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PubMed1999

[Determination of the numbers of monitoring medical institutions necessary for estimating incidence rates in the surveillance of infectious diseases in Japan].

Our purpose was to determine the number of monitoring stations (medical institutions) necessary for estimating incidence rates in the surveillance system of infectious diseases in Japan. Infectious diseases were selected by the type of monitoring stations: 15 diseases in pediatrics stations, influenza in influenza stations, 3 diseases in ophthalmology stations and 5 diseases in the stations of sexually transmitted diseases (STD). For each type of monitoring station, 5 cases of the number of monitoring stations in each health center, including the number determined from presently established standards and the actual number in 1997, were given. It was assumed that monitoring stations were randomly selected among medical institutions in health centers. For each infectious disease, each case and each type of monitoring station, standard error rates of estimated numbers of incidence cases in the whole country were calculated in 1993-1997 using the data of the surveillance of infectious diseases. Among 5 cases of monitoring stations, the case satisfied the condition that those standard error rates were lower than the critical values, was selected. The critical values were 5% in pediatrics and influenza stations, and 10% in ophthalmology and STD stations. The numbers of monitoring stations in the selected cases were 3,000 in pediatrics stations, 5,000 in influenza stations (including all pediatrics stations), 605 in ophthalmology stations and 900 in STD stations.

Child↗
PubMed2004

[Vascular access surveillance with blood flow monitoring: a prospective study with 65 patients].

BACKGROUND: Periodic intra-access blood flow rate (QA) monitoring is the preferred method for vascular access (VA) surveillance (NKF-K/DOQI, update 2000). OBJECTIVES: 1) To determine the ultrafiltration (UF) method accuracy for early detection of VA stenosis. 2) To evaluate the hemodynamic effect of elective VA intervention (angioplasty or surgery). 3) To define the impact of periodic QA monitoring using the UF method combined by elective VA intervention on VA thrombosis. PATIENTS AND METHODS: We prospectively monitored QA during hemodialysis (HD) in 65 ESRD (mean age 64.9 +/- 11.4 years, 20% diabetes) patients over 1 year period. All patients undergoing HD in the Hospital de Mollet by arteriovenous fistula (89.2%) or graft 10.8%. QA was measured at least every 4 months by the UF method using the Crit Line III Monitor. Fifty (77%) patients were included at the beginning of the study period and the remaining 15 (23%) were added later when they started HD. All patients with absolute QA <700 ml/min or decreased >20% from baseline met criteria of positive evaluation (PE) and were referred for angiography (AG) plus subsequent preventive intervention (angioplasty or surgery) if VA stenosis >50%. We also studied 94 not QA monitored patients since the beginning of the study period (mean age 64.6 +/- 13.7 years; 12.8% diabetes) that undergoing HD simultaneous in the Institut Nefrològic Granollers. RESULTS: We performed 200 QA measurements in 509 months of follow-up. The overall mean QA was 1176.7 +/- 491.8 ml/min (range, 380.5-2904.0 ml/min). Three patients (4.6%) thrombosed VA. Nineteen (29.2%) patients had PE; none of them clotted VA. The AG was performed in 84.2% (16/19) patients with PE and all of them (16/16) showed VA stenosis > or =50%; 31.2% (5/16) were lost to follow-up (3 death, 2 transplantation); of the remaining explored patients (11/16), 72.7% (8/11) underwent intervention (3 angioplasty, 5 surgery). The mean QA increased from 577.2 +/- 108.2 ml/min to 878.1 +/- 264.4 ml/min postintervention (p=0.005). The positive predictive value, negative predictive value, sensitivity and specificity of UF method for VA stenosis were 84.2%, 93.5%, 84.2% and 93.5%, respectively. VA thrombosis rate in our 50 beginners QA monitored patients (mean age 64.5 +/- 1 1.4 years; 20% diabetes) was lower (2/50, 4%) compared to 94 not QA monitored patients (16/94, 17%) (p=0.024). CONCLUSIONS: 1) QA monitoring using the UF method allows an early diagnosis of VA stenosis. 2) Serial QA measurement by UF method can be used in assessing the functional response to corrective VA intervention. 3) Periodic VA surveillance by QA measurements using the UF method combined with elective intervention results in reduced VA thrombosis.

Adult↗
PubMedDate not supplied

Process and product monitoring of recombinant DNA-derived biopharmaceuticals with high-performance capillary electrophoresis.

High-performance capillary electrophoresis (HPCE) has emerged over the past 20 years as a powerful multidimensional separation tool that is orthogonal to HPLC and comparable to sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) slab gel methods. HPCE is most frequently applied in the QC release testing of recombinant DNA-derived protein and monoclonal antibody (MAb) biopharmaceuticals. HPCE is a rugged and robust separation tool that can be used like HPLC to monitor the purification process, as well as to analyze bulk drug and drug substances. Examples of the practical applications of the predominant free-solution capillary electrophoresis (FSCE) and capillary gel electrophoresis (CGE) formats of HPCE, applied for process monitoring and product monitoring of recombinant protein and MAb biotherapeutics, are presented. HPCE has been applied in FSCE mode to monitor the purification of the rDNA-derived protein, recombinant human interleukin-4 (rhIL4). FSCE is demonstrated to be a robust method that can be used to monitor multiple column chromatographic purification processes, such as immobiilized metal-ion affinity chromatography (IMAC), ion exchange chromatography (IEC), and size exclusion chromatography (SEC) columns. The FSCE data are used to pool fractions to carry forward for further purification. The FSCE method is compared to the corresponding RP-HPLC method for rhIL4. HPCE has been applied in the CGE mode to monitor the purification of an rDNA-derived IgG4 MAb. CGE is demonstrated to be a convenient and rapid method to profile the purification process, compare purification processes, and provide a fingerprint of the MAb bulk drug that is useful for determining purity and lot-to-lot consistency. The practical advantages and limitations of CGE for process monitoring and product monitoring of MAbs are presented. The CGE method is compared to the high-performance SEC separation of the MAb under nondenaturing (HP-SEC) and denaturing (HP-DSEC) conditions and to SDS-PAGE gels for the analysis and characterization of MAb bulk drugs.

Antibodies, Monoclonal↗
PubMed2005

Monitor height affects surgeons' stress level and performance on minimally invasive surgery tasks.

This study investigated the effect of monitor height on surgeons' workload and performance during simulated minimally invasive surgery (MIS). Fourteen volunteer subjects (7 experienced, 7 inexperienced) performed a cutting task in a training box at a standard MIS station with the video monitor positioned in random order at, below (-35 degrees), and above (+15 degrees) the subject's eye level. Task time and error, difficulty and discomfort, head orientation, trapezius and neck muscle activity, and skin conductance were recorded. The experienced subjects performed the task faster, with less error, and with less difficulty than did the inexperienced subjects. For the experienced subjects, error decreased when the monitor was lowered. Difficulty and discomfort increased at the high monitor position. As the monitor was lowered, the head pitched forward, and paraspinal cervical muscle activity increased. Variability in sternocleidomastoid activity increased both at the low and high monitor positions. The results show that monitor height affects both performance and workload. The monitor should be lowered to reduce error and task difficulty but not so low as to produce excessive neck flexion.

Adult↗
PubMed1992

Development of self-monitoring behavior from early to late adolescence.

The purpose of this study was to examine the development of self-monitoring behavior during adolescence. Due to limitations of the widely used Revised Self-Monitoring Scale (Lennox & Wolfe, 1984), the construct of self-monitoring has not been successfully examined in individuals younger than college age. For the purpose of expanding our knowledge regarding the developmental aspects of self-monitoring, the Adolescent Self-Monitoring Scale (ASMS) was developed, administered to young (junior high) adolescents, and found to be internally consistent and highly correlated with the Revised Self-Monitoring Scale. Factor analysis identified two subscales: (1) Ability to Modify Self-Presentation and (2) Sensitivity to Expressive Behavior of Others. An examination of 490 adolescents from 12 to 18 years of age provided support for the hypothesis that self-monitoring behavior does increase from early to late adolescence. ANOVAs produced a significant difference by age in overall self-monitoring behavior and in sensitivity to the expressive behavior of others. No age differences in the ability to modify self-presentation were found. The development of behavioral measures is suggested to determine more accurately the developmental aspects of the ability to modify self-presentation.

Adolescent↗
PubMed1985

Adolescent self-monitoring.

Self-monitoring attributes of 239 adolescents were studied from the viewpoint of providing psychologists and educators with insight into impression management both as a facilitator of youths' development, especially with regard to identity formation, and as a possible detriment due to its overuse in a defensive posture. Adolescents highly adept at self-monitoring displayed social competencies most related to interpersonal adequacy, poise and ascendance; however, medium levels of self-monitoring were associated most with interpersonal values, maturity, and responsibility. It is suggested that high self-monitors may sacrifice concern for others in the interest of self-serving attitudes. Adolescents low in self-esteem are likely to use self-monitoring techniques as a defense against inadequate feelings. Generally, self-monitoring attributes were related mainly to social, rather than intellectual characteristics. In contrast to past research, the use of moderate self-monitoring levels along with sex and self-esteem as variables, provided a means of examining some variation in the adaptive uses of self-monitoring not heretofore observed.

Achievement↗
PubMed1993

An evaluation of the carcinoembryonic antigen (CEA) test for monitoring patients with resected colon cancer.

OBJECTIVE: To determine the effectiveness of carcinoembryonic antigen (CEA) monitoring in detecting surgically curable recurrence of colon cancer. DESIGN: Clinical data were collected from a national surgical adjuvant trial in which CEA monitoring was elective. SETTING: Cancer centers, universities, and community clinics. PATIENTS: A total of 1216 patients with resected colon cancer, 1017 (84%) of whom had CEA monitoring. MAIN OUTCOME MEASURES: Sensitivity and specificity of CEA testing for cancer recurrence and CEA-motivated diagnostic and surgical interventions and their end results. RESULTS: Among 417 monitored patients with recurrence, 59% had a preceding elevation of CEA concentration. Sixteen percent of 600 patients without recurrence showed a false-positive test result. Carcinoembryonic antigen testing was most sensitive for hepatic or retroperitoneal metastasis and relatively insensitive for local, pulmonary, or peritoneal involvement. Surgical explorations were performed in 115 patients with CEA elevations, and 47 recurrences, usually hepatic, were resected with curative intent. On the other hand, 38 patients with normal CEA concentrations and 23 patients not monitored also underwent such resections--usually for pulmonary or local recurrence. Of all CEA-monitored patients, 2.3% are alive and disease free more than 1 year after salvage surgery (2.9% of those with CEA elevations and 1.9% of those with no elevations). Of patients with no CEA monitoring, 2.0% are also alive and disease free more than 1 year after salvage surgery. CONCLUSIONS: Cancer cures attributable to CEA monitoring are, at best, infrequent. It is questionable whether this small gain justifies the substantial cost in dollars and physical and emotional stress that this intervention may cause for patients.

Biomarkers, Tumor↗
PubMedDate not supplied

U.S. Food and Drug Administration monitoring of pesticide residues in infant foods and adult foods eaten by infants/children.

The U.S. Food and Drug Administration uses 3 approaches to monitor pesticide residues in foods: regulatory monitoring, incidence/level monitoring, and the Total Diet Study. The results of monitoring infant foods and adult foods that may be eaten by infants/children under these 3 approaches are presented. Under regulatory monitoring, which is performed to enforce tolerances set by the U.S. Environmental Protection Agency (EPA), during fiscal years 1985-1991, over 10,000 such domestic and imported food samples were collected and analyzed, and under the Total Diet Study, in which pesticide residue intakes are estimated in foods prepared for consumption, the food items in 27 market baskets were analyzed. Under incidence/level monitoring, which is complementary to regulatory monitoring, over 4000 analyses were performed on infant foods and adult foods eaten by children. Fewer than 50 of the 10,000 regulatory samples had violative residues; nearly all of those were residues for which there was no tolerance for the particular commodity/pesticide combination. Under incidence/level monitoring and the Total Diet Study, the levels of pesticide residues found in infant foods and adult foods eaten by children were well below tolerances set by EPA.

Child↗
PubMed1997

Accuracy of detection of clinically important dysrhythmias with and without a dedicated monitor watcher.

BACKGROUND: Although dedicated monitor watchers are used in many progressive care units with telemetry monitors, this costly practice has not been evaluated. OBJECTIVE: To compare the accuracy of detection of clinically important dysrhythmias with and without a dedicated monitor watcher. METHODS: On a 26-bed cardiac progressive care unit, documentation of four categories of dysrhythmias during a 7-week period when a monitor watcher was present was compared with that during a 7-week period when no monitor watcher was present. The Hewlett-Packard CareVue Clinical Event Review, a full-disclosure system, was used as the gold standard. RESULTS: Accuracy of detection of nonsustained ventricular tachycardia, supraventricular tachycardia, and pauses was significantly better with a monitor watcher than without. Although the detection of life-threatening rhythms was correct a higher percentage of the time with a monitor watcher, the difference was not significant. CONCLUSIONS: The efficiency and quality of patient care can be enhanced by using a dedicated monitor watcher. The results of this study raise the question of whether improved accuracy of detection of dysrhythmias results in better outcomes for patients.

Arrhythmias, Cardiac↗
PubMed1996

[Problems and limits in noninvasive oxygen monitoring].

Recently, professional anaesthesiologists organizations, have set up recommendations for intraoperative monitoring. These recommendations are based upon the assumption that anaesthesia-related deaths are largely preventable and that extensive monitoring will reduce mortality. Hypoxaemia appears to be an important pathophysiological mechanism, and this is why oxygen monitoring is given a high priority in safety standards in anaesthesia. However, no reduction in mortality has been definitively shown to follow the use of any monitoring device in randomized, controlled trials. Four techniques of oxygen monitoring are discussed and evaluated. Oxygen monitoring during inspiration can be recommended, although its implementation will probably prevent only a few anaesthesia-related deaths. Pulse oximetry is certainly highly recommended, but also has some deficiencies which are not sufficiently well known considering the popularity of this technique. Transcutaneous PO2 is considered mainly for historical reasons. Near infrared spectrometry is a new technique offering noninvasive and continuous monitoring of intracerebral oxygenation.

Anesthesiology↗
PubMed1996

Blood pressure evaluation by noninvasive and traditional methods. Consistencies and discrepancies among photoplethysmomanometry, office sphygmomanometry, and ambulatory monitoring. Effects of blood pressure measurement.

Three hundred eight outpatients referred for hypertension were studied. A continuous beat-to-beat noninvasive recording (Finapres) of blood pressure evaluated the blood pressure increase (9 mm Hg systolic and 4 mm Hg diastolic) induced by office sphygmomanometry. Thereafter, patients underwent a 24-h ambulatory blood pressure monitoring. The evaluation against Finapres showed that office sphygmomanometry overestimates the systolic blood pressure by 3 +/- 36 mm Hg (mean +/- 2 SD) and the diastolic blood pressure by 15 +/- 25 mm Hg (mean +/- 2 SD). Blood pressure monitoring showed similar discrepancies. On the basis of both monitoring (normalcy defined from a population of 550 normotensive subjects) and office sphygmomanometry, patients were considered normotensive, hypertensive (either untreated or under active drug treatment), white coat hypertensive (monitoring below the 95th percentile and sphygmomanometry more than 140/90 mm Hg, either untreated or under active drug treatment), and reverse white coat patients (monitoring over the 95th percentile and sphygmomanometry less than 140/90 mm Hg). Patients showed different levels of alert reaction (the highest in white coat hypertensive and the lowest in reverse white coat hypertensive patients), and a similar increase in blood pressure induced by conventional sphygmomanometry. During initial readings of ambulatory monitoring, blood pressure decreased from the first reading to the third reading. This decrease is related to the increase of blood pressure under sphygmomanometry. Caution should be paid in interpreting results of sphygmomanometry (error level in the single patient as high as +/- 40 mm Hg), and interpreting and averaging results of the first hour of blood pressure monitoring (variably affected by the alert reaction to the clinical environment).

Adolescent↗
PubMed1987

Retinopathy of prematurity. A randomized, prospective trial of transcutaneous oxygen monitoring.

To determine whether the use of continuous transcutaneous oxygen monitoring (tcPO2) could reduce the incidence of retinopathy of prematurity (ROP) in pre-term infants receiving oxygen therapy, a randomized, prospective trial of constant monitoring using the transcutaneous oxygen monitor versus intermittent monitoring of oxygen was performed on a population of premature infants at very high risk for the development of ROP. Two hundred ninety-six infants were randomly assigned to either a constantly monitored (CM) or standard care (SC) group. CM infants had tcPO2 monitored continuously as long as they required supplemental oxygen, whereas SC infants had tcPO2 monitored only during the more acute state of their illness. Management of both groups was otherwise identical. One hundred one of 148 infants in the CM group and 113 of 148 in the SC group survived. The overall incidence of ROP was 51% in the CM group and 59% in the SC group (no significant difference). In infants over 1000 g birthweight, as the weight increased there was increasing risk of developing ROP in the SC group. The odds ratio for the ROPsc:ROPcm reached 7.6 in infants between 1200 and 1300 g in infants with Apgar scores greater than or equal to 8 at 5 minutes. The incidence of cicatricial ROP was similar in both groups: four in the CM and five in the SC group.

Blood Gas Monitoring, Transcutaneous↗
PubMed2001

Reliability of ambulatory blood pressure monitoring.

OBJECTIVE: To focus on the reliability of ambulatory blood pressure monitoring and on its limitations in clinical practice, and to construct adequate strategies to improve ambulatory monitoring performance. METHODS: The literature was reviewed, and personal data were used. DISCUSSION: Since the beginning of non-invasive ambulatory blood pressure monitoring, it appeared that some subjects had a high proportion of outlying readings that were unlikely to be accurate. Although ambulatory blood pressure is more reproducible than clinic blood pressure, large day-to-day differences have also been reported in reproducibility studies for average 24 h blood pressure. It has been shown that, for day-to-day 24 h blood pressure differences greater than 4/3 mmHg, ambulatory blood pressure is poorly predictive of the degree of target organ damage. The variability of average 24 h blood pressure may arise from several causes, including true biological variability, a lack of standardization of activities and measurement errors. Artefactual readings can easily occur if patients are not properly instructed. Although editing procedures can eliminate outliers, it is often impossible to identify inaccurate readings included within the patient's trend. To optimize ambulatory blood pressure monitoring, health-care providers should be instructed adequately on how to perform this technique. Appropriate patient selection, a proper application of instrumentation and the checking of its performance, careful instructions to patients, the immediate evaluation of the patient's diary and 24 h tracing after completion of the recording should improve the results of ambulatory monitoring. CONCLUSIONS: A checklist of criteria that should be used for optimizing ambulatory monitoring in clinical practice should be proposed by the Consensus Conference on ambulatory blood pressure monitoring. To improve doctors' proficiency, strategies including educational protocols and training programmes should be implemented.

Blood Pressure Monitoring, Ambulatory↗
PubMed2002

Self-monitored blood pressure: a role in clinical practice?

Electronic self-monitoring of blood pressure is increasing in popularity and most international guidelines on the management of hypertension approve cautious use of the technique in the assessment of potentially hypertensive individuals. A recent editorial in the Archives of Internal Medicine suggested that it was "appropriate to encourage the widespread use of self recorded BP as an important adjunct to the clinical care of the patient with hypertension". Such a statement is based on increasing evidence that self-monitoring of blood pressure gives similar information to daytime ambulatory blood pressure -- a now well-established technology in the management of hypertension. Suggested strategies for the use of self-monitoring of blood pressure include monitoring in individuals whose clinical risk status is low enough that they need not necessarily be given medical therapy simply on the basis of a clinic pressure (i.e. at a 10 year risk of cardiovascular disease below 20%). The threshold for defining 'normotension/hypertension' is now regarded as being broadly similar for ABPM and SBPM and is set at 135/85 mmHg. In a recent meta-analysis of all available studies the average difference between these techniques, using the same patients, is -1.7/1.2 mmHg. There is some evidence that careful use of self-monitoring may improve blood pressure control in patients who are otherwise resistant to care. Self-monitoring of blood pressure has now been shown in at least one major prospective study to predict outcome better than clinic pressures and in that setting it now has equivalence to the use of ABPM. There remain issues regarding the availability of validated devices, the quality of training of patients in their use and the possibility that inaccurate recording might occur, either deliberately or by accident. Self-monitoring of blood pressure may well not give the same readings as carefully measured blood pressure by research nurses but its use is clearly superior to routine clinical practice. The technique is ripe for widespread application.

Blood Pressure↗
PubMed2005

Convenience of ambulatory blood pressure monitoring: comparison of different devices.

OBJECTIVE: Twenty-four-hour ambulatory blood pressure monitoring has emerged as an important tool supporting physicians in the diagnosis and management of arterial hypertension. Compared with office measurements and self-measurements, however, ambulatory blood pressure monitoring shows the lowest patients' acceptance. The present study compares the convenience of different monitors in order to examine whether the patients benefit from new technologies. METHODS: In a prospective randomized study, we compared the side effects of the Spacelabs 90207 with the I.E.M. Mobilograph monitor in 250 patients by means of a questionnaire that covered the following aspects: restriction in everyday activities, noise, sleep disturbance, pain and mobility. Complaints were measured by a five-point scale ranging from 'no complaints at all' to 'severe complaints'. RESULTS: In all, 205 patients returned completed surveys (101 patients of the I.E.M. group, 104 patients of the Spacelabs group), yielding an 82% final response rate. The overall mean complaint score was significantly higher in the Spacelabs group than in the I.E.M group (2.24 vs. 1.78; P<0.001). The Mobilograph revealed less discomfort in every single question and differences were significant for restrictions in everyday activities, noise, pain, disturbance of the patient's or the patient's partner's sleep and restrictions in walking. Sleep disturbance was the aspect with the highest difference in the two groups. CONCLUSION: The present work confirms that ambulatory blood pressure monitoring monitors are cumbersome to wear. Devices, however, differ in their comfort. Monitors with an improved convenience might lead to a higher patients' acceptance of this powerful diagnostic tool.

Activities of Daily Living↗
PubMed2006

Monitoring of vital signs during dental care.

Advances in medicine have greatly increased the survival of patients with severe health problems and have significantly prolonged life in elderly individuals with systemic disorders. Concomitant advances in dentistry and evolving societal expectations regarding dental health and function have likewise ensured that these patients are increasingly retaining their teeth and/or seeking dental care. The administration of local anaesthetics and the performance of extensive dental procedures may cause stress and systemic disturbances in such patients. In order to avoid potentially serious reactions, dentists are obligated to monitor continuously their medically challenged patients. Monitoring provides three important benefits. First, it helps the dentist detect acute medical emergencies that may require an immediate response. Second, monitoring may reveal gradual deleterious trends that can often be easily reversed before a true emergency occurs. Third, monitoring can assist the dentist in evaluating the efficacy of any emergency treatments or preventive measures that are rendered. The purposes of this article are to: briefly review monitoring techniques and devices, discuss their suitability for use in the dental office, and provide some tips for their application during dental care. In overall decreasing order of routine importance, monitoring resources include the following: responsible personnel, non-invasive blood pressure monitor, pulse oximeter, ECG, and the pretracheal stethoscope or capnograph.

Blood Pressure↗
PubMed1999

Comparison of two home blood pressure monitors with a mercury sphygmomanometer in an ambulatory population.

We performed a randomized, single-visit, crossover study to compare the precision of a digital monitor and an aneroid monitor relative to a desktop mercury sphygmomanometer (DMS). Three blood pressure measurements per patient, one per device, were taken over 25 minutes. Of 99 patients, 95 had complete blood pressure data. Systolic blood pressures measured with the digital monitor were significantly different from those with the DMS (p<0.01). Thirty-four percent of systolic and 48% of diastolic pressures measured with the digital monitor were within +/- 5 mm Hg of the DMS. The aneroid monitor performed significantly better than the digital monitor, with 54% of systolic (p<0.01) and 58% of diastolic blood pressures within +/- 5 mm Hg of the DMS standard. Health care providers are encouraged to supervise patients' initial use of a home blood pressure monitor and calibrate readings against a standard mercury sphygmomanometer.

Adult↗
PubMed1992

[Development of a method of continuous monitoring of spontaneous respiration in the postoperative phase. 1. Normal values for cutaneous pO2- and pCO2-partial pressure together with pulse oximetry determined oxygen saturation in healthy young volunteers].

METHODS: Twenty-eight healthy volunteers of both sexes (14 male, 14 female, age 31 +/- 7 years, weight 70 +/- 12 kg) breathing room air were monitored for cutaneous partial pressures of oxygen and carbon dioxide (pctO2, pctCO2) and partial oxygen saturation (psO2) as determined by pulse oximetry. Data triplets were collected and stored by a personal computer at 30-s intervals during a 4-h resting period to establish a confidence range for the devices in use (TCM 3 with a combination electrode E 5270, and Pulse Oximeter, Radiometer). This data range was intended to be used in later noninvasive, continuous respiratory studies with postoperative patients. Means, standard deviations, and ranges were calculated for individual data and data pooled from 15-min intervals. Data distribution over time was calculated for 30-min intervals. RESULTS: Contrary to the saturation data delivered by pulse oximetry, the pctO2 and pctCO2 readings needed about 15 min to stabilize. The mean +/- SD of a total of 12,600 pctO2 measurements (77.2 +/- 10.9 mmHg) could not simply be compared with arterial normal values, whereas the pctCO2 measurements (39.9 +/- 3.6 mmHg) fit well with arterial data from the literature. Interestingly, pctCO2 values in unmedicated healthy adults were not uniformly distributed, suggesting individual differences in either skin permeability of central regulation of respiration. Additionally, the pctO2 readings were characterized by serious inter-subject variability, which confirms earlier studies that pctO2 is not suitable for routine monitoring procedures in adults, the mean +/- SD of a total of 4500 psO2 measurements was 94.9 +/- 1.6%. A statistically significant correlation was found between pctO2 and psO2 (r = 0.358). Cutaneous carbon dioxide readings of greater than 50 mmHg were observed in only 0.06% of all 12,600 data sets (maximum 51.3 mmHg; 28 volunteers), desaturations (less than 90%) in only 0.24% of all 4,500 saturation measurements (minimum 86%; 10 volunteers). DISCUSSION AND CONCLUSION: Monitoring of spontaneous respiration in the recovery room is regarded as essential to prevent serious complications resulting from surgery and anesthesia. This has become particularly true with newer analgesic techniques like spinal opiates or patient-controlled analgesia. Since minor degrees of opiate-induced respiratory depression are easily influenced by external stimulation, it is mandatory that any monitoring of spontaneous respiration must be nonstimulant, and prefereably noninvasive. The present communication is the first of a series of investigations to develop of monitoring technique for postoperative patients. Because normal values for the parameters studied are either lacking or dependent on the monitoring devices in use, the present paper defined the respective data ranges. It is concluded that pulse oximetry and pctCO2 measurement are both useful and sensitive for continuous, non-invasive respiratory monitoring in adults, whereas pctO2 measurements are of lesser value. Results in volunteers treated with opiates and postoperative patients under patient-controlled analgesia using the above mentioned equipment will be reported in following publications.

Adult↗