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Scarano A, Inchingolo F, Rapone B, Festa F, Rexhep Tari S, Lorusso F. Protective Face Masks: Effect on the Oxygenation and Heart Rate Status of Oral Surgeons during Surgery. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052363. [PMID: 33670983 PMCID: PMC7967725 DOI: 10.3390/ijerph18052363] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 02/21/2021] [Accepted: 02/24/2021] [Indexed: 12/23/2022]
Abstract
Background: Safety in medical work requires eye protection, such as glasses, and protective facial masks (PFM) during clinical practice to prevent viral respiratory infections. The use of facial masks and other full personal protective equipment increases air flow resistance, facial skin temperature and physical discomfort. The aim of the present study was to measure surgeons’ oxygenation status and discomfort before and after their daily routine activities of oral interventions. Methods: 10 male voluntary dentists, specializing in oral surgery, and 10 male voluntary doctors in dentistry, participating in master’s courses in oral surgery in the Department of Oral Surgery of the University of Chieti, with mean age 29 ± 6 (27–35), were enrolled. This study was undertaken to investigate the effects of wearing a PFM on oxygenation status while the oral surgeons were actively working. Disposable sterile one-way surgical paper masks (Surgical Face Mask, Euronda, Italy) and FFP2 (Surgical Face Mask, Euronda, Italy) were used and the mask position covering the nose did not vary during the procedures. The FFP2 was covered by a surgical mask during surgical treatment. A pulse oximeter was used to measure the blood oximetry saturation during the study. Results: In all 20 surgeons wearing FFP2 covered by surgical masks, a reduction in arterial O2 saturation from around 97.5% before surgery to 94% after surgery was recorded with increase of heart rates. A shortness of breath and light-headedness/headaches were also noted. Conclusions: In conclusion, wearing an FFP2 covered by a surgical mask induces a reduction in circulating O2 concentrations without clinical relevance, while an increase of heart frequency and a sensation of shortness of breath, light-headedness/headaches were recorded.
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Affiliation(s)
- Antonio Scarano
- Department of Innovative Technologies in Medicine & Dentistry, University of Chieti-Pescara, Via dei Vestini, 31, 66100 Chieti, Italy; (F.F.); (S.R.T.)
- Correspondence: ; Tel.: +39-0871-3554-084; Fax: +39-0871-3554-099
| | - Francesco Inchingolo
- Department of Interdisciplinary Medicine, University of Medicine Aldo Moro, 70124 Bari, Italy;
| | - Biagio Rapone
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, “Aldo Moro” University of Bari, 70121 Bari, Italy;
| | - Felice Festa
- Department of Innovative Technologies in Medicine & Dentistry, University of Chieti-Pescara, Via dei Vestini, 31, 66100 Chieti, Italy; (F.F.); (S.R.T.)
| | - Sergio Rexhep Tari
- Department of Innovative Technologies in Medicine & Dentistry, University of Chieti-Pescara, Via dei Vestini, 31, 66100 Chieti, Italy; (F.F.); (S.R.T.)
| | - Felice Lorusso
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Via dei Vestini, 31, 66100 Chieti, Italy;
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A flow-leak correction algorithm for pneumotachographic work-of-breathing measurement during high-flow nasal cannula oxygen therapy. Med Eng Phys 2018; 54:32-43. [PMID: 29487038 DOI: 10.1016/j.medengphy.2018.02.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 12/07/2017] [Accepted: 02/11/2018] [Indexed: 11/22/2022]
Abstract
Measuring work of breathing (WOB) is an intricate task during high-flow nasal cannula (HFNC) therapy because the continuous unidirectional flow toward the patient makes pneumotachography technically difficult to use. We implemented a new method for measuring WOB based on a differential pneumotachography (DP) system, equipped with one pneumotachograph inserted in the HFNC circuit and another connected to a monitoring facemask, combined with a leak correction algorithm (LCA) that corrects flow measurement errors arising from leakage around the monitoring facemask. To test this system, we used a mechanical lung model that provided data to compare LCA-corrected respiratory flow, volume and time values with effective values obtained with a third pneumotachograph used instead of the LCA to measure mask flow leaks directly. Effective and corrected volume and time data showed high agreement (Bland-Altman plots) even at the highest leak. Studies on two healthy adult volunteers confirmed that corrected respiratory flow combined with esophageal pressure measurements can accurately determine WOB (relative error < 1%). We conclude that during HFNC therapy, a DP system combined with a facemask and an algorithm that corrects errors due to flow leakages allows pneumotachography to measure reliably the respiratory flow and volume data needed for calculating WOB.
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Britton D, Roeske A, Ennis SK, Benditt JO, Quinn C, Graville D. Utility of Pulse Oximetry to Detect Aspiration: An Evidence-Based Systematic Review. Dysphagia 2017; 33:282-292. [PMID: 29243086 DOI: 10.1007/s00455-017-9868-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 11/22/2017] [Indexed: 11/29/2022]
Abstract
Pulse oximetry is a commonly used means to measure peripheral capillary oxyhemoglobin saturation (SpO2). Potential use of pulse oximetry to detect aspiration is attractive to clinicians, as it is readily available, quick, and noninvasive. However, research regarding validity has been mixed. This systematic review examining evidence on the use of pulse oximetry to detect a decrease in SpO2 indicating aspiration during swallowing is undertaken to further inform clinical practice in dysphagia assessment. A multi-engine electronic search was conducted on 8/25/16 and updated on 4/8/17 in accordance with standards published by the Preferred Reporting for Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA). Inclusion criteria included use of pulse oximetry to detect aspiration with simultaneous confirmation of aspiration via a gold standard instrumental study. Keywords included dysphagia or aspiration AND pulse oximetry. Articles meeting criteria were reviewed by two blinded co-investigators. The search yielded 294 articles, from which 19 were judged pertinent and reviewed in full. Ten met the inclusion criteria and all were rated at Level III-2 on the Australian Diagnostic Levels of Evidence. Study findings were mixed with sensitivity ranging from 10 to 87%. Potentially confounding variables were observed in all studies reviewed, and commonly involved defining "desaturation" within a standard measurement error range (~ 2%), mixed populations, mixed viscosities/textures observed during swallowing, and lack of comparison group. The majority of studies failed to demonstrate an association between observed aspiration and oxygen desaturation. Current evidence does not support the use of pulse oximetry to detect aspiration.
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Affiliation(s)
- Deanna Britton
- Department of Speech & Hearing Sciences, Portland State University (PSU), Portland, OR, USA. .,Northwest Clinic for Voice and Swallowing (NWCVS), Department of Otolaryngology - Head & Neck Surgery, Oregon Health & Sciences University (OHSU), Portland, OR, USA.
| | - Amy Roeske
- Providence Sacred Heart Medical Center, Spokane, WA, USA
| | | | - Joshua O Benditt
- Division of Pulmonary and Critical Care Medicine, University of Washington Medical Center (UWMC), Seattle, WA, USA
| | - Cassie Quinn
- Department of Speech & Hearing Sciences, Portland State University (PSU), Portland, OR, USA
| | - Donna Graville
- Northwest Clinic for Voice and Swallowing (NWCVS), Department of Otolaryngology - Head & Neck Surgery, Oregon Health & Sciences University (OHSU), Portland, OR, USA
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4
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Abstract
The main goals of assessing respiratory system mechanical function are to evaluate the lung function through a variety of methods and to detect early signs of abnormalities that could affect the patient's outcomes. In ventilated patients, it has become increasingly important to recognize whether respiratory function has improved or deteriorated, whether the ventilator settings match the patient's demand, and whether the selection of ventilator parameters follows a lung-protective strategy. Ventilator graphics, esophageal pressure, intra-abdominal pressure, and electric impedance tomography are some of the best-known monitoring tools to obtain measurements and adequately evaluate the respiratory system mechanical function.
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5
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Bien UDS, Souza GF, Campos ES, Farah de Carvalho E, Fernandes MG, Santoro I, Costa D, Arena R, Sampaio LMM. Maximum inspiratory pressure and rapid shallow breathing index as predictors of successful ventilator weaning. J Phys Ther Sci 2015; 27:3723-7. [PMID: 26834339 PMCID: PMC4713778 DOI: 10.1589/jpts.27.3723] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 09/17/2015] [Indexed: 12/05/2022] Open
Abstract
[Purpose] To investigate the predictive value of maximum inspiratory pressure (MIP) and
the rapid shallow breathing index (RSBI) in a ventilator weaning protocol and to evaluate
the differences between clinical and surgical patients in the intensive care unit.
[Subjects and Methods] Patients aged ≥15 years who underwent orotracheal intubation for
mechanical ventilation and who met the criteria of the weaning protocol were included in
the study. Receiver operating characteristic (ROC) curves were calculated for the analysis
of each index. [Results] Logistic regression analysis was also performed. MIP showed
greater sensitivity and specificity [area under the curve (AUC): 0.95 vs. 0.89] and
likelihood ratios (LR) (positive(+): 20.85 vs. 9.45; negative(−): 0.07 vs. 0.17) than RSBI
in the overall sample (OS) as well as in clinical patients (CP) (AUC: 0.99 vs. 0.90; LR+:
24.66 vs. 7.22; LR-: 0.01 vs. 0.15) and surgical patients (SP) (AUC: 0.99 vs. 0.87; LR+:
9.33 vs. 5.86; LR−: 0.07 vs. 0.14). The logistic regression analysis revealed that both
parameters were significantly associated with the weaning success. The MIP showed greater
accuracy than the RSBI (OS: 0.93 vs. 0.85; CP: 0.98 vs. 0.87; SP: 0.93 vs. 0.87).
[Conclusion] Both parameters are good predictors of successful ventilator weaning.
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Affiliation(s)
| | | | | | | | | | | | - Dirceu Costa
- Post Graduation Science Rehabilitation, Nove de Julho University, Brazil
| | - Ross Arena
- Department of Physical Therapy and Integrative Physiology Laboratory, College of Applied Health Sciences, University of Illinois, USA
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6
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De Jong MJ, Schmelz J, Evers K, Bradshaw P, McKnight K, Bridges E. Accuracy and precision of buccal pulse oximetry. Heart Lung 2011; 40:31-40. [DOI: 10.1016/j.hrtlng.2009.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2009] [Accepted: 12/10/2009] [Indexed: 11/26/2022]
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7
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Winters ME, McCurdy MT, Zilberstein J. Monitoring the critically ill emergency department patient. Emerg Med Clin North Am 2008; 26:741-57, ix. [PMID: 18655943 DOI: 10.1016/j.emc.2008.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Many critically ill patients are remaining in the emergency department for extended periods of time, and delays in diagnosis and/or therapy may increase patient morbidity and mortality. All emergency physicians use monitoring modalities in critically ill patients to detect early cardiovascular compromise and impaired oxygen delivery before disastrous collapse occurs. The authors hope the discussion in this article regarding the monitoring of oxygenation, ventilation, arterial perfusion pressure, intravascular volume, markers of tissue hypoxia, and cardiac output will help the EP provide optimal care for this complicated patient population.
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Affiliation(s)
- Michael E Winters
- Department of Emergency Medicine, University of Maryland School of Medicine, 110 South Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201, USA.
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8
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Abstract
PURPOSE OF REVIEW The severe acute respiratory syndrome epidemic of 2002-2003, recent natural catastrophes, burgeoning concerns regarding intentional catastrophes, and the looming threat of an influenza pandemic have focused attention on large-scale, survivable respiratory failure. In this article, we review appropriate medical equipment, treatment space, and strategies to augment health professional staff in response to a massive increase in need for sustained critical care. RECENT FINDINGS There is insufficient modern healthcare experience with mass casualty respiratory failure to develop evidence-based preparedness efforts. For this reason, initial efforts to augment critical care capability in response to disasters have relied on extrapolation from the routine critical care knowledge base, military medicine, critical care transport, and expert opinion. We review recently published documents on augmenting supplies of positive pressure ventilation equipment, ongoing projects for increasing health professional staff, and infection control issues during epidemics. SUMMARY Mass casualty respiratory failure remains a largely unstudied field, but we believe informed decisions about equipment stockpiling and use, the development of creative operational concepts to increase staffing, and the careful implementation of rational infection control practices can lay a foundation for an appropriate response until additional data become available.
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Affiliation(s)
- Elizabeth L Daugherty
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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9
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Couchman BA, Wetzig SM, Coyer FM, Wheeler MK. Nursing care of the mechanically ventilated patient: what does the evidence say? Part one. Intensive Crit Care Nurs 2006; 23:4-14. [PMID: 17046259 DOI: 10.1016/j.iccn.2006.08.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2006] [Revised: 08/08/2006] [Accepted: 08/08/2006] [Indexed: 11/26/2022]
Abstract
The care of the mechanically ventilated patient is at the core of a nurse's clinical practice in the Intensive Care Unit (ICU). Published work relating to the numerous nursing issues of the care of the mechanically ventilated patient in the ICU is growing significantly. Literature focuses on patient assessment and management strategies for patient stressors, pain and sedation. Yet this literature is fragmentary by nature. The purpose of this paper is to provide a single comprehensive examination of the evidence related to the care of the mechanically ventilated patient. In part one of this two-part paper, the evidence on nursing care of the mechanically ventilated patient is explored with specific focus on patient safety: particularly patient and equipment assessment. Part two of the paper examines the evidence related to the mechanically ventilated patient's comfort, the patient/family unit, patient position, hygiene, management of stressors, pain management and sedation.
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Affiliation(s)
- Bronwyn A Couchman
- Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Butterfield St., Brisbane, Qld 4029, Australia
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10
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Mattison S, Christensen M. The pathophysiology of emphysema: considerations for critical care nursing practice. Intensive Crit Care Nurs 2006; 22:329-37. [PMID: 16901700 DOI: 10.1016/j.iccn.2006.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2005] [Revised: 03/06/2006] [Accepted: 03/12/2006] [Indexed: 11/30/2022]
Abstract
Emphysema is caused by exposure to cigarette smoking as well as alpha(1)-antitrypsin deficiency. It has been estimated to cost the National Health Service (NHS) in excess of 800 million pounds per year in related health care costs. The challenges for Critical Care nurses are those associated with dynamic hyperinflation, Auto-PEEP, malnutrition and the weaning from invasive and non-invasive mechanical ventilation. In this paper we consider the impact of the pathophysiology of emphysema, its effects on other body systems as well as the impact acute exacerbations have when patients are admitted to the Intensive Care Unit.
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Affiliation(s)
- Sue Mattison
- Bournemouth University, Christchurch Road, Bournemouth, United Kingdom
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11
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Abstract
OBJECTIVES To examine the published evidence regarding the use of transthoracic electric bioimpedance (TEB) for the non-invasive monitoring of cardiac output in the ED. METHOD Databases of the medical literature, relevant textbooks and the Internet were searched for articles regarding TEB. Criteria for inclusion were drawn up prior to examination of the articles and included adherence to guidelines for comparing methods of clinical measurement. RESULTS Results are discussed under the following headings: technological capability, diagnostic accuracy, limitations, range of possible uses, therapeutic impact, impact on health care providers, patient outcome and future directions. CONCLUSION TEB is a technique for the non-invasive monitoring of cardiac output whose ease of use, continuous data acquisition and versatility suggest it may have a role to play in the care of patients in our EDs.
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Affiliation(s)
- Ogilvie Thom
- Department of Epidemiology and Preventive Medicine, Monash University, Box Hill Hospital, Victoria, Australia.
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12
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Grinnan DC, Truwit JD. Clinical review: respiratory mechanics in spontaneous and assisted ventilation. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2005; 9:472-84. [PMID: 16277736 PMCID: PMC1297597 DOI: 10.1186/cc3516] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Pulmonary disease changes the physiology of the lungs, which manifests as changes in respiratory mechanics. Therefore, measurement of respiratory mechanics allows a clinician to monitor closely the course of pulmonary disease. Here we review the principles of respiratory mechanics and their clinical applications. These principles include compliance, elastance, resistance, impedance, flow, and work of breathing. We discuss these principles in normal conditions and in disease states. As the severity of pulmonary disease increases, mechanical ventilation can become necessary. We discuss the use of pressure–volume curves in assisting with poorly compliant lungs while on mechanical ventilation. In addition, we discuss physiologic parameters that assist with ventilator weaning as the disease process abates.
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Affiliation(s)
- Daniel C Grinnan
- Department of Pulmonary and Critical Care, University of Virginia Health System, Virginia, USA.
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13
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Nava S, Cuomo AM. Acute respiratory failure in the cancer patient: the role of non-invasive mechanical ventilation. Crit Rev Oncol Hematol 2005; 51:91-103. [PMID: 15276174 DOI: 10.1016/j.critrevonc.2004.04.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2004] [Indexed: 10/26/2022] Open
Abstract
The most common cause of ICU admission in patients affected by a hematologic or solid cancer is acute respiratory failure, often associated with a respiratory infection. The prognosis of these critically ill patients is disappointingly low especially if they require endotracheal intubation. In the last 10 years, non-invasive mechanical ventilation (NIV), delivered through a face or nose mask, has been increasingly used as an alternative to invasive ventilation. There is good evidence that, compared to the standard medical therapy alone or with invasive mechanical ventilation, NIV may improve survival and reduce the rate of infectious complications in patients affected by hematologic cancers. Patients with a solid tumor and "reversible" acute respiratory failure are also likely to benefit from NIV, while the use of NIV in palliative care of terminally ill patients still needs to be elucidated. The success of NIV is strictly dependent on its "early" use and on the experience of the staff involved.
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Affiliation(s)
- Stefano Nava
- Respiratory Unit, Istituto Scientifico di Pavia, Fondazione S. Maugeri, I.R.C.C.S., Via Ferrata 8, 27100 Pavia, Italy.
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Riou Y, Leclerc F, Neve V, Dupuy L, Noizet O, Leteurtre S, Sadik A. Reproducibility of the respiratory dead space measurements in mechanically ventilated children using the CO2SMO monitor. Intensive Care Med 2004; 30:1461-7. [PMID: 15138670 DOI: 10.1007/s00134-004-2288-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2003] [Accepted: 03/18/2004] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To assess the reproducibility of respiratory dead space measurements in ventilated children. DESIGN Prospective study. SETTING University pediatric intensive care unit. PATIENTS Thirty-two mechanically ventilated children (0.13-15.4 years) who were clinically stable. METHODS The single-breath CO(2) test (SBT-CO(2)) was recorded using the CO(2)SMO Plus from the mean of 30 ventilatory cycles during 1 h (at T0, T15, T30, T45, and T60). Airway dead space was determined automatically (Novametrix Medical Systems, USA), and manually by Bohr- Enghoff equations using data obtained by SBT-CO(2). At the end of the study period, arterial blood gas was sampled in order to calculate alveolar and physiologic dead space. Intrasubject reproducibility of measurements was evaluated by the intraclass correlation coefficient. Two-way analysis of variance was used to evaluate the relationships between time and measurements. The two methods for calculating airway dead space were compared by using two-tailed Student's t-test and Bland-Altman analysis. RESULTS Airway dead space measurement had a good reproducibility during the 1-h period, whatever the method used (intraclass correlation coefficient: 0.84 to 0.87). No significant difference was observed with time. Airway dead space values from the SBT-CO(2) method were smaller than those from Bohr-Enghoff equations. Physiologic dead space values from the SBT-CO2 method were similar to those from Bohr-Enghoff equations. CONCLUSION The measurement of airway dead space by the CO(2)SMO Plus was reproducible over a 1-h period in children requiring mechanical ventilation, provided ventilatory parameters were constant throughout the study. SBT-CO(2) analysis may provide a bedside non-invasive monitoring of volumetric capnography.
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Affiliation(s)
- Y Riou
- Department of Respiratory Physiology, University Hospital of Lille, Lille, France
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15
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Abstract
Anemia may be the most common illness of critically ill patients. The majority of critically ill patients are anemic at admission to the intensive care unit (ICU), and hemoglobin concentrations typically decline during the first 3 days of ICU stay. Hemoglobin continues to decline for patients with sepsis and higher severity of illness. This patient population may be at particular risk of adverse consequences of anemia given the cardiovascular, respiratory, and metabolic compromise frequently encountered during critical illness. The etiology of anemia of critical illness is multifactorial, resulting from phlebotomy, gastrointestinal bleeding, coagulation disorders, blood loss from vascular procedures, renal failure, nutritional deficiencies,bone marrow suppression, and impaired erythropoietin response.
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Affiliation(s)
- Robert A Fowler
- Sunnybrook and Women's College Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada.
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16
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Abstract
OBJECTIVE To describe blood conservation strategies for critically ill patients. DATA SOURCES By using a predefined strategy, we searched the electronic databases of Medline, EMBASE, CINAHL, the Cochrane database of systematic reviews, Cochrane central register of controlled trials, ACP Journal Club, Database of abstracts of reviews and effects, and HealthSTAR for descriptions and evaluations of strategies of blood conservation among critically ill patients. DATA SUMMARY A number of blood conservation strategies have been used to prevent or treat anemia among critically ill patients. These include restrictive diagnostic phlebotomy using small-volume or pediatric phlebotomy tubes, point-of-care and inline bedside microanalysis, minimization of diagnostic sample waste, minimization of routine multiple daily phlebotomies, red blood cell salvage and antifibrinolytic agents for bleeding patients, consideration of removal of central venous and arterial catheters when no longer required for physiologic monitoring, threshold-based transfusion policy, and healthcare professional education. CONCLUSIONS There are many strategies of blood conservation for critically ill patients. The effects of these strategies on phlebotomy volumes, hemoglobin and hematocrit levels, transfusion requirements, clinical outcomes, as well as intensive care unit and laboratory resources and costs should be further evaluated.
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Affiliation(s)
- Robert A Fowler
- Department of Medicine and Interdepartmental Division of Critical Care Medicine, Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada
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17
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Añón Elizalde JM, García De Lorenzo Mateos A, Alvarez-Sala Walther R, Escuela Gericó MP. [Treatment and prognosis of the severe exacerbation in the chronic obstructive pulmonary disease]. Rev Clin Esp 2001; 201:658-66. [PMID: 11786136 DOI: 10.1016/s0014-2565(01)70941-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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18
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Abstract
Pulse oximetry and capnography are widely used in clinical practice. They provide quick and noninvasive methods to estimate arterial oxygen saturation and carbon dioxide tension in different situations including emergency departments, intensive care units, and during procedures. This article reviews the principles of surgery, accuracy, limitations, and clinical applications of these instruments.
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Affiliation(s)
- A O Soubani
- Division of Pulmonary, Critical Care and Sleep Medicine, Wayne State University School of Medicine, Detroit, MI, USA.
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19
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Abstract
Hypoxemia is a prevalent problem in the chronically critically ill patient. This article reviews the pathophysiologic mechanisms of hypoxemia in this patient population, discusses how oxygenation is evaluated, and reviews methods for delivery of oxygen. Other topics directly related to oxygen use, such as oxygen toxicity, heliox use, and portable oxygen devices, are included.
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Affiliation(s)
- A C White
- Department of Medicine, Pulmonary and Critical Care Division, New England Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA.
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20
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Abstract
This review provides an update on the various techniques that are available to monitor patients during mechanical ventilation with an emphasis on clinical observations and applications in critically ill patients.
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Affiliation(s)
- A Jubran
- Division of Pulmonary and Critical Care Medicine, Edward Hines Jr., Veterans Affairs Hospital and Loyola University of Chicago Stritch School of Medicine, Hines, IL 60141, USA
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21
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Cutillo AG, Ailion DC. Modeling the nuclear magnetic resonance behavior of lung: from electrical engineering to critical care medicine. Bioelectromagnetics 1999; Suppl 4:110-9. [PMID: 10334720 DOI: 10.1002/(sici)1521-186x(1999)20:4+<110::aid-bem13>3.0.co;2-f] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The present article reviews the basic principles of a new approach to the characterization of pulmonary disease. This approach is based on the unique nuclear magnetic resonance (NMR) properties of the lung and combines experimental measurements (using specially developed NMR techniques) with theoretical simulations. The NMR signal from inflated lungs decays very rapidly compared with the signal from completely collapsed (airless) lungs. This phenomenon is due to the presence of internal magnetic field inhomogeneity produced by the alveolar air-tissue interface (because air and water have different magnetic susceptibilities). The air-tissue interface effects can be detected and quantified by magnetic resonance imaging (MRI) techniques using temporally symmetric and asymmetric spin-echo sequences. Theoretical models developed to explain the internal (tissue-induced) magnetic field inhomogeneity in aerated lungs predict the NMR lung behavior as a function of various technical and physiological factors (e.g., the level of lung inflation) and simulate the effects of various lung disorders (in particular, pulmonary edema) on this behavior. Good agreement has been observed between the predictions obtained from the mathematical models and the results of experimental NMR measurements in normal and diseased lungs. Our theoretical and experimental data have important pathophysiological and clinical implications, especially with respect to the characterization of acute lung disease (e.g., pulmonary edema) and the management of critically ill patients.
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Affiliation(s)
- A G Cutillo
- Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, USA.
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22
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Bendel-Stenzel EM, Bing DR, Meyers PA, Connett JE, Mammel MC. Synchronized gas and partial liquid ventilation in lung-injured animals: improved gas exchange with decreased effort. Pediatr Pulmonol 1999; 27:242-50. [PMID: 10230923 DOI: 10.1002/(sici)1099-0496(199904)27:4<242::aid-ppul4>3.0.co;2-g] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We hypothesized that partial liquid ventilation (PLV) with perflubron in spontaneously breathing lung-injured animals would increase respiratory workload compared to animals treated with gas ventilation (GV), and that a fully synchronized mode, assist-control ventilation (AC), would reduce the piglets' effort when compared to intermittent mandatory ventilation (IMV) or synchronized IMV (SIMV) during both GV and PLV. Newborn piglets with saline lavage-induced lung injury were randomized to sequential 30-min periods of IMV --> SIMV --> AC (n = 5), or AC --> SIMV --> IMV (n = 5) during GV followed by PLV. Pulmonary mechanics measurements and an esophageal patient effort index (PEI, defined as the product of the area below baseline of the esophageal pressure-time curve and respiratory rate [RR]) were determined to estimate the patient's nonmechanical work of breathing, using a computer-assisted lung mechanics analyzer. GV to PLV comparisons showed no change in PEI (IMV, 57.8 vs. 49.7; SIMV, 52.3 vs. 46.8; AC, 15.7 vs. 13.7 cm H2O x s/min); intermode comparisons showed significantly decreased PEI in AC vs. IMV and SIMV during GV, and in AC vs. SIMV (AC vs. IMV, P = 0.06) during PLV. AC consistently resulted in the highest minute ventilation, lowest total respiratory rate, most physiologic pH, and least tidal volume variability. These observations suggest that synchronization with AC during GV and PLV may have substantial physiologic benefits.
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Affiliation(s)
- E M Bendel-Stenzel
- Infant Pulmonary Research Center, Children's Hospitals and Clinics, St. Paul, Minnesota 55102, USA
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Abstract
Pulse oximetry is one of the most commonly employed monitoring modalities in the critical care setting. This review describes the latest technological advances in the field of pulse oximetry. Accuracy of pulse oximeters and their limitations are critically examined. Finally, the existing data regarding the clinical applications and cost-effectiveness of pulse oximeters are discussed.
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Affiliation(s)
- Jubran
- Division of Pulmonary and Critical Care Medicine, Veterans Administration Hospital and Loyola University of Chicago Stritch School of Medicine, Hines, Illinois 60141, USA
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24
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Abstract
This article provides a review of respiratory mechanics that can be monitored in ventilator-dependent patients during passive and spontaneous breathing. Special focus is placed on resistance, compliance, and work of breathing. A description of methods and techniques, and a summary of clinical observations and applications in critically-ill patients are also included.
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Affiliation(s)
- A Jubran
- Division of Pulmonary and Critical Care Medicine, Edward Hines Jr Veterans Affairs Hospital, Hines, Illinois, USA
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