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PubMed2001

Cardiorespiratory events in preterm infants referred for apnea monitoring studies.

BACKGROUND: Episodes of apnea, desaturation, and bradycardia are common in preterm infants. Such infants who have persistent cardiorespiratory events detected by clinical bedside monitoring often are referred for overnight apnea monitoring studies. OBJECTIVE: To characterize apnea, bradycardia, and desaturation events in infants referred for an overnight apnea monitoring study and compare them with corresponding events in control infants of similar age and weight with no bedside monitor alarms. METHODS: Twelve-hour bedside apnea monitoring studies were performed on 68 preterm infants before hospital discharge. This population included 35 infants who were referred by their attending physicians because of persistent bedside monitor alarms (referral group) and 33 infants who had no documented cardiorespiratory events for at least 2 days before the study (control group). Each study monitored respiration via respiratory inductance plethysmography, oxygen saturation (Sao2), and heart rate. Events were defined as meeting 1 of the following criteria: apnea > or =20 seconds, bradycardia < or =80 beats per minute, or Sao2 < or =80%. RESULTS: The incidence of apnea > or =20 seconds was low, with no significant difference between infant groups. Referral infants exhibited a higher occurrence of desaturation episodes (20 +/- 6 vs 6 +/- 3 episodes/12-hour study) and a higher occurrence of bradycardia episodes (4.3 +/- 0.8 vs 1.1 +/- 0.3 episodes/12-hour study) than controls. These episodes of desaturation and bradycardia were always preceded by a respiratory pause, which was shorter in the referral infants (10.0 +/- 0.4 seconds vs 12.0 +/- 1.0 seconds). Baseline Sao2 was lower in referrals than controls (95 +/- 1% vs 98 +/- 1%), and the incidence of periodic breathing was significantly higher. CONCLUSIONS: Infants referred for apnea monitoring studies because of persistent bedside monitor alarms have very infrequent prolonged apnea but a higher frequency of desaturation and bradycardia in response to short respiratory pauses than infants without persistent bedside monitor alarms. Referral infants also exhibit a lower baseline Sao2. These abnormalities in oxygenation and cardiorespiratory control may be markers for subtle residual lung disease or functional central nervous system abnormalities.

Apnea↗
PubMed2005

Intradialytic blood volume monitoring in ambulatory hemodialysis patients: a randomized trial.

Complications related to inadequate volume management are common during hemodialysis. This trial tested the hypothesis that availability of an intradialytic blood volume monitoring (IBVM) device improves fluid removal, reducing morbidity. A six-center, randomized trial with 6 mo of intervention comparing IBVM using Crit-Line versus conventional clinical monitoring was conducted. The average rate of non-access-related hospitalizations was compared across treatment groups using Poisson regression. Mortality analysis used the Kaplan Meier method. A total of 227 patients were randomized to Crit-Line, and 216 were randomized to conventional monitoring. Both groups had similar baseline characteristics. During the study, no differences in weight, BP, or number of dialysis-related complications were observed. There were 120 and 81 non-access-related hospitalizations in the Crit-Line and conventional monitoring groups. The adjusted risk ratio for non-access-related and access-related hospitalization was 1.61 (95% confidence interval 1.15 to 2.25; P = 0.01) and 1.52 (95% confidence interval 1.02 to 2.28; P = 0.04) for the Crit-Line monitoring group. Mortality was 8.7% in the Crit-Line monitoring group and 3.3% in the conventional group (P = 0.021). Standardized mortality ratios comparing the Crit-Line and conventional monitoring groups to the prevalent hemodialysis population were 0.77 (NS) and 0.26 (P < 0.001). Hospitalization rates were 1.51 and 1.03 events/yr in the Crit-Line and standard monitoring groups, compared with 2.01 for the prevalent hemodialysis population. IBVM was associated with higher nonvascular and vascular access-related hospitalizations and mortality compared with conventional monitoring. The atypically low hospitalization and mortality rates for the conventional monitoring group suggest that these findings should be generalized to the US hemodialysis population with caution.

Adult↗
PubMed2000

Methods for clinical monitoring of cyclosporin in transplant patients.

Cyclosporin was introduced into clinical practice in the early 1980s and has since been shown to prolong survival for transplant recipients. Because cyclosporin is a narrow therapeutic index drug and there are significant consequences associated with 'subtherapeutic' and 'supratherapeutic' concentrations, cyclosporin therapy is monitored as part of routine patient follow-up. However, the optimal method for the therapeutic drug monitoring of cyclosporin has yet to be defined. Currently, the most common method involves monitoring pre-dose trough concentrations, but this method is less than ideal. Other methods of monitoring cyclosporin therapy include monitoring the area under the concentration-time curve, limited sampling strategies, monitoring of single concentrations other than troughs and pharmacodynamic monitoring. Bayesian forecasting has been used successfully in clinical practice with other drugs with narrow therapeutic indices. However, few studies are available regarding Bayesian forecasting and cyclosporin. Existing studies are preliminary in nature and involve the old Sandimmun formulation rather than the Neoral formulation. Although these methods show promise, they have not gained widespread acceptance. This is because of their impracticality and the lack of prospective studies comparing other monitoring methods with trough concentration monitoring. Further comparative studies evaluating the impact of the specific monitoring method on definite patient outcomes are warranted.

Bayes Theorem↗
PubMed1999

Interictal and ictal video-EEG monitoring.

PURPOSE: The purpose of this paper is to demonstrate the diagnostic efficacy and therapeutic relevance of video-EEG monitoring in an large patient population with long-term follow-up. PATIENTS AND METHODS: Between October 1990 and May 1997, 400 patients were monitored at the Epilepsy Monitoring Unit (EMU) of the University Hospital in Gent. In all patients, the following parameters were retrospectively examined: reason for referral, tentative diagnosis, prescribed antiepileptic drugs (AEDs), seizure frequency, number of admission days, number of recorded seizures, ictal and interictal EEG, clinical and electroencephalographic diagnosis following the monitoring session. During follow-up visits at the Epilepsy Clinic, we prospectively collected data on different types of treatment and post-monitoring seizure control. RESULTS: 255/400 (64%) patients were referred for refractory epilepsy. 145/400 (36%) patients were evaluated for attacks of uncertain origin. Mean follow-up, available in 225 patients, was 28 months (range: 6-80 months). Mean duration of a single monitoring session was 4 days (range: 2-7 days). Prolonged interictal EEG was recorded in all patients and ictal EEG in 258 (65%) patients. Following the monitoring session, the diagnosis of epilepsy was confirmed in 217 patients. Pseudoseizures were diagnosed in 31 patients (8%). AEDs were started in 19 patients, stopped in 6 and left unchanged in 110. The type and/or number of AEDs was changed in 111 patients. Sixty patients underwent epilepsy surgery. In 48 surgery patients, follow-up data were available, 29 of whom became seizure-free, and 16 of whom experienced a greater than 90% seizure reduction. Vagus nerve stimulation was performed in 11 patients, 2 became seizure-free, and 7 improved markedly. Of the non-invasively treated patients in whom follow-up was available (n = 135), 70 became seizure-free or experienced a greater than 50% reduction in seizure frequency; 51 patients experienced no change in seizure frequency. Outcome was unrelated to the availability of ictal video-EEG recording. In patients with complex partial seizures, seizure control was significantly improved when a well-defined ictal onset zone could be defined during video-EEG monitoring. CONCLUSION: Prolonged interictal EEG monitoring is mandatory in the successful management of patients with refractory epilepsy. Ictal video-EEG monitoring is very helpful but not indispensable, except in patients enrolled for presurgical evaluation or suspected of having pseudoseizures.

Adolescent↗
PubMed1999

Home blood pressure monitoring: its effect on the management of hypertension in general practice.

BACKGROUND: Ambulatory and home blood pressure monitoring have been shown to improve the management of hypertension. Either can be used to diagnose 'white coat hypertension' (WCH), which affects 10% to 20% of hypertensives and usually does not require drug treatment. Home monitoring has been used little in primary care. AIM: To investigate the use and acceptability of home monitoring, and to establish the incidence of WCH as diagnosed in a primary care setting. METHOD: Twenty practices were asked to monitor hypertensive patients, in particular those about to start drug treatment and those who were poorly controlled. RESULTS: A total of 660 patients were monitored. Sixty-four (27%) of the 236 untreated patients had WCH and no medication was started in 60 (94%) of this group. Forty-five (17%) of the 258 poorly-controlled patients had WCH and, of these, 34 (76%) continued with the same medication and 11 (24%) either reduced or stopped it. Compliance with recording was high. Questionnaires and focus groups with doctors and nurses showed that home monitoring represented a valuable enhancement of their management of hypertensive patients. Patients reported a high degree of interest and satisfaction with monitoring. CONCLUSIONS: Patients, doctors, and nurses found monitoring valuable, and found the instruments easy to use with few problems. The feasibility of screening for WCH with home blood pressure monitoring was demonstrated, and, for this specific purpose, it is recommended as the preferred alternative to ambulatory monitoring in primary care.

Adult↗
PubMed1999

Before the storm: informing and involving stakeholder groups in workplace biomarker monitoring.

The social, legal and ethical implications of advances in biomarker indentification have been discussed by scholars and environmental researchers, but not by the "everyday" professionals and workers who may eventually make and be affected by decisions about their workplace applications. Through the use of a hypothetical scenario, this study introduced members of various professional and occupational groups to the potential uses of biomarkers research on biological monitoring in the workplace. The purpose was to obtain opinions about how events would proceed based on the scenario, leading to a broad discussion of potential uses and abuses of biomarker-based health monitoring. Six professionally homogeneous focus groups, comprised of 1) company health professionals, 2) third-party payers, 3) attorneys, 4) human resource managers, 5) non-unionized workers, and 6) unionized workers, participated in focus groups presented as "think-tank" discussions in Greenville and Charleston, S.C. Participants were given a fictitious "newspaper article" about the use of biomarker-based monitoring at a chemical plant and were asked to comment on what they thought would happen next. The discussion expanded to a general consideration of biological monitoring and its legal, social and ethical ramifications. Data was analyzed through the "immersion/crystallization" method. Few participants reported any knowledge of biological monitoring prior to the focus group session. Some had initial difficulty understanding the concept and how it differs from other means of measuring environmental risk. Although biological monitoring was previously unknown to many participants, occupational groups were relatively consistent in the issues they raised about its use in the workplace. In all groups, questions about potential discrimination against employees were raised. The general consensus was that the use of biomarker-based monitoring would result in conflict and litigation without regulations to protect employees from discrimination. Although most participants saw potential health benefits resulting from the preventive advantages associated with this technology, their concerns about its misuses were paramount. Perceptions varied as a function of occupation. Non-unionized workers expressed the most concern about discriminatory uses of biological monitoring. Unionized workers, who said they believed the union would support their interests, expressed much less concern. Health professionals (company physicians and nurse practitioners) were most alarmed about the "extra work" a monitoring program would create for them. Human resource managers concentrated on the company's "damage control" efforts. Attorneys emphasized that the reliable use of such tests would establish a causal relationship between exposure and personal injury. The results of this project illustrate that people who are most likely to be affected by biomarker-based biological monitoring in the workplace readily understand and are alarmed by its legal and ethical implications. It is unlikely that this technology will be fully accepted as an environmental risk assessment tool or as a prevention strategy without stringent protection of workers' rights. This study demonstrated the value of focus groups in obtaining opinion data about an environmental risk issue that it not yet well known to the general public.

Adult↗
PubMed2002

Clinical performance of an in-line, ex vivo point-of-care monitor: a multicenter study.

BACKGROUND: The management of critically ill infants and neonates includes frequent determination of arterial blood gas, electrolyte, and hematocrit values. An objective of attached point-of-care patient monitoring is to provide clinically relevant data without the adverse consequences associated with serial phlebotomy. METHODS: We prospectively determined the mean difference (and SD of the difference) from laboratory methods of an in-line, ex vivo monitor, the VIA LVM Blood Gas and Chemistry Monitoring System (VIA LVM Monitor; Metracor Technologies, Inc.), in 100 critically ill neonates and infants at seven children's hospitals. In doing so, we examined monitor stability with continuous use. In vivo patient test results from laboratory benchtop analyzers were compared with those from the VIA LVM Monitor on paired samples. In a separate in vitro comparison, benchtop analyzer and monitor test results were compared on whole-blood split samples. RESULTS: A total of 1414 concurrent, paired-sample measurements were obtained. The mean differences (SD of differences) from laboratory methods and r values for the combined data for the VIA LVM Monitor from the seven sites were 0.001 (0.026) and 0.97 for pH, 0.7 (3.6) mmHg and 0.94 for PCO(2), 4.2 (9.6) mmHg and 0.98 for PO(2), 0.0 (2.9) mmol/L and 0.87 for sodium, 0.1 (0.2) mmol/L and 0.96 for potassium, and 0.3% (2.9%) and 0.90 for hematocrit. Performance results were similar among the study sites with increasing time of monitor use and between in vivo paired-sample and in vitro split-sample test results. CONCLUSION: The VIA LVM Monitor can be used to assess critically ill neonates and infants.

Critical Illness↗
PubMed2002

[Value of long-distance fetal heart rate monitoring on the pre-partum health care of the pregnant woman with umbilical cord loops].

OBJECTIVE: To explore the value of the long-distance fetal heart rate (FHR) monitoring on the pre-partum health care of self-monitoring at home for pregnant woman with the umbilical cord loops. METHODS: The umbilical cord loops was diagnosed by ultrasonography. In the study group, 896 pregnant women with the umbilical cord loops accepted long-distance FHR monitoring and the count of fetal movement (FM) as family-self monitoring methods, while in the control group, 1 914 pregnant women with the umbilical cord loops used the count of FM only as family-self monitoring method. Abnormal non-stress test (NST), variable deceleration, fetal distress, neonate asphyxia, fetal death, stillbirth, operative delivery rate were analyzed between the study and control group retrospectively. RESULTS: The incidence of NST reactive pattern and non- reactive pattern and the variable deceleration in long-distance FHR monitoring of the study group were significantly higher than those in routine FHR monitoring. The incidence of fetal distress in the study group (35.0%) was significantly higher than that in the control group (30.9%), while the incidence of neonatal asphyxia in the study group (3.5%) was significantly lower than that in the control group (5.6%). The incidence of outside hospital fetal death in the study group (0.1%) was significantly lower than that in the control group (0.8%). There were no significant differences of cesarean section rate, forceps or vacuum extractor delivery between the two groups (P > 0.05). CONCLUSIONS: This study suggested that the high variable rate in the long-distance FHR monitoring curve was related to the incidence of the fetal distress. It didn't increase the cesarean section rate and vaginal operative delivery rate, but decreased the neonatal asphyxia and outside hospital fetal death rate. The long-distance FHR monitoring combined with the count of FM may be a better family-self monitoring method for the pregnant women with the umbilical cord loops.

Cesarean Section↗
PubMed2004

Frequency of self-monitoring and its effect on metabolic control in patients with type 2 diabetes.

The aim of the study was to investigate the frequency of self-monitoring of blood glucose in patients with type 2 diabetes and to determine its effect on metabolic control measured as glycosylated hemoglobin level. The study involved 218 patients with type 2 diabetes (68.8% of females and 31.19% of males) who reported to the Outpatient Department for Diabetes at the Institute of Agricultural Medicine in Lublin. All patients were asked to complete a questionnaire form containing questions concerning, among other things, demographic data, course of diabetes, method of treatment, ability to adjust insulin doses and frequency of self-monitoring of blood glucose level. The levels of glycosylated emoglobin were obtained based on medical records. The analysis of the data showed that 59.22% of patients tested their blood glucose levels at home > or = 1/day, 21.36% of them tested their blood glucose > or = 1/week, whereas 8.74% of patients tested glucose < or = 1/week. 10.68% of patients stated that they never racticed SMBG. Statistical differences were observed in the level of education. Among the group of patients who exercised self-monitoring the most dominant were those with secondary school or university level of education (60.66%), while among patients who did not maintain self-monitoring the greatest number had only elementary or vocational education (72.73) (p = 0.01). The greatest number of patients who most often maintained self-monitoring were office workers (52.46%), whereas among those who did not exercise self-monitoring, those employed in agriculture dominated (45.45%) (p < 0.01). Urban inhabitants exercised self-monitoring more frequently than urban inhabitants (p < 0.01). The frequency of self-monitoring did not affect glycemia control. Urban inhabitants with secondary school or university education level and those who perform office work are more keen on frequent home monitoring of glycemia. In patients with type 2 diabetes the intensity of self-monitoring does not exert any effect on diabetes control evaluated by means of glycosylated hemoglobin level.

Adult↗
PubMed1989

Fetal monitoring and predictions by clinicians: observations during a randomized clinical trial in very low birth weight infants.

Predictions about perinatal outcome in very low birth weight infants were studied in a randomized clinical trial of electronic fetal monitoring and periodic auscultation to assess the effect of diagnostic monitoring information on clinicians' ability to predict perinatal outcomes. The only predictions consistently correct before monitoring information was available were those regarding infant survival (88% correct, kappa [kappa] = 0.40, P less than .001 for the electronic fetal monitoring group; 80% correct, kappa = 0.35, P less than .01 for the periodic auscultation group). After monitoring, predictions of 5-minute Apgar scores and arterial cord pH were significantly more accurate, and clinicians' confidence in their predictions increased significantly in both the electronic fetal monitoring and the auscultation groups. Predictions of 5-minute Apgar scores were significantly more accurate in the electronic fetal monitoring group (92% correct, kappa = 0.80) than in the periodic auscultation group (61% correct, kappa = 0.28) (Z difference = 3.04; P less than .01). We conclude that clinicians gain information during intrapartum monitoring that generally leads to improved predictions and increased confidence in predictions. In this study, they made more accurate predictions about 5-minute Apgar scores with electronic fetal monitoring, suggesting that electronic fetal monitoring may provide better information about neonatal well-being than does periodic auscultation. Improved information, as measured by clinical predictions, is probably highly valued by patients and clinicians and may be an important determinant of acceptance of this diagnostic technology.

Apgar Score↗
PubMedDate not supplied

[Study of the validity and reproducibility of passive ozone monitors].

The aim of this study was to evaluate the validity and reproducibility between ozone measurements obtained with passive ozone monitors and those registered with a continuous ozone monitor, to determine the applicability of passive monitors in epidemiological research. The study was carried out during November and December 1992. Indoor and outdoor classroom air ozone concentrations were analyzed using 28 passive monitors and using a continuous monitor. The correlation between both measurements was highly significant (r = 0.089, p < 0.001), indicating a very good validity. Also, the correlation between the measurements obtained with two different passive monitors exposed concurrently was very high (r = 0.97, p < 0.001), indicating a good reproducibility in the measurements of the passive monitors. The relative error between the concentrations measured by the passive monitors and those from the continuous monitor tended to decrease with increasing ozone concentrations. The results suggest that passive monitors should be used to determine cumulative exposure of ozone exceeding 100 ppb, corresponding to an exposure period greater than five days, if used to analyze indoor air.

Air Pollution, Indoor↗
PubMed1995

Cost implications of event recordings in apnea/bradycardia home monitoring: a theoretical analysis.

OBJECTIVES: To evaluate the financial impact of incorporating event recordings as an integral component of home apnea/bradycardia monitoring. STUDY DESIGN: This theoretical analysis examines the cost of home monitoring when medical decisions are based on an evaluation of the cardiorespiratory waveforms surrounding each apnea/bradycardia monitor alarm (documented monitoring) compared to those based on parental observations. Data for both approaches were obtained from 155 infants referred within the first 10 days of life, because a sibling died of sudden infant death syndrome. All were followed on an impedance type apnea/bradycardia monitor with an attached event recorder. The monitor settings were 20 seconds for apnea and 80 beats per minute (bpm) for bradycardia. Parents were taught how to use the equipment, resuscitative techniques, and to complete an alarm log. The clinical protocol provided for home monitoring until there were no "episodes" (prolonged apnea or prolonged bradycardia) for 16 consecutive weeks. A polysomnogram would be obtained if an "episode" occurred. For each infant two independent approaches were used to judge the occurrence of an "episode": (1) parental report of an apnea alarm occurring during sleep or a physiologic alarm associated with skin color change or resuscitative intervention and (2) apnea > or = 20 seconds long or bradycardia > or = 10 seconds. The cost was calculated assuming a 4-week monitor rental fee of $350, a 4-week waveform interpretation fee of $180, and a $600 fee for performing and interpreting a polysomnogram. RESULTS: Episodes defined from an interpretation of the cardiorespiratory waveforms resulted in fewer diagnostic studies, a shorter period of home monitoring, and lower per patient treatment costs. CONCLUSION: Despite the increased monthly cost, incorporating event recordings as an integral component of home monitoring resulted in a lower average per patient cost.

Apnea↗
PubMed1993

[The sudden infant death syndrome. II. Its prevention by home monitoring].

Sudden infant death syndrome (SIDS) is a very dramatic situation with a very high incidence rate. Children with a high risk of SIDS can be identified by clinical/epidemiological scorings. The preventive usefulness of home monitoring is now a matter of study. Our experience is reported in this article. Thirty-nine infants at high risk were selected, although the monitoring program was finally achieved in only 36 cases. A cardiorespiratory impedance monitor (Centurion, Clinical Data, Boston, USA) was used. The tachycardia alarm was set at 200 b/min, bradycardia at 60 b/min and apnea > 20 seconds. The parents were trained in running the monitor and received technical support by phone during 24 hour per day. They filled out a daily record sheet with the observed anomalies. The mean time of monitoring was 8.2 months. After the withdrawal of the monitor, the parents answered a form with 26 questions. Twenty-four of the children needed, at least at some occasion, a light stimulation and 12 (33.3%) required a strong one. Meanwhile, the other 12 did not need any type of stimulus during monitoring. A simultaneous apnea/bradycardia alarm occurred in 17 cases. The home monitoring program was considered positive by the parents and only 4 families had technical difficulties. After the second week the fear and anxiety disappeared and only 1 family continued to be nervous throughout the monitoring program. The mean number of false alarms was 13.3/child, as opposed to 15.6 alarms due to apnea, 11.6 due to tachycardia and 0.9 due to apnea plus bradycardia. In conclusion, we think that home monitoring is easy, it reassures the families and their acceptance of the program is good.

Electrodes↗
PubMed1993

Comparison of simultaneous esophageal pH monitoring and scintigraphy in infants with gastroesophageal reflux.

Twenty-nine infants under 1 yr of age were studied by simultaneous esophageal pH monitoring and scintigraphy for evaluation of gastroesophageal reflux (GER). Scintigraphy and pH monitoring were performed for 120 min after infants ingested their usual volume of formula. The number of reflux episodes during six 20-min intervals, as determined by both tests, were recorded. Esophageal pH monitoring was continued for 18-24 h. Sixteen of 29 patients exhibited GER by pH monitoring during the 2-h study. Gastroesophageal reflux occurred in seven of 29 during the first hour and 13 of 29 during the second hour. The mean time of first reflux episode detected by pH monitoring following the feeding was 82.4 +/- 49.3 min. In comparison, 28 of 29 patients had GER by scintigraphy during the 2 h. All 28 exhibited GER during the first hour, whereas only 22 of 29 patients exhibited GER during the second hour. The mean time of first episode of reflux by scintigraphy was 3.1 +/- 2.7 min. Forty-five percent of all reflux episodes detected by scintigraphy occurred during the first 20 min and 80% were detected during the first hour. In contrast, only 17% of reflux episodes were seen by pH monitoring during the first 20 min and 35% during the first hour; 65% of reflux episodes detected by pH monitoring were during the second hour. There was no correlation between the total number of reflux episodes detected by scintigraphy and 2-h esophageal pH monitoring during the 2-h study period (r = 0.326; p > 0.1). Overall, to detect reflux, scintigraphy was a more sensitive method than esophageal pH monitoring under the conditions of this study. Scintigraphy selectively detected reflux during the first 60 min post-prandially whereas pH monitoring was more likely to detect reflux beyond the first postprandial hour. These observations help to explain the lack of correlation between the two tests.

Esophagus↗
PubMed1995

Recent advances in home infant apnea monitoring.

Appropriate and effective nursing intervention is an essential element in determining how the family responds to the monitor in the home. Accurate assessment of the family system and dynamics provides the basis for a plan of care. The family's and infant's specific needs must be addressed. Careful implementation of the plan allows for changes and unexpected outcomes. Frequent evaluation of monitoring is necessary to determine if a change in the plan of care is needed. Recent changes in home apnea monitoring technology are rapidly altering the care of infants at risk for apnea and SIDS. The advent of the documented or recording monitor has the potential to demystify the events occurring while the infant is being monitored. Parents can get answers about their infant as quickly as a telephone call. The clinician can differentiate between a true and a false alarm and reassure the parents accordingly. Documenting false events and shallow-breathing alarms will potentially reduce the duration of monitoring, decreasing costs to the entire health care system. Documented monitoring is a valuable tool for nurses. For the staff nurse, clinical observation can be validated through trending and print out of events can be done at the bedside. For the advanced practice nurse, management of care can become more efficient through remote monitoring via modem. Patient teaching can be followed with immediate feedback. Monitors may assist in allaying anxiety in families who have lost children to SIDS or had an unexpected death in a previous sibling. Families may feel less anxious about having an "at risk" child in the home if the events are continuously being recorded. Length of hospital stay may decrease initially, with fewer rehospitalizations. Nursing research in these areas is necessary. Evaluating events occurring in the home may also help shed light on the enigma of SIDS. Several SIDS deaths have been recorded on documented monitors. If we can pinpoint exactly what takes place prior to and immediately after a SIDS episode, the enigma that has had physicians puzzled for so long may finally begin to unravel.

Apnea↗
PubMed1996

[Monitoring of multiple trauma in an emergency hospital unit].

In the monitoring of multiple trauma patients in the emergency hospital setting the use of monitors should be graduated. However, the use and interpretation of data from these monitors is becoming increasingly complex and can lead to errors and responses which may not be adopted. Clinical nomination and observation have their limits and the anaesthetist is faced with the added difficulties of interpretation of data from monitors and is pitfalls. The management of the patient is based on this human-machine relationship, which provides the basis for the therapeutic attitude and the treatment which ensues. Basic monitoring comprises a pulse oximeter, a capnograph, an ECG and a blood pressure monitor, 52% of incidents are detected by these instruments; 27% by SpO2, 24% by capnography. The pertinence is 82% for the oximeter when used alone and 55% for the capnography alone, although when the two are used together this increases to 88%. If the blood pressure monitor is added the pertinence increases to 93%, and to 95% if the FiO2 is monitored. The use of monitors of levels of haemoglobin or haematocrit must take into account the important variations in volaemia. The displayed values have a poor predictive value. The second level of monitoring comprises the use of a pulmonary artery catheter. The errors in measurement and interpretation are reviewed and finally, we consider the possible use of FOE transoesophageal echocardiography in the multiple trauma patient.

Blood Pressure Determination↗
PubMed1997

Vagal nerve monitoring: a comparison of techniques in a canine model.

HYPOTHESIS: An optimal technique exists for intraoperative, electrophysiologic vagal nerve monitoring. BACKGROUND: Analogous to facial nerve monitoring during lateral skull base surgery, vagal nerve monitoring may be used at surgery involving the jugular foramen, the posterior cranial fossa, the infratemporal fossa, the parapharyngeal space, and the thyroid gland to decrease the incidence of iatrogenic injuries. Laryngeal electromyography (EMG) is an accurate test of vagal nerve function: four applications have been described for use intraoperatively. The purpose of this study was to compare the sensitivities of these techniques in a canine model in order to identify the optimal method of intraoperative vagal nerve monitoring. METHODS: Four techniques of EMG vagal nerve monitoring were studied in dogs. The thyroarytenoid muscle (TA) was monitored directly in three techniques. Two methods used bipolar hookwire electrodes (L.A. Diagnostics, Los Angeles, CA) inserted in the TA percutaneously through the cricothyroid membrane or via direct laryngoscopy (DL). The third TA monitoring technique involved the use of an EMG endotracheal tube (Xomed-Treace, Jacksonville, FL). The fourth technique used a laryngeal surface EMG electrode (RLN Systems, Jefferson City, MO), laryngoscopically placed in the postcricoid space. After placing each monitoring device, the vagus nerve was identified bilaterally in the neck. The nerves were sequentially stimulated at a constant current of 4.1 Hz with increasing intensity (starting at 0.05 mAmps) to determine the minimum thresholds to stimulate vocal cord contraction. A positive response at the vocal cord was defined as a train of four contractions of > or = 50 mV. The lowest threshold for each technique in each dog was recorded. RESULTS: A positive response was obtained in 27 of 32 possible cases using a maximum boundary of 0.5 mAmps for stimulus intensity. Survival analysis was then used to generate Kaplan-Meier survival curves, allowing a comparison of the mean time needed to obtain a response. Log-rank chi statistics showed that the survival curves are inhomogenous (degrees of freedom [df] = 3, chi = 15.58, p < 0.001). The laryngeal surface electrode appears to offer the most sensitive method for vagal nerve monitoring. CONCLUSIONS: Four techniques of intraoperative, EMG vagal nerve monitoring were compared in a canine model. The results suggest that EMG recordings can be obtained successfully through a variety of techniques and that the laryngeal surface electrode appears to be the most sensitive technique in the canine model.

Animals↗
PubMed1999

Temperature monitoring practices during regional anesthesia.

UNLABELLED: Monitoring and maintaining body temperature during the perioperative period has a significant impact on the risk of myocardial ischemia, cardiac morbidity, wound infection, surgical bleeding, and patient discomfort. To test the hypothesis that body temperature is inadequately monitored during regional anesthesia (RA), we randomly surveyed 60 practicing anesthesiologists to determine practice patterns for temperature monitoring. Only 33% of the clinicians surveyed routinely monitor body temperature during RA. Although skin temperature monitoring has limitations, it was the most commonly used method among the survey respondents. When temperature is monitored during RA, most clinicians use either liquid crystal skin-surface monitoring or axillary temperature probes. Of those surveyed, < 15% use acceptable core temperature monitoring techniques (urinary bladder or tympanic membrane). In conclusion, it seems that body temperature is often not monitored in patients receiving RA. IMPLICATIONS: The results of this survey of practicing anesthesiologists indicate that body temperature is often not monitored in patients receiving regional anesthesia. It is therefore likely that significant hypothermia goes undetected and untreated in these patients.

Anesthesia, Conduction↗