure monitoring is the gold standard against which other methods of monitoring are compared. In this assessment of the Philips MP90 monitor, the objective was to determine whether or not oscillometric measurements were within the accuracy standards set by the Association for the Advancement of Medical Instrumentation (AAMI) and the British Hypertension Society (BHS). Three hundred and one invasive and noninvasive paired measurements were obtained from eleven adult patients on the neurosurgical service at Stanford University Medical Center. ⋯ When the BHS guidelines were applied, the device merited a grade "D" for systolic and mean arterial pressure, and a grade "C" for diastolic pressure, with the highest possible grade level being "A." There was a poor correlation between noninvasive and invasive measurements of arterial blood pressure as measured with a cuff and radial arterial cannula using the Philips MP90 monitor. These inaccuracies could lead to unnecessary interventions, or lack of appropriate interventions in anesthetic management. Further study is needed to specify the absolute inaccuracy of the monitor, and to determine if accuracy between the two methods varies with patient co-morbidities, surgical procedures, or anesthetic management.
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J Clin Monit Comput · Jun 2009
Randomized Controlled Trial Comparative StudyComparison between a dorsal and a belt tactile display prototype for decoding physiological events in the operating room.
Vibrotactile display technology represents an innovative method to communicate vital information on patients from physiological monitoring devices to clinicians. The increasing number of sensors used in clinical practice has increased the amount of information required to be communicated, overwhelming the capacity of visual and auditory displays. The capacity to communicate could be increased with the use of a tactile display. In this study, we have compared a dorsal (DTD) and belt tactile (TB) display prototype in terms of learnability, error rate, and efficiency. ⋯ The communication of information on physiological parameters by tactile displays was easy to learn and accurate for both prototypes. The DTD was easier to learn and affected less by distraction. Further evaluation is required in a clinical setting with expert users to determine the clinical applicability of these prototypes.