Impact factor 0.175

Signa Vitae

A Journal In Intensive Care And Emergency Medicine

Tag: monitoring

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

Read More

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

Read More

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

Read More

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

Read More

First measured intrathoracic blood volume in icu patients indicates the appropriateness of circulatory volume management

Abstract

Hemodynamic monitoring in Intensive Care Unit (ICU) settings is usually introduced when a patient becomes hemodynamically unstable. We analyzed how empirically guided volume management relates to first measured intrathoracic blood volume (ITBV), at the moment of the beginning of Puls Contour Cardiac Output (PiCCO) hemodynamic monitoring.
Data and measurements from 37 ICU patients, divided into four groups according to diagnosis of primary condition, were retrospectively studied. The first group consisted of polytrauma patients, second group of patients with pancreatitis and/or peritonitis, third group were postoperative patients, and fourth group were patients with various medical diagnosis: sepsis, acute respiratory distress syndrome (ARDS), acute lung failure (ALF), and acute heart failure (AHF). PiCCO monitor was introduced when the signs of hemodynamic instability were observed. First measured ITBV was recorded and analyzed according to deviation from reference values.
First measured ITBV was in reference range in 14 (37.8%) patients. Volume overloading was observed in 16 (43.2%) and hypovolemia in 7 (18.9%) patients.
The observed inappropriate blood volume in patients of all studied groups suggests that there is the need for defining indications and earlier application of hemodynamic monitoring, as well as reassessment of usual empirically guided infusion therapy in ICU setting.

Key words: hemodynamic process, intensive care, hypovolemia, monitoring

Read More

© 2015. Signa Vitae. Except where otherwise noted, content on this site is licensed under a Creative Commons Attribution 4.0 International license.