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Sample records for capnography

  1. Capnography during cardiopulmonary resuscitation: Current evidence and future directions

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    Bhavani Shankar Kodali

    2014-01-01

    Full Text Available Capnography continues to be an important tool in measuring expired carbon dioxide (CO 2 . Most recent Advanced Cardiac Life Support (ACLS guidelines now recommend using capnography to ascertain the effectiveness of chest compressions and duration of cardiopulmonary resuscitation (CPR. Based on an extensive review of available published literature, we selected all available peer-reviewed research investigations and case reports. Available evidence suggests that there is significant correlation between partial pressure of end-tidal CO 2 (PETCO 2 and cardiac output that can indicate the return of spontaneous circulation (ROSC. Additional evidence favoring the use of capnography during CPR includes definitive proof of correct placement of the endotracheal tube and possible prediction of patient survival following cardiac arrest, although the latter will require further investigations. There is emerging evidence that PETCO 2 values can guide the initiation of extracorporeal life support (ECLS in refractory cardiac arrest (RCA. There is also increasing recognition of the value of capnography in intensive care settings in intubated patients. Future directions include determining the outcomes based on capnography waveforms PETCO 2 values and determining a reasonable duration of CPR. In the future, given increasing use of capnography during CPR large databases can be analyzed to predict outcomes.

  2. Temporal comparison of ultrasound vs. auscultation and capnography in verification of endotracheal tube placement

    DEFF Research Database (Denmark)

    Pfeiffer, P; Rudolph, S S; Neimann, Jens Dupont Børglum

    2011-01-01

    This study compared the time consumption of bilateral lung ultrasound with auscultation and capnography for verifying endotracheal intubation.......This study compared the time consumption of bilateral lung ultrasound with auscultation and capnography for verifying endotracheal intubation....

  3. The role of capnography in endoscopy patients undergoing nurse-administered propofol sedation: a randomized study.

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    Slagelse, Charlotte; Vilmann, Peter; Hornslet, Pernille; Jørgensen, Henrik L; Horsted, Tina I

    2013-10-01

    OBJECTIVE. Standard benzodiazepine/opioid cocktail has proven inferior to propofol sedation during complicated endoscopic procedures and in low-tolerance patients. Propofol is a short-acting hypnotic with a potential risk of respiratory depression at levels of moderate to deep sedation. The existing literature on capnography for endoscopy patients sedated with nurse-administered propofol sedation (NAPS) is limited. Can the addition of capnography to standard monitoring during endoscopy with NAPS reduce the number, duration, and level of hypoxia. MATERIALS AND METHODS. This study was a randomized controlled trial with an intervention group (capnography) and a control group (without capnography). Eligible subjects were consecutive patients for endoscopy at Gentofte Hospital compliant with the criteria of NAPS. RESULTS. Five hundred and forty patients, 263 with capnography and 277 without capnography, were included in the analysis. The number and total duration of hypoxia was reduced by 39.3% and 21.1% in the intervention group compared to the control group (p > 0.05). No differences in actions taken against insufficient respiration were found. Changes in end-tidal carbon dioxide (R = 0.177, p-value 0.05). Capnography is able to detect insufficient respiration that may lead to hypoxia prior to changes in pulse oximetry. However, due to a limited clinical benefit and additional costs associated with capnography, we do not find capnography necessary during the use of NAPS.

  4. PQRST - a unique aide-memoire for capnography interpretation during cardiac arrest.

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    Heradstveit, Bård E; Heltne, Jon-Kenneth

    2014-11-01

    The use of capnography is recommended during resuscitation. By implementing the mnemonic "PQRST", rescuers have a ready-made checklist to help them achieve the full potential of capnography. This approach can facilitate efforts to both reduce the hands-off time and individualize the treatment, which can lead to improved survival for our patients.

  5. The role of capnography in endoscopy patients undergoing nurse-administered propofol sedation

    DEFF Research Database (Denmark)

    Slagelse, Charlotte; Vilmann, Peter; Hornslet, Pernille;

    2013-01-01

    . The existing literature on capnography for endoscopy patients sedated with nurse-administered propofol sedation (NAPS) is limited. Can the addition of capnography to standard monitoring during endoscopy with NAPS reduce the number, duration, and level of hypoxia. Materials and methods. This study...

  6. A prospective randomised controlled trial of capnography vs. bronchoscopy for Blue Rhino percutaneous tracheostomy.

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    Mallick, A; Venkatanath, D; Elliot, S C; Hollins, T; Nanda Kumar, C G

    2003-09-01

    A crucial step for successful percutaneous tracheostomy is the introduction of the needle and guide wire into the trachea. Capnography has recently been proposed as one way to confirm tracheal needle placement. In this randomised controlled study, we used capnography in 26 patients and bronchoscopy in 29 patients to confirm needle placement for percutaneous tracheostomy using Blue Rhino kit. The operating times and the incidence of peri-operative complications were similar for both groups. Capnography proved to be as effective as bronchoscopy in confirming correct needle placement.

  7. Volumetric capnography for the evaluation of chronic airways diseases

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    Veronez L

    2014-09-01

    Full Text Available Liliani de Fátima Veronez,1 Monica Corso Pereira,2 Silvia Maria Doria da Silva,2 Luisa Affi Barcaui,2 Eduardo Mello De Capitani,2 Marcos Mello Moreira,2 Ilma Aparecida Paschoalz2 1Department of Physical Therapy, University of Votuporanga (Educational Foundation of Votuporanga, Votuporanga, 2Department of Internal Medicine, School of Medical Sciences, State University of Campinas (UNICAMP, Campinas, Sao Paulo, BrazilBackground: Obstructive lung diseases of different etiologies present with progressive peripheral airway involvement. The peripheral airways, known as the silent lung zone, are not adequately evaluated with conventional function tests. The principle of gas washout has been used to detect pulmonary ventilation inhomogeneity and to estimate the location of the underlying disease process. Volumetric capnography (VC analyzes the pattern of CO2 elimination as a function of expired volume.Objective: To measure normalized phase 3 slopes with VC in patients with non-cystic fibrosis bronchiectasis (NCB and in bronchitic patients with chronic obstructive pulmonary disease (COPD in order to compare the slopes obtained for the groups.Methods: NCB and severe COPD were enrolled sequentially from an outpatient clinic (Hospital of the State University of Campinas. A control group was established for the NCB group, paired by sex and age. All subjects performed spirometry, VC, and the 6-Minute Walk Test (6MWT. Two comparisons were made: NCB group versus its control group, and NCB group versus COPD group. The project was approved by the ethical committee of the institution. Statistical tests used were Wilcoxon or Student’s t-test; P<0.05 was considered to be a statistically significant difference.Results: Concerning the NCB group (N=20 versus the control group (N=20, significant differences were found in body mass index and in several functional variables (spirometric, VC, 6MWT with worse results observed in the NCB group. In the comparison between

  8. Capnography and the Bispectral Index—Their Role in Pediatric Sedation: A Brief Review

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    Maria Sammartino

    2010-01-01

    Full Text Available Sedation in children is increasingly emerging as a minimally invasive technique that may be associated with local anaesthesia or diagnostic and therapeutic procedures which do not necessarily require general anaesthesia. Standard monitoring requirements are not sufficient to ensure an effective control of pulmonary ventilation and deep sedation. Capnography in pediatric sedation assesses the effect of different drugs on the occurrence of respiratory failure and records early indicators of respiratory impairment. The Bispectral index (BIS allows the reduction of dose requirements of anaesthetic drugs, the reduction in the time to extubation and eye opening, and the reduction in the time to discharge. In the field of pediatric sedation, capnography should be recommended to prevent respiratory complications, particularly in spontaneous ventilation. The use of the BIS index, however, needs further investigation due to a lack of evidence, especially in infants. In this paper, we will investigate the role of capnography and the BIS index in improving monitoring standards in pediatric sedation.

  9. Verification of endotracheal intubation in obese patients - temporal comparison of ultrasound vs. auscultation and capnography

    DEFF Research Database (Denmark)

    Pfeiffer, P; Bache, Stefan Holst; Isbye, D L

    2012-01-01

    Ultrasound (US) may have an emerging role as an adjunct in verification of endotracheal intubation. Obtaining optimal US images in obese patients is generally regarded more difficult than for other patients. This study compared the time consumption of bilateral lung US with auscultation...... and capnography for verifying endotracheal intubation in obese patients....

  10. Predictive Value of Capnography for Suspected Diabetic Ketoacidosis in the Emergency Department

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    Soleimanpour, Hassan

    2013-11-01

    Full Text Available Introduction: Metabolic acidosis confirmed by arterial blood gas (ABG analysis is one of the diagnostic criteria for diabetic ketoacidosis (DKA. Given the direct relationship between end-tidal carbon dioxide (ETco2, arterial carbon dioxide (PaCO2 and metabolic acidosis, measuring ETco2 may serve as a surrogate for ABG in the assessment of possible DKA. The current study focuses on the predictive value of capnography in diagnosing DKA in patients referring to the emergency department (ED with increased blood sugar levels and probable diagnosis of DKA.Methods: In a cross-sectional prospective descriptive-analytic study carried out in an ED, we studied 181 patients older than 18 years old with blood sugar levels of higher than 250 mg/dl and probable DKA. ABG and capnography were obtained from all patients. To determine predictive value, sensitivity, specificity and cut-off points, we developed receiver operating characteristic curves.Results: Sixty-two of 181 patients suffered from DKA. We observed significant differences between both groups (DKA and non-DKA regarding age, pH, blood bicarbonate, PaCO2 and ETco2 values (P≤0.001. Finally, capnography values more than 24.5 mmHg could rule out the DKA diagnosis with a sensitivity and specificity of 0.90.Conclusion: Capnography values greater than 24.5 mmHg accurately allow the exclusion of DKA in ED patients suspected of that diagnosis. Capnography levels lower that 24.5 mmHg were unable to differentiate between DKA and other disease entities. [West J Emerg Med. 2013;14(6:590–594.

  11. Assessment and confirmation of tracheal intubation when capnography fails: a novel use for an USB camera.

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    Karippacheril, John George; Umesh, Goneppanavar; Nanda, Shetty

    2013-10-01

    A 62 year old male with a right pyriform fossa lesion extending to the right arytenoid and obscuring the glottic inlet was planned for laser assisted excision. Direct laryngoscopic assessment after topicalization of the airway, showed a Cormack Lehane grade 3 view. We report a case where, in the absence of a fiberscope, a novel inexpensive Universal Serial Bus camera was used to obtain an optimal laryngoscopic view. This provided direct visual confirmation of tracheal intubation with a Laser Flex tube, when capnography failed to show any trace. Capnography may not be reliable as a sole indicator of confirmation of correct endotracheal tube placement. Video laryngoscopy may provide additional confirmation of endotracheal intubation.

  12. Volumetric capnography: In the diagnostic work-up of chronic thromboembolic disease

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    Marcos Mello Moreira

    2010-05-01

    Full Text Available Marcos Mello Moreira1, Renato Giuseppe Giovanni Terzi1, Laura Cortellazzi2, Antonio Luis Eiras Falcão1, Heitor Moreno Junior2, Luiz Cláudio Martins2, Otavio Rizzi Coelho21Department of Surgery, 2Department of Internal Medicine, State University of Campinas, School of Medical Sciences, Campinas, Sao Paulo, BrazilAbstract: The morbidity and mortality of pulmonary embolism (PE have been found to be related to early diagnosis and appropriate treatment. The examinations used to diagnose PE are expensive and not always easily accessible. These options include noninvasive examinations, such as clinical pretests, ELISA D-dimer (DD tests, and volumetric capnography (VCap. We report the case of a patient whose diagnosis of PE was made via pulmonary arteriography. The clinical pretest revealed a moderate probability of the patient having PE, and the DD result was negative; however, the VCap associated with arterial blood gases result was positive. The patient underwent all noninvasive exams following admission to hospital and again eight months after discharge. Results gained from invasive tests were similar to those produced by image exams, highlighting the importance of VCap as an important noninvasive tool.Keywords: pulmonary embolism, pulmonary hypertension, volumetric capnography, d-dimers, pretest probability

  13. Progressive reduction in central blood volume is not detected by sublingual capnography.

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    Chung, Kevin K; Ryan, Kathy L; Rickards, Caroline A; Hinojosa-Laborde, Carmen; Pamplin, Jeremy C; Patel, Shimul S; Herold, Thomas S; Convertino, Victor A

    2012-06-01

    Early detection and management of shock are important in optimizing clinical outcomes. One regional marker, sublingual capnography (SLCO2), is particularly appealing as redistribution of blood flow away from the sublingual mucosa can happen very early in the compensatory phase of hypovolemic shock. Our objective was to test the hypothesis that SLCO2 would detect early hypovolemia in a human laboratory model of hemorrhage: progressive lower body negative pressure until onset of cardiovascular collapse. Eighteen healthy nonsmoking subjects (10 males, 8 females) with mean age of 28 (SD, 8) years, body weight of 72 (SD, 13) kg, and height of 172 (SD, 9) cm were recruited to participate, of whom 17 completed the experiment. Average time to presyncope was 1,579 ± 72 s (mean ± SE). At the time of cardiovascular collapse, lower body negative pressure altered (P < 0.001) systolic blood pressure (mean ± SE: 130 ± 3 vs. 98 ± 2 mm Hg), pulse pressure (mean ± SE: 58 ± 2 vs. 33 ± 2 mm Hg), and heart rate (mean ± SE: 63 ± 3 vs. 102 ± 6 beats/min) when compared with baseline, whereas SLCO2 did not change (49.1 ± 1.0 vs. 48.6 ± 1.5 mm Hg, P = 0.624). In a model of progressive central hypovolemia in humans, we did not detect metabolic derangements in the sublingual mucosa as measured by SLCO2.

  14. Long-term tolerability of capnography and respiratory inductance plethysmography for respiratory monitoring in pediatric patients treated with patient-controlled analgesia

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    Miller, Karen M.; Kim, Andrew Y.; Yaster, Myron; Kudchadkar, Sapna R.; White, Elizabeth; Fackler, James; Monitto, Constance L.

    2016-01-01

    Background The Anesthesia Patient Safety Foundation has advocated the use of continuous electronic monitoring of oxygenation and ventilation to preemptively identify opioid-induced respiratory depression. In adults, capnography is the gold standard in respiratory monitoring. An alternative technique used in sleep laboratories is respiratory inductance plethysmography (RIP). However, it is not known if either monitor is well tolerated by pediatric patients for prolonged periods of time. Aim The goal of this study was to determine whether capnography or RIP is better tolerated in non-intubated, spontaneously breathing pediatric patients being treated with intravenous patient-controlled analgesia (IVPCA). Methods Nasal cannula capnography with oral sampling and thoracic and abdominal inductance plethysmography bands were placed along with routine monitors on pediatric patients being treated for acute pain with IVPCA. Study monitors were left in place for as long as they were tolerated by the patient, for a maximum of 24 consecutive hours. If the patient did not wear a particular study monitor for any reason, but tolerated the remaining monitor, participation in the study continued. If the patient would not wear either monitor, participation was terminated. Results Twenty-six patients (18 female, 8 male, average age 10.1 ± 5.5 years) consented to participate, but only 14 patients attempted to wear one or both devices. Among those who wore either device, median time to device removal was 8.33 hours (range 0.3–23.6 hours) for capnography and 23.5 hours (range 0.7–24 hours) for RIP bands. Conclusion Children did not tolerate wearing capnography cannulae for prolonged periods of time, limiting the usefulness of this device as a continuous monitor of ventilation in children. RIP bands were better tolerated; however, they require further assessment of their utility. Until more effective, child-friendly monitors are developed and their utility validated, guidelines

  15. A novel application of capnography during controlled human exposure to air pollution

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    Fila Michael

    2006-10-01

    Full Text Available Abstract Background The objective was to determine the repeatability and stability of capnography interfaced with human exposure facility. Methods Capnographic wave signals were obtained from five healthy volunteers exposed to particle-free, filtered air during two consecutive 5 min intervals, 10 min apart, within the open and then the sealed and operational human exposure facility (HEF. Using a customized setup comprised of the Oridion Microcap® portable capnograph, DA converter and AD card, the signal was acquired and saved as an ASCII file for subsequent processing. The minute ventilation (VE, respiratory rate (RR and expiratory tidal volume (VTE were recorded before and after capnographic recording and then averaged. Each capnographic tracing was analyzed for acceptable waves. From each recorded interval, 8 to 19 acceptable waves were selected and measured. The following wave parameters were obtained: total length and length of phase II and III, slope of phase II and III, area under the curve and area under phase III. In addition, we recorded signal measures including the mean, standard deviation, mode, minimum, maximum – which equals end-tidal CO2 (EtCO2, zero-corrected maximum and true RMS. Results Statistical analysis using a paired t-test for means showed no statistically significant changes of any wave parameters and wave signal measures, corrected for RR and VTE, comparing the measures when the HEF was open vs. sealed and operational. The coefficients of variation of the zero-corrected and uncorrected EtCO2, phase II absolute difference, signal mean, standard deviation and RMS were less than 10% despite a sub-atmospheric barometric pressure, and slightly higher temperature and relative humidity within the HEF when operational. Conclusion We showed that a customized setup for the acquisition and processing of the capnographic wave signal, interfaced with HEF was stable and repeatable. Thus, we expect that analysis of capnographic

  16. Capnography is superior to pulse oximetry for the detection of respiratory depression during colonoscopy La capnografía es superior a la pulsioximetría en la detección de depresión respiratoria durante las colonoscopias

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    G. Cacho

    2010-02-01

    Full Text Available Background: pulse oximetry is a widely accepted procedure for ventilatory monitoring during gastrointestinal endoscopy, but this method provides an indirect measurement of the respiratory function. In addition, detection of abnormal ventilatory activity can be delayed, especially if supplemental oxygen is provided. Capnography offers continuous real-time measurement of expiratory carbon dioxide. Objective: we aimed at prospectively examining the advantages of capnography over the standard pulse oximetry monitoring during sedated colonoscopies. Patients and methods:fifty patients undergoing colonoscopy were simultaneously monitored with pulse oximetry and capnography by using two different devices in each patient. Several sedation regimens were administered. Episodes of apnea or hypoventilation detected by capnography were compared with the occurrence of hypoxemia. Results: twenty-nine episodes of disordered respiration occurred in 16 patients (mean duration 54.4 seconds. Only 38% of apnea or hypoventilation episodes were detected by pulse oximetry. A mean delay of 38.6 seconds was observed in the events detected by pulse oximetry (two episodes of disturbed ventilation were simultaneously detected by capnography and pulse oximetry. Conclusions: apnea or hypoventilation commonly occurs during colonoscopy with sedation. Capnography is more reliable than pulse oximetry in early detection of respiratory depression in this setting.

  17. Comparison of the pulmonary dead-space fraction derived from ventilator volumetric capnography and a validated equation in the survival prediction of patients with acute respiratory distress syndrome

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    Yu-Jiao Zhang; Xin-Jing Gao; Zhi-Bo Li; Zhi-Yong Wang; Quan-Sheng Feng; Cheng-Fen Yin; Xing Lu

    2016-01-01

    Purpose:This prospective observational study aims to evaluate the accuracy of dead-space fraction derived from the ventilator volumetric capnography (volumetric CO2) or a prediction equation to predict the survival of mechanically ventilated patients with acute respiratory distress syndrome (ARDS).Methods:Consecutive VD/VT measurements were obtained based upon a prediction equation validated by Frankenfield et al for dead-space ventilation fraction:VD/VT 0.320 + 0.0106 (PaCO2-ETCO2) + 0.003 (RR) + 0.0015 (age) in adult patients who had infection-related severe pneumonia and were confirmed as having ARDS.Here PaCO2 is the arterial partial pressure of carbon dioxide in mmHg;ETCO2,the endtidal carbon dioxide measurement in mmHg;RR,respiratory rate per minute;and age in years.Once the patient had intubation,positive end expiratory pressure was adjusted and after Phigh reached a steady state,VD/VT was measured and recorded as the data for the first day.VD/VT measurement was repeated on days 2,3,4,5 and 6.Meanwhile we collected dead-space fraction directly from the ventilator volumetric CO2 and recorded it as Vd/Vt.We analyzed the changes in VD/VT and Vd/Vt over the 6-day period to determine their accuracy in predicting the survival of ARDS patients.Results:Overall,46 patients with ARDS met the inclusion criteria and 24 of them died.During the first 6 days of intubation,VD/VT was significantly higher in nonsurvivors on day 4 (0.70 ± 0.01 vs 0.57 ± 0.01),day 5 (0.73 ± 0.01 vs.0.54 ± 0.01).and day 6 (0.73 ± 0.02 vs.0.54 ± 0.01) (all p =0.000).Vd/Vt showed no significant difference on days 1-4 but it was much higher in nonsurvivors on day 5 (0.45 ± 0.04 vs.0.41 ± 0.06) and day 6 (0.47 ± 0.05 vs.0.40 ± 0.03) (both p =0.008).VD/VT on the fourth day was more accurate to predict survival than Vd/Vt.The area under the receiver-operating characteristic curve for VD/VT and Vd/Vt in evaluating ARDS patients survival was day 4 (0.974 ± 0.093 vs.0.701 ± 0.023,p 0

  18. Capnografia volumétrica como auxílio diagnóstico não-invasivo no tromboembolismo pulmonar agudo Volumetric capnography as a noninvasive diagnostic procedure in acute pulmonary thromboembolism

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    Marcos Mello Moreira

    2008-05-01

    Full Text Available O tromboembolismo pulmonar é uma situação freqüente que pode ser diagnosticada pela cintilografia pulmonar, angiotomografia computadorizada, arteriografia pulmonar e, como método de exclusão, dosagem do dímero-D. Como estes exames nem sempre estão disponíveis, a validação de outros métodos diagnósticos é fundamental. Relata-se o caso de uma paciente com hipertensão pulmonar crônica, agudizada por tromboembolismo pulmonar. Confirmou-se o diagnóstico por cintilografia, angiotomografia computadorizada, arteriografia pulmonar; a dosagem do dímero-D resultou positiva. A capnografia volumétrica associada à gasometria arterial foi realizada na admissão e após o tratamento. As variáveis obtidas foram comparadas com os resultados dos exames de imagem.Pulmonary thromboembolism is a common condition. Its diagnosis usually requires pulmonary scintigraphy, computed angiotomography, pulmonary arteriography and, in order to rule out other diagnoses, the measurement of D-dimer levels. Due to the fact that these diagnostic methods are not available in most Brazilian hospitals, the validation of other diagnostic techniques is of fundamental importance. We describe a case of a woman with chronic pulmonary hypertension who experienced a pulmonary thromboembolism event. Pulmonary scintigraphy, computed angiotomography and pulmonary arteriography were used in the diagnosis. The D-dimer test result was positive. Volumetric capnography was performed at admission and after treatment. The values obtained were compared with the imaging test results.

  19. 容积二氧化碳图在气道反应性测定中的应用%Application of volumetric capnography in the measurement of bronchial hyperresponsiveness

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    孙晓丽; 刘锦铭; 杨文兰

    2010-01-01

    Objective To investigate the sensitivity and specificity of volumetric capnography (VCap) parameters in the measurement of bronchial hyperresponsiveness (BHR) and bronchodilator responsiveness,and compared with the routine spirometry method. Methods Sixty chronic cough suspect cough variation asthmatic outpatients were selected randomly to perform bronchial challenge test with VCap and spirometry respectively, VCap were measured firstly every step. Results Positive rate of BHR was 50%. In the posifive group, FEV1 ,PEF and VDT, VDF, VDW,dC3/DV were significantly changed between the postchallenge value and the baseline value(P0.05),VDT、VDF、VDW激发后和舒张后值之间差异有统计学意义(P<0.05).所有患者的基础值、激发后、舒张后数据,FEV1均与PEF、Vcap各参数(除dC2/DV、dC3/DV、SR23外)呈显著直线相关(P<0.05).激发试验过程中各死腔参数的下降提前于FEV1和PEF的下降.激发试验终止时,ROC曲线提示VDT、VDF为最敏感指标,VDT较基础值增加28%、VDF较基础值增加20%,可作为Vcap气道高反应性阳性判断标准.结论 Vcap是一种定量评估支气管阻塞严重性的有效方法,可应用于气道反应性测定.

  20. Research Progress of Capnography and Its Application in Non-intubated Patients%呼出气二氧化碳监测仪的研究进展及其在非气管插管患者中的应用

    Institute of Scientific and Technical Information of China (English)

    张小青(综述); 李民(审校)

    2016-01-01

    [Summary] Alveolar hypoventilation and respiratory depression occur frequently in a variety of clinical settings where patients receive sedatives or opioids .Current clinical guidelines recommend capnography as one of the best non -invasive methods , which should be routinely used for non-intubated patients with high respiratory depression risk .This article reviewed the current evidences for the application of capnography in non-intubated patients and summarized the outcomes in recent clinical trials .The clinical studies support the use of this non-invasive technique .Clinicians should not solely rely on pulse oximetry in assessing patients with high risk of respiratory depression .%肺泡通气不足和呼吸抑制常见于接受镇静药物或阿片类药物的患者。目前的临床指南均推荐将无创的呼出气二氧化碳监测仪作为有呼吸抑制风险的非插管患者的常规监测方法。本文对呼出气二氧化碳监测仪对非插管患者进行监测的临床研究进行文献综述,其在保障患者安全、及时发现呼吸抑制方面发挥重要作用,对存在呼吸抑制风险的患者,不应单纯依赖脉搏氧饱和度。

  1. Change of slope parameters in volumetric capnography of asthma patients at acute episodes%急性发作期支气管哮喘患者的容积二氧化碳图斜率参数变化

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    齐广生; 刘锦铭; 顾文超; 杨文兰; 郭建; 王英敏; 郑卫; 徐黎青

    2016-01-01

    Objective: To investigate the diagnostic value of volumetric capnography (VCap) parameters for asthma patients at acute episodes. Methods:VCap and spirometry were performed in 53 asthma patients at acute episodes and 43 healthy subjects. Correlation between VCap slope parameters and spirametory parameters were tested by Pearson analysis. Diagnostic performance of VCap slope for differentiating asthma patients from healthy subjects was evaluated by receiver operator characteristic (ROC) curve. Result: dC3/DV and SR23 were negatively correlated with FEV1/pre and FEV1/FVC%, respectively (P<0.05), while dC2/DV was positively correlated with FEV1/FVC% (P<0.05). dC3/DV and SR23 increased significantly in asthma group than those in healthy subjects. ROC curve analysis showed that AUC for dC2/DV, dC3/DV and SR23 were 0.605,0.724 and 0.757, respectively. Conclusions: Change of slope parameters in VCap is a simple method, which could provide references for diagnosing asthma patient at acute episode.%目的:探讨容积二氧化碳图(volumetric capnography,VCap)斜率参数对急性发作期支气管哮喘(以下简称哮喘)的诊断价值。方法:对53例急性发作期哮喘患者(哮喘组)及43名健康者(健康组)进行肺通气功能及VCap测定。采用Pearson相关性分析检验肺通气功能与VCap斜率指标间的相关性,采用独立样本t检验比较哮喘组与健康组间的VCap斜率指标差异,并用受试者工作特征曲线(receiver operator characteristic curve,ROC曲线)分析VCap斜率指标对急性发作期哮喘患者与健康人的鉴别效能。结果:Ⅲ相斜率(dC3/DV)、SR23分别与一秒钟用力呼气量(forced expiratory volume in one second,FEV1)占预计值百分比(FEV1/pre)、FEV1/用力肺活量(forced vital capacity, FVC)%呈负相关(P<0.05)。 dC2/DV与FEV1/FVC%成正相关(P<0.05)。哮喘组dC3/DV、SR23均较健康组增大,差异有统计学意义(P<0.01

  2. The similar and different changes of volumetric capnography dead spaces in chronic obstructive pulmonary disease and asthma%容积二氧化碳图死腔参数在慢性阻塞性肺疾病和支气管哮喘中的异同特点分析

    Institute of Scientific and Technical Information of China (English)

    齐广生; 刘锦铭; 周志才; 顾文超; 奚峰; 杨文兰; 吴浩

    2012-01-01

    目的 探讨死腔参数在慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)与支气管哮喘(简称哮喘)中变化趋势的异同.方法 对49例COPD患者、35例哮喘患者和35名健康志愿者的肺通气指标及Threshhold死腔(VDT)、Langley死腔(VDL)、Fowler死腔(VDF)、Wolff死腔(VDW)和Bohr死腔(VDB)进行测定分析.结果 与健康对照组比较,COPD组VDT显著减小,而VDW、VDB则显著增大,差异均有统计学意义(P<0.05),COPD组中VDL、VDF与健康对照组比较差异无统计学意义;在哮喘组中,VDT、VDL、VDF、VDW均较健康对照组显著减小,而VDB与健康对照组比较差异无统计学意义.阻塞程度相同的COPD与哮喘患者比较,VDF、VDW和VDB在COPD组显著高于哮喘组,而VDT、VDL在两组间差异则无统计学意义.相关分析显示,在COPD组中,VDT、VDF、VDW及VDB均与FEV1/FVC呈负相关(P<0.05).VDF、VDW及VDB还与FEV1呈负相关(P<0.05).而在哮喘组中,除VDB与FEV1呈负相关外(P<0.05),其余死腔参数与FEV1/FVC、FEV1均无明显相关性(P>0.05).结论 由于COPD和哮喘患者在呼吸生理方面变化的异同,其各容积二氧化碳图死腔参数的变化也有所区别.通过分析两者死腔参数的变化趋势,可为临床工作者在COPD和哮喘的诊断及鉴别诊断中提供参考.%Objective To evaluate the similar and different changes of volumetric capnography dead spaces between chronic obstructive pulmonary disease(COPD) and asthma.Methods Forty-nine COPD patients,thirty-five asthma patients and thirty-five healthy volunteers were enrolled in this study.We measured their spirometry indices and volumetric capnography dead spaces such as VDT,VDL,VDF,VDW and VDB.Results Compared with the healthy controls,VDT in COPD patients decreased significantly,while VDW and VDB significantly increased on the other hand.There were no difference about VDL and VDF between COPD patients and healthy controls.Except for VDB,all of the dead

  3. Influência da insuflação de gás traqueal sobre a capnografia de pacientes anestesiados Influencia de la insuflación de gas traqueal sobre la capnografía de pacientes anestesiados Influence of tracheal gas insufflation during capnography in anesthetized patients

    Directory of Open Access Journals (Sweden)

    Ana Carolina Ortiz

    2008-10-01

    in anesthetized patients. METHODS: Eleven patients, ages 18 to 60 years, ASA I or II, without lung diseases were evaluated prospectively. After tracheal intubation, a TGI catheter was inserted 2 to 3 cm from the carina. Patients underwent volume-controlled ventilation. The volumetric capnography curve was recorded during 20 minutes and blood was drawn to determine the PaCO2. Twenty minutes after TGI was instituted, the capnograph curve was recorded and blood was drawn once more to measure PaCO2. The end-tidal partial pressure of CO2 (P ET CO2 and PaCO2 were evaluated before and after TGI. The capnography curve was observed before and during TGI. RESULTS: PaCO2 and P ET CO2 without TGI were: 33.48 ± 6.81 and 36.91 ± 6.54 mmHg (mean ± standard deviation, respectively, and after TGI, 33.85 ± 8.31 and 36.55 ± 7.93 mmHg, respectively. Parameters were not statistically different before and after TGI, both for PaCO2 and P ET CO2 (p = 0.65 and 0.82. The capnography curve showed changes in alveolar air during expiration. CONCLUSIONS: The use of TGI did not result in a reduction in PaCO2 or P ET CO2, but it altered the morphology of the capnography curve.

  4. Changes and clinical value of dead space parameters in volumetric capnography of chronic obstructive pulmonary disease%慢性阻塞性肺疾病中容积二氧化碳图死腔参数的变化及其临床价值

    Institute of Scientific and Technical Information of China (English)

    齐广生; 刘锦铭; 顾文超; 杨文兰; 郭健; 徐黎青; 郑卫; 王英敏

    2016-01-01

    Objective To investigate the application value of volumetric capnography (VCap) dead space pa-rameters in diagnosis of chronic obstructive pulmonary disease (COPD). Methods Seventy-four patients with COPD (COPD group) and 38 healthy volunteers (healthy group) in our hospital for outpatient and inpatient treatment from 2013 to 2014 were selected as the research subjects. The pulmonary ventilation, volume and dispersion index, Threshold dead space (VDT), Langley dead space (VDL), Fowler dead space (VDF), Wolff dead space (VDW) and Bohr dead spaces (VDB) were measured in all the subjects. First, the formula for predicted value was obtained through multiple regression analysis with dead space as the dependent variable, and gender, age, height, weight, tidal volume, respiratory frequency as the independent variables. The predicted values of all subjects were computed by the formula. The difference between the predicted value and the measured value of dead space in COPD group was compared by paired t test. The discriminant effi-ciency of dead space on COPD patients and healthy people was analyzed by discriminant analysis. Correlations between dead space parameters and routine pulmonary function parameters were analyzed by partial correlation analysis. Results In the COPD group, the measured value of VDT was lower than the predicted value [(79.51 ± 39.29) mL vs (97.42 ± 30.53) mL, P<0.01], while the measured values of VDF, VDW, and VDB were significantly increased than the predicted values [(190.20 ± 57.41) mL vs 177.18±38.99) mL, (214.04±73.35) mL vs (183.86±46.63) mL, (294.89±93.12) mL vs (237.44±62.27) mL, P<0.05]. In the discriminant analysis of dead space on COPD patients and healthy people, only VDT and VDB entered the equation, with the total classification accuracy of 87.9% (116/132). In COPD group, VDT and VDF were negatively correlated with FEV1, FEV1/FVC and DLCO (P<0.05). VDW was negatively correlated with FEV1, FEV1/FVC and DLCO (P<0.05), which was

  5. Effects of manual chest compression and descompression maneuver on lung volumes, capnography and pulse oximetry in patients receiving mechanical ventilation Efeitos da manobra de compressão e descompressão torácica nos volumes pulmonares, capnografia e oximetria de pulso em pacientes submetidos à ventilação mecânica

    Directory of Open Access Journals (Sweden)

    Fabiana Della Via

    2012-10-01

    Full Text Available OBJECTIVES: The aims of this study were to evaluate whether there are changes in lung volumes, capnography, pulse oximetry and hemodynamic parameters associated with manual chest compression-decompression maneuver (MCCD in patients undergoing mechanical ventilation (MV. Method: A prospective study of 65 patients undergoing to MV after 24 hours. All patients received bronchial hygiene maneuvers and after 30 minutes they were submitted to ten repetitions of the MCCD during 10 consecutive respiratory cycles in the right hemithorax and than in the left hemithorax. The data were collected before the application of the maneuver and after 1, 5, 10, 15, 20, 25, 30, 35 and 40 minutes following application of the maneuver. RESULTS: There were statistical significant (pOBJETIVOS: Avaliar a presença de alterações nos volumes pulmonares, oximetria de pulso, capnografia e alterações hemodinâmicas associadas à intervenção da manobra de compressão e descompressão torácica (MCDT nos pacientes submetidos à ventilação mecânica (VM. Método: Tratou-se de um estudo prospectivo em que foram incluídos 65 pacientes em VM há mais de 24 horas. O protocolo consistiu na aplicação de manobras de higiene brônquica e, após 30 minutos, os pacientes eram submetidos a dez repetições da MCDT em dez respirações consecutivas no hemitórax direito e, posteriormente, no hemitórax esquerdo, coletando os dados antes e após a aplicação da manobra nos tempos 1, 5, 10, 15, 20, 25, 30, 35 e 40 minutos. RESULTADOS: Constatou-se aumento significante (p<0,001 do volume corrente inspiratório (pré: 458,2±132,1 ml; pós 1 minuto: 557,3±139,1; pós 40 minutos: 574,4±151, volume minuto corrente (pré: 7,0±2,7 L/min; pós 1 minuto: 8,7±3,3; pós 40 minutos: 8,8±3,8 e oximetria de pulso (pré: 97,4±2,2%; pós 1 minuto: 97,9±1,8; pós 40 minutos: 98,2±1,6; p<0,05. Ocorreu redução no CO2 expirado (pré: 35,1±9,0 mmHg; pós 1 minuto: 31,5±8,2; pós 40

  6. Diagnosis and evaluation of volumetric capnography for pulmonary gas exchange dysfunction in patients with pulmonary disease%呼出气CO2容积曲线对肺部疾病换气功能障碍的诊断与评价

    Institute of Scientific and Technical Information of China (English)

    赵明华; 韩克斯; 王辉

    2008-01-01

    注失调间接指标.③Vm50-75/VT%≥10%和dC/dV3≥1.3%/L用于评价肺气肿有较高敏感度和特异度.%Objective To evaluate the diagnostic and clinical value of volumetric capnography(VCap)for pulmonary gas exchange dysfunction in patients with pulmonary disease. Methods VCap was performedon all patients with pulmonary disease, including 287 chronic obstructive pulmonary disease (COPD)patients,251 asthma patients, 45 interstitial lung diseases(ILD) patients and 94 control subjects. Mainvariables: maximum CO2 concentration(CO2 max), the slope of phase3 (dC/dV3), volume between 25% and50 % of CO2 max (Vm25-50), volume between 50% and 75% of CO2 max (Vm50-75), Vm25-50/VT, Vm50-75/VT.Results (1)Four variables of Vcap exhibited statistical differences (P<0.01) between three disease groups(ILD,asthma,COPD) and control group; (2) Vm50-75/VT and dC/dV2 had no statistical differences betweenlight asthma and light COPD, but showed statistical differences (P<0.01) between moderate, severeasthma and COPD, and had no statistical differences between COPD(emphysema) and asthma combiningwith emphysema; (3) Vm50-75/VT and dC/dV3 had high sensitivity (98.3%, 96.50%) and specificity (91.4 %,86.1%) in estimating COPD(emphysema). Conclusions (1)The values and pattern of VCap are obviouslyabnormal,which can be used for diagnosing pulmonary gas exchange dysfunction of patients with COPD.dC/dV3 (≥1.3%) has a prominent rise in COPD patients and relates to the severity of COPD, showing anunequal pulmonary gas distributing;(2)Vm50-75/VT and Vm25-50/VT are less affected by physiological factorsand expired volume, Vm25-50/VT (≥7%), Vm50-75/VT≥10%) indirectly reflects alveolar dead spaceincreasing and unequal ventilation-perfusion ratio commendably; (3)VCap is simple, rapid, non-invasive, andsecure and can be repeated well.

  7. [Collecting end-expiratory air for capnography in high-frequency jet ventilation].

    Science.gov (United States)

    Rockemann, M G; Doehn, M

    1985-04-01

    By means of an ejector attachment to the endotracheal tube a negative intratracheal pressure of approx. -1 mmHg is created during an interruption of HFJV. Within 4 to 10 sec. this suction supplies alveolar air to the distal end of the endotracheal tube where capnographic analysis is possible in the mainstream or bystream. The end-tidal pCO2 differs by 0.1 mmHg (mean) from the arterial carbon dioxide partial pressure with a highly positive correlation (R = 0.98).

  8. Correlation Between Capnography and Arterial Carbon Dioxide Before, During, and After Severe Chest Injury in Swine

    Science.gov (United States)

    2012-01-01

    During phase 2, animals developed decreased oxygenation ( PaO2 :FiO2 [fraction of inspired oxygen] ratio G200) and hy- potension (mean arterial...mercury), ABG, and ratio of arterial oxygen content ( PaO2 ) to FIO2 (PFR). All data col lection was during three phases (1, 2, and 3) of the experiment...did not show an increase in correlation and was therefore left out of the final model. Ratio of PaO2 to FIO2 was not associated with PaCO2. Using

  9. Implementation of a novel postoperative monitoring system using automated Modified Early Warning Scores (MEWS) incorporating end-tidal capnography.

    Science.gov (United States)

    Blankush, Joseph M; Freeman, Robbie; McIlvaine, Joy; Tran, Trung; Nassani, Stephen; Leitman, I Michael

    2016-10-20

    Modified Early Warning Scores (MEWS) provide real-time vital sign (VS) trending and reduce ICU admissions in post-operative patients. These early warning calculations classically incorporate oxygen saturation, heart rate, respiratory rate, systolic blood pressure, and temperature but have not previously included end-tidal CO2 (EtCO2), more recently identified as an independent predictor of critical illness. These systems may be subject to failure when physiologic data is incorrectly measured, leading to false alarms and increased workload. This study investigates whether the implementation of automated devices that utilize ongoing vital signs monitoring and MEWS calculations, inclusive of a score for end-tidal CO2 (EtCO2), can be feasibly implemented on the general care hospital floor and effectively identify derangements in a post-operative patient's condition while limiting the amount of false alarms that would serve to increase provider workload. From July to November 2014, post-operative patients meeting the inclusion criteria (BMI > 30 kg/m(2), history of obstructive sleep apnea, or the use of patient-controlled analgesia (PCA) or epidural narcotics) were monitored using automated devices that record minute-by-minute VS included in classic MEWS calculations as well as EtCO2. Automated messages via pagers were sent to providers for instances when the device measured elevated MEWS, abnormal EtCO2, and oxygen desaturations below 85 %. Data, including alarm and message details from the first 133 patients, were recorded and analyzed. Overall, 3.3 alarms and pages sounded per hour of monitoring. Device-only alarms sounded 2.7 times per hour-21 % were technical alarms. The remaining device-only alarms for concerning VS sounded 2.0/h, 70 % for falsely recorded VS. Pages for abnormal EtCO2 sounded 0.4/h (82 % false recordings) while pages for low blood oxygen saturation sounded 0.1/h (55 % false alarms). 143 times (0.1 pages/h) the devices calculated a MEWS warranting a page (rise in MEWS by 2 or 5 or greater)-62 % were false scores inclusive of falsely recorded VS. An abnormal EtCO2 value resulted in or added to an elevated MEWS score in 29 % of notifications, but 50 % of these included a falsely abnormal EtCO2 value. To date, no adverse events have occurred. There were no statistically significant demographic, post-operative condition, or pre-existing comorbidity differences between patients who had a majority of true alarms from those who had mostly false-positive alarms. Although not statistically significant, the group of patients in whom automated MEWS suggested greater utility included those with a history of hypertension (p = 0.072) and renal disease (p = 0.084). EtCO2 monitoring was more likely to be useful in patients with a history of type 2 diabetes, coronary artery disease, and obstructive sleep apnea (p < 0.05). These patients were also more likely to have been on a PCA post-operatively (p < 0.05). Overall, non-invasive physiologic monitoring incorporating an automated MEWS system, modified to include end-tidal CO2 can be feasibly implemented in a hospital ward. Further study is needed to evaluate its clinical utility, including an end-tidal CO2 score, is feasibly implemented and can be useful in monitoring select post-operative patients for derangements in physiologic metrics. Like any other monitoring system, false alarms may occur at high rates. While further study is needed to determine the additive utility of EtCO2 in MEWS calculations, this study suggests utility of EtCO2 in select post-operative patients.

  10. PROGNOSTIC VALUE OF INITIAL ASSESSMENT OF RESIDUAL HYPOVENTILATION USING NOCTURNAL CAPNOGRAPHY IN MECHANICALLY VENTILATED NEUROMUSCULAR PATIENTS: A 5 YEARS FOLLOW-UP STUDY.

    Directory of Open Access Journals (Sweden)

    Adam Ogna

    2016-09-01

    Full Text Available BackgroundRestrictive respiratory failure is a major cause of morbidity and mortality in neuromuscular diseases (NMD. Home mechanical ventilation (HMV is used to treat hypoventilation, and its efficiency is mostly assessed by daytime blood gases or nocturnal oxygen saturation monitoring (SpO2. Non-invasive transcutaneous measure of CO2 (TcCO2 allows to directly assess nocturnal hypercapnia and to detect residual hypoventilation with a higher sensitivity than SpO2.We aimed to compare the prognostic value of nocturnal SpO2 and TcCO2 in ventilated adult NMD patients. MethodsAll consecutive capno-oximetries performed between 2010 and 2011 in ventilated adult NMD patients were analysed retrospectively. Concomitant blood gas analysis and lung function data were collected. Patients on oxygen therapy were excluded. Nocturnal hypoxemia and hypercapnia (using 4 different definitions at baseline were compared in their ability to predict mortality and respiratory events requiring ICU admission during follow-up. ResultsData from 55 patients were analysed (median age 28 IQR 25 - 36.5 years; 71% Duchenne muscular dystrophy; vital capacity 12 7 - 27 % of predicted; 51% tracheostomy.Capno-oxymetry showed hypoxemia in 14.5% and hypercapnia in 12.7 to 41.8%, according to the used definition.Over a follow-up lasting up to 5 years (median 4.0 3.6 - 4.5 years, we observed 12 deaths and 20 respiratory events requiring ICU admission. Hypercapnia was significantly associated with the study outcomes, with TcCO2 >49 mmHg during ≥10% of the time being the best definition, whilst hypoxemia was not.ConclusionsOur data show for the first time that residual hypoventilation, assessed by capnometry, is significantly associated with negative outcomes in adult ventilated NMD patients, whilst oximetry is not. Accordingly, we suggest capnometry to be included in the systematic assessment of HMV efficiency in NMD patients.

  11. Development of application and studies of volume-capnography in critical patients%容量-呼气末二氧化碳分压波在危重患者中临床应用解析

    Institute of Scientific and Technical Information of China (English)

    江学成

    2011-01-01

    Background Volume PETCO2 is a sigal-wave plot based on the expired carbon dioxide fraction,which is the standard tool for understanding carbon dioxide elimination and the dead space. Objective The basic principles and clinical significance of normal and abnormal waveform of v-PETCO2 is introduced. Content v-PETCO2 wave morphology depends on production, transport (pulmonary perfusion) and diffusion of the carbon dioxide, as well as any changes in respiratory pathophysiology, v-PETCO2 can be used to study the dynamics of CO2. This plot yields three parts: first phase is carbon dioxide free;phase Ⅱ represents the transition between gas from the airways and alveolar gas, and phase Ⅲ represents alveolar gas. The respiratory dysfunction reduces ventilation in some units more than others, causing an increased scatter of ventilation/perfusion (V/Q)ratios and thus of the range of alveolar PCO2 values. They results in increased slope of phase 3 and three dead space estimates derived from the v-capnogram, including the anatomical dead space, alveolar dead space and physiological dead space. This can differentiate a patient with a pulmonary embolism from a healthy patient or a COPD, ARDS or asthma patients. Trend v-PETCO2 is the standard tool for understanding carbon dioxide elimination and the dead space concept.%背景容量-呼气末二氧化碳分压图(volume-capnogram,v-PETCO2)是根据呼吸周期中呼出气量对应CO2水平描记的单波图,是评价呼吸障碍患者死腔或分流的最有价值的无创性新工具。目的讲述v-PETCO2的基本原理、正常波形和异常波形的临床意义。内容v-PETCO2波的形态取决于CO2产生、运输(肺灌注)和弥散以及任何原因引起的肺病理生理学改变,可用来更好地了解和研究CO2动力学过程。v-PETCO2有3个呼气相:相Ⅰ,呼出的为无CO2的气道气体,相Ⅱ是气道和肺泡混合气体,相Ⅲ完全是肺泡气体。呼吸障碍时通气/灌注比率不匹配,导致肺泡序贯性排空,呼出气CO2水平不同,v-PETCO2波的相Ⅲ斜率增加,解剖死腔、肺泡死腔和/或生理死腔及及其计算参数增加。根据v -PETCO2波的相Ⅲ斜率能将肺栓塞与肺疾患轻易区别,通过死腔参数较精确地评价急性呼吸窘迫综合征(acute respiratory distresssyndrome,ARDS)、哮喘、慢性阻塞性肺病(chronic obstructive pulmonary diseases,COPD)等严重程度和鉴别。趋向PETCO2波对危重患者肺功能临床评价和研究具有突破性贡献和非常高的价值。

  12. Diagnostic accuracy of methods used to verify nasogastric tube position in mechanically ventilated adult patients

    DEFF Research Database (Denmark)

    Bennetzen, Linda Vad; Håkonsen, Sasja Jul; Svenningsen, Helle

    2015-01-01

    -100% AND SPECIFICITY WAS 99-100%.: Capnography obtained a specificity of 100% but sensitivity for when the nasogastric tube was inserted through the nose could not be calculated based on available data. CONCLUSIONS: We found evidence (Level 2b) for colorimetric capnography to be a valid method for verifying...... systematic review were designed based on diagnostic test accuracy studies. Types of outcomes: The outcome was the accuracy (sensitivity and specificity) of the methods to discriminate between respiratory and gastrointestinal placement of the nasogastric tube. SEARCH STRATEGY: The search strategy aimed...... in tables. When these were not written in the studies, calculations were performed based on data presented in the studies. RESULTS: Five relevant papers describing two different methods for determining nasogastric tube position were identified: colorimetric capnography (four studies) and capnography (one...

  13. Acoustic method respiratory rate monitoring is useful in patients under intravenous anesthesia.

    Science.gov (United States)

    Ouchi, Kentaro; Fujiwara, Shigeki; Sugiyama, Kazuna

    2017-02-01

    Respiratory depression can occur during intravenous general anesthesia without tracheal intubation. A new acoustic method for respiratory rate monitoring, RRa(®) (Masimo Corp., Tokyo, Japan), has been reported to show good reliability in post-anesthesia care and emergency units. The purpose of this study was to investigate the reliability of the acoustic method for measurement of respiratory rate during intravenous general anesthesia, as compared with capnography. Patients with dental anxiety undergoing dental treatment under intravenous anesthesia without tracheal intubation were enrolled in this study. Respiratory rate was recorded every 30 s using the acoustic method and capnography, and detectability of respiratory rate was investigated for both methods. This study used a cohort study design. In 1953 recorded respiratory rate data points, the number of detected points by the acoustic method (1884, 96.5 %) was significantly higher than that by capnography (1682, 86.1 %) (P < 0.0001). In the intraoperative period, there was a significant difference in the LOA (95 % limits of agreement of correlation between difference and average of the two methods)/ULLOA (under the lower limit of agreement) in terms of use or non-use of a dental air turbine (P < 0.0001). In comparison between capnography, the acoustic method is useful for continuous monitoring of respiratory rate in spontaneously breathing subjects undergoing dental procedures under intravenous general anesthesia. However, the acoustic method might not accurately detect in cases in with dental air turbine.

  14. Estimation of respiratory rates based on photoplethysmographic measurements at the sternum

    DEFF Research Database (Denmark)

    Chreiteh, Shadi; Belhage, Bo; Hoppe, Karsten;

    2015-01-01

    rate is extracted using photoplethysmography (PPG) on the chest bone (sternum). Sternal PPG signals were acquired from 10 healthy subjects resting in a supine position. As reference signals, finger PPG, electrocardiogram (ECG), and capnography were simultaneously recorded during spontaneous and paced...... breathing. The sternal PPG signals were then compared with the reference signals in terms of Bland-Altman analysis, the power spectrum analysis and the magnitude squared coherence. The Bland-Altman analysis showed an average bias of 0.21 breaths/min between RR extracted from sternal PPG and capnography....... The respiratory power content at the sternum was 78.8 (38) % in terms of the median and (the interquartile range). The cardiac content was 19 (18.4) % within the cardiac region. The results from the magnitude squared coherence analysis was 0.97 (0.09) in the respiratory region (6 to 27 breaths/min) and 0.98 (0...

  15. Mechanical ventilation and respiratory mechanics during equine anesthesia.

    Science.gov (United States)

    Moens, Yves

    2013-04-01

    The mechanical ventilation of horses during anesthesia remains a crucial option for optimal anesthetic management, if the possible negative cardiovascular side effects are managed, because this species is prone to hypercapnia and hypoxemia. The combined use of capnography and pitot-based spirometry provide complementary information on ventilation and respiratory mechanics, respectively. This facilitates management of mechanical ventilation in conditions of changing respiratory system compliance (ie, laparoscopy) and when investigating new ventilatory strategies including alveolar recruitment maneuvers and optimization of positive expiratory pressure.

  16. Sidestream Capnographic Monitoring Reduces the Incidence of Arterial Oxygen Desaturation During Propofol Ambulatory Anesthesia for Surgical Abortion

    OpenAIRE

    Zongming, Jiang; Zhonghua, Chen; Xiangming, Fang

    2014-01-01

    Background This study investigated whether early intervention based on additional use of sidestream capnography could reduce the incidence of oxygen desaturation and hypoxic events in patients receiving propofol anesthesia during surgical abortion. Material/Methods We recruited 704 ASAI-III female patients, 18–52 years old and scheduled for planned painless surgical abortion, and randomized them into a control group (n=359) receiving standard monitoring and an experimental group (n=341) recei...

  17. SEDATION IN COLONOSCOPY BY USING THREE DIFFERENT PROPOFOL INFUSION METHODS AND ANALYSIS OF PLASMA CONCENTRATION LEVELS: A PROSPECTIVE COMPARATIVE STUDY

    Science.gov (United States)

    de CARVALHO, Paulo Henrique Boaventura; OTOCH, José Pinhata; KHAN, Mohamad Ali; SAKAI, Paulo; GUEDES, Hugo Gonçalo; ARTIFON, Everson Luiz de Almeida

    2016-01-01

    ABSTRACT Background: The propofolemia becomes directly linked to the clinical effects of this anesthetic and is the focus for studies comparing propofol clinical use, in different administration methods routinely used in endoscopy units where sedation is widely administered to patients. Aim: To evaluate the effects of three different regimens of intravenous propofol infusion in colonoscopies. Methods: A total of 50 patients that underwent colonoscopies were consecutively assigned to three groups: 1) intermittent bolus infusion; 2) continuous manually controlled infusion; 3) continuous automatic infusion. Patients were monitored with Bispectral IndexTM (BIS) and propofol serum levels were collected at three different timepoints. The development of an original dilution of propofol and an inventive capnography catheter were necessary. Results: Regarding clinical outcomes, statistical differences in agitation (higher in group 1, p=0.001) and initial blood pressure (p=0.008) were found. As for propofol serum levels, findings were similar in consumption per minute (p=0.748) and over time (p=0.830). In terms of cost analysis, group 1 cost was R$7.00 (approximately US$2,25); group2, R$17.50 (approximately US$5,64); and group 3, R$112.70 (approximately US$36,35, p<0.001). Capnography was able to predict 100% of the oxygen saturation drop (below 90%). Conclusion: The use of propofol bolus administration for colonoscopies, through continuous manually controlled infusion or automatic infusion are similar regarding propofolemia and the clinical outcomes evaluated. The use of an innovative capnography catheter is liable and low-cost solution for the early detection of airway obstruction. PMID:28076483

  18. A Brief Review of Non-invasive Monitoring of Respiratory Condition for Extubated Patients with or at Risk for Obstructive Sleep Apnea after Surgery.

    Science.gov (United States)

    Zhang, Xuezheng; Kassem, Mahmoud Attia Mohamed; Zhou, Ying; Shabsigh, Muhammad; Wang, Quanguang; Xu, Xuzhong

    2017-01-01

    Obstructive sleep apnea (OSA) is one of the important risk factors contributing to postoperative airway complications. OSA alters the respiratory physiology and increases the sensitivity of muscle tone of the upper airway after surgery to residual anesthetic medication. In addition, the prevalence of OSA was reported to be much higher among surgical patients than the general population. Therefore, appropriate monitoring to detect early respiratory impairment in postoperative extubated patients with possible OSA is challenging. Based on the comprehensive clinical observation, several equipment have been used for monitoring the respiratory conditions of OSA patients after surgery, including the continuous pulse oximetry, capnography, photoplethysmography (PPG), and respiratory volume monitor (RVM). To date, there has been no consensus on the most suitable device as a recommended standard of care. In this review, we describe the advantages and disadvantages of some possible monitoring strategies under certain clinical conditions. According to the literature, the continuous pulse oximetry, with its high sensitivity, is still the most widely used device. It is also cost-effective and convenient to use but has low specificity and does not reflect ventilation. Capnography is the most widely used device for detection of hypoventilation, but it may not provide reliable data for extubated patients. Even normal capnography cannot exclude the existence of hypoxia. PPG shows the state of both ventilation and oxygenation, but its sensitivity needs further improvement. RVM provides real-time detection of hypoventilation, quantitative precise demonstration of respiratory rate, tidal volume, and MV for extubated patients, but no reflection of oxygenation. Altogether, the sole use of any of these devices is not ideal for monitoring of extubated patients with or at risk for OSA after surgery. However, we expect that the combined use of continuous pulse oximetry and RVM may be

  19. A Brief Review of Non-invasive Monitoring of Respiratory Condition for Extubated Patients with or at Risk for Obstructive Sleep Apnea after Surgery

    Science.gov (United States)

    Zhang, Xuezheng; Kassem, Mahmoud Attia Mohamed; Zhou, Ying; Shabsigh, Muhammad; Wang, Quanguang; Xu, Xuzhong

    2017-01-01

    Obstructive sleep apnea (OSA) is one of the important risk factors contributing to postoperative airway complications. OSA alters the respiratory physiology and increases the sensitivity of muscle tone of the upper airway after surgery to residual anesthetic medication. In addition, the prevalence of OSA was reported to be much higher among surgical patients than the general population. Therefore, appropriate monitoring to detect early respiratory impairment in postoperative extubated patients with possible OSA is challenging. Based on the comprehensive clinical observation, several equipment have been used for monitoring the respiratory conditions of OSA patients after surgery, including the continuous pulse oximetry, capnography, photoplethysmography (PPG), and respiratory volume monitor (RVM). To date, there has been no consensus on the most suitable device as a recommended standard of care. In this review, we describe the advantages and disadvantages of some possible monitoring strategies under certain clinical conditions. According to the literature, the continuous pulse oximetry, with its high sensitivity, is still the most widely used device. It is also cost-effective and convenient to use but has low specificity and does not reflect ventilation. Capnography is the most widely used device for detection of hypoventilation, but it may not provide reliable data for extubated patients. Even normal capnography cannot exclude the existence of hypoxia. PPG shows the state of both ventilation and oxygenation, but its sensitivity needs further improvement. RVM provides real-time detection of hypoventilation, quantitative precise demonstration of respiratory rate, tidal volume, and MV for extubated patients, but no reflection of oxygenation. Altogether, the sole use of any of these devices is not ideal for monitoring of extubated patients with or at risk for OSA after surgery. However, we expect that the combined use of continuous pulse oximetry and RVM may be

  20. Difficult airway equipment: a survey of standards across metropolitan Perth.

    Science.gov (United States)

    Alakeson, N; Flett, T; Hunt, V; Ramgolam, A; Reynolds, W; Hartley, K; Hegarty, M; von Ungern-Sternberg, B S

    2014-09-01

    The importance of appropriate equipment to manage the difficult airway has been highlighted by the publication of the Australian and New Zealand College of Anaesthetists (ANZCA) guidelines in 2012. We set out to audit compliance with these guidelines in all public and private sites providing general anaesthesia in metropolitan Perth. Public and private health care websites identified 39 sites of which 37 were studied. Institutional and ethics approval was obtained. A tick-box design audit tool, based on the ANZCA guidelines, was used to collect information regarding the dedicated difficult airway container (DDAC) at each site. As recommended in the guidelines, only equipment within the DDAC was considered. Further data about each site, including the number of theatre suites, satellite anaesthetic areas, use of capnography and categories of patients treated (adult, obstetric and paediatric) were collected. An adult DDAC was found at 92% of all sites, but none of the sites had all the essential equipment listed in the ANZCA guidelines. There was limited provision of adult difficult airway equipment within private sites compared to public, and less provision of paediatric difficult airway equipment across all sites treating paediatric patients in metropolitan Perth. Capnography was available in 76% of post anaesthesia care units and used regularly in 27%. Adherence to the ANZCA guidelines regarding the DDAC could be improved. Standardised equipment across a metropolitan region would be of value in the management of the difficult airway.

  1. Risks of Using Bedside Tests to Verify Nasogastric Tube Position in Adult Patients

    Directory of Open Access Journals (Sweden)

    Melody Ni

    2014-12-01

    Full Text Available Nasogastric (NG tubes are commonly used for enteral feeding. Complications of feeding tube misplacement include malnutrition, pulmonary aspiration, and even death. We built a Bayesian network (BN to analyse the risks associated with available bedside tests to verify tube position. Evidence on test validity (sensitivity and specificity was retrieved from a systematic review. Likelihood ratios were used to select the best tests for detecting tubes misplaced in the lung or oesophagus. Five bedside tests were analysed including magnetic guidance, aspirate pH, auscultation, aspirate appearance, and capnography/colourimetry. Among these, auscultation and appearance are non-diagnostic towards lung or oesophagus placements. Capnography/ colourimetry can confirm but cannot rule out lung placement. Magnetic guidance can rule out both lung and oesophageal placement. However, as a relatively new technology, further validation studies are needed. The pH test with a cut-off at 5.5 or lower can rule out lung intubation. Lowering the cut-off to 4 not only minimises oesophageal intubation but also provides extra safety as the sensitivity of pH measurement is reduced by feeding, antacid medication, or the use of less accurate pH paper. BN is an effective tool for representing and analysing multi-layered uncertainties in test validity and reliability for the verification of NG tube position. Aspirate pH with a cut-off of 4 is the safest bedside method to minimise lung and oesophageal misplacement.

  2. Cardiorespiratory monitoring during neonatal resuscitation for direct feedback and audit

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    Jeroen Johannes van Vonderen

    2016-04-01

    Full Text Available Neonatal resuscitation is one of the most frequently performed procedures and it is often successful if the ventilation applied is adequate. Over the last decade, interest in seeking objectivity in evaluating the infant’s condition at birth or the adequacy and effect of the interventions applied has markedly increased. Clinical parameters such as heart rate, colour and chest excursions are difficult to interpret and can be very subjective and subtle. The use of ECG, pulse oximetry, capnography and respiratory function monitoring can add objectivity to the clinical assessment. These physiological parameters, with or without the combination of video recordings, can be used directly to guide care, but can also be used later for audit and teaching purposes. Further studies are needed to investigate whether this will improve the quality of delivery room management. In this review we will give an update of the current developments in monitoring neonatal resuscitation.

  3. [Bilateral diaphragmatic paralysis due to Parsonage-Turner syndrome].

    Science.gov (United States)

    Tissier-Ducamp, D; Martinez, S; Alagha, K; Charpin, D; Chanez, P; Palot, A

    2015-09-01

    We report the case of a 49-years-old patient who presented to the accident and emergency department with sudden onset dyspnea associated with acute shoulder pain. He was breathless at rest with supine hypoxemia. He had an amyotrophic left shoulder with localized paresis of the shoulder. Both hemi-diaphragms were elevated on chest X-rays. Pulmonary function tests showed a restrictive pattern and both phrenic nerve conduction velocities were decreased. At night, alveolar hypoventilation was evidenced by elevated mean capnography (PtcCO2: 57mmHg). Neuralgic amyotrophy, Parsonage-Turner syndrome was the final diagnosis. This syndrome is a brachial plexus neuritis with a predilection for the suprascapular and axillary nerves. Phrenic nerve involvement is rare but where present can be the most prominent clinical feature as in our case report.

  4. [Pediatric advanced life support].

    Science.gov (United States)

    Muguruma, Takashi

    2011-04-01

    Important changes or points of emphasis in the recommendations for pediatric advanced life support are as follows. In infants and children with no signs of life, healthcare providers should begin CPR unless they can definitely palpate a pulse within 10 seconds. New evidence documents the important role of ventilations in CPR for infants and children. Rescuers should provide conventional CPR for in-hospital and out-of-hospital pediatric cardiac arrests. The initial defibrillation energy dose of 2 to 4J/kg of either monophasic or biphasic waveform. Both cuffed and uncuffed tracheal tubes are acceptable for infants and children undergoing emergency intubation. Monitoring capnography/capnometry is recommended to confirm proper endotracheal tube position.

  5. Comparison of end-tidal carbon dioxide and arterial blood bicarbonate levels in patients with metabolic acidosis referred to emergency medicine

    Science.gov (United States)

    Taghizadieh, Ali; Pouraghaei, Mahboub; Moharamzadeh, Payman; Ala, Alireza; Rahmani, Farzad; Basiri Sofiani, Karim

    2016-01-01

    Introduction: The routine and gold standard method to diagnose of acid – base disturbance is arterial blood gas (ABG) sampling. Capnography could be used to measure the end-tidal carbon dioxide (ETCO2) levels and ETco2 has a close correlation with the PaCo2. The aim of this study was comparison the ETco2 and arterial blood bicarbonate levels in patients with metabolic acidosis. Methods: In a descriptive-analytical study that performed in Emergency Department of Emam Reza Medical Research and Training Hospital of Tabriz on patients with metabolic acidosis, ETco2 level and blood bicarbonate levels in 262 patients were evaluated. Results: Mean of ETco2 and Hco3 levels in patients with metabolic acidosis were 22.29 ± 4.15 and 12.78 ± 3.83, respectively. In all patients, the significant direct linear relationship was found between ETco2 with Hco3 (r = 0.553, P < 0.001). We had 4 groups of patients with metabolic acidosis, also there is a significant direct linear relationship between the ETCo2 and the Hco3 level of arterial blood in patients with renal failure (P < 0.001 and r = 0.551), sepsis (P < 0.001 and r = 0.431), drug toxicity (P < 0.001 and r = 0.856), and ketoacidosis (DKA) (P < 0.001 and r = 0.559). Conclusion: According to the results of this study, capnography can be used for primary diagnosis of metabolic acidosis in spontaneously breathing patients who referred to the emergency wards, however, the ABG must be considered as the gold standard tool for diagnosis and guiding the treatment. PMID:27777693

  6. Monitoring during Mechnical Ventilation

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    Dean Hess

    1996-01-01

    Full Text Available Monitoring is a continuous, or nearly continuous, evaluation of the physiological function of a patient in real time to guide management decisions, including when to make therapeutic interventions and assessment of those interventions. Pulse oximeters pass two wavelengths of light through a pulsating vascular bed and determine oxygen saturation. The accuracy of pulse oximetry is about ±4%. Capnography measures carbon dioxide at the airway and displays a waveform called the capnogram. End-tidal PCO2 represents alveolar PCO2 and is determined by the ventilation-perfusion quotient. Use of end-tidal PCO2 as an indication of arterial PCO2 is often deceiving and incorrect in critically ill patients. Because there is normally very little carbon dioxide in the stomach, a useful application of capnography is the detection of esophageal intubation. Intra-arterial blood gas systems are available, but the clinical impact and cost effectiveness of these is unclear. Mixed venous oxygenation (PvO2 or SvO2 is a global indicator of tissue oxygenation and is affected by arterial oxygen content, oxygen consumption and cardiac output. Indirect calorimetry is the calculation of energy expenditure and respiratory quotient by the measurement of oxygen consumption and carbon dioxide production. A variety of mechanics can be determined in mechanically ventilated patients including resistance, compliance, auto-peak end-expiratory pressure (PEEP and work of breathing. The static pressure-volume curve can be used to identify lower and upper infection points, which can be used to determine the appropriate PEEP setting and to avoid alveolar overdistension. Although some forms of monitoring have become a standard of care during mechanical ventilation (eg, pulse oximetry, there is little evidence that use of any monitor affects patient outcome.

  7. Applied value of dead spaces measuring in bronchial asthma%死腔测定在支气管哮喘中应用价值的研究

    Institute of Scientific and Technical Information of China (English)

    齐广生; 刘锦铭; 高蓓兰; 储海青; 杨文兰; 郑卫

    2009-01-01

    Objective To investigate the applied value and implications of dead spaces from volumetric capnography(VCap)in bronchial asthma(asthma).Methods The ventilation and volume function together with series dead spaces,which include Langley dead space(VDL),Fowler dead space(VDF)and Wolff dead space(VDW) were measured in 52 patients with asthma exacerbation and 35 controls.Results Compared with healthy group,VDL,VDF and VDW in asthma group showed significant decrease(P<0.01,0.01,0.01).In asthma group,VDL,VDF and VDW were all negative correlated with FEVl%pred,FEV1/FVC%,PEF%pred,FEF25%pred,FEF50%pred,FEF75%pred and MMEF%pred(P<0.05).At the same time,they were positive correlated with RV.TLC and RV/TLC(P<0.05).Conclusions The dead spaces measurement of VCap is easy to be cooperated by patients.And it may have clinical value in diagnosing asthma.%目的 探讨容积二氧化碳图(volumetric capnography,VCap)技术死腔测定在支气管哮喘(简称哮喘)中的应用价值及临床意义.方法 对52例急性发作期哮喘患者及35名健康志愿者的常规肺功能指标及Langley死腔(VDL)、Fowler死腔(VDF)、Wolff死腔(VDW)进行测定分析.结果 本研究显示:哮喘组中VDL、VDF及VDW均较对照组显著减小(P<0.01,0.01,0.01).相关分析显示:VDL、VDF和VDW分别与FEV1占预计值%、FEV1/FVC%、PEF占预计值%、FEF25占预计值%、FEF50占预计值%、FEF75占预计值%、MMEF占预计值%呈负相关(P<0.05),与RV占预计值%、TLC占预计值%、Rv/TLC%呈正相关(P<0.05).结论 VCap死腔测定患者易于配合,对哮喘的辅助诊断及进一步了解其病理生理改变具有一定的临床价值和意义.

  8. COPD phenotypes on computed tomography and its correlation with selected lung function variables in severe patients

    Directory of Open Access Journals (Sweden)

    da Silva SMD

    2016-03-01

    Full Text Available Silvia Maria Doria da Silva, Ilma Aparecida Paschoal, Eduardo Mello De Capitani, Marcos Mello Moreira, Luciana Campanatti Palhares, Mônica Corso PereiraPneumology Service, Department of Internal Medicine, School of Medical Sciences, State University of Campinas (UNICAMP, Campinas, São Paulo, BrazilBackground: Computed tomography (CT phenotypic characterization helps in understanding the clinical diversity of chronic obstructive pulmonary disease (COPD patients, but its clinical relevance and its relationship with functional features are not clarified. Volumetric capnography (VC uses the principle of gas washout and analyzes the pattern of CO2 elimination as a function of expired volume. The main variables analyzed were end-tidal concentration of carbon dioxide (ETCO2, Slope of phase 2 (Slp2, and Slope of phase 3 (Slp3 of capnogram, the curve which represents the total amount of CO2 eliminated by the lungs during each breath.Objective: To investigate, in a group of patients with severe COPD, if the phenotypic analysis by CT could identify different subsets of patients, and if there was an association of CT findings and functional variables.Subjects and methods: Sixty-five patients with COPD Gold III–IV were admitted for clinical evaluation, high-resolution CT, and functional evaluation (spirometry, 6-minute walk test [6MWT], and VC. The presence and profusion of tomography findings were evaluated, and later, the patients were identified as having emphysema (EMP or airway disease (AWD phenotype. EMP and AWD groups were compared; tomography findings scores were evaluated versus spirometric, 6MWT, and VC variables.Results: Bronchiectasis was found in 33.8% and peribronchial thickening in 69.2% of the 65 patients. Structural findings of airways had no significant correlation with spirometric variables. Air trapping and EMP were strongly correlated with VC variables, but in opposite directions. There was some overlap between the EMP and AWD

  9. Carbon dioxide insufflation during colonoscopy in deeply sedated patients

    Institute of Scientific and Technical Information of China (English)

    Rajvinder Singh; Eu Nice Neo; Nazree Nordeen; Ganesananthan Shanmuganathan; Angelie Ashby; Sharon Drummond; Garry Nind

    2012-01-01

    AIM:To compare the impact of carbon dioxide (CO2) and air insufflation on patient tolerance/safety in deeply sedated patients undergoing colonoscopy.METHODS:Patients referred for colonoscopy were randomized to receive either CO2 or air insufflation during the procedure.Both the colonoscopist and patient were blinded to the type of gas used.During the procedure,insertion and withdrawal times,caecal intubation rates,total sedation given and capnography readings were recorded.The level of sedation and magnitude of patient discomfort during the procedure was assessed by a nurse using a visual analogue scale (VAS) (0-3).Patients then graded their level of discomfort and abdominal bloating using a similar VAS.Complications during and after the procedure were recorded.RESULTS:A total of 142 patients were randomized with 72 in the air arm and 70 in the CO2 arm.Mean age between the two study groups were similar.Insertion time to the caecum was quicker in the CO2 group at 7.3 min vs 9.9 min with air (P =0.0083).The average withdrawal times were not significantly different between the two groups.Caecal intubation rates were 94.4% and 100% in the air and CO2 groups respectively (P =0.012).The level of discomfort assessed by the nurse was 0.69 (air) and 0.39 (CO2) (P =0.0155) and by the patient 0.82 (air) and 0.46 (CO2) (P =0.0228).The level of abdominal bloating was 0.97 (air) and 0.36 (CO2) (P =0.001).Capnography readings trended to be higher in the CO2 group at the commencement,caecal intubation,and conclusion of the procedure,even though this was not significantly different when compared to readings obtained during air insufflation.There were no complications in both arms.CONCLUSION:CO2 insuffiation during colonoscopy is more efficacious than air,allowing quicker and better cecal intubation rates.Abdominal discomfort and bloating were significantly less with CO2 insufflation.

  10. Difficult airway equipment in departments of emergency medicine in Ireland: results of a national survey.

    LENUS (Irish Health Repository)

    Walsh, K

    2012-02-03

    BACKGROUND AND OBJECTIVE: Adverse effects associated with difficult airway management can be catastrophic and include death, brain injury and myocardial injury. Closed-malpractice claims have shown prolonged and persistent attempts at endotracheal intubation to be the most common situation leading to disastrous respiratory events. To date, there has been no evaluation of the types of difficult airway equipment currently available in Irish departments of emergency medicine. The objective of this survey was to identify the difficult airway equipment available in Irish departments of emergency medicine. METHODS: Departments of emergency medicine in the Republic of Ireland with at least one dedicated Emergency Medicine consultant were surveyed via telephone. RESULTS: All of the departments contacted held at least one alternative device on site for both ventilation and intubation. The most common alternative ventilation device was the laryngeal mask airway (89%). The most common alternative intubating device was the surgical airway device (100%). CONCLUSIONS: Irish departments of emergency medicine compare well with those in the UK and USA, when surveyed concerning difficult airway equipment. However, we believe that this situation could be further improved by training inexperienced healthcare providers in the use of the laryngeal mask airway and intubating laryngeal mask airway, by placing greater emphasis on the ready availability of capnography and by the increased use of portable difficult airway storage units.

  11. The Predictors of Obesity Hypoventilation Syndrome in Obstructive Sleep Apnea

    Science.gov (United States)

    Pıhtılı, Aylin; Bingöl, Züleyha; Kıyan, Esen

    2017-01-01

    Background: As obesity increases, the frequency of obstructive sleep apnea and obesity hypoventilation syndrome increases also. However, obesity hypoventilation syndrome frequency is not known, as capnography and arterial blood gas analysis are not routinely performed in sleep laboratories. Aims: To investigate the frequency and predictors of obesity hypoventilation syndrome in obese subjects. Study Design: Retrospective clinical study. Methods: Obese subjects who had arterial blood gas analysis admitted to the sleep laboratory and polysomnography were retrospectively analyzed. Subjects with restrictive (except obesity) and obstructive pulmonary pathologies were excluded. Demographics, Epworth-Sleepiness-Scale scores, polysomnographic data, arterial blood gas analysis, and spirometric measurements were recorded. Results: Of the 419 subjects, 45.1% had obesity hypoventilation syndrome. Apnea hypopnea index (p<0.001), oxygen desaturation index (p<0.001) and sleep time with SpO2<90% (p<0.001) were statistically higher in subjects with obesity hypoventilation syndrome compared to subjects with eucapnic obstructive sleep apnea. The nocturnal mean SpO2 (p<0.001) and lowest SpO2 (p<0.001) were also statistically lower in subjects with obesity hypoventilation syndrome. Logistic regression analysis showed that the lowest SpO2, oxygen desaturation index, apnea hypopnea index and sleep time with SpO2 <90% were related factors for obesity hypoventilation syndrome. Conclusion: Obesity hypoventilation syndrome should be considered when oxygen desaturation index, apnea hypopnea index and sleep time with SpO2 <90% are high. PMID:28251022

  12. Chronic respiratory failure in patients with neuromuscular diseases: diagnosis and treatment.

    Science.gov (United States)

    Paschoal, Ilma Aparecida; Villalba, Wander de Oliveira; Pereira, Mônica Corso

    2007-01-01

    Neuromuscular diseases affect alveolar air exchange and therefore cause chronic respiratory failure. The onset of respiratory failure can be acute, as in traumas, or progressive (slow or rapid), as in amyotrophic lateral sclerosis, muscular dystrophies, diseases of the myoneural junction, etc. Respiratory muscle impairment also affects cough efficiency and, according to the current knowledge regarding the type of treatment available in Brazil to these patients, it can be said that the high rates of morbidity and mortality in these individuals are more often related to the fact that they cough inefficiently rather than to the fact that they ventilate poorly. In this review, with the objective of presenting the options of devices available to support and substitute for natural ventilation in patients with neuromuscular diseases, we have compiled a brief history of the evolution of orthopedic braces and prostheses used to aid respiration since the end of the 19th century. In addition, we highlight the elements that are fundamental to the diagnosis of alveolar hypoventilation and of failure of the protective cough mechanism: taking of a clinical history; determination of peak cough flow; measurement of maximal inspiratory and expiratory pressures; spirometry in two positions (sitting and supine); pulse oximetry; capnography; and polysomnography. Furthermore, the threshold values available in the literature for the use of nocturnal ventilatory support and for the extension of this support through the daytime period are presented. Moreover, the maneuvers used to increase cough efficiency, as well as the proper timing of their introduction, are discussed.

  13. [What non invasive haemodynamic assessment in paediatric intensive care unit in 2009?].

    Science.gov (United States)

    Brissaud, O; Guichoux, J; Villega, F; Orliaguet, G

    2010-03-01

    The haemodynamic assessment of the patients is a daily activity in paediatric intensive care unit. It completes and is guided by the clinical examination. The will to develop the least invasive possible coverage of the patients is a constant concern. The haemodynamic monitoring, all the more if it is invasive, ceaselessly has to put in balance the profit and the risk of beginning this technique at a fragile patient. In the last three decades, numerous non-invasive haemodynamic tools were developed. The ideal one must be reliable, reproducible, with a time of fast, easily useful answer, with a total harmlessness, cheap and allowing a monitoring continues. Among all the existing tools (oesophageal Doppler ultrasound method, transthoracic echocardiography, NICO, thoracic impedancemetry, plethysmography, sublingual capnography), no one allies all these qualities. We can consider that the transthoracic echocardiography gets closer to most of these objectives. We shall blame it for its cost and for the fact that it is an intermittent monitoring but both in the diagnosis and in the survey, it has no equal among the non-invasive tools of haemodynamic assessment from part the quality and the quantity of the obtained information. The learning of the basic functions (contractility evaluation, cardiac output, cardiac and the vascular filling) useful for the start of a treatment is relatively well-to-do. We shall miss the absence of training in this tool in France in its paediatric and neonatal specificity within the university or interuniversity framework.

  14. ASPECTOS HEMODINÂMICOS DA CIRCULAÇÃO EXTRACORPÓREA EM CÃES

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    Sheila Nogueira Ribeiro Knupp

    2014-06-01

    Full Text Available The cardiopulmonary bypass (CPB promotes major changes to the body of the patient that needs to be subjected to this procedure, but it can be circumvented or minimized with specific maneuvers for each situation. Despite being an established technique in human medicine, there are still improvements to be achieved. The purposes of this work were to clarify the cardiopulmonary bypass and inform its hemodynamic effects when applied to dogs. Four mongrel healthy dogs were used. The animals were anesthetized and monitored and samples were collected (T0. After that, the animals underwent median sternotomy and cannulation of the aorta and cranial and caudal vena cava and they were kept in CPB for a period of 30 minutes (T1, then disconnected from the CPB machine during 30 minutes in reperfusion process (T2, followed by one hour of reperfusion (T3, and then they were euthanized. The following parameters were evaluated: mean arterial pressure (MAP, central venous pressure (CVP, oxygenation (SaO2 and capnography (ETCO2. MAP, CVP and SaO2 remained within normal limits during the times evaluated. Although the observed average of ETCO2 was low in one of the experimental animals, it maintained the values ​​within the normal range in most experimental animals. We concluded that CPB can be performed in dogs without severe hemodynamic compromise, considering the parameters evaluated in this experiment.

  15. Multivariate modeling of cognitive-motor stimulation on neurovascular coupling: transcranial Doppler used to characterize myogenic and metabolic influences.

    Science.gov (United States)

    Panerai, Ronney B; Eyre, Michelle; Potter, John F

    2012-08-15

    Neural activation induces changes in cerebral blood flow velocity (CBFV) with separate contributions from resistance-area product (V(RAP)) and critical closing pressure (V(CrCP)). We modeled the dependence of V(RAP) and V(CrCP) on arterial blood pressure (ABP), end-tidal CO(2) (EtCO(2)), and cognitive stimulation to test the hypothesis that V(RAP) reflects myogenic activity while V(CrCP) reflects metabolic pathways. In 14 healthy subjects, CBFV was measured with transcranial Doppler ultrasound, ABP with the Finapres device and EtCO(2) with infrared capnography. Two different paradigms (word or puzzle) were repeated 10 times (30 s on-off), and the corresponding square-wave signal was used, together with ABP and EtCO(2), as inputs to autoregressive-moving average (ARMA) models, which allowed identification of the separate contributions of the three inputs to either V(RAP) or V(CrCP). For both paradigms, the contribution of ABP was mainly manifested through V(RAP) (P modeling of V(RAP) and V(CrCP) allows the separation of the effects of cerebral autoregulation and CO(2) reactivity from the main effects of cognitive-motor stimulation and have the potential to improve the diagnostic value of neurovascular coupling testing in physiological and clinical studies.

  16. Mistaken Endobronchial Placement of a Nasogastric Tube During Mandibular Fracture Surgery.

    Science.gov (United States)

    Kalava, Arun; Clark, Kirpal; McIntyre, John; Yarmush, Joel M; Lizardo, Teresita

    2015-01-01

    A 64-year-old male had an awake right nasal fiber-optic intubation with an endotracheal tube for open reduction and internal fixation of bilateral displaced mandibular fractures. After induction of anesthesia, an 18 Fr nasogastric tube (NGT) was inserted through the left nostril and was secured. The patient required high flow rates to deliver adequate tidal volumes with the ventilator. A chest x-ray done in the postanesthesia care unit revealed a malpositioned NGT in the left lower lobe bronchus, which was immediately removed. The patient was extubated on postoperative day 2. Various traditional methods, such as aspiration of gastric contents, auscultation of gastric insufflations, and chest x-ray are in use to detect or prevent the misplacement of an NGT. These methods can be unreliable or impractical. Use of capnography to detect an improperly placed NGT should be considered in the operating room as a simple, cost-effective method with high sensitivity to prevent possibly serious sequelae of an NGT placed within the bronchial tree.

  17. Nocturnal hypoxia in ALS is related to cognitive dysfunction and can occur as clusters of desaturations.

    Directory of Open Access Journals (Sweden)

    Su-Yeon Park

    Full Text Available BACKGROUND: Amyotrophic lateral sclerosis (ALS is a neurodegenerative disease that leads to progressive weakness of the respiratory and limb muscles. Consequently, most patients with ALS exhibit progressive hypoventilation, which worsens during sleep. The aim of this study was to evaluate the relationship between nocturnal hypoxia and cognitive dysfunction and to assess the pattern of nocturnal hypoxia in patients with ALS. METHOD: Twenty-five patients with definite or probable ALS underwent neuropsychologic testing, nocturnal pulse oximetry, and capnography. Patients were grouped according to the presence of nocturnal hypoxia (SpO2<95% for ≥10% of the night and their clinical characteristics and cognitive function were compared. RESULTS: Compared to patients without nocturnal hypoxia, those with nocturnal hypoxia (n = 10, 40% had poor memory retention (p = 0.039 and retrieval efficiency (p = 0.045. A cluster-of-desaturation pattern was identified in 7 patients (70% in the Hypoxia Group. CONCLUSIONS: These results suggest that nocturnal hypoxia can be related to cognitive dysfunction in ALS. In addition, a considerable number of patients with ALS may be exposed to repeated episodes of deoxygenation-reoxygenation (a cluster-of-desaturation pattern during sleep, which could be associated with the generation of reactive oxygen species. Further studies are required to define the exact causal relationships between these phenomena, the exact manifestations of nocturnal cluster-of-desaturation patterns, and the effect of clusters of desaturation on ALS progression.

  18. Fração tardia do espaço morto (fDlate antes e após embolectomia pulmonar Late dead space fraction (fDlate before and after pulmonary embolectomy

    Directory of Open Access Journals (Sweden)

    Marcos Mello Moreira

    2005-03-01

    Full Text Available Este relato de caso apresenta os resultados da fDlate (fração tardia de espaço morto em um paciente submetido a embolectomia por tromboembolismo pulmonar (TEP. O TEP foi diagnosticado por ultrassonografia ecodoppler de membros inferiores, cintilografia pulmonar, tomografia helicoidal computadorizada e arteriografia pulmonar. O cálculo da fDlate se baseou na capnografia volumétrica e na gasometria arterial de acordo com ERIKSSON et al. [1]. A fDlate pré-operatória foi de 0,16 e foi considerada positiva por estar acima do valor de corte de 0,12. A fDlate pós-operatória foi de - 0,04, um valor inferior ao valor de corte de 0,12 e foi caracterizada como negativa. A correlação da fDlate com os resultados de imagem confirma a validade desta nova ferramenta diagnóstica não-invasiva.This report presents data on the late dead space fraction (fDlate of a patient submitted to surgical pulmonary embolectomy. Pulmonary thromboembolism (PTE was diagnosed by echo-Doppler ultrasound of the lower limbs, lung scintigraphy, computerized helical tomography and angiography. The fDlate was calculated based on volumetric capnography as well as on arterial blood gases according to ERIKSSON et al. [1]. The preoperative fDlate value was 0.16, which was considered positive for the diagnosis of PTE, as it was higher than the cut-off point of 0.12. The postoperative fDlate value was - 0.04, which was below 0.12 and was characterized as negative. The agreement of fDlate with the imaging results confirms the validity of this new, noninvasive diagnostic tool.

  19. Impact of Post-Intubation Interventions on Mortality in Patients Boarding in the Emergency Department

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    Rahul Bhat

    2014-09-01

    Full Text Available Introduction: Emergency physicians frequently perform endotracheal intubation and mechanical ventilation. The impact of instituting early post-intubation interventions on patients boarding in the emergency department (ED is not well studied. We sought to determine the impact of postintubation interventions (arterial blood gas sampling, obtaining a chest x-ray (CXR, gastric decompression, early sedation, appropriate initial tidal volume, and quantitative capnography on outcomes of mortality, ventilator-associated pneumonia (VAP, ventilator days, and intensive care unit (ICU length-of-stay (LOS. Methods: This was an observational, retrospective study of patients intubated in the ED at a large tertiary-care teaching hospital and included patients in the ED for greater than two hours postintubation. We excluded them if they had incomplete data, were designated “do not resuscitate,” were managed primarily by the trauma team, or had surgery within six hours after intubation. Results: Of 169 patients meeting criteria, 15 died and 10 developed VAP. The mortality odds ratio (OR in patients receiving CXR was 0.10 (95% CI 0.01 to 0.98, and 0.11 (95% CI 0.03 to 0.46 in patients receiving early sedation. The mortality OR for patients with 3 or fewer interventions was 4.25 (95% CI 1.15 to 15.75 when compared to patients with 5 or more interventions. There was no significant relationship between VAP rate, ventilator days, or ICU LOS and any of the intervention groups. Conclusion: The performance of a CXR and early sedation as well as performing five or more vs. three or fewer post-intubation interventions in boarding adult ED patients was associated with decreased mortality. [West J Emerg Med. 2014;15(6:708-711

  20. [Emergency anesthesia, airway management and ventilation in major trauma. Background and key messages of the interdisciplinary S3 guidelines for major trauma patients].

    Science.gov (United States)

    Bernhard, M; Matthes, G; Kanz, K G; Waydhas, C; Fischbacher, M; Fischer, M; Böttiger, B W

    2011-11-01

    Patients with multiple trauma presenting with apnea or a gasping breathing pattern (respiratory rate traumatic brain injury [Glasgow Coma Scale (GCS)29/min). The induction of anesthesia after preoxygenation is conducted as rapid sequence induction (analgesic, hypnotic drug, neuromuscular blocking agent). With the availability of ketamine as a viable alternative, the use of etomidate is not encouraged due to its side effects on adrenal function. An electrocardiogram (ECG), blood pressure measurement and pulse oximetry are needed to monitor the emergency anesthesia and the secured airway. Capnography is absolutely mandatory to confirm correct placement of the endotracheal tube and to monitor tube dislocations as well as ventilation and oxygenation in the prehospital and hospital setting. Because airway management is often complicated in trauma patients, alternative devices and a fiber-optic endoscope need to be available within the hospital. Use of these alternative measures for airway management and ventilation should be considered at the latest after a maximum of three unsuccessful intubation attempts. Emergency medical service (EMS) physicians should to be trained in emergency anesthesia, ETI and alternative methods of airway management on a regular basis. Within hospitals ETI, emergency anesthesia and ventilation are to be conducted by trained and experienced anesthesiologists. When a difficult airway or induction of anesthesia is expected, endotracheal intubation should be supervised or conducted by an anesthesiologist. Normoventilation should be the goal of mechanical ventilation. After arrival in the resuscitation room the ventilation will be controlled and guided with the help of arterial blood gas analyses. After temporary removal of a cervical collar, the cervical spine needs to be immobilized by means of manual in-line stabilization when securing the airway.

  1. Relationship between Musical Characteristics and Temporal Breathing Pattern in Piano Performance

    Science.gov (United States)

    Sakaguchi, Yutaka; Aiba, Eriko

    2016-01-01

    Although there is growing evidence that breathing is modulated by various motor and cognitive activities, the nature of breathing in musical performance has been little explored. The present study examined the temporal breath pattern in piano performance, aiming to elucidate how breath timing is related to musical organization/events and performance. In the experiments, the respiration of 15 professional and amateur pianists, playing 10 music excerpts in total (from four-octave C major scale, Hanon's exercise, J. S. Bach's Invention, Mozart's Sonatas, and Debussy's Clair de lune), was monitored by capnography. The relationship between breathing and musical characteristics was analyzed. Five major results were obtained. (1) Mean breath interval was shortened for excerpts in faster tempi. (2) Fluctuation of breath intervals was reduced for the pieces for finger exercise and those in faster tempi. Pianists showing large within-trial fluctuation also exhibited large inter-excerpt difference. (3) Inter-trial consistency of the breath patterns depended on the excerpts. Consistency was generally reduced for the excerpts that could be performed mechanically (i.e., pieces for finger exercise), but interestingly, one third of the participant showed consistent patterns for the simple scale, correlated with the ascending/descending sequences. (4) Pianists tended to exhale just after the music onsets, inhale at the rests, and inhibit inhale during the slur parts. There was correlation between breathing pattern and two-voice polyphonic structure for several participants. (5) Respiratory patterns were notably different among the pianists. Every pianist showed his or her own characteristic features commonly for various musical works. These findings suggest that breathing in piano performance depends not only on musical parameters and organization written in the score but also some pianist-dependent factors which might be ingrained to individual pianists. PMID:27516736

  2. Relationship between Musical Characteristics and Temporal Breathing Pattern in Piano Performance.

    Science.gov (United States)

    Sakaguchi, Yutaka; Aiba, Eriko

    2016-01-01

    Although there is growing evidence that breathing is modulated by various motor and cognitive activities, the nature of breathing in musical performance has been little explored. The present study examined the temporal breath pattern in piano performance, aiming to elucidate how breath timing is related to musical organization/events and performance. In the experiments, the respiration of 15 professional and amateur pianists, playing 10 music excerpts in total (from four-octave C major scale, Hanon's exercise, J. S. Bach's Invention, Mozart's Sonatas, and Debussy's Clair de lune), was monitored by capnography. The relationship between breathing and musical characteristics was analyzed. Five major results were obtained. (1) Mean breath interval was shortened for excerpts in faster tempi. (2) Fluctuation of breath intervals was reduced for the pieces for finger exercise and those in faster tempi. Pianists showing large within-trial fluctuation also exhibited large inter-excerpt difference. (3) Inter-trial consistency of the breath patterns depended on the excerpts. Consistency was generally reduced for the excerpts that could be performed mechanically (i.e., pieces for finger exercise), but interestingly, one third of the participant showed consistent patterns for the simple scale, correlated with the ascending/descending sequences. (4) Pianists tended to exhale just after the music onsets, inhale at the rests, and inhibit inhale during the slur parts. There was correlation between breathing pattern and two-voice polyphonic structure for several participants. (5) Respiratory patterns were notably different among the pianists. Every pianist showed his or her own characteristic features commonly for various musical works. These findings suggest that breathing in piano performance depends not only on musical parameters and organization written in the score but also some pianist-dependent factors which might be ingrained to individual pianists.

  3. Understanding Heroin Overdose: A Study of the Acute Respiratory Depressant Effects of Injected Pharmaceutical Heroin.

    Science.gov (United States)

    Jolley, Caroline J; Bell, James; Rafferty, Gerrard F; Moxham, John; Strang, John

    2015-01-01

    Opioids are respiratory depressants and heroin/opioid overdose is a major contributor to the excess mortality of heroin addicts. The individual and situational variability of respiratory depression caused by intravenous heroin is poorly understood. This study used advanced respiratory monitoring to follow the time course and severity of acute opioid-induced respiratory depression. 10 patients (9/10 with chronic airflow obstruction) undergoing supervised injectable opioid treatment for heroin addiction received their usual prescribed dose of injectable opioid (diamorphine or methadone) (IOT), and their usual prescribed dose of oral opioid (methadone or sustained release oral morphine) after 30 minutes. The main outcome measures were pulse oximetry (SpO2%), end-tidal CO2% (ETCO2%) and neural respiratory drive (NRD) (quantified using parasternal intercostal muscle electromyography). Significant respiratory depression was defined as absence of inspiratory airflow >10s, SpO2% 10s and ETCO2% per breath >6.5%. Increases in ETCO2% indicated significant respiratory depression following IOT in 8/10 patients at 30 minutes. In contrast, SpO2% indicated significant respiratory depression in only 4/10 patients, with small absolute changes in SpO2% at 30 minutes. A decline in NRD from baseline to 30 minutes post IOT was also observed, but was not statistically significant. Baseline NRD and opioid-induced drop in SpO2% were inversely related. We conclude that significant acute respiratory depression is commonly induced by opioid drugs prescribed to treat opioid addiction. Hypoventilation is reliably detected by capnography, but not by SpO2% alone. Chronic suppression of NRD in the presence of underlying lung disease may be a risk factor for acute opioid-induced respiratory depression.

  4. Evaluation of a new side-stream, low dead space, end-tidal carbon dioxide monitoring system in rats.

    Science.gov (United States)

    Beck, Christopher; Barthel, Franziska; Hahn, Anna-Maria; Vollmer, Christian; Bauer, Inge; Picker, Olaf

    2014-01-01

    The aim of this study was to evaluate a newly developed infrared side-stream capnograph with minimal sample volume for the continuous measurement of end-tidal carbon dioxide (CO2) concentrations in small rodents. Thirty-four male Wistar rats (weight 345 ± 70 g) were treated in accordance with the National Institutes of Health (NIH) guidelines for animal care. All experiments were performed with approval of the local animal care and use committee. Sepsis was induced by implanting an 18 gauge stent into the colon 24 h prior to the experiments, allowing a constant fecal leakage into the peritoneal cavity (25 septic and nine control animals). Hemodynamic variables and end-tidal CO2 were recorded continuously and arterial blood (5 × 120 µL) was sampled periodically for arterial blood gas analysis. After baseline controlled mechanical ventilation was randomized and titrated to either normocapnia (35-45 mmHg) or hypercapnia (65-75 mmHg) with exogenous application of CO2. A total of 155 paired CO2 measurements comparing end-tidal and arterial partial pressure were conducted. Side-stream capnography underestimated the CO2 partial pressure with a bias of -6.1 mmHg and a 95% limit of agreement from 6.7 to -19.1 mmHg. Our results suggest that side-stream end-tidal CO2 monitoring with a low dead space could be utilized in rats as a surrogate for the arterial CO2 measurement over a wide range of partial pressures in normal and septic animals.

  5. The use of a volatile anesthetic regimen protects against acute normovolemic hemodilution induced myocardial depression in patients with coronary artery disease

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    Lorsomradee Sratwadee

    2009-01-01

    Full Text Available Background: Previous studies indicated that acute normovolemic hemodilution (ANH was associated with a depression of myocardial function in coronary surgery patients with baseline heart rate faster than 90 bpm. It was suggested that this phenomenon could be explained by the occurrence of myocardial ischemia. In the present study, we hypothesized that the cardioprotective properties of a volatile anesthetic regimen might protect against the ANH related myocardial functional impairment. Materials and Methods: Forty elective coronary surgery patients with baseline heart rate faster than 90 bpm were randomly allocated to receive different anesthetic regimens. Group A (n = 20 received midazolam-based anesthesia. Group B (n = 20 received a sevoflurane-based anesthesia. Five-lead electrocardiogram, pulse oximetry, capnography, radial arterial pressure, and Swan Ganz continuous thermodilution cardiac output via right internal jugular vein were monitored. Measurements were obtained before and after ANH. Data were compared using paired t test. All data were expressed as mean ± SD. Data were considered significant if P < 0.05. Results: After ANH, systemic vascular resistance was slightly decreased in group A while there was a significant decrease in group B. In group A, cardiac output was slightly decreased from 5.07±1.17 l/min to 5.02±1.28 l/min after ANH, whereas in group B, cardiac output was significantly increased from 4.84±1.21 l/min to 6.02±1.28 l/min after ANH. Conclusion: In coronary surgery patients, with baseline heart rate faster than 90 bpm, anesthesia with sevoflurane during ANH was associated with an improvement in myocardial function after ANH, which was not present in patients anesthetized with midazolam.

  6. Pulmonary function responses to ozone in smokers with a limited smoking history

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    Bates, Melissa L., E-mail: mlbates@pediatrics.wisc.edu [Interdisciplinary Graduate Degree Program in Physiology, Pennsylvania State University, University Park, PA 16802 (United States); Department of Pediatrics, Critical Care Division, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792 (United States); John Rankin Laboratory of Pulmonary Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792 (United States); Brenza, Timothy M. [Department of Chemical Engineering, Pennsylvania State University, University Park, PA 16802 (United States); Ben-Jebria, Abdellaziz [Interdisciplinary Graduate Degree Program in Physiology, Pennsylvania State University, University Park, PA 16802 (United States); Department of Chemical Engineering, Pennsylvania State University, University Park, PA 16802 (United States); Bascom, Rebecca [Division of Pulmonary, Allergy and Critical Care Medicine, Penn State College of Medicine, Hershey, PA 17033 (United States); Eldridge, Marlowe W. [Department of Pediatrics, Critical Care Division, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792 (United States); John Rankin Laboratory of Pulmonary Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792 (United States); Department of Kinesiology, University of Wisconsin-Madison, Madison, WI 53792 (United States); Department of Bioengineering, University of Wisconsin-Madison, Madison, WI 53792 (United States); Ultman, James S. [Interdisciplinary Graduate Degree Program in Physiology, Pennsylvania State University, University Park, PA 16802 (United States); Department of Chemical Engineering, Pennsylvania State University, University Park, PA 16802 (United States)

    2014-07-01

    In non-smokers, ozone (O{sub 3}) inhalation causes decreases in forced expiratory volume (FEV{sub 1}) and dead space (V{sub D}) and increases the slope of the alveolar plateau (S{sub N}). We previously described a population of smokers with a limited smoking history that had enhanced responsiveness to brief O{sub 3} boluses and aimed to determine if responsiveness to continuous exposure was also enhanced. Thirty smokers (19 M, 11 F, 24 ± 4 years, 6 ± 4 total years smoking,4 ± 2 packs/week) and 30 non-smokers (17 M, 13 F, 25 ± 6 years) exercised for 1 h on a cycle ergometer while breathing 0.30 ppm O{sub 3}. Smokers and non-smokers were equally responsive in terms of FEV{sub 1} (− 9.5 ± 1.8% vs − 8.7 ± 1.9%). Smokers alone were responsive in terms of V{sub D} (− 6.1 ± 1.2%) and S{sub N} (9.1 ± 3.4%). There was no difference in total delivered dose. Dead space ventilation (V{sub D}/V{sub T}) was not initially different between the two groups, but increased in the non-smokers (16.4 ± 2.8%) during the exposure, suggesting that the inhaled dose may be distributed more peripherally in smokers. We also conclude that these cigarette smokers retain their airway responsiveness to O{sub 3} and, uniquely, experience changes in V{sub D} that lead to heterogeneity in airway morphometry and an increase in S{sub N}. - Highlights: • We previously found lung function responses to O{sub 3} bolus exposure in smokers. • Here, we describe their responsiveness to continuous O{sub 3} exposure with exercise. • Spirometry and capnography were used to assess pulmonary function changes. • Enhanced bronchoconstriction in smokers increases parenchymal delivery of O{sub 3}.

  7. Effects of concurrent intravenous morphine sulfate and naltrexone hydrochloride on end-tidal carbon dioxide

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    Goli Veeraindar

    2012-03-01

    Full Text Available Abstract Background Respiratory depression, a potentially fatal side-effect of opioid-overdose, may be reversed by timely administration of an opioid antagonist, such as naloxone or naltrexone. Tampering with a formulation of morphine sulfate and sequestered naltrexone hydrochloride extended release capsules (MS-sNT releases both the opioid morphine and the antagonist naltrexone. A study in recreational opioid-users indicated that morphine and naltrexone injected in the 25:1 ratio (duplicating the ratio of the formulation found MS-sNT reduced morphine-induced euphoric effects vs intravenous (IV morphine alone. In the same study, the effects of morphine + naltrexone on end-tidal carbon dioxide (EtCO2, a measure of respiratory-depression, were evaluated and these data are reported here. Methods Single-center, placebo-controlled, double-blind crossover study. Non-dependent male opioid users were randomized to receive single IV doses of placebo, 30 mg morphine alone, and 30 mg morphine + 1.2 mg naltrexone. EtCO2 was measured by noninvasive capnography. Results Significant differences in EtCO2 least-squares means across all treatments for maximal effect (Emax and area under the effect curve (AUE0-2, AUE0-8, AUE0-24 were detected (all p ≤ 0.0011. EtCO2 Emax values for morphine + naltrexone were significantly reduced vs morphine alone (42.9 mm Hg vs 47.1 mm Hg, p max was delayed for morphine + naltrexone vs morphine alone (5.0 h vs 1.0 h. Conclusions Results provide preliminary evidence that the naltrexone:morphine ratio within MS-sNT is sufficient to significantly reduce EtCO2 when administered intravenously to non-dependent male recreational opioid-users. Further studies with multiple measures of respiratory-function are warranted to determine if risk of respiratory depression is also reduced by naltrexone in the tampered formulation.

  8. Role of anesthesiology curriculum in improving bag-mask ventilation and intubation success rates of emergency medicine residents: a prospective descriptive study

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    Golzari Samad EJ

    2011-06-01

    Full Text Available Abstract Background Rapid and safe airway management has always been of paramount importance in successful management of critically ill and injured patients in the emergency department. The purpose of our study was to determine success rates of bag-mask ventilation and tracheal intubation performed by emergency medicine residents before and after completing their anesthesiology curriculum. Methods A prospective descriptive study was conducted at Nikoukari Hospital, a teaching hospital located in Tabriz, Iran. In a skills lab, a total number of 18 emergency medicine residents (post graduate year 1 were given traditional intubation and bag-mask ventilation instructions in a 36 hour course combined with mannequin practice. Later the residents were given the opportunity of receiving training on airway management in an operating room for a period of one month which was considered as an additional training program added to their Anesthesiology Curriculum. Residents were asked to ventilate and intubate 18 patients (Mallampati class I and ASA class I and II in the operating room; both before and after completing this additional training program. Intubation achieved at first attempt within 20 seconds was considered successful. Successful bag-mask ventilation was defined as increase in ETCo2 to 20 mm Hg and back to baseline with a 3 L/min fresh gas-flow and the adjustable pressure limiting valve at 20 cm H2O. An attending anesthesiologist who was always present in the operating room during the induction of anesthesia confirmed the endotracheal intubation by direct laryngoscopy and capnography. Success rates were recorded and compared using McNemar, marginal homogeneity and paired t-Test tests in SPSS 15 software. Results Before the additional training program in the operating room, the participants had intubation and bag-mask ventilation success rates of 27.7% (CI 0.07-0.49 and 16.6% (CI 0-0.34 respectively. After the additional training program in the

  9. The cardiovascular and respiratory effects of medetomidine and thiopentone anaesthesia in dogs breathing at an altitude of 1486 m

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    K. E. Joubert

    2002-07-01

    Full Text Available The purpose of this study was to evaluate the cardio-respiratory effects of the combination of medetomidine and thiopentone followed by reversal with atipamezole as a combination for anaesthesia in 10 healthy German Shepherd dogs breathing spontaneously in a room at an altitude of 1486 m above sea level with an ambient air pressure of 651 mmHg. After the placement of intravenous and intra-arterial catheters, baseline samples were collected. Medetomidine (0.010 mg/kg was administered intravenously and blood pressure and heart rate were recorded every minute for 5 minutes. Thiopentone was then slowly administered until intubation conditions were ideal. An endotracheal tube was placed and the dogs breathed room air spontaneously. Blood pressure, pulse oximetry, respiratory and heart rate, capnography, blood gas analysis and arterial lactate were performed or recorded every 10 minutes for the duration of the trial. Thiopentone was administered to maintain anaesthesia. After 60 minutes, atipamezole (0.025 mg/kg was given intramuscularly. Data were recorded for the next 30 minutes. A dose of 8.7 mg/kg of thiopentone was required to anaesthetise the dogs after the administration of 0.010 mg/kg of medetomidine. Heart rate decreased from 96.7 at baseline to 38.5 5 minutes after the administration of medetomidine (P < 0.05. Heart rate then increased with the administration of thiopentone to 103.2 (P < 0.05. Blood pressure increased from 169.4/86.2 mmHg to 253.2/143.0 mmHg 5 minutes after the administration of medetomidine (P < 0.05. Blood pressure then slowly returned towards normal. Heart rate and blood pressure returned to baseline values after the administration of atipamezole. Arterial oxygen tension decreased from baseline levels (84.1 mmHg to 57.8 mmHg after the administration of medetomidine and thiopentone (P < 0.05. This was accompanied by arterial desaturation from 94.7 to 79.7 % (P < 0.05. A decrease in respiratory rate from 71.8 bpm to 12

  10. Carbon dioxide accumulation during analgosedated colonoscopy: Comparison of propofol and midazolam

    Institute of Scientific and Technical Information of China (English)

    Ludwig T Heuss; Shajan Peter Sugandha; Christoph Beglinger

    2012-01-01

    AIM:To characterize the profiles of alveolar hypoventilation during colonoscopies performed under sedoanalgesia with a combination of alfentanil and either midazolam or propofol.METHODS:Consecutive patients undergoing routine colonoscopy were randomly assigned to sedation with either propofol or midazolam in an open-labeled design using a titration scheme.All patients received 4 μg/kg per body weight alfentanil for analgesia and 3 L of supplemental oxygen.Oxygen saturation (SpO2) was measured by pulse oximetry (POX),and capnography (PcCO2) was continuously measured using a combined dedicated sensor at the ear lobe.Instances of apnea resulting in measures such as stimulation of the patient,a chin lift,a mask maneuver,or withholding of sedation were recorded.PcCO2 values (as a parameter of sedation-induced hypoventilation) were compared between groups at the following distinct time points:baseline,maximal rise,termination of the procedure and 5 min after termination of the procedure.The number of patients in both study groups who regained baseline PcCO2 values (± 1.5 mmHg) five minutes after the procedure was determined.RESULTS:A total of 97 patients entered this study.The data from 14 patients were subsequently excluded for clinical procedure-related reasons or for technical problems.Therefore,83 patients (mean age 62 ± 13 years) were successfully randomized to receive propofol (n =42) or midazolam (n =41) for sedation.Most of the patients were classified as American Society of Anesthesiologists (ASA) Ⅱ [16 (38%) in the midazolam group and 15 (32%) in the propofol group] and ASA Ⅲ [14 (33%) and 13 (32%) in the midazolam and propofol groups,respectively].A mean dose of 5 (4-7) mg of Ⅳ midazolam and 131 (70-260) mg of Ⅳ propofol was used during the procedure in the corresponding study arms.The mean SpO2 at baseline (%) was 99± 1 for the midazolam group and 99 ± 1 for the propofol group.No cases of hypoxemia (SpO2 < 85%) or apnea were

  11. Comparative study among acepromazine, chlorpromazine and methotrimeprazine in different doses, through bispectral index, term and pressure algimetry, in dogs / Estudo comparativo entre a acepromazina, clorpromazina e levomepromazina em diferentes doses, através do exame bispectral, termo e pressoalgimetria, em cães

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    Lidia Mitsuko Matsubara

    2009-12-01

    Full Text Available The study’s objective was to realize comparisons among different acepromazine, chlorpromazine and methotrimeprazine doses, evaluate parametric changes, test analgesia using press and term algimetry, and evaluate bispectral condition. 90 mongrel dogs were used, male and female, adult, weighting 10 to 15 Kg as a rule, distributed in 9 groups with 10 animals each. At first, second and third groups acepromazine was used at 0,1; 0,05 e 0,025 mg/Kg, respectively. At forth, fifth and sixth groups, chlorpromazine was used at 1,0; 0,5 and 0,25 mg/Kg, respectively. At seventh, eighth and ninth groups, methotrimeprazine at 1,0; 0,5 and 0,25 mg/Kg was used, respectively. All drugs were administered intravenously. Objects of study: heart rate (HR, non invasive blood pressure (SAP, MAP, DAP, respiratory rate (f, capnography (ETCO2, pulse oxymetry (SatO2, mouth and rectal temperature, bispectral index (BIS, electromyography (EMG%, press and term algimetry. Somatic analgesia was evaluated by animal’s response to nociceptives stimulus. We concluded that chlorpromazine had more hypotension. Dogs showed higher hypnosis level at chlorpromazine group, with evident myorelaxation. All groups showed analgesia to thermic and mechanic stimulus. Acepromazine group showed high duration to both pain stimuli. Bispectral index was shorten at chlorpromazine group at 1,0 mg/kg doses, showing higher hypnosis index, and acepromazine was the less depressing considering the bispectral index.Objetivou-se comparar, em diferentes doses, a acepromazina, a clorpromazina e a levomepromazina com relação às alterações paramétricas, à analgesia avaliada através da presso e termoalgimetria e a condição bispectral em 90 cães sem raça definida alocados em nove grupos. No primeiro, segundo e terceiro grupo foi empregada a acepromazina nas doses de 0,1; 0,05 e 0,025 mg/kg, respectivamente. No quarto, quinto e sexto grupo foi empregada a clorpromazina nas doses de 1,0; 0,5 e 0

  12. Variáveis capnográficas pré e pós-tromboendarterectomias pulmonares Pre and post-pulmonary thromboendarterectomies campnographic variables

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    Marcos Mello Moreira

    2007-12-01

    Full Text Available Este relato de dois casos com os resultados da fração tardia de espaço morto (fDlate, fração do espaço morto alveolar end-tidal (AVDSf, gradiente artério-alveolar de CO2 [P(a-etCO2] e slope da fase 3 do espirograma, submetidos à tromboendarterectomia pulmonar por tromboembolismo pulmonar (TEP. O TEP foi diagnosticado pela cintilografia pulmonar, tomografia helicoidal computadorizada e por arteriografia pulmonar. O cálculo da fDlate, AVDSf e P(a-etCO2 baseou-se na capnografia volumétrica associada à gasometria arterial. A fDlate préoperatória do primeiro paciente foi de 0,16 (cutoff de 0,12 e a AVDSf = 0,30 (cutoff de 0,15. Já a fDlate do segundo paciente resultou falso-negativa (0,01, embora a AVDSf resultasse positiva (0,28. A fDlate pós-operatória do primeiro paciente foi de -0,04 e a AVDSf de 0,16; a fDlate do segundo paciente foi de 0,07 e a AVDSf = 0,28. A associação destas variáveis com os exames por imagem reforça a importância deste método como ferramenta diagnóstica não-invasiva no diagnóstico de TEP.In these case report, the results of late dead space fraction (fDlate, end-tidal alveolar dead space fraction (AVDSf, arterial-alveolar gradient CO2 [P(a-etCO2], and slope phase 3 of spirogram of two patients who underwent thromboendarterectomy for pulmonary embolism (PE are shown. PE was diagnosed by pulmonary scintigraphy, helical tomography, and pulmonary angiography. The calculation of fDlate, AVDSf and P(a-etCO2 was based on volumetric capnography associated with arterial blood gas analysis. The pre-operative fDlate of the first patient was 0.16 (cutoff 0.12 and AVDSf was 0.30 (cutoff 0.15. However, the fDlate of the second patient was false-negative (0.01 but, the AVDSf was positive (0.28. Postoperative fDlate of the first patient was -0.04 and AVDSf was 0.16; for the second patient, the values were 0.07 and 0.28, respectively. The association of these capnographic variables with image exams reinforces the

  13. Insuficiência respiratória crônica nas doenças neuromusculares: diagnóstico e tratamento Chronic respiratory failure in patients with neuromuscular diseases: diagnosis and treatment

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    Ilma Aparecida Paschoal

    2007-02-01

    . Respiratory muscle impairment also affects cough efficiency and, according to the current knowledge regarding the type of treatment available in Brazil to these patients, it can be said that the high rates of morbidity and mortality in these individuals are more often related to the fact that they cough inefficiently rather than to the fact that they ventilate poorly. In this review, with the objective of presenting the options of devices available to support and substitute for natural ventilation in patients with neuromuscular diseases, we have compiled a brief history of the evolution of orthopedic braces and prostheses used to aid respiration since the end of the 19th century. In addition, we highlight the elements that are fundamental to the diagnosis of alveolar hypoventilation and of failure of the protective cough mechanism: taking of a clinical history; determination of peak cough flow; measurement of maximal inspiratory and expiratory pressures; spirometry in two positions (sitting and supine; pulse oximetry; capnography; and polysomnography. Furthermore, the threshold values available in the literature for the use of nocturnal ventilatory support and for the extension of this support through the daytime period are presented. Moreover, the maneuvers used to increase cough efficiency, as well as the proper timing of their introduction, are discussed.

  14. Associação entre índice de ventilação e tempo de ventilação mecânica em lactentes com bronquiolite viral aguda Association between ventilation index and time on mechanical ventilation in infants with acute viral bronchiolitis

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    Armando A. Almeida-Júnior

    2005-12-01

    of variables with significant correlations. METHODS: Twenty-nine infants admitted to the pediatric intensive care unit of UNICAMP university hospital were studied. Acute viral bronchiolitis was defined according to clinical and radiological criteria. Children with chronic diseases and those that were hemodynamically unstable were excluded. All measurements were taken after 24 to 72 hours' mechanical ventilation, using volumetric capnography and blood gas analysis. Mechanical ventilation time was divided into: 7 days. Association between time on mechanical ventilation and the variables analyzed was determined by Spearman's Correlation Coefficient (r s. RESULTS: Time on mechanical ventilation showed a significant positive correlation with PaCO2 (r s = 0.45, p = 0.01 and ventilation index (r s = 0.51, p = 0.005, and a negative correlation with pH (r s = -0.40, p = 0.03. Ventilation indices of 37, measured between day one and day five, was associated with a progressively increased risk of more than 7 days on mechanical ventilation (OR = 4.2 on the first day to 15.71 on the fourth day. CONCLUSION: Ventilation index, PaCO2 and pH, measured early, were associated with prolonged mechanical ventilation, reflecting the severity of ventilatory disturbance and the need for support.

  15. Comparison between insufflation with air or carbon dioxide during the colonoscopy in sedated patients with propofol Comparación entre la insuflación con aire ambiente o con dióxido de carbono durante la colonoscopia en pacientes sedados con propofol

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    Pilar Díez-Redondo

    2012-08-01

    Full Text Available Objectives: compare the intensity of pain experienced after colonoscopy with air or with CO2 and evaluate the safety of CO2 in colonoscopies performed with moderate/deep sedation. Materials and methods: individuals undergoing ambulatory colonoscopy without exclusion criteria (severe respiratory disease, morbid obesity were randomized in air or CO2 group. We recorded different variables prior to, during and upon completion of the colonoscopy, performing monitoring using pulse oximetry and capnography. Each patient rated, using a visual numeric scale, the intensity of post-colonoscopy pain at different moments. Results: 141 individuals in the air group (sex M/F 63/78, age 24-83 and 129 in the CO2 group (sex M/F 59/70, age 24-82. No significant differences existed in the recorded variables in both groups except for the greater number of explorations performed by an endoscopist in training (TE in the air group compared to those by a more experienced endoscopist (SE. CO2 in expired air, episodes of oxygen desaturation and of apnoea and dose of propofol, of midazolam were similar in both groups. No episodes of hypercapnea or any complication requiring cardiopulmonary resuscitation measures were recorded. The pain in the air group was significantly higher at 15 minutes and at 1, 3 and 6 hours after the endoscopy, equalising at 24 hours. After multivariant adjustment for type of doctor (TE vs. SE the differences observed in pain intensity for each group were maintained. Conclusions: a the use of CO2 in colonoscopy causes significantly less pain in the first 6 hours after the procedure; b its use in patients with moderate/deep sedation is safe; and c performance of the endoscopic technique is not modified, nor are times reduced.Objetivos: comparar la intensidad del dolor experimentado tras una colonoscopia con aire ambiente o con dióxido de carbono (CO2 y evaluar la seguridad del CO2 en pacientes con sedación moderada o profunda. Materiales y m

  16. Manejo anestésico e complicações no implante percutâneo de válvula aórtica Manejo anestésico y complicaciones en el implante percutáneo de válvula aórtica Anesthetic management and complications of percutaneous aortic valve implantation

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    Tailur Alberto Grando

    2013-06-01

    monitorizada con una presión arterial promedio (PAP, electrocardiograma (ECG, oximetría, capnografía, ecocardiograma transesofágico, termometría y marcapaso transvenoso. RESULTADOS: Fueron sometidos con éxito al implante valvular 28 pacientes, con una edad promedio de 82,46 años, EuroScore medio de 20,98%, clase funcional III/IV. Nueve pacientes necesitaron implante de marcapaso definitivo. En el seguimiento de los pacientes hubo dos decesos, uno en el transoperatorio por perforación del VI y uno al tercer día por causa desconocida. En 24 meses un paciente falleció con diagnóstico de mieloma múltiple. La técnica anestésica fue segura. CONCLUSIONES: La experiencia inicial con implante valvular aórtico percutáneo bajo anestesia general ha sido segura y eficaz sin complicaciones anestésicas importantes para ese procedimiento.BACKGROUND AND OBJECTIVE: Aortic stenosis is a highly prevalent and life-threatening disease. In elderly patients with comorbidities, percutaneous valve implantation is an option. The aim of the study was to describe the anesthetic management and complications of general anesthesia. METHOD: Case series with 30-day and 24-month follow-ups after implantation of the CoreValve device performed at the Institute of Cardiology/University Foundation of Cardiology between December 2008 and January 2012. The patients underwent general anesthesia monitored with mean arterial pressure (PAM, electrocardiogram (ECG, pulse oximetry, capnography, transesophageal echocardiography, thermometry, and transvenous pacemaker. RESULTS: Twenty-eight patients, mean age 82.46 years, 20.98% mean EuroSCORE, functional class III/IV, successfully underwent valve implantation. Nine patients required permanent pacemaker implantation. During follow-up, two patients died: one during surgery due to LV perforation and the other on the third day of unknown causes. At 24 months, one patient diagnosed with multiple myeloma died. This anesthetic technique proved to be safe

  17. Manuseio de grave diminuição de hemoglobina em paciente jovem, testemunha de Jeová, submetido à proctocolectomia total: relato de caso Manoseo de grave disminución de hemoglobina en paciente joven, testigo de Jehová, sometido a la proctocolectomia total: relato de caso Extreme intraoperative hemodilution in Jehovah’s witness patient submitted total proctocolectomy: case report

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    Luiz Eduardo Imbelloni

    2005-10-01

    family history of adenomatous polyposis. The disease was manifested at eight years of age, characterized by bleeding. At 13 years of age he was submitted to total colectomy. At 17 years of age he was submitted to total proctocolectomy. Patient was prepared with erythropoietin, folic acid, infusion of iron and vitamin B12. Red blood cell count revealed He = 4,200,000/mm³, hemoglobin = 10.5 g/dL, hematocrit = 37% platelets = 273,000/mm³ and normal prothrombin time. Patient was continuously monitored with NIBP, pulse oximetry, capnography and ECG. Anesthesia was induced with propofol, sufentanil, pancuronium and enflurane in closed system. Patient received 7,000 mL lactated Ringer’s and 150 mL of 20% human albumin. Total diuresis was 2,900 mL. Surgery lasted 10 hours and 30 minutes. Patient was referred to the ICU with 20% hematocrit, 2,300,000/mm³ red cells, 4,2 g/dL hemoglobin and was maintained with propofol and atracurium. Next day evaluation revealed 18% hematocrit, 2,050,000/mm³ red cells and 4 g/dL hemoglobin. Patient was extubated 18 hours after surgery and was referred to the ward. Patient started eating four days after surgery and was discharged the 10th postoperative day. Thirty days later patient presented 35% hematocrit, 4,000,000/mm³ red cells and 9.5 g/dL hemoglobin. Six months later he returned for ileostomy closing. Patient was submitted to 12 surgeries without a single blood transfusion. CONCLUSIONS: A good planning of the whole team (clinician, surgeon, anesthesiologist, intensive care staff allows us to perform surgical procedures associated to major blood losses without administering blood.

  18. Remifentanil versus dexmedetomidina como coadjuvantes de técnica anestésica padronizada em pacientes com obesidade mórbida Remifentanil versus dexmedetomidina como coadyuvantes de técnica anestésica de modelo en pacientes con obesidad mórbida Remifentanil versus dexmedetomidine as coadjutants of standardized anesthetic technique in morbidly obese patients

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    Eliana Cristina Murari Sudré

    2004-04-01

    ás 30% para ambas luego después de la intubación traqueal. Los pacientes fueron monitorizados con presión arterial media invasiva, oximetría de pulso, BIS, capnografia, estimulador de nervio periférico y electrocardiograma. Fueron evaluados: 1 diferentes tiempos de recuperación anestésica (abertura de los ojos, reinicio de la respiración espontanea, tiempo de extubación traqueal, tiempo para el alta de la sala de recuperación pos-anestésica y hospitalar, 2 la evolución de la gasometria arterial, y 3 analgesia pos-operatoria. RESULTADOS: Ochenta y ocho pacientes fueron evaluados. Los pacientes del grupo R presentaron abertura ocular mas precoz (9,49 ± 5,61 min versus 18,25 ± 10,24 min, p BACKGROUND AND OBJECTIVES: Two coadjuvant anesthetic drugs - remifentanil and dexmedetomidine - were compared in terms of anesthetic recovery, arterial pH and PaCO2 evolution, in morbidly obese patients submitted to Capella's surgery. METHODS: Participated in this prospective, randomized and double blind study 92 patients divided in two groups and submitted to standardized anesthetic technique (general/epidural. Remifentanil Group (Group R and Dexmedetomidine Group (Group D received continuous intravenous infusion of these drugs (0.1 µg.kg-1.min-1 and 0.5 µg.kg-1.h-1, ideal body weight plus 30% for both immediately after tracheal intubation. Monitoring consisted of invasive mean blood pressure, pulse oximetry, BIS EEG, capnography, peripheral nerve stimulator and EKG. The following parameters were evaluated: 1 different anesthetic recovery times (eye opening, return to spontaneous ventilation, tracheal extubation time, time for post anesthetic recovery unit and hospital discharge; 2 arterial blood gas analysis evolution; and 3 postoperative analgesia. RESULTS: Evaluation was possible in 88 patients. Patients group R had earlier eye opening (9.49 ± 5.61 min versus 18.25 ± 10.24 min, p < 0.0001, faster return to spontaneous ventilation (9.78 ± 5.80 min versus 16.58 ± 6

  19. Intubação nasotraqueal às cegas em paciente acordada candidata à hemimandibulectomia: relato de caso Intubación nasotraqueal a ciegas en paciente despierta candidata a la hemimandibulectomía: relato de caso Blind nasotracheal intubation in awaken patient scheduled for hemimandibulectomy: case report

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    Daniel de Carli

    2008-02-01

    old patient, weighing 56 kg, was scheduled for hemimandibulectomy; she presented cervical immobility secondary to arthrodesis, mouth opening of 2.2 cm, moderate retrognatism, voluntary protrusion of the mandible was absent, mentosternal distance of 11 cm and mento-thyroid distance of 6 cm, therefore receiving a score of 5 on the Wilson scale. The patient signed an informed consent after being informed about the procedure. After monitoring and oxygenation, continuous infusion of dexmedetomidine was initiated. Superior and inferior laryngeal nerve block was performed with 2.0% lidocaine without vasoconstrictor and the hypopharinx was anesthetized with a lidocaine spray. Before NTI, ondansetron, midazolam, fentanyl, and droperidol were administered and the patient remained awake and cooperative. Nasal insertion of the tracheal tube was oriented by its opacification and respiratory sounds and the placement was confirmed by pulmonary auscultation and capnography. Continuous infusion of propofol and remifentanil was instituted, vecuronium was administered and controlled ventilation was initiated. The surgery lasted 60 minutes without intercurrences. At the end, the patient was breathing spontaneously, so she was extubated and transferred to the recovery room from where she was discharged without any complaints. CONCLUSION: Nasotracheal intubation is an alternative to fiberoptic endoscopy when safety and control of the airways is uncertain. Informing the patient about the procedure was essential. Safety was assured and respiratory depression and hemodynamic instability was not observed.

  20. Instabilidade hemodinâmica grave durante o uso de isoflurano em paciente portador de escoliose idiopática: relato de caso Severe hemodynamic instability during the use of isoflurane in a patient with idiopathic scoliosis: case report

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    Adriano Bechara de Souza Hobaika

    2007-04-01

    ámica grave causada por isoflurano en pacientes previamente saludables. Anafilaxia, taquicardia supraventricular con repercusión hemodinámica y sensibilidad cardiaca aumentada al isoflurano son discutidas como posibles causas de la inestabilidad hemodinámica. Actualmente, existen evidencias de que el isoflurano pude interferir en el sistema de acoplamiento y desacoplamiento de la contratilidad miocárdica a través de la reducción del Ca2+ citosólico y/o deprimiendo la función de las proteínas contráctiles. Los mecanismos moleculares fundamentales de este proceso deben ser elucidados todavía. El relato sugiere que la administración del isoflurano fue la causa de las alteraciones hemodinámicas presentadas por el paciente y que este, probablemente, presentó una sensibilidad cardiovascular no común al fármaco.BACKGROUND AND OBJECTIVES: Isoflurane is considered a safe inhalational anesthetic. It has a low level of biotransformation, and low hepatic and renal toxicity. In clinical concentrations, it has minimal negative inotropic effect, causes a small reduction in systemic vascular resistance, and, rarely, can cause cardiac arrhythmias. The objective of this report was to present a case of severe hemodynamic instability in a patient with idiopathic scoliosis. CASE REPORT: Male patient, 13 years old, ASA physical status I, with no prior history of allergy to medications, scheduled for surgical repair of idiopathic scoliosis. After anesthetic induction with fentanyl, midazolam, propofol, and atracurium, 1% isoflurane with 100% oxygen was initiated for anesthesia maintenance. After five minutes, the patient presented severe hypotension (MAP = 26 mmHg associated with sinus tachycardia (HR = 166 bpm that did not respond to the administration of vasopressors and fluids. Lung and heart auscultation, pulse oxymetry, capnography, nasopharyngeal temperature, and arterial blood gases did not change. The patient was treated for anaphylaxis and the surgery was cancelled. The

  1. Hipercapnia acentuada durante circulação extracorpórea em cirurgia para revascularização do miocárdio: relato de caso Hipercapnia acentuada durante circulación extracorpórea en cirugía para revascularización del miocárdio: relato de caso Marked hypercapnia during cardiopulmonary bypass for myocardial revascularization: case report

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    Maurício Serrano Nascimento

    2002-04-01

    ía estar conectado al cilindro de aire comprimido. CONCLUSIONES: Fallas mecánicas de los componentes del circuito de extracorpórea pueden ocurrir en el per-operatorio y exigen correcciones rápidas. Los avanzos tecnológicos en los equipamientos de anestesia, monitorización y normatizaciones de seguridad atenuaron la posibilidad de que casos como ese se repitan, más jamás substituirán la presencia vigilante del anestesiólogo.BACKGROUND AND OBJECTIVES: Bypassing heart blood and returning it oxygenated to systemic circulation is achieved at the expenses of major cardiopulmonary physiologic changes. The aim of this report was to present an anesthetic complication during CPB and to warn for the need of interaction of the whole anesthetic-surgical team to prevent adverse perioperative events. CASE REPORT: A brown female patient, 56 years old, 95 kg, height 1.65 m, physical status ASA IV, with chronic renal failure under hemodialysis was admitted for myocardial revascularization. Monitoring consisted of ECG, invasive blood pressure, pulse oximetry, capnography, esophageal temperature, central venous pressure and anesthetic gases analysis. Patient was premedicated with intravenous midazolam (0.05 mg.kg-1. Anesthesia was induced with fentanyl (16 µg.kg-1, etomidate (0.3 mg.kg-1 and pancuronium (0.1 mg.kg-1, and was maintained with O2, isoflurane (0.5 - 1 MAC and fentanyl continuous infusion. Blood gas analysis after induction has shown: pH: 7.41; PaO2: 288 mmHg; PaCO2: 38 mmHg; HCO3: 24 mmol.L-1; BE: 0 mmol.L-1; SatO2 100%. A second blood gases analysis, sampled soon after CPB, returned in 30 minutes, showing: pH 7.15; PaO2: 86 mmHg; PaCO2 224 mmHg; HCO3: 29 mmol.L-1; BE: -3 mmol.L-1; SatO2 99%. Thorough and urgent checking of anesthetic and perfusion equipment was performed and revealed that the gas blender was connected to the O2 line and to a CO2 cylinder, when it should be connected to the compressed air cylinder. CONCLUSIONS: Bypass circuit mechanical problems may