Journal of clinical monitoring
-
A computer-based system was developed for monitoring cardiac output using the Fick principle during general anesthesia. The variables of the oxygen-consumption Fick equation were measured using the following system: oxygen uptake by an originally developed respiratory gas monitoring system, arteriovenous oxygen saturation difference by pulse and fiberoptic oximetry, and hemoglobin concentration by an in vitro oximeter. Fick cardiac output and systemic vascular resistance were calculated every 30 seconds. ⋯ The Fick cardiac output was significantly lower than the thermodilution cardiac output, especially in the low flow range. We demonstrated that this new monitoring system was clinically feasible and sufficiently accurate, under the limited circumstances of our study. The integration of routinely used equipment has made possible a frequently repeatable method for estimating cardiac output in patients.
-
We have described a computerized data acquisition system for clinical investigation that can record over fifty physiologic variables from up to twenty-four electronic monitors. The information is acquired by a personal computer using RS-232C serial communications and analog-to-digital conversion. ⋯ The system records parameter or waveform information and writes the data into a file that can be accessed by commercially available graphical and statistical packages. The data acquisition system is easy to use, transportable, and inexpensive.
-
Prediction of flow capability in intravenous infusion systems: implications for fluid resuscitation.
The pressure-flow (P-F) relationship for intravenous infusion systems is nonlinear and may be expressed by the quadratic model P = RLF + RTF2. The flow parameters RL and RT may represent the resistance of laminar and turbulent flow, respectively. In this study pressure and flow were measured, and RL and RT were calculated for several infusion tubings, catheter, and system components. ⋯ The order of devices removed or replaced, from largest to least pressure drop, was as follows: fluid warmer, 16-gauge catheter, check valve, 14-gauge catheter, standard-bore Y tubing, 12-gauge catheter, and standard-bore stopcock, leaving 10-gauge catheter + wide tubing. Devices with large RT, such as fluid warmers and check valves that produce large pressure drops, should generally be avoided during fluid resuscitation when high flows are needed. A similar ordering of device removal or substitution (largest to least pressure drop) was determined using the traditional but incorrect linear P-F model, P = RF, and the order of devices chosen for elimination was different.(ABSTRACT TRUNCATED AT 250 WORDS)
-
End-tidal carbon dioxide (ETCO2) values obtained from awake nonintubated patients may prove to be useful in estimating a patient's ventilatory status. This study examined the relationship between arterial carbon dioxide tension (PaCO2) and ETCO2 during the preoperative period in 20 premedicated patients undergoing various surgical procedures. ETCO2 was sampled from a 16-gauge intravenous catheter pierced through one of the two nasal oxygen prongs and measured at various oxygen flow rates (2, 4, and 6 L/min) by an on-line ETCO2 monitor with analog display. ⋯ Values for subgroups within the patient population were also analyzed, and it was shown that patients with minute respiratory rates greater than 20 but less than 30 and patients age 65 years or older did not differ from the overall studied patient population with regard to PaCO2-ETCO2 difference. A small subset of patients with respiratory rates of 30/min or greater (n = 30) did show a significant increase in the PaCO2-ETCO2 difference (P less than 0.001). It was concluded that under the conditions of this study, peak ETCO2 values did correlate with PaCO2 values and were not significantly affected by oxygen flow rate.(ABSTRACT TRUNCATED AT 250 WORDS)
-
The most efficient site for monitoring heart and lung sounds by esophageal stethoscope is not the warmest segment of the esophagus. This study investigated the ability of passive warming of airway gases to increase the accuracy of temperatures measured at this site (i.e., to decrease their difference from core temperature). In 15 adult patients undergoing general anesthesia and endotracheal intubation, esophageal temperatures were measured before and after use of a heat and moisture exchanger (an artificial nose) that passively warmed inspired gases. ⋯ After passive warming of inspired gases, esophageal temperatures increased significantly (mean increase +/- SD, 0.5 +/- 0.2 degrees C; P less than or equal to 0.001) but inconsistently (range, 0.1 to 1.2 degrees C). However, the mean difference between esophageal and nasopharyngeal temperatures was still significant (0.5 +/- 0.3 degrees C; P less than 0.001). Discrepancies between esophageal and core temperatures persist when a currently available esophageal stethoscope with adjacent auscultation chamber and temperature probe is used, despite passive warming of airway gases.