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Signa Vitae

A Journal In Intensive Care And Emergency Medicine

Tag: monitoring (Page 1 of 2)

Middle latency auditory evoked potential index for prediction of post-resuscitation survival in elderly populations with out-of-hospital cardiac arrest

Abstract

Background. Out-of-hospital cardiac arrest (OHCA) is associated with a high mortality rate in the elderly. Although most reports have investigated among elderly patients with OHCA until 1990s, non-invasive monitorings cannot presently predicted cerebral resuscitation during cardiopulmonary resuscitation (CPR). Findings of a previous study suggest that monitoring of middle latency auditory evoked potentials (MLAEP) during CPR could provide an indicator of effective post-resuscitation survival.

Objectives. We speculated that the MLAEP index (MLAEPi), measured in an emergency room, can predict post-resuscitation survival among elderly patients with OHCA.

Methods. This prospective study included 31 elderly patients aged ≥65 years with OHCA who received basic life support (BLS) and did not achieve restoration of spontaneous circulation (ROSC) until arrival at the emergency center between December 2010 and December 2011. All patients were administered advanced cardiac life support (ACLS) in the emergency room. Initial MLAEPi was measured using an MLAEP monitor (aepEX plus®, Audiomex, UK) during the first cycle of ACLS. Prediction of the post-resuscitation survival was investigated.

Results. Eight patients who achieved ROSC were admitted to our hospital and 23 did not achieve ROSC in the emergency room. Initial MLAEPi was significantly higher in patients with than without ROSC (median, 33 vs. 26, p = 0.02). Three survivors, among patients with ROSC, were discharged from our hospital (survivors) and 5 died during hospitalization (non-survivors). Initial MLAEPi was significantly higher in survivors than in non-survivors (median, 35 vs. 28, p = 0.03) or patients without ROSC (median, 35 vs. 26, p < 0.01).

Conclusions. MLAEPi satisfactorily denotes cerebral function and predicts post-resuscitation survival in elderly populations.

Key words: cardiopulmonary resuscitation, basic life support, advanced cardiac life support, age, monitoring, critical care

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Bispectral analysis in medical-surgical ICU

Abstract

The effectiveness of sedation in the ICU is routinely assessed by subjective monitoring of the patient’s clinical condition or by using the monitors. The aim of our study was to review the monitoring of sedation using bispectral analysis (BIS) in medical-surgical ICU. A retrospective analysis of patients who were treated in the ICU from 2008 to 2014 was made. The data of 104 patients were analyzed. The average values of age are 54.38 (SD ±18,93; median 58). 39 (37,5%) of the patients died. The patients were referred to the ICU from medical (37), surgical departments (23) and traumatology (44). The patients were treated in the ICU for 13.84 days (SD ±17.29; median 8). The burst suppression pattern was noticed in 31 (29.8%) patients. Delirium occurred in 3 patients after the separation from the ventilator. In heterogeneous groups of patients, in which BIS was applied, it is not possible to make certain conclusions. The cost of the method unfortunately limits its wider usage. It is necessary to wait for the results of future studies which will set clear indications for the use of BIS in certain groups of patients.

Key words: bispectral index, critical care, monitoring, sedation

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Monitoring of a middle latency auditory evoked potential index during postresuscitation care with induced therapeutic hypothermia

Abstract

A 48-year-old man suddenly suffered a cardiac arrest at the supermarket and underwent bystander cardiopulmonary resuscitation. During transportation to our emergency center, ventricular fibrillation occurred and defibrillation was successful. Restoration of spontaneous circulation (ROSC) with sinus rhythm occurred 12 min after sudden cardiac arrest. On arrival at the emergency center 2 min after ROSC, middle latency auditory evoked potential index (MLAEPi) was measured and MLAEPi monitoring was continued to post-resuscitation care with induced therapeutic hypothermia (TH). This case highlights the usefulness of MLAEPi monitoring during primary care in the emergency center and postresuscitation care, including TH, for predicting neurological outcome.

Key words: resuscitation, cardiopulmonary arrest, monitoring, prognosis

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Regional cardiac resuscitation systems of care

Abstract

Out-of-hospital cardiac arrest (OOHCA) is a common public health problem, with large and important regional variations in outcomes. Survival rates vary widely among patients treated with OOHCA by emergency medical services (EMS), or among patients transported to the hospital after return of spontaneous circulation. Most regions lack a well-coordinated approach to post-cardiac arrest care. Effective hospital-based interventions for OOHCA exist but are used infrequently. Increased volume of patients or procedures of individual providers and hospitals is associated with better outcomes for several other clinical disorders. Regional systems of cardiac resuscitation include a process for identification of patients with OOHCA, standard field and hospital care protocols for patients with OOHCA, monitoring of care processes and outcome, and periodic review and feedback of these quality improvement data to identify problems and implement solutions. Similar systems have improved provider experience and patient outcomes for those with ST-elevation myocardial infarction and life-threatening traumatic injury. Many more people could survive OOHCA if regional systems of cardiac resuscitation were implemented and maintained. The time has come to do so wherever feasible.

Key words: out-of-hospital cardiac arrest, emergency medical services, hospital-based interventions, regional systems of cardiopulmonary resuscitation (CPR), monitoring, outcome, transport time, improve of quality, survival

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Clinical Applications of Capnography

Abstract

This article gives a short review of the basic definitions of capnography and its use. The introduction gives an overview of the historical development of this procedure. Technical features of the method are presented, followed by several definitions for understanding the basic terms needed to realize the applications of capnography. The last section is a descriptive part that explains the most important clinical applications of capnography, the strengths and limitations of this method. This article distinguishes capnography applications as a single procedure and its benefits as a complimentary procedure.

Key words: capnography, monitoring, ventilation, end-tidal CO2

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