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Gatti S, Rezoagli E, Madotto F, Foti G, Bellani G. A non-invasive continuous and real-time volumetric monitoring in spontaneous breathing subjects based on bioimpedance-ExSpiron®Xi: a validation study in healthy volunteers. J Clin Monit Comput 2024; 38:539-551. [PMID: 38238635 PMCID: PMC10994998 DOI: 10.1007/s10877-023-01107-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 11/10/2023] [Indexed: 04/06/2024]
Abstract
Tidal volume (TV) monitoring breath-by-breath is not available at bedside in non-intubated patients. However, TV monitoring may be useful to evaluate the work of breathing. A non-invasive device based on bioimpedance provides continuous and real-time volumetric tidal estimation during spontaneous breathing. We performed a prospective study in healthy volunteers aimed at evaluating the accuracy, the precision and the trending ability of measurements of ExSpiron®Xi as compared with the gold standard (i.e. spirometry). Further, we explored whether the differences between the 2 devices would be improved by the calibration of ExSpiron®Xi with a pre-determined tidal volume. Analysis accounted for the repeated nature of measurements within each subject. We enrolled 13 healthy volunteers, including 5 men and 8 women. Tidal volume, TV/ideal body weight (IBW) and respiratory rate (RR) measured with spirometer (TVSpirometer) and with ExSpiron®Xi (TVExSpiron) showed a robust correlation, while minute ventilation (MV) showed a weak correlation, in both non/calibrated and calibrated steps. The analysis of the agreement showed that non-calibrated TVExSpiron underestimated TVspirometer, while in the calibrated steps, TVExSpiron overestimated TVspirometer. The calibration procedure did not reduce the average absolute difference (error) between TVSpirometer and TVExSpiron. This happened similarly for TV/IBW and MV, while RR showed high accuracy and precision. The trending ability was excellent for TV, TV/IBW and RR. The concordance rate (CR) was >95% in both calibrated and non-calibrated measurements. The trending ability of minute ventilation was limited. Absolute error for both calibrated and not calibrated values of TV, TV/IBW and MV accounting for repeated measurements was variably associated with BMI, height and smoking status. Conclusions: Non-invasive TV, TV/IBW and RR estimation by ExSpiron®Xi was strongly correlated with tidal ventilation according to the gold standard spirometer technique. This data was not confirmed for MV. The calibration of the device did not improve its performance. Although the accuracy of ExSpiron®Xi was mild and the precision was limited for TV, TV/IBW and MV, the trending ability of the device was strong specifically for TV, TV/IBW and RR. This makes ExSpiron®Xi a non-invasive monitoring system that may detect real-time tidal volume ventilation changes and then suggest the need to better optimize the patient ventilatory support.
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Affiliation(s)
- Stefano Gatti
- Department of Emergency and Intensive Care, Terapia Intensiva e Semintensiva adulti e Pediatrica, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Emanuele Rezoagli
- Department of Emergency and Intensive Care, Terapia Intensiva e Semintensiva adulti e Pediatrica, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Fabiana Madotto
- Department of Area Emergenza Urgenza, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Giuseppe Foti
- Department of Emergency and Intensive Care, Terapia Intensiva e Semintensiva adulti e Pediatrica, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Giacomo Bellani
- Centre for Medical Sciences - CISMed, University of Trento, Trento, Italy.
- Anesthesia and Intensive Care, Santa Chiara Regional Hospital, APSS Trento Largo Medaglie d'Oro, Trento, Italy.
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van den Bosch OFC, Alvarez-Jimenez R, de Grooth HJ, Girbes ARJ, Loer SA. Breathing variability-implications for anaesthesiology and intensive care. Crit Care 2021; 25:280. [PMID: 34353348 PMCID: PMC8339683 DOI: 10.1186/s13054-021-03716-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 07/29/2021] [Indexed: 12/04/2022] Open
Abstract
The respiratory system reacts instantaneously to intrinsic and extrinsic inputs. This adaptability results in significant fluctuations in breathing parameters, such as respiratory rate, tidal volume, and inspiratory flow profiles. Breathing variability is influenced by several conditions, including sleep, various pulmonary diseases, hypoxia, and anxiety disorders. Recent studies have suggested that weaning failure during mechanical ventilation may be predicted by low respiratory variability. This review describes methods for quantifying breathing variability, summarises the conditions and comorbidities that affect breathing variability, and discusses the potential implications of breathing variability for anaesthesia and intensive care.
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Affiliation(s)
- Oscar F C van den Bosch
- Departments of Anesthesiology and Intensive Care, Amsterdam UMC, VUMC, ZH 6F 003, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
| | - Ricardo Alvarez-Jimenez
- Departments of Anesthesiology and Intensive Care, Amsterdam UMC, VUMC, ZH 6F 003, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Harm-Jan de Grooth
- Departments of Anesthesiology and Intensive Care, Amsterdam UMC, VUMC, ZH 6F 003, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Armand R J Girbes
- Departments of Anesthesiology and Intensive Care, Amsterdam UMC, VUMC, ZH 6F 003, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Stephan A Loer
- Departments of Anesthesiology and Intensive Care, Amsterdam UMC, VUMC, ZH 6F 003, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
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Patient-Controlled Analgesia in High-Risk Populations: Implications for Safety. CURRENT ANESTHESIOLOGY REPORTS 2020. [DOI: 10.1007/s40140-020-00406-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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American Society for Pain Management Nursing Guidelines on Monitoring for Opioid-Induced Advancing Sedation and Respiratory Depression: Revisions. Pain Manag Nurs 2020; 21:7-25. [DOI: 10.1016/j.pmn.2019.06.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 05/25/2019] [Accepted: 06/14/2019] [Indexed: 01/12/2023]
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Nafiu OO, Mills K, Tremper KK. Some Cautionary Tales About Ideal Body Weight Dosing of Anesthetic Medications: It Is Not All That Ideal! Anesth Analg 2019; 127:586-588. [PMID: 29200076 DOI: 10.1213/ane.0000000000002662] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Olubukola O Nafiu
- From the Section of Pediatric Anesthesiology, Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
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Jungquist CR, Chandola V, Spulecki C, Nguyen KV, Crescenzi P, Tekeste D, Sayapaneni PR. Identifying Patients Experiencing Opioid-Induced Respiratory Depression During Recovery From Anesthesia: The Application of Electronic Monitoring Devices. Worldviews Evid Based Nurs 2019; 16:186-194. [PMID: 31050151 DOI: 10.1111/wvn.12362] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Postsurgical patients experiencing opioid-related adverse drug events have 55% longer hospital stays, 47% higher costs associated with their care, 36% increased risk of 30-day readmission, and 3.4 times higher risk of inpatient mortality compared to those with no opioid-related adverse drug events. Most of the adverse events are preventable. GENERAL AIM This study explored three types of electronic monitoring devices (pulse oximetry, capnography, and minute ventilation [MV]) to determine which were more effective at identifying the patient experiencing respiratory compromise and, further, to determine whether algorithms could be developed from the electronic monitoring data to aid in earlier detection of respiratory depression. MATERIALS AND METHODS A study was performed in the postanesthesia care unit (PACU) in an inner city. Sixty patients were recruited in the preoperative admissions department on the day of their surgery. Forty-eight of the 60 patients wore three types of electronic monitoring devices while they were recovering from back, neck, hip, or knee surgery. Machine learning models were used for the analysis. RESULTS Twenty-four of the 48 patients exhibited sustained signs of opioid-induced respiratory depression (OIRD). Although the SpO2 values did not change, end-tidal CO2 levels increased, and MV decreased, representing hypoventilation. A machine learning model was able to predict an OIRD event 10 min before the actual event occurred with 80% accuracy. LINKING EVIDENCE TO ACTION Electronic monitoring devices are currently used as a tool to assess respiratory status using thresholds to distinguish when respiratory depression has occurred. This study introduces a potential paradigm shift from a reactive approach to a proactive approach that would identify a patient at high risk for OIRD. Capnography and MV were found to be effective tools in detecting respiratory compromise in the PACU.
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Affiliation(s)
| | - Varun Chandola
- Department of Computer Science and Engineering, University at Buffalo, Buffalo, NY, USA
| | | | | | | | | | - Phani Ram Sayapaneni
- Department of Computer Science and Engineering, University at Buffalo, Buffalo, NY, USA
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Chao CM, Lai CC, Cheng AC, Chiang SR, Liu WL, Ho CH, Hsing SC, Chen CM, Cheng KC. Establishing failure predictors for the planned extubation of overweight and obese patients. PLoS One 2017; 12:e0183360. [PMID: 28813495 PMCID: PMC5558963 DOI: 10.1371/journal.pone.0183360] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 08/02/2017] [Indexed: 12/26/2022] Open
Abstract
We investigated failure predictors for the planned extubation of overweight (body mass index [BMI] = 25.0–29.9) and obese (BMI ≥ 30) patients. All patients admitted to the adult intensive care unit (ICU) of a tertiary hospital in Taiwan were identified. They had all undergone endotracheal intubation for > 48 h and were candidates for extubation. During the study, 595 patients (overweight = 458 [77%]); obese = 137 [23%]) with planned extubation after weaning were included in the analysis; extubation failed in 34 patients (5.7%). Their mean BMI was 28.5 ± 3.8. Only BMI and age were significantly different between overweight and obese patients. The mortality rate for ICU patients was 0.8%, and 2.9% for inpatients during days 1–28; the overall in-hospital mortality rate was 8.4%. Failed Extubation group patients were significantly older, had more end-stage renal disease (ESRD), more cardiovascular system-related respiratory failure, higher maximal inspiratory pressure (MIP), lower maximal expiratory pressure (MEP), higher blood urea nitrogen, and higher ICU- and 28-day mortality rates than did the Successful Extubation group. Multivariate logistic regression showed that cardiovascular-related respiratory failure (odds ratio [OR]: 2.60; 95% [confidence interval] CI: 1.16–5.80), ESRD (OR: 14.00; 95% CI: 6.25–31.35), and MIP levels (OR: 0.94; 95% CI: 0.90–0.97) were associated with extubation failure. We conclude that the extubation failure risk in overweight and obese patients was associated with cardiovascular system-related respiratory failure, ESRD, and low MIP levels.
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Affiliation(s)
- Chien-Ming Chao
- Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Taiwan
| | - Chih-Cheng Lai
- Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Taiwan
| | - Ai-Chin Cheng
- Departments of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Shyh-Ren Chiang
- Departments of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
- Chia Nan University of Pharmacy & Science, Tainan, Taiwan
| | - Wei-Lun Liu
- Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Taiwan
| | - Chung-Han Ho
- Departments of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
| | - Shu-Chen Hsing
- Departments of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Chin-Ming Chen
- Chia Nan University of Pharmacy & Science, Tainan, Taiwan
- Departments of Intensive Care Medicine, Chi Mei Medical Center, Tainan, Taiwan
- * E-mail: (KCC); (CMC)
| | - Kuo-Chen Cheng
- Departments of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
- Department of Safety Health and Environmental Engineering, Chung Hwa University of Medical Technology, Tainan, Taiwan
- * E-mail: (KCC); (CMC)
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Mehta JH, Williams GW, Harvey BC, Grewal NK, George EE. The relationship between minute ventilation and end tidal CO2 in intubated and spontaneously breathing patients undergoing procedural sedation. PLoS One 2017; 12:e0180187. [PMID: 28662195 PMCID: PMC5491149 DOI: 10.1371/journal.pone.0180187] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 06/12/2017] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Monitoring respiratory status using end tidal CO2 (EtCO2), which reliably reflects arterial PaCO2 in intubated patients under general anesthesia, has often proven both inaccurate and inadequate when monitoring non-intubated and spontaneously breathing patients. This is particularly important in patients undergoing procedural sedation (e.g., endoscopy, colonoscopy). This can be undertaken in the operating theater, but is also often delivered outside the operating room by non-anesthesia providers. In this study we evaluated the ability for conventional EtCO2 monitoring to reflect changes in ventilation in non-intubated surgical patients undergoing monitored anesthesia care and compared and contrasted these findings to both intubated patients under general anesthesia and spontaneously breathing volunteers. METHODS Minute Ventilation (MV), tidal volume (TV), and respiratory rate (RR) were continuously collected from an impedance-based Respiratory Volume Monitor (RVM) simultaneously with capnography data in 160 patients from three patient groups: non-intubated surgical patients managed using spinal anesthesia and Procedural Sedation (n = 58); intubated surgical patients under General Anesthesia (n = 54); and spontaneously breathing Awake Volunteers (n = 48). EtCO2 instrument sensitivity was calculated for each patient as the slope of a Deming regression between corresponding measurements of EtCO2 and MV and expressed as angle from the x-axis (θ). All data are presented as mean ± SD unless otherwise indicated. RESULTS While, as expected, EtCO2 and MV measurements were negatively correlated in most patients, we found gross systematic differences across the three cohorts. In the General Anesthesia patients, small changes in MV resulted in large changes in EtCO2 (high sensitivity, θ = -83.6 ± 9.9°). In contrast, in the Awake Volunteers patients, large changes in MV resulted in insignificant changes in EtCO2 (low sensitivity, θ = -24.7 ± 19.7°, p < 0.0001 vs General Anesthesia). In the Procedural Sedation patients, EtCO2 sensitivity showed a bimodal distribution, with an approximately even split between patients showing high EtCO2 instrument sensitivity, similar to those under General Anesthesia, and patients with low EtCO2 instrument sensitivity, similar to the Awake Volunteers. CONCLUSIONS When monitoring non-intubated patients undergoing procedural sedation, EtCO2 often provides inadequate instrument sensitivity when detecting changes in ventilation. This suggests that augmenting standard patient care with EtCO2 monitoring is a less than optimal solution for detecting changes in respiratory status in non-intubated patients. Instead, adding direct monitoring of MV with an RVM may be preferable for continuous assessment of adequacy of ventilation in non-intubated patients.
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Affiliation(s)
- Jaideep H. Mehta
- Department of Anesthesiology, The University of Texas Health Science Center at Houston, Houston, Texas, United States of America
| | - George W. Williams
- Department of Anesthesiology, The University of Texas Health Science Center at Houston, Houston, Texas, United States of America
| | - Brian C. Harvey
- Respiratory Motion, Inc. Waltham, Massachusetts, United States of America
| | - Navneet K. Grewal
- Department of Anesthesiology, The University of Texas Health Science Center at Houston, Houston, Texas, United States of America
| | - Edward E. George
- Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
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