Journal of clinical monitoring
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To evaluate the utility of the iSTAT blood analyzer, a bedside device for hematocrit, sodium, potassium, and glucose measurement during cardiopulmonary bypass (CPB). ⋯ In summary, we found that in patients undergoing CPB, the iSTAT values agreed sufficiently well with standard laboratory values and that the iSTAT instrument can be relied upon for bedside measurements.
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Resistance to fluid infusion can be derived from measurements of pressure at two or more flow rates. We measured resistance in 31 patients using a pressure-monitoring infusion pump (Model 560, IVAC) by recording pressure at five flow rates (0, 50, 100, 200, and 300 mL/hr), and computing resistance as the slope of the pressure versus flow curve. Resistance was measured subcutaneously (Rtissue) and intravenously (Rvein) immediately after unsuccessful or successful IV catheter placement. ⋯ The median value for Rvein was 62 RU (range -13.6 to 420 RU), and for Rtissue, 544 RU (range 65.7 to 4170 RU). Receiver operating characteristic (ROC) analysis revealed that a 200-RU threshold detected infiltration with 0.90 sensitivity and 0.91 specificity. We conclude that elevated resistance during fluid infusion is an important early and easily measurable finding in fluid extravasation.
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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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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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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.