Journal of clinical monitoring
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although the waveform derived from a peripheral pulse monitor or pulse oximeter may resemble an arterial pressure waveform, it is in fact a visualization of blood volume change in transilluminated tissue caused by passage of blood: an indication of perfusion or blood flow. Most currently available pulse oximeters indicate this flow, but few display it in usable form. Since adequate tissue blood flow is a prerequisite for normal metabolic activity, it is a parameter that should merit a place in standard anesthesia or intensive care monitors. ⋯ The importance and application of the Valsalva effect on the waveform is emphasized. This effect is particularly applicable for monitoring adequate fluid loading and the action of vasodilator drugs, which are both important in anesthesia. Differences between the arterial pulse pressure wave and tissue flow wave are discussed, as well as the cause of certain artifacts, including the wandering dicrotic notch.
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Comparative Study
Reproducibility of thermodilution cardiac output determination in critically ill patients: comparison between bolus and continuous method.
A semi-continuous thermodilution method (CCO) was recently developed to measure cardiac output with less risk of bacterial contamination, fluid overload, and user-induced errors than the classical bolus technique (BCO). Previous comparison between these two methods showed negligible bias. However, large limits of agreement suggest that the two methods are not interchangeable. We hypothesized that this poor agreement may be due to differences in reproducibility. ⋯ Differences in reproducibility may explain the poor agreement between the CCO and BCO methods. The better reproducibility of the CCO method allows the detection of smaller variations in cardiac output and suggests the superiority of this new method.
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To study the usefulness of three electro-encephalographic descriptors, the average median frequency, the average 90% spectral edge frequency, and a bispectral variable were used with the anesthetic concentrations in estimating the depth of anesthesia. ⋯ The bispectral variable seems to reduce the non-linearity in the boundary separating the class of non-responders from the class of responders. Consequently, the neural network based on the bispectral variable is less complex than the neural network that uses a power spectral variable as one of its inputs.
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Monitoring jugular venous oxygen saturation (SjvO2) has been useful for the early identification and treatment of cerebral ischemia in patients with severe head injury. However, the catheters that have been used for this purpose have not performed optimally. The purpose of this study was to evaluate the performance of a new regional oxygen saturation catheter for monitoring SjvO2. ⋯ The new regional oxygen saturation catheter provided reliable measurement of SjvO2 83% of the time when the signal quality index was < or = 3, and may be useful for continuous monitoring of SjvO2.
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The accuracy and precision of the new IRMA (Immediate Response Mobile Analysis System, Diametrics, Inc., St. Paul, MN) handheld blood gas analyzer was compared with that of two benchtop blood gas analyzers. The IRMA consists of a notebook-sized machine and disposable cartridges, each containing a pH, a CO2 and an O2 electrode, and provides bedside (point-of-care) blood gas analysis. ⋯ The new technology incorporated in the IRMA blood gas analyzer provides results with an accuracy that is similar to that of benchtop analyzers, but with all of the advantages of point-of-care analysis.