Journal of clinical monitoring and computing
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J Clin Monit Comput · Oct 2008
Pulse and systolic pressure variation assessment in partially assisted ventilatory support.
The use of pulse pressure variation (PPV) and systolic pressure variation (SPV) is possible during controlled ventilation (MV). Even in acute respiratory failure, controlled MV tends to be replaced by assisted ventilatory support. We tested if PPV and SPV during flow triggered synchronized intermittent mechanical ventilation (SIMV) could be as accurate as in controlled MV. ⋯ PPV and SPV measured during SIMV fitted with the findings in controlled MV. Dynamic indexes could be accurately monitored in patients breathing with assisted respiratory assistance adding an imposed large enough SIMV breath.
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J Clin Monit Comput · Aug 2008
Randomized Controlled TrialA randomized-controlled study of intrathecal versus epidural thoracic analgesia in patients undergoing abdominal cancer surgery.
We sought to determine the effectiveness of continuous intrathecal thoracic analgesia (ITA) in comparison with continuous epidural thoracic analgesia (ETA) for the management of postoperative pain after abdominal cancer surgery in a randomised controlled study. ⋯ ITA and ETA produced the same levels of analgesia, without relevant complications.
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J Clin Monit Comput · Aug 2008
Comparative StudyContinuous, non-invasive techniques to determine cardiac output in children after cardiac surgery: evaluation of transesophageal Doppler and electric velocimetry.
Continuous and non-invasive measurement of cardiac output (CO) may contribute helpful information to the care and treatment of the critically ill pediatric patient. Different methods are available but their clinical verification is still a major problem. ⋯ In pediatric patients non-invasive measurement of CO and SV with TED and EV is useful for continuous monitoring after heart surgery. Both new methods seem to underestimate cardiac output in terms of absolute values. However, TED shows tolerable bias and precision and may be helpful for continuous CO monitoring in a deeply sedated and ventilated pediatric patient, e.g. in the operating room or intensive care unit.
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J Clin Monit Comput · Aug 2008
Noninvasive detection of the hemodynamic stress of exercise using the photoplethysmogram.
Exercise induced hemodynamic stress has been studied extensively using a wide range of physiological sensors. While athletes can modulate their training intensity using EKG-based heart rate monitors, there are currently no noninvasive monitors that can be used to ascertain with a high degree of certainty the hemodynamic stress an individual is experiencing because of fatigue or an underlying pathology. We propose that cardiac stress will result in detectable changes in skin blood flow. ⋯ As volitional fatigue approached, the low frequency (f = 0.05-0.2 Hz) amplitude modulation observed in the PPG became more pronounced; then, within several seconds of the cessa- tion of the protocol, they disappeared. Using a software-based detector, these distinct waves are reliably detected, with a low incidence of false positives, in all subjects before the onset of volitional fatigue. We hypothesize that the low frequency waves observed in the PPG of individuals exercising to volitional fatigue provide a mechanism for noninvasively detecting hemodynamic stress to the human vascular system.