Journal of clinical monitoring and computing
-
J Clin Monit Comput · Aug 2022
Randomized Controlled TrialComparing the first-attempt tracheal intubation success of the hyperangulated McGrath® X-blade vs the Macintosh-type CMAC videolaryngoscope in patients with cervical immobilization: a two-centre randomized controlled trial.
We compared the hyperangulated McGrath X-blade with the Macintosh-type CMAC videolaryngoscope through the use of manual in-line stabilization on patients. The primary hypothesis was that the McGrath X-blade has a similar first-attempt success rate as the CMAC videolaryngoscope. 210 patients of ASA physical status I to III, aged 21 to 80 years old, undergoing general anesthesia requiring tracheal intubation were prospectively recruited into this two-centre randomized controlled trial, from June 2016 to April 2019. Patients with history of or predicted difficult airway, pre-existing dental risks, BMI > 35 kg/m2, cervical spondylosis or myelopathy, aspiration risks, patients who declined to participate or lacked the mental capacity to give consent were excluded. ⋯ Our study did not demonstrate a significant difference in efficacy between the McGrath X-blade and the CMAC videolaryngoscope. In patients with manual in-line stabilization, no anticipated airway difficulty and in the hands of experienced operators, the McGrath X-blade provided superior glottic views but conferred no advantage over the C-MAC, with a longer median time to intubation compared to the CMAC videolaryngoscope. Trial registration: Australian New Zealand Clinical Trial Registry (ACTRN12616000668404).
-
J Clin Monit Comput · Aug 2022
Randomized Controlled TrialEffect of pressure-controlled ventilation-volume guaranteed mode combined with individualized positive end-expiratory pressure on respiratory mechanics, oxygenation and lung injury in patients undergoing laparoscopic surgery in Trendelenburg position.
The study aimed to investigate the efficacy of PCV-VG combined with individual PEEP during laparoscopic surgery in the Trendelenburg position. 120 patients were randomly divided into four groups: VF group (VCV plus 5cmH2O PEEP), PF group (PCV-VG plus 5cmH2O PEEP), VI group (VCV plus individual PEEP), and PI group (PCV-VG plus individual PEEP). Pmean, Ppeak, Cdyn, PaO2/FiO2, VD/VT, A-aDO2 and Qs/Qt were recorded at T1 (15 min after the induction of anesthesia), T2 (60 min after pneumoperitoneum), and T3 (5 min at the end of anesthesia). The CC16 and IL-6 were measured at T1 and T3. ⋯ At T3, the concentration of CC16 in PI group was lower compared with other groups, and IL-6 level of PI group was decreased than that in VF and VI group. In conclusion, the patients who underwent laparoscopic surgery, PCV-VG combined with individual PEEP produced favorable lung mechanics and oxygenation, and thus reducing inflammatory response and lung injury. Clinical Trial registry: chictr.org. identifier: ChiCTR-2100044928.
-
J Clin Monit Comput · Aug 2022
ReviewPreoperative heart rate variability as a predictor of perioperative outcomes: a systematic review without meta-analysis.
Heart rate variability (HRV) is a predictor of mortality and morbidity after non-lethal cardiac ischemia, but the relation between preoperatively measured HRV and intra- and postoperative complications is sparsely studied and most recently reviewed in 2007. We, therefore, reviewed the literature regarding HRV as a predictor for intra- and postoperative complications and outcomes. We carried out a systematic review without meta-analysis. ⋯ Detrended fluctuation analysis of HRV is a promising candidate for predicting postoperative atrial fibrillation. This updated review of the relation between preoperative HRV and surgical outcome suggests a clinically relevant role of HRV but calls for high quality studies due to methodological heterogeneity in the current literature. Areas for future research are suggested.
-
J Clin Monit Comput · Aug 2022
Observational StudyComparison of cutaneous facial temperature using infrared thermography to standard temperature measurement in the critical care setting.
To assess the accuracy and precision of infrared cameras compared to traditional measures of temperature measurement in a temperature, humidity, and distance controlled intensive care unit (ICU) population. This was a prospective, observational methods comparison study in a single centre ICU in Metropolitan Melbourne, Australia. A convenience sample of 39 patients admitted to a single room equipped with two ceiling mounted thermal imaging cameras was assessed, comparing measured cutaneous facial temperature via thermal camera to clinical temperature standards. ⋯ It has a moderate ability to discriminate fever. It is unclear if this would be sensitive enough for infection screening purposes. Fig. 1 Bland-Altman plots for temperatures measured using clinical standards to infrared camera. a Wide-angle camera versus bladder temperature. b Narrow-angle camera versus bladder temperature.
-
J Clin Monit Comput · Aug 2022
Changes in corrected carotid flow time induced by recruitment maneuver predict fluid responsiveness in patients undergoing general anesthesia.
Non-invasive methods to assess patients' fluid responsiveness during lung-protective ventilation are needed. We hypothesized changes in the corrected carotid flow time induced by the recruitment maneuver predict fluid responsiveness under general anesthesia. Thirty patients undergoing general anesthesia in the supine position were prospectively enrolled. ⋯ The optimal threshold for changes in the corrected flow time was - 11.7% with a sensitivity of 95.0% (95% CI 75.1-99.9%) and a specificity of 80.0% (95% CI 44.4-97.5%). The gray-zone of changes in the corrected flow time was from - 25.1 to - 12.2% and included 12 patients (40%). Changes in the corrected carotid flow time were a useful, technically easy-to-perform, and non-invasive method to predict fluid responsiveness without a need for hemodynamic monitoring or arterial cannulation.