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PubMed2001

The clinical evaluation of the Respi-check mask: a new oxygen mask incorporating a breathing indicator.

UNLABELLED: Study objective-To investigate the correlation between the Respi-check sensor and simultaneous chest auscultation in determining the respiratory rates in adults. METHODS: Random visits to a local accident and emergency (A&E) department were made and all patients wearing oxygen masks were recruited into the study. The new sensor was attached to the outside of the mask. One researcher auscultated the chest to count breaths, the other counted the sensor activity. Each was blinded to the activities of the other. Breaths were counted by each researcher simultaneously and independently over one minute. A total of 40 patients were recruited into the study. A difference of more than two breaths/min compared with chest auscultation was deemed as a sensor failure. RESULTS: The respiratory rates of 40 patients were measured. There were 28 men, 12 women. Twenty six patients were wearing an Intersurgical high concentration (flow 12l/min) mask, 14 were wearing an aerosol mask with variable venturi (flow 3-12l/min) by Medicaid. Over one minute rates determined by the two methods were the same in 28 cases (70%). It was accurate to within one breath in 37 cases (93%) and to within two breaths in 39 (98%) cases and in one case (2.5%) the sensor failed. The mean difference (mean of the differences between rates obtained from auscultation and the new sensor) was -0.1282 breaths/min, with limits of agreement (d (2SD) between -1.414 to 1.157 breaths/min. CONCLUSION: The Respi-check sensor provides an accurate method of estimating the respiratory rate in adult patients attending the A&E department.

Adolescent↗
PubMedDate not supplied

Respiratory assessment.

The ability to carry out and document a full respiratory assessment is an essential skill for all nurses. The elements included are: an initial assessment, history taking, inspection, palpation, percussion, auscultation and further investigations. A prompt initial assessment allows immediate evaluation of severity of illness and appropriate treatment measures may warrant instigation at this point. Following this, a comprehensive patient history will be elicited. Clinical examination of the patient follows and involves inspection, palpation, percussion and auscultation. At this point, consideration must be given to preparation of a light, warm, quiet, private environment for examination and suitable patient positioning. Inspection is a comprehensive visual assessment, while palpation involves using touch to gather information. The next stages are percussion and auscultation. While percussion is striking the chest to determine the state of underlying tissues, auscultation entails listening to and interpreting sound transmission through the chest wall via a stethoscope. Finally, further investigations may be necessary to confirm or negate suspected diagnoses.

Auscultation↗
PubMed2002

Fetal health surveillance in labour.

OBJECTIVE: This guideline defines the standards pertaining to the application and documentation of fetal surveillance in labour that will decrease the incidence of birth asphyxia while maintaining the lowest possible rate of obstetrical intervention. Both high- and low-risk obstetrical populations are considered. It is intended that this guideline could be used by all persons providing intrapartum care in Canada, including nurses, physicians, and midwives. OPTIONS: Consideration has been given to methods of fetal surveillance currently available in Canada, including intermittent auscultation, electronic fetal monitoring (alone and when paired with vibro-acoustic or scalp stimulation and fetal scalp blood sampling), the "admission strip," computerized heart rate analysis, fetal oxygen saturation monitoring, fetal electrocardiogram analysis, and near-infrared spectroscopy. OUTCOMES: Short- and long-term outcomes were considered that may indicate the presence of birth asphyxia. The associated rates of operative or other labour interventions were also considered. EVIDENCE: A comprehensive review of randomized controlled trials performed from 1995 to date and a search of the literature using Medline and the Cochrane Database of all new studies on fetal surveillance. The level of evidence has been determined using the criteria described by the Canadian Task Force on the Periodic Health Examination. RECOMMENDATIONS: Part I: Standard Fetal Surveillance in Labour 1. Women in active labour should receive continuous close support from an appropriately trained professional. One-to-one nursing is recommended. (I-A) 2. Intermittent auscultation following an established protocol of surveillance and response (Figure 1) is the preferred method of fetal surveillance in healthy pregnancies in the active phase of labour. (I-A) 3. Labour induction requires close monitoring of uterine activity and fetal heart rate. (III-B) 4. In the presence of abnormal fetal heart rate characteristics detected by intermittent auscultation and unresponsive to resuscitative measures, increased surveillance by continuous electronic fetal monitoring or fetal scalp sampling or delivery should be instituted. (I-A) 5. Continuous intrapartum electronic fetal monitoring is recommended: a) for pregnancies where there is an increased risk of perinatal death, cerebral palsy, or neonatal encephalopathy (III-C) b) when oxytocin is being used for augmentation of labour (1-A) c) when oxytocin is being used for induction of labour (III-C). 6. With respect to continuous electronic fetal monitoring, all professionals must be familiar with the paper speed used in each case to avoid misinterpretation. The correct time should be recorded on the electronic fetal monitoring record. (III-C) 7. Electronic fetal monitoring records should be inspected and documented every 15 minutes in the active phase of labour and at least every 5 minutes in the second stage of labour. (III-C) 8. The timing of electronic fetal monitoring patterns should be determined in association with uterine contractions. The contraction frequency, duration, intensity, and resting tone should be assessed and documented. Abdominal palpation, a tocodynamometer, or an intrauterine pressure catheter may be used to facilitate the assessment. (III-C) 9. Practitioners should use standard terminology when describing fetal heart rate characteristics of an electronic fetal monitoring record. (III-C) 10. Fetal scalp blood sampling is recommended in association with electronic fetal monitoring patterns that are uninterpretable or non-reassuring, such as sustained minimal or absent variability, uncorrectable late decelerations, increasing fetal tachycardia, and abnormal FHR characteristics on auscultation. (II-3B) 11. The limited knowledge available on the use of labour admission tests warrants further research to establish the usefulness of this screening approach. (III-C) Part II: New Technologies for Fetal Surveillance in Labour 12. The use of computer-based algorithms alone to interpret fetal heart rate patterns is not recommended as a standard of care at the present time. (III-D) 13. Fetal pulse oximetry as an adjunct to electronic fetal heart monitoring in patients with non-reassuring HR status is not recommended as a standard of care at the present time. (III-D) 14. ST waveform analysis technology is under development but is not recommended as a standard of care at this time. (III-C) 15. Near-infrared spectroscopy as an adjunct to electronic fetal monitoring is currently not recommended as there is insufficient evidence to assess its efficacy in fetal surveillance. (III-D) 16. Further study of fetal pulse oximetry, ST waveform analysis, and near-infrared technology in clinical research settings is encouraged. (III-B) VALIDATION: This guideline was reviewed by the SOGC Clinical Practice Obstetrics Committee, Maternal Fetal Medicine Committee, and ALARM Committee, as well as by the Canadian Medical Protective Association. SPONSOR: The Society of Obstetricians and Gynaecologists of Canada.

Algorithms↗
PubMed1990

Whither electronic fetal monitoring?

Largely based on promising animal studies, continuous electronic fetal monitoring (EFM) was introduced into clinical practice in the early 1970s. After almost 20 years of experience, it is now apparent that the anticipated benefits of this technology have not materialized. Undesirable side effects of EFM include inappropriate operative intervention for some patients and increased liability for physicians and hospitals, resulting in an increase in the costs of obstetric services. After reviewing several research studies, The American College of Obstetricians and Gynecologists concluded that EFM and intermittent auscultation are equivalent methods for intrapartum assessment. We have developed a protocol for the performance of intermittent auscultation, including indicated responses to different levels of bradycardia. This protocol has allowed us to substitute auscultation for EFM in a high percentage of patients using existing nursing personnel. Laboring patients should, at a minimum, receive information on both intermittent auscultation and EFM to enable them to make an informed choice of method for intrapartum fetal assessment.

Bradycardia↗
PubMed1987

A randomized trial of electronic fetal monitoring in preterm labor.

Intrapartum electronic fetal heart rate (FHR) monitoring and fetal blood gas sampling were compared with periodic auscultation of FHR in a multicentered randomized trial of preterm singleton pregnancies with fetal weights of 700-1750 g. Two hundred forty-six pregnancies were studied (electronic FHR monitoring N = 122, auscultation N = 124). Perinatal or infant death was associated with 14% of pregnancies with electronic FHR monitoring and 15% with auscultation. No significant differences were noted in the prevalence of low five-minute Apgar scores, intrapartum acidosis, intracranial hemorrhage, or frequency of cesarean section (P greater than .10). Compared with electronic FHR monitoring, intrapartum auscultation as done in this study is unlikely to be associated with detectable differences in perinatal outcomes within the high-risk setting of preterm labor.

Apgar Score↗
PubMed1997

Reliability of telemedicine examination.

OBJECTIVES: To assess the reliability of telemedicine examination and identify the issues to be addressed if the conduct of physical examination and the reading of images and tracings by telemedicine are to be as reliable as conventional examination and reading. METHODS: Patients were examined both conventionally and by telemedicine in 12 clinics, and the results were compared. There were 1826 matched pairs of observations. Cardiac auscultation, echocardiography, electrocardiography, electroencephalography, obstetric ultrasonography, ophthalmologic examination, physical therapy assessment, pulmonary auscultation, and the reading of chest radiographs with telemedicine cameras and monitors were studied. The main outcome measure was agreement between the telemedicine findings and a criterion standard. RESULTS: For ophthalmology, physical therapy, and cardiac auscultation, 91.2% of the conventional findings and 86.5% of the telemedicine findings were identical or similar to the criterion standard. The kappa coefficient on matched-pair analysis was 0.66. For pulmonary auscultation and reading of chest films with a telemedicine camera and monitor abnormalities were suppressed at default settings but subsequently revealed with extensive manipulation of system settings. For tracings and images, both conventional and telemedicine findings showed 92% reliability, with a kappa coefficient of 0.87. CONCLUSIONS: On the basis of these observations and the methods used, reliability varied with the type of examination, clinician experience with telemedicine, and participant knowledge of system limitations. Clinicians without experience or knowledge of system limitations missed findings of clinical importance. Improvements in equipment since the clinics were conducted in 1994 may have resolved some of these problems. Our findings raise doubts about the reliability of occasional telemedicine consultations by clinicians inexperienced in the technology.

Bias↗
PubMed1981

A comparison of the Sphygmetrics SR-2 Automatic Blood Pressure Recorder to the mercury sphygmomanometer in population studies.

The Sphygmetrics SR-2 Automatic Blood Pressure Recorder uses an infrasonic technique for detecting artery wall motion to estimate systemic arterial pressure and produces a permanent record of the results. It therefore is potentially useful in reducing observer bias in epidemiologic studies of blood pressure (BP). Two blood pressures were recorded in 21 men and 50 women using the SR-2 simultaneously with two auscultators using a biaural stethoscope and mercury syhgmomanometer. The SR-2 measured slightly higher systolic nd slightly lower diastolic pressures on average, but the differences were not significant. The two auscultators were highly correlated with one another (r = 0.99 systolic/0.97 diastolic) and with the SR-2 (0.93 and 0.92 for systolic, 0.84 and 0.85 for diastolic). The correlations were unrelated to sex, age, or antihypertensive medication status, but the correlations between th SR-2 and either auscultator for diastolic BP were quite low (0.36, 0.55) in subjects whose relative weight was below 1.0. Interpretation of the SR-2 disc was very reliable, with inter- and intra-reader correlations being 0.99 for systolic and 0.84 to 0.94 for diastolic. The SR-2 was found to be comparable to auscultation in estimating systolic BP in a heterogeneous population which has the advantages of reducing observer bias and producing a permanent record. Its use in estimating diastolic pressure in thin individuals and children needs further evaluation.

Adult↗
PubMed1976

The evaluation of continuous fetal heart rate monitoring in high-risk pregnancy.

Intrapartum electronic fetal heart rate monitoring of the high-risk obstetric patient is thought to improve the perinatal outcome. A prospective randomized study of 483 high-risk obstetric patients in labor was carried out comparing the effectiveness of electronic fetal monitoring with auscultation of fetal heart tones. The infant outcome was measured by neonatal death, Apgar scores, cord blood gases, and neonatal nursery morbidity. There were no differences in the infant outcomes in any measured category between the electronically monitored group and the auscultated group. The cesarean section rate was markedly increased in the monitored group (16.5 vs. 6.8 per cent in the auscultated patients). The presumptive benefits of electronic fetal monitoring for improving fetal outcome were not found in this study.

Apgar Score↗
PubMedDate not supplied

Austin Flint: on cardiac murmurs.

Austin Flint first ausculted the murmur associated with his name in 1859. Suspecting it to be of mitral origin, he identified it as occurring in aortic insufficiency three years later. Recent echocardiographic study has indicated that this murmur is produced by an aortic insufficiency jet colliding with the anterior mitral valve leaflet. Flint was among the first to recognize the importance of normal cardiac and respiratory sounds. He advocated routine auscultation on all patients, and had great influence in popularizing auscultation in American medicine.

Aortic Valve Insufficiency↗
PubMed2000

Prevalence and diagnostic value of precordial murmurs for valvular regurgitation in obese patients treated with dexfenfluramine.

Echocardiography is recommended for the detection of valvular regurgitation in asymptomatic users of anorexigens with a heart murmur. To determine the prevalence and diagnostic value of heart murmurs for valvular regurgitation, 223 patients receiving dexfenfluramine therapy for 6.9 months and 189 matched controls underwent history and cardiac auscultation by experienced noncardiologists unaware of echocardiography. Color Doppler echocardiograms were interpreted by 3 observers unaware of patients' clinical data. The frequency of at least mild regurgitation of any valve and abnormal regurgitation (moderate mitral or tricuspid or mild aortic regurgitation) were determined. Heart murmurs heard in 31 dexfenfluramine users (14%) and in 20 controls (11%) were all systolic and of grade I to II/VI intensity. Mild or worse regurgitation of any valve showed a trend in patients (18% vs 11.6% in controls, odds ratio [OR] 1.66, confidence interval [CI] 0.95 to 2.9, p = 0.08), but abnormal regurgitation (includes Food and Drug Administration grade regurgitation) was more common in patients (9% vs 3% in controls, OR 3.0, CI 1.18 to 7.65, p = 0.02). In dexfenfluramine users, heart murmurs were associated with at least mild or abnormal regurgitation (OR 3.1 and 3.05, 95% CI 1.34 to 7.13 and 1.1 to 8.67; p = 0.008 and 0.036, respectively), had a specificity of 89% and 88%, negative predictive value of 85% and 93%, but sensitivity of 37% and 30%, and positive predictive value of 35% and 19%, respectively. Most valves missed by cardiac auscultation had normal morphology and mild regurgitation. Finally, heart murmurs had better diagnostic value for either type of valvular regurgitation than heart murmurs and clinical variables or clinical variables alone. In summary, in dexfenfluramine users the prevalence of heart murmurs was low and their absence predicted absence of mild or worse regurgitation of any valve or abnormal valvular regurgitation. Therefore, cardiac auscultation should be the screening method of choice for detecting valvular regurgitation in users of anorexigens.

Case-Control Studies↗
PubMed2001

Cardiac auscultatory skills of physicians-in-training: a comparison of three English-speaking countries.

PURPOSE: Cardiac auscultation is suffering from a declining interest caused by competing diagnostic technology and, possibly, inadequate teaching and testing of physicians-in-training. Because access to technology, traditional teaching practices, and methods of trainees' assessment vary among different countries, we speculated that trainees' proficiency in auscultation might also vary. SUBJECTS AND METHODS: We tested the cardiac auscultatory skills of 314 internal medicine residents (189 from the United States, 89 from Canada, and 36 from England) from 14 programs. All participants were asked to listen by stethophones to 12 prerecorded cardiac events and to answer a multiple-choice questionnaire. They also completed a survey concerning attitudes toward cardiac auscultation and auscultatory teaching received during training. RESULTS: Mean (+/- SD) identification scores for the 12 cardiac events ranged from 0% to 58% for American trainees (mean 22% +/- 12%), 0% to 58% for Canadians (mean 26% +/- 13%), and 0% to 42% for British trainees (mean 20% +/- 12%). Canadians' cumulative scores were slightly but significantly greater than those of American (P = 0.02) and British house officers (P = 0.05). British house officers improved the most during the 3 years of training (P < 0.05). Canadian and British trainees had received more auscultatory teaching during medical school and residency; they had also used audiotapes more frequently (all P < 0.001). CONCLUSIONS: Auscultatory proficiency was poor in all three countries. Although there were slight differences among countries, the most striking finding was the consistent inaccuracy of all trainees. This suggests that variables other than teaching and testing affect proficiency.

Adult↗
PubMed1995

Measles pneumonitis.

STUDY OBJECTIVE: To investigate the finding of increased alveolar-arterial (A-a) gradient in adult patients with measles who have normal results on both pulmonary auscultation and chest radiography. DESIGN: Retrospective, descriptive case series. SETTING: An urban county teaching hospital in southern California. PARTICIPANTS: Consecutive adult patients with the clinical diagnosis of measles seen in the emergency department. METHODS: Patients were considered to have pneumonitis if they had any of the following: ED diagnosis of pneumonia; an A-a gradient of more than 30 mm Hg; one or more infiltrates on chest radiograph. RESULTS: Seventy-five patients, including 44 men and 31 women (median age, 25 years; 25% to 75% interquartile range [IQR], 20 to 28 years) were seen during the 36-month study period. Forty-three patients (57%; 95% confidence interval [CI], 45% to 69%) had pneumonitis, with a median A-a gradient of 42 mm Hg (IQR, 34 to 48 mm Hg). Twenty-seven of the 43 patients with pneumonitis (63%; CI, 48% to 77%) had both normal pulmonary auscultation findings and normal chest radiographs; this represented 36% of the study population (CI, 25% to 50%). Thirty-eight of the 43 patients with pneumonitis were admitted; one patient was later intubated after respiratory failure developed. Two of the 5 patients with pneumonitis who were sent home were admitted the following day for worsening symptoms. All 75 patients eventually did well. CONCLUSION: A significant percentage of adult patients with measles presenting to an ED with both normal pulmonary auscultation and normal chest radiographs have increased A-a gradients. These patients warrant close follow-up and perhaps hospital admission.

Adult↗
PubMed1996

Historical perspectives: forgotten past, unpredictable future.

Intrapartum surveillance has in recent years become a matter of debate. Following its earlier development, first in auscultation and then 40 years ago in electronic monitoring, obstetricians accepted its use with great, perhaps too great, enthusiasm. Years later, attempts to evaluate the actual consequences of this use led to disappointment: although its benefit on perinatal mortality is acknowledged, two observations lead one to reconsider the legitimacy of its use. First the apparent lack of beneficial influence on neonatal long-term morbidity, and second the definite increase in the rate of caesarean section. Furthermore, recent comparative studies, despite some discrepancies, seem to indicate that clinical monitoring by auscultation leads to results as good as those from electronical monitoring, particularly with respect to fetal mortality and infant morbidity. These observations obviously merit careful consideration; some explanations may be put forward to explain these apparently surprising results. From a practical point of view, this discussion leads to two opposite choices for obstetric policy: either to 'go back' to auscultation or to try to identify indicators more specific to fetal asphyxia and increased risk of cerebral palsy, leading to more precise and fewer indications for caesarean section. This chapter on historical perspectives may be useful in pointing out what were the goals of the obstetric pioneers involved in electronic monitoring: definitely not to build theoretical considerations on the pathophysiology of fetal distress, but to gather continuous information about the fetal heart rate in the hope of detecting changes announcing fetal asphyxia before it becomes irremediable, and hence preventing fetal death. These promises have been fulfilled. It follows that continuous clinical monitoring, which provides the same kind of information, is quite likely to lead to similar clinical results. It also follows that this relatively cumbersome method has really nothing to do with the 'classical' clinical surveillance in use before the widespread acceptance of electronical monitoring. It may be beneficial to experiment with this specific type of clinical surveillance; it would be dangerous, however, to 'go back' to the type of monitoring practised 40 years ago.

Auscultation↗
PubMed2003

Comparative evaluation of methods for ensuring the correct position of the tracheal tube in children undergoing open heart surgery.

The length of the trachea varies and is relatively short in children, it is therefore difficult to determine the correct depth of tracheal tube placement. In 85 children, the tube was placed using one of the following methods: (i) after deliberate endobronchial intubation, withdrawal to the carina was confirmed by auscultation, and the tube was then withdrawn a further 2 cm (auscultation group); (ii) as above, except that withdrawal to the carina was confirmed by a decrease in peak inspiratory pressure (pressure group); (iii) the tube was placed with a 3.0-cm mark at the vocal cords (mark group). The mean (SD) distance from the tip of the tube to the carina was 1.91 (0.81) cm in the auscultation group, and 1.93 (0.67) cm in the pressure group. These were not significantly different (p > 0.05) from targeted distance of 2 cm. In the mark group, the tube was located 2.30 (0.98) cm above the carina in children younger than 36 months and was further from the carina [6.16 (1.0) cm] in older children. In 20% of patients initially randomly allocated to the mark group, the mark could not be visualised. In conclusion, the methods described above effectively achieve adequate tracheal tube depth in children.

Aging↗
PubMed1999

Accuracy of strategies for monitoring fetal heart rate in labor.

We investigated whether the accuracy of auscultation could be improved with the use of a heart rate meter. Six fetal heart rate (FHR) traces were presented in a random sequence to 30 subjects using a customized computer program in each of three modalities: auscultation by counting alone, auscultation with the aid of an FHR meter, and visual assessment. The following characteristics were assessed: baseline rate, baseline variability, periodic change, and interpretation of the trace. For baseline rate, counting was associated with consistent underestimation of the FHR, which became more evident as the heart rate increased. The variation observed with each method was greatest with counting. For baseline variability, the proportion of correct responses using a meter was comparable to visual assessment, whereas counting was significantly less effective in 4 of 6 traces. For periodic change, the use of a meter was superior to counting in 4 of 6 traces, but both were inferior to visual assessment in 4 of 6 traces. In the interpretation of the trace, the use of a meter was again superior to counting, but both were inferior to visual assessment. Discrepancies were most marked in the least reassuring traces. Assessment of the FHR is significantly more accurate with the aid of a heart rate meter, and reduces interobserver variation.

Cardiotocography↗
PubMed1999

Crepitation and clicking as signs of TMD in preschool children.

Children [N = 540, age 5.1 +/- 0.72 (SD)], were tested for association between temporomandibular (TM) joint sounds and symptoms of TM disorder (TMD). The prevalence of TMJ sounds as found by auscultation and confirmed by self-report was 16.7%. There was significant association after Bonferroni correction between the presence of TM joint sounds, as reported by the children, and all but one of the eleven pain/dysfunction variables. There was significant association also between crepitation as heard at auscultation and palpation tenderness in the TMJ and masseter areas (p < 0.001), but not between clicking and any of the TMD variables. Agreement between subjects and examiners regarding the presence of TMJ sounds was poor (kappa = 0.097). The results indicate that joint sounds and TMD symptoms are common already in small children and thus demonstrate a possible early onset of TMD. Patients' own reports of TMJ sounds may have more clinical relevance than auscultation findings.

Age of Onset↗
PubMed2000

Positioning of a double-lumen endobronchial tube without the aid of any instruments: an implication for emergency management.

BACKGROUND: Lung isolation and preservation of normal lung are the first lines of therapy in life-threatening massive hemoptysis. If bleeding continues but the side of origin is uncertain, use of a double-lumen tube (DLT) is reasonable. Utilizing a blind method to locate the bronchial cuff of a left-sided DLT without using any instrument, a DLT (Broncho-Cath, Mallinckrodt Medical Ltd., Athlone, Ireland) was successfully positioned without delay in a patient with massive hemoptysis, where auscultation could be misleading or useless and fiberoptic bronchoscope (FOB) was inapplicable. This study was performed to discern whether this blind method could substitute for FOB verification or auscultation in most circumstances where these two methods are unavailable or inapplicable. METHODS: After receiving informed consent and hospital ethics board approval, 58 elective thoracic surgical patients, aged 17 to 67 years, were enrolled in the study and divided into two groups. A conventional method using an FOB was used to locate the left-sided DLT in 29 patients (group 1). In the other 29 patients (group 2), the blind manual method was used. The left-sided DLT was inserted until some resistance was felt, at which time the bronchial cuff was inflated with approximately 2.0 mL of air. While gently holding the pilot with thumb and index finger of the nondominant hand, the DLT was slowly withdrawn until an abrupt decrease of pilot pressure was sensed. At that moment, the bronchial cuff was deflated, and the DLT was advanced approximately 1.5 cm; using an FOB, its position was checked by an independent observer not involved in positioning the DLT. Success was defined as the point when the proximal margin of the carina was within the margin of safety for the DLT, which is defined as the difference between the length of the left main bronchus and the length of the tube between the proximal margin of the left bronchial cuff and the left lumen tip. Postoperative FOB was performed to evaluate bronchial injury. RESULTS: In 26 of 29 patients (group 2), the position of the DLT was bronchoscopically confirmed to be a success. The other three cases were deemed to be too shallow; specifically, the bronchial cuffs were slightly herniated onto the carina (acceptable position). This method was more traumatic than FOB-guided DLT intubation (conventional method) (p = 0.001); however, the most severe damage was erosion. CONCLUSION: This method, which requires no specific instrument and no time-consuming technique, can be taught easily and may be used in a situation where the rapidity of lung isolation or collapse is the key to saving life. We conclude that this blind method can be an alternative to the FOB and/or auscultation for the positioning of DLT in an emergency situation.

Adolescent↗
PubMed2005

Differences in oscillometric non-invasive blood pressure measurements recorded by different revisions of the Philips Component Monitoring System.

OBJECTIVE: To investigate whether a simulator can detect differences in oscillometric noninvasive blood pressure measurements in different revisions of the Philips Component Monitoring System. Philips revised the intraarterial-based algorithm with software revision C.0, and added an auscultation-based algorithm in revision C.1. METHODS: Three methods were adopted. Firstly, differences were assessed using the Dynatech Nevada CuffLink simulator. Five noninvasive blood pressure modules were tested on monitors with software revision C (software revision prior to C.0) and revision C.0. Monitor C.1 allows the selection of the original intraarterial algorithm (as for revision C), the improved intraarterial (revision C.0) or auscultation; two noninvasive blood pressure modules were tested on it.Secondly, pressures were recorded simultaneously from a participant's left and right arms by monitors C and C.0. The monitors were then swapped between arms and a second set of six pressures were recorded. The two sets were subtracted to calculate the differences between monitors, removing interarm differences. The experiment was carried out on two participants.Thirdly, pressures were recorded from three participants with a simultaneous reference auscultatory measurement. Six sets of simultaneous oscillometric and auscultatory determinations were recorded from monitors C and C.0. RESULTS AND CONCLUSIONS: All three methods revealed that the 'original' intraarterial-based algorithm in revision C recorded lower systolic, diastolic and mean arterial pressures than revision C.0, with the difference in diastolic pressure being the greatest. The difference in diastolic pressures between C and C.0 was up to 15 mmHg. The simulator evaluation finding of higher systolic and diastolic pressures recorded by the revised intraarterial algorithm (C.1 option 3) than by the auscultation-based algorithm (C.1 option 2) is in qualitative agreement with the regression equations of the clinical validation studies. The results suggest that simulators can identify the existence of differing algorithms used to measure blood pressure by the CMS monitor. Philips has continued to develop the algorithms used to determine the pressure by the oscillometric method. While significantly different pressures were recorded by the different revisions, it is interesting that each revision passed clinical validation studies.

Algorithms↗