Journal of clinical monitoring
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The pulmonary elimination of the volume of CO2 per breath (VCO2/br, integration of product of airway flow (V) and PCO2 over a single breath) is a sensitive monitor of cardio-pulmonary function and tissue metabolism. Negligible inspired PCO2 results when the capnometry sampling site (SS) is positioned at the entry of the inspiratory limb to the airway circuit. In this study, we test the hypothesis that moving SS lungward will result in significant inspired CO2 (VCO2[I]), that needs to be excluded from VCO2/br. ⋯ When the SS was moved lungward from the inspiratory limb, instrumental dead space (VDINSTR) increased and, at end-expiration, contained exhaled CO2 from the previous breath. During the next inspiration, this CO2 was rebreathed relative to SS (i.e. VCO2[I]), and contributed to VCO2[E]. Thus, VCO2[E] overestimated VCO2/br (%error) by the amount of rebreathing, which was exacerbated by larger VDINSTR (increased VCO2[I]) or smaller VT (increased VCO2[I]-to-VCO2/br ratio).
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The safety of a new continuous cardiac output monitoring system, recently introduced by Baxter Healthcare Corporation's Edwards Critical-Care Division, was evaluated in normal sheep. The study compared the biocompatibility and safety of the Vigilance CCO Monitoring System, which employs a continuous cardiac output (CCO) catheter with Baxter Edward's standard Paceport pulmonary artery catheter. The CCO catheter, which monitors hemodynamic pressures and provides continuous measurement of cardiac output based on the thermodilution principle, contains a thermal filament that is powered and controlled by a unique cardiac output monitor. ⋯ In acute groups, these changes consisted of a localized myofiber degeneration or necrosis, while in subacute and recovery groups, consisted only of fibrosis. None of the changes were clinically significant. Thus, the CCO catheter, used in conjunction with the Vigilance CCO Monitoring System, appears to pose no additional risk over a standard Paceport catheter in normal sheep after continuous use for up to 7 days.
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Comparative Study
Monitoring body-core temperature from the trachea: comparison between pulmonary artery, tympanic, esophageal, and rectal temperatures.
We designed an endotracheal tube (ETT) for acquiring body-core temperature from the trachea. This ETT had two temperature sensors, one attached to the inside surface of the cuff, the other mounted on the ETT shaft underneath the cuff. The ETT was evaluated in vitro and in dogs to determine: 1) optimal position of temperature sensors and 2) the responsiveness, accuracy, and resistance to ventilatory artifacts. ⋯ The cuff of the ETT is a reliable site for measuring body-core temperature in intubated patients.
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To develop an in-line microwave fluid warming system that eliminates the difficulties of uneven heating that are characteristic of batch-mode microwave fluid warmers. ⋯ The combination of proportional and adaptive control is successful in controlling the permanent magnet magnetron microwave energy to heat the icewater tested. The in-line microwave warmer has the potential to become a successful medical fluid warmer. More study is needed to determine the stability of the control system under clinical conditions, and to evaluate its utility for warming blood.