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At least 847 records · Page 47Linked to original sources
PubMed1994

Monitor surveillance and vigilance of anesthesia residents.

BACKGROUND: Anesthesia residents take longer to detect changes in electronically monitored data during the induction phase of anesthesia during the maintenance phase. This study was performed to investigate the reasons for this delay and to validate a method of measuring vigilance. METHODS: The activity of ten residents was studied during 73 surgical procedures. Data were collected during three 15-min periods from each case: induction, starting with application of the electrocardiograph; maintenance, an arbitrary period between induction and emergence; and emergence, ending with detachment of the electrocardiograph. Vigilance was measured as the time taken to detect a change, from normal to abnormal, of an artificial parameter displayed on the physiologic monitor (response time). An observer simultaneously recorded each time that the resident looked toward the monitors. RESULTS: Vigilance to the monitor display was less during induction and emergence than during maintenance (P < 0.005). Residents spent less total time watching monitors during induction than during maintenance (P < 0.005), and the duration of each monitor observation was shorter (P < 0.0005). Anesthesia residents usually looked at the monitors several times before detecting the abnormal value. The measure of anesthesia vigilance correlated with independent measures of monitor watching time and frequency. CONCLUSIONS: The results suggest that during induction of anesthesia, which is a period of high anesthesiologist workload, residents glance toward monitors to gather data rather than scan displays. The results help to validate the method for measuring anesthesia vigilance.

Anesthesia↗
PubMed1997

Monitoring interactions between spontaneous respiration and mechanical inflations in preterm neonates.

OBJECTIVES: To determine the value of a new bedside monitor in assessing the interactions between spontaneous respiratory activity and ventilator inflations in preterm infants; and to monitor continuously the degree of patient-ventilator synchrony and the stability of spontaneous respiratory effort during different modes of ventilation and in response to care procedures. DESIGN: A prospective, observational study of physiologic variables recorded by a computerized monitoring system. SETTING: A neonatal intensive care unit in a teaching hospital. PATIENTS: Thirty-one neonates (median gestational age of 28 wks [range 24 to 36]; median birth weight of 942 g [range 624 to 2940]) were monitored during conventional mandatory ventilation at rates ranging from 47 to 108 inflations/min, and 22 infants (median gestational age of 27.5 wks [range 25 to 40]; median birth weight of 1345 g [range 510 to 3490]) were monitored during patient-triggered ventilation. All infants were sedated as part of the routine care policy. INTERVENTIONS: Spontaneous respiration (abdominal pressure capsule) and ventilator inflations (airway pressure) were recorded continuously for periods of up to 3 days in mechanically ventilated preterm infants. MEASUREMENTS AND MAIN RESULTS: The monitoring system uses the Frequency Tracking Locus method to derive the interaction Score, which quantifies the degree of entrainment of the spontaneous respiratory pattern by the ventilator. This analysis was applied to airway pressure and abdominal capsule signals. A perfect 1:1 interaction between spontaneous inspirations and mechanical inflations returns an interaction Score of 1.00, and irregular interactions return a score of > 1.5. During conventional mandatory ventilation, a total of 53,074 16-sec epochs (representing 782,811 spontaneous breaths) were studied in 31 preterm infants: 27.4% of epochs showed a 1:1 interaction, 60.5% a non 1:1 interaction, and 12.1% indicated a passive (i.e., infant apneic) response by the infant, despite excluding periods when paralyzing agents were used. The median interaction Score value during 1:1 interactions was 1.2, whereas for non 1:1 interactions the interaction Score was 2.2. One to one entrainment occurred at conventional mandatory ventilation rates between 50 and 85 inflations/min: for many infants, such entrainment was achievable over a range of conventional mandatory ventilation rates, while in some infants respiration was unstable at all rates of conventional mandatory ventilation. During passive ventilation, the median Interaction Score was 1.0. During patient-triggered mechanical ventilation, approximately 67,150 spontaneous respiratory cycles, represented by 3,592 16-sec epochs, were studied in 22 infants. Overall, 19.5% (702) of epochs showed the criteria for ideal triggering by spontaneous inspiration and 19.6% (703) showed autotriggering. In 60.9% (2187) of epochs, a non 1:1 interaction was noted. During ideal patient-triggered mechanical ventilation, the median interaction Score was 1.14; during passive (autotriggered) ventilation, the median Interaction Score was 1.05; and during non 1:1 ventilation, the median score was 1.74. "Autotriggering" was found frequently in infants of < or = 28 wks gestation. The monitor was able to distinguish between stable and unstable interactions and apnea during conventional mandatory ventilation and patient-triggered mechanical ventilation by reference to the Interaction Score value. CONCLUSIONS: We describe a new kind of bedside monitor for the Interpretation of respiratory data. Unlike other methods, it is able to give the clinician a continuous measure of patient-ventilator interaction which is easy to interpret. It appears to have wide-spread application in neonatal intensive care nurseries where the babies' own breathing efforts can affect the efficiency of respiration and cause unwanted physiologic instability. The monitor can be used to determine the optimal ventilatory settings to

Humans↗
PubMed1994

Design, calibration, and operation of 220Rn stack effluent monitoring systems at Argonne National Laboratory.

A group of stack effluent monitoring systems have been developed to monitor discharges of 220Rn from a hot cell facility at Argonne National Laboratory. The stack monitors use flow-through scintillation cells and are completely microprocessor-based systems. A method for calibrating the stack monitors in the laboratory and in the field is described. A nominal calibration factor for the stack monitoring systems in use is 15.0 cts min-1 per kBq m-3 (0.56 cts min-1 per pCi L-1) +/- 26% at the 95% confidence level. The plate-out fraction of decay products in the stack monitor scintillation cells, without any pre-filtering, was found to be nominally 25% under normal operating conditions. When the sample was pre-filtered upstream of the scintillation cell, the observed cell plate-out fraction ranged from 16-22%, depending on the specific sampling conditions. The instantaneous 220Rn stack concentration can be underestimated or overestimated when the steady state condition established between 220Rn and its decay products in the scintillation cell is disrupted by sudden changes in the monitored 220Rn concentration. For long-term measurements, however, the time-averaged response of the monitor represents the steady state condition and leads to a reasonable estimate of the average 220Rn concentration during the monitoring period.

Calibration↗
PubMed2002

Prolonged esophageal pH monitoring in the evaluation of gastroesophageal reflux in children with chronic tubotympanal disorders.

BACKGROUND: Children with ear, nose and throat disorders are believed to have a high incidence of pathologic gastroesophageal reflux (GER). This study was designed to establish the frequency and ratio of pathologic GER in the development of chronic tubotympanal disorders. METHODS: Twenty-seven children with chronic tubotympanal disorders (mean age, 2 to 13 years; average age, 6.8 years) underwent 24-hour continuous pH monitoring. Fourteen of the examined patients had secretory otitis, whereas 13 patients had recurrent otitis. From each 24-hour pH monitoring, 12-hour daytime and nighttime periods were selected. Eleven patients were tested using simultaneous dual pH monitoring (distal and proximal pH monitoring). RESULTS: Fifteen (55.6%) of 27 patients had pathologic GER. The authors did not find a relation between pathologic GER and different types of ear disorders. Daytime pH monitoring yielded significantly more episodes of reflux than did nighttime monitoring. The reflux index was substantially higher during the day. In the current study, distal pH monitoring showed that 6 of 11 patients had pathologic GER, whereas proximal pH monitoring showed that only only 3 of 11 patients had pathologic GER. CONCLUSIONS: The authors recommend that a pH study be performed in children with chronic tubotympanal disorders when standard treatment is ineffective. The method of choice for the diagnosis of pathologic GER in patients with chronic tubotympanal disorders should be pH monitoring of the esophagus and throat.

Adolescent↗
PubMed1999

Accuracy of a miniature intracranial pressure monitor, its function during magnetic resonance scanning, and assessment of image artifact generation.

OBJECTIVE: We examined the accuracy and repeatability of an intracranial pressure (ICP) monitor (Codman MicroSensor; Johnson & Johnson Professional, Inc., Raynham, MA) in a nonmagnetic environment and during magnetic resonance imaging (MRI). The resulting image artifact generation was calculated. ICP monitoring is essential in management of severe head injury, but few ICP monitoring devices are compatible with use in an MRI scanner. The use of MRI to assess head injury is increasing, and developing safe methods of continuously monitoring ICP may improve patient care. METHODS: A water manometer was used as the standard for comparison. We assessed pressure readings from the ICP monitor in a nonmagnetic environment using a standard and a long connector cable between the pressure transducer and display unit. This long cable permitted testing during MRI sequences because the display unit could be distanced from the magnet. Accuracy was determined during T2-weighted imaging, proton spectroscopy, and diffusion-weighted imaging, and artifact generation was assessed. RESULTS: We found a high degree of accuracy for repeated measurements over a clinical pressure range using both standard and long connector cables outside the MRI room. During MRI scanning, the ICP monitor was accurate during T2 and proton spectroscopy sequences. Accuracy during diffusion-weighted imaging, however, was clinically unacceptable. This ICP monitor creates a reduction in signal-to-noise ratio in the received signal during T2-weighted imaging and proton spectroscopic imaging, with the obtained images still radiologically interpretable. CONCLUSION: The Codman ICP monitor is sufficiently accurate and free of artifact generation to be used during most clinical MRI applications. This could enhance patient monitoring and safety.

Artifacts↗
PubMedDate not supplied

Ambulatory blood pressure monitoring is associated with reduced physical activity during everyday life.

OBJECTIVE: The objective of this study was to assess the impact on noninvasive ambulatory blood pressure monitoring on physical activity measured objectively by use of triaxial accelerometers. METHODS: Twenty-four working men and women performed ambulatory blood pressure plus activity monitoring for 1 working day and evening and activity monitoring alone for a separate day and evening. Blood pressure measures were taken at 20-minute intervals during the day and 30-minute intervals in the evening and were accompanied by diary assessments of mood, location, and posture. Comparisons were made of energy expenditure on the 2 days and of activity levels during the minutes surrounding each blood pressure reading and diary completion. RESULTS: Energy expenditure assessed in terms of activity calories per hour was significantly lower during blood pressure plus activity monitoring compared with activity monitoring alone (mean 37.3, SD = 16.3 vs. mean = 43.0, SD = 18.7 kcal, respectively: p = .02). Energy expenditure was lower during the 4 minutes surrounding each blood pressure reading than in the intervals between blood pressure readings. However, energy expenditure was also lower in the intervals between blood pressure readings than during comparable times on the activity only monitoring day. Blood pressure, heart rate, and physical activity were moderately correlated within individuals. CONCLUSIONS: Ambulatory blood pressure recording using automated sphygmomanometers is associated with reduced physical activity during the monitoring day. This is due partly to regular periods of immobility during cuff inflation and deflation and diary completion and partly to more general self-imposed restrictions on activity. This pattern has implications for the representativeness of ambulatory blood pressure monitoring, and the construction of ambulatory monitoring diaries.

Adult↗
PubMed1986

Present status and trends in biological monitoring of exposure to industrial chemicals.

This paper describes the current practice of biological monitoring of populations exposed to occupational or environmental pollutants. The three types of monitoring are ambient monitoring, biological monitoring of exposure, and health surveillance (also called biological monitoring of effects). The trend in biological monitoring today is to develop tests that provide information on the amount of chemical bound to the critical sites of action (target dose). Ambient monitoring and biological monitoring assess the health risk by comparing the current exposure with the permissible exposure limits. They are essentially preventive activities. By contrast, health surveillance or biological monitoring of effects assesses the health status and aims at detecting the early adverse health effects. Health surveillance is part of the medical screening program for the early detection of health impairment due to industrial chemicals.

Environmental Exposure↗
PubMed2004

Direct access ambulatory BP monitoring--the Edinburgh experience.

The use of electronic measurement of blood pressure and, in particular, ambulatory blood pressure monitoring offers the opportunity to determine which patients with apparent hypertension have truly sustained elevation of their blood pressure levels. Given the high prevalence of hypertension and the even larger number of individuals who appear to be hypertensive but may not be so, it is difficult to deliver ambulatory blood pressure monitoring to all individuals who might benefit from it. In Edinburgh, Scotland, we have piloted a system of direct access ambulatory blood pressure monitoring whereby physicians in primary care can request of the hospital service, an ambulatory monitor on their patient without the patients attending a formal hospital clinic. In the 7 years since the service was first instituted, almost 6,000 monitors have been performed with referrals running at approximately 100 per month in recent times. The present study was set up to assess the impact of the ambulatory monitor result on clinical decision making in primary care. The referral form invited primary care physicians to indicate their planned management if an ambulatory monitor had not been available and we thereafter audited patient records to determine what ultimately happened following the advice given on the basis of the ambulatory monitoring record.A random sample of results was obtained on untreated patients and approximately 500 were analysed. It was clear that if the advice to the primary care physician based upon the ABPM was not to treat, that this was largely followed with some 94% of patients not receiving treatment within 3 months of the monitor. If, however, the advice given was to start treatment, this was less reliably followed and in only 76% of patients treatment was started within 3 months. At the time of the audit this figure had increased to 82%. Primary care physicians had indicated that they would have treated 60% of the individuals referred and in reality only treated 40%. The potential saving in drug costs from the reduction by 20% of those treated would have significant impact on health care budgets.

Blood Pressure Monitoring, Ambulatory↗
PubMed2005

Multimodality monitoring and telemonitoring in neurocritical care: from microdialysis to robotic telepresence.

PURPOSE OF REVIEW: This review will highlight the state-of-the-art in brain monitoring in neurointensive care and define methods of integrating this technology into patient care using telemedicine methods. RECENT FINDINGS: Several new methods of brain monitoring have been established over the last several years including continuous EEG monitoring, brain tissue oxygenation, jugular venous oxygenation, and cerebral microdialysis. Observational research using these monitors has documented that the brain metabolism, blood flow and function are dynamic after a primary insult. The dynamic nature of the brain can predispose the brain to secondary insults that can occur in the setting of intensive care. Several variables of brain metabolism and function can be monitored and directly impact treatment decisions as well as provide diagnostic and prognostic information. General treatment guidelines for brain injury and brain hemorrhage were developed, in part, prior to implementation of use of these monitors, and there is a trend away from adoption of a one-size-fits-all approach and a trend towards monitor-guided therapy. Dealing with the data provided by multimodality monitoring can be overwhelming. Efficient use of such information requires methods to integrate diverse sets of information, and methods to access the online monitoring information remotely and at any time, day or night. Such remote access integration methods will be reviewed. SUMMARY: Multimodality and telemedicine techniques have advanced the state of knowledge about brain function in critically ill patients, and are presently being implemented to direct therapy. Increasing complexity of care will become commonplace, but will be facilitated by computer-enhanced tools that permit the intensivist to integrate this information into an improved treatment regimen.

Brain Injuries↗
PubMed2005

Limited (6-h) ambulatory blood pressure monitoring is a valid replacement for the office blood pressure by trained nurse clinician in the diagnosis of hypertension.

OBJECTIVE: To assess the ability of limited ambulatory blood pressure monitoring as a valid replacement for office blood pressure measurement done to American Heart Association criteria in diagnosing hypertension. METHODS: In all, 105 adults, who had been referred for limited ambulatory blood pressure monitoring, participated in the study. Limited ambulatory blood pressure monitoring consisted of 6 h of blood pressure measurement while ambulatory at the Mayo Clinic, using a SpaceLabs 90207 (SpaceLabs Medical, Issaquah, Washington, USA) collecting six readings per hour for the period of observation. The study participants gave consent for three additional consecutive office blood pressure measurements, using a validated aneroid device, done to American Heart Association criteria, by a single hypertension nurse specialist. RESULTS: Mean systolic blood pressure by limited ambulatory blood pressure monitoring was 137.9+/-14.2 mmHg and for the nurse, 137.9+/-20.1 mmHg. Mean diastolic blood pressure by limited ambulatory blood pressure monitoring was 81.5+/-9.7 mmHg and for the nurse, 74.3+/-11.9 mmHg. The intermethod difference for systolic blood pressure was 0.03+/-12.5 mmHg and diastolic blood pressure, -7.2+/-8.0 mmHg. Using <140/90 as criteria factor, limited ambulatory blood pressure monitoring and the trained nurse agreed 77% of the time on whether the patient was hypertensive. This agreement increased to 81% if the participant's referral blood pressure was >or=140/90. CONCLUSIONS: Limited ambulatory blood pressure monitoring is an excellent replacement for office blood pressure, done to American Heart Association criteria, in diagnosing hypertension. This avoids issues of variability introduced by the observers, such as digit preference and bias, and increases reproducibility of blood pressure measurements. The appropriate normal value for limited ambulatory blood pressure monitoring is <140/90 mmHg compared with <135/85 mmHg used in 24-h ambulatory blood pressure monitoring.

Adolescent↗
PubMed2006

Monitoring buried free flaps: limitations of the implantable Doppler and use of color duplex sonography as a confirmatory test.

BACKGROUND: Postoperative monitoring of free flaps is important to minimize the risk of flap failure, but monitoring buried free flaps is difficult because the standard methods of clinical examination and surface Doppler monitoring are not possible. Buried free flaps are often monitored using an implantable 20-MHz ultrasonic Doppler probe. METHODS: The authors conducted a retrospective clinical study of buried free flaps to assess the reliability of the implantable Doppler probe in postoperative monitoring of free flaps. RESULTS: During the 38-month study period, 956 free flap operations were performed at the authors' institution. Twenty (2.1 percent) of these cases involved completely buried free flaps in which an implantable Doppler probe was used for flap monitoring. Implantable Doppler probe monitoring had a 100 percent sensitivity rate in detecting loss of flap perfusion, making it a good screening test for free flap viability. However, it suffered from a high false-positive rate of 88 percent, which resulted in a high proportion of subsequent negative surgical explorations. In one case, color duplex sonography, a rapid and noninvasive test, revealed that the loss of signal from the implantable Doppler probe was a false-positive result. CONCLUSIONS: The implantable Doppler probe is a sensitive method for postoperative monitoring of free flaps but is prone to false-positive signals. The use of color duplex sonography to confirm implantable Doppler probe findings may avert unnecessary surgical exploration, thereby improving postoperative monitoring of free flaps.

Humans↗
PubMed2000

Optimum bedside cardiac monitoring.

Correct electrode placement is critical to obtaining accurate information from any monitoring lead. The choice of lead should be based on the goals of monitoring for a specific patient population and on the individual patient's clinical situation. When using a 5-wire monitoring cable, arm electrodes should be placed on the shoulders; leg electrodes, on the lower thorax or hip area; and the chest electrode, in the desired V lead position. When using a 3-wire system, lead placement depends on which lead is desired for monitoring. If arrhythmia diagnosis is the goal of monitoring, lead V1 is the best lead; lead V6 is the next best lead. If ST segment monitoring for ischemia or reocclusion following percutaneous coronary interventions is the goal, the best lead depends on the coronary artery involved. Multiple lead monitoring is superior to single lead monitoring. If two leads are available, V1 and lead III or aVF (or a limb lead with maximal ST segment displacement) are good choices. If three leads are available, leads V1, III, and aVF are the best choices. Continuous 12-lead monitoring is available and offers several advantages.

Benchmarking↗
PubMed2006

Monitoring for adverse drug reactions.

Monitoring describes the prospective supervision, observation, and testing of an ongoing process. The result of monitoring provides reassurance that the goal has been or will be achieved, or suggests changes that will allow it to be achieved. In therapeutics, most thought has been given to Therapeutic Drug Monitoring, that is, monitoring of drug concentrations to achieve benefit or avoid harm, or both. Patients and their clinicians can also monitor the progress of a disease, and adjust treatment accordingly, for example, to achieve optimum glycaemic control. Very little consideration has been given to the development of effective schemes for monitoring for the occurrence of adverse effects, such as biochemical or haematological disturbance. Significant harm may go undetected in controlled clinical trials. Even where harm is detected, published details of trials are usually insufficient to allow a practical monitoring scheme to be introduced. The result is that information available to prescribers, such as the Summary of Product Characteristics, frequently provides advice that is incomplete or impossible to follow. We discuss here the elements of logical schemes for monitoring for adverse drug reactions, and the possible contributions that computerized decision support can make. We should require evidence that if a monitoring scheme is proposed, it can be put into practice, will prove effective, and is affordable.

Adverse Drug Reaction Reporting Systems↗
PubMed1998

Monitoring of oxygen delivery in cardiac and vascular surgery.

Monitoring the adequacy of oxygen (O2) delivery is of paramount significance in the perioperative period of surgical patients undergoing cardiac and major vascular surgery. These patients are at considerable risk for ischemic perioperative complications due to a high incidence of coronary artery disease. Monitoring the adequacy of global O2 delivery is based on observing stability of haemodynamics, absence of elevated lactate levels and preservation of O2 consumption. Monitoring the adequacy of regional O2 delivery focuses on the coronary, cerebral, splanchnic and renal circulation. Myocardial ischemia can be detected relatively easily by continuous ECG monitoring of leads II and V5 and in selected cases by transesophageal echocardiography. There are relatively few monitoring modalities clinically available at the present time to reliably assess adequacy of O2 delivery in the cerebral, splanchnic and renal circulation. Expecting relatively low intra- and postoperative haemoglobin levels per se does not necessarily mandate greatly exaggerated monitoring. However, continuous ECG monitoring of leads II and V5, invasive blood pressure measurement, determination of hourly urine production may be indicated in most patients. In high risk patients extended monitoring with a pulmonary artery catheter and transesophageal echocardiography may be indicated. Most important, however, is the clinical surveillance by an experienced physician integrating the information of all applied monitoring modalities who realizes early alterations indicating (potentially) compromised O2 delivery.

Blood Pressure Determination↗
PubMed1986

The use of ambulatory monitoring in the prognostic evaluation of patients with sustained ventricular tachycardia treated with amiodarone.

We recently reported a retrospective experience with serial Holter monitoring as a guide to therapy in patients with sustained ventricular tachycardia treated with amiodarone. To confirm and substantiate these findings, a prospective study was designed that included baseline 24 hr Holter monitoring and serial Holter monitoring after 1 week of therapy with amiodarone. Fifty-two patients with documented sustained ventricular tachycardia who manifest nonsustained ventricular tachycardia on baseline Holter monitoring were treated with amiodarone. Thirty-four patients (group I) had nonsustained ventricular tachycardia completely suppressed and 18 patients (group II) had continued nonsustained ventricular tachycardia on serial Holter monitoring performed on days 8, 9, and 10 of therapy. At 11.6 +/- 1.0 (mean +/- SE) months follow-up, three (9%) group I patients and 12 (67%) group II patients had recurrent sustained ventricular tachycardia or sudden cardiac death (p less than .01). The sensitivity, specificity, positive and negative predictive value, and predictive accuracy of ventricular tachycardia on 24, 48, and 72 hr Holter monitoring over days 8, 9, and 10 for predicting recurrent sustained ventricular tachycardia or sudden cardiac death were analyzed. The positive and negative predictive values were 89% and 84%, 69% and 89%, and 67% and 91% for 24, 48, and 72 hr Holter monitoring, respectively. Overall predictive accuracy was 85%, 83%, and 83%, respectively. We conclude that early Holter monitoring is useful in assessing the clinical efficacy of amiodarone in patients with sustained ventricular tachycardia who manifest nonsustained ventricular tachycardia on baseline Holter monitoring.

Amiodarone↗
PubMed1994

Performance of a patient-dedicated, on-demand blood gas monitor in medical ICU patients.

We examined the performance characteristics of a new bedside blood gas monitor. This monitor's fluorescent pH, PCO2, and PO2 sensors are embedded in a cassette, which is calibrated in vitro and then inserted into the patient's radial artery tubing set. In 50 medical ICU patients, 683 paired monitor and conventional blood gas analyzer values were obtained. Performance was assessed via calculations of bias (mean monitor and analyzer difference) and its standard deviation (SD), plots of monitor and analyzer differences against the means (of monitor and analyzer), and linear regression analysis of the sequential changes in monitor values versus the corresponding sequential changes in analyzer values. The ex vivo calibration, assessed using the initial paired blood samples, showed a bias +/- SD of 0.02 +/- 0.02 for pH, -0.1 +/- 1.9 mm Hg for PCO2, and 4.3 +/- 6.0 mm Hg for PO2. For all paired samples (n = 683), the biases +/- SD were 0.004 +/- 0.023 for pH, 0.6 +/- 2.4 mm Hg for PCO2, and 2.7 +2- 6.4 mm HG for PO2. The PO2 bias increased as PO2 increased. The standard deviations (imprecision) of both PCO2 and PO2 also increased as the magnitudes of these variables increased. Sequential changes in monitor values versus the corresponding sequential changes in analyzer values revealed regression lines close to the line of identity. Serum sodium had no effect on pH bias. Daily drift of the sensors was inconsequential, with values of -0.01/d for pH, 1.7 mm Hg/d for PCO2, and 1.1 mm Hg/d for PO2. We conclude that the performance of this monitor is comparable to that of conventional blood gas analyzers.

Blood Gas Analysis↗
PubMed2006

A randomized clinical trial of peak flow versus symptom monitoring in older adults with asthma.

OBJECTIVE: To determine whether peak flow monitoring has value above and beyond symptom monitoring when used as part of an asthma management plan. METHODS: From a large managed-care organization, 296 adults, aged 50-92 yr, were recruited and randomly assigned in equal numbers to either use of symptoms or peak flow rate (twice daily or "as needed") for asthma monitoring, and monitored every 6 mo for 2 yr. Interventions were delivered in four 90-min small-group classes and included a personalized action plan and coaching in proper use of asthma inhalers. RESULTS: We found no significant differences between peak flow rate and symptom monitoring, or between twice-daily and as-needed peak flow monitoring in the primary or secondary study outcomes: health care utilization (acute, nonacute, or total asthma visits), Asthma Quality-of-Life Questionnaire (AQLQ) scores, and lung function. AQLQ scores and prebronchodilator FEV1 increased significantly for both groups between baseline and 6 mo (AQLQ: mean, 0.4 units; 95% confidence interval, 0.3, 0.5; p < 0.0001; FEV1% predicted: mean, 4%). Inhaler technique improved substantially in both groups. CONCLUSIONS: Peak flow monitoring has no advantage over symptom monitoring as an asthma management strategy for older adults with moderate-severe asthma when used in a comprehensive asthma management program. Improved outcomes in both groups suggest that understanding proper medication use, regular monitoring of asthma status, and understanding how to respond to changes are of primary importance.

Aged↗
PubMed2004

The use of end-tidal carbon dioxide monitoring to confirm endotracheal tube placement in adult and paediatric intensive care units in Australia and New Zealand.

The use of end-tidal carbon dioxide monitoring to assist in confirming endotracheal tube placement is currently not mandatory in intensive care units (ICUs) in Australia and New Zealand. Early detection of failed tracheal intubation is vital to optimize management and to prevent complications. Questionnaires were sent to the lead clinician/head of department of all 66 intensive care units approved for training purposes by the Joint Faculty of Intensive Care Medicine in Australia and New Zealand. The methods used to confirm correct endotracheal tube placement, the availability of end-tidal carbon dioxide monitoring and its role in confirming endotracheal tube placement in the intensive care unit were explored. Completed questionnaires were received from 61 of the 66 centres (92.4%). Wide variation in the method of confirmation of endotracheal tube position was demonstrated, with 23 (37.7%) of units using sub-optimal methods. Sixty (98.3%) of units had end-tidal carbon dioxide monitoring available. Thirty-eight (62%) units shared monitors between several beds; and 22 (36%) had one monitor per bed. End-tidal carbon dioxide monitoring was used routinely to confirm endotracheal tube placement in 42 (68.8%) units. Fifty-two respondents (83.3%) felt that end-tidal carbon dioxide monitoring was superior to other methods for confirming endotracheal tube placement in critically ill patients. Thirty-eight respondents (62.3%) thought that end-tidal carbon dioxide monitoring should be mandatory to confirm tracheal intubation in the intensive care unit. If it were available, 42 respondents (68.8%) would use end-tidal carbon dioxide monitoring for confirmation of every intubation. Mandatory end-tidal carbon dioxide confirmation of endotracheal tube placement was policy in 33 (54.1%) of the intensive care units.

Australia↗