Objective Dehiscence or leakage following bowel anastomoses is associated with high morbidity and mortality. Perfusion and local tissue oxygenation (StO2), independent of systemic oxygen saturation, are fundamental determinates of anastomotic viability. As current technology is limited for monitoring local StO2 at bowel anastomoses, we aimed to construct a wireless pulse oximeter (WiPOX) to monitor real-time intraoperative tissue oxygenation, permitting identification of compromised anastomotic perfusion. Methods We have: (a) designed a handheld device capable of real-time monitoring of serosal and mucosal StO2 through endoscopic ports with wireless data transmission to standard intraoperative monitors, (b) constructed the WiPOX using materials meeting FDA regulations for intraoperative use and re-use, (c) performed accuracy testing in humans by comparing the WiPOX to standard pulse oximeters, and (d) tested WiPOX efficacy for detecting early tissue hypoxia in stomach, intestines, and kidneys in anesthetized rats and swine. Results In humans, WiPOX demonstrated accuracy within 3% when compared to commercially available pulse oximeters. Application of the WiPOX in rats and swine demonstrated normal serosal and mucosal StO2 and pulse rates in healthy small bowel and stomach. Within 30 seconds of compromised perfusion, the WiPOX detected bowel hypoxia over a wide range of oxygen saturation (p<0.005). A greater degree of hypoxia was detected in mucosal versus serosal measurements during early ischemia, despite normal appearance of tissue. The onboard sensor-processor unit permitted non-invasive pulse oximetry and integration with current intraoperative monitoring. The contact pressure-sensing head allowed for consistent, high quality StO2 waveform readouts despite the presence of body fluids. Conclusions We have constructed, validated, and successfully tested a novel wireless pulse oximeter capable of detecting intraoperative tissue hypoxia in open or endoscopic surgery. This device will aid surgeons in detecting anastomotic vascular compromise and facilitate choosing an ideal site for bowel anastomosis by targeting well-perfused tissue with optimal healing capacity.
JUSTIFICATIVA E OBJETIVOS: O desmame da ventilação mecânica é o processo de transição da ventilação mecânica para a espontânea. A prática atual do desmame mostra que o empirismo é insuficiente e inadequado. Em contrapartida, as padronizações de desmame proporcionam melhor condução no processo. O objetivo deste estudo foi avaliar os efeitos da aplicação de um protocolo de desmame da ventilação mecânica em uma unidade de terapia intensiva.
RESUMO JUSTIFICATIVA E OBJETIVOS:A posição em decúbi-to ventral (posição prona) aplicada em pacientes com síndrome do desconforto respiratório agudo (SDRA), tem demonstrado melhora da oxigenação em mais de 70% dos casos. Uma vez que essa posição promove uma série de alterações pulmonares, inclusive na mecânica pulmonar, abre-se a hipótese da necessidade de otimizar os parâmetros ventilatórios após a instalação deste novo decúbito, principalmente do valor da pressão positiva expiratória final (PEEP). O objetivo deste estudo foi avaliar a influência da posição prona no cálculo da PEEP ideal, titulada pela melhor complacência pulmonar e comparar as alterações pulmonares de mecânica, de oxigenação e de ventilação nas posições supina e prona.
Objectives: This study attempted to identify which is the more effective suction system. The objective was to compare open versus closed suction systems according to a systematic review. Methods: A search of scientific literature was conducted in MedLine, LILACS and Cochrane between 1997 and August 2007 using the key words: endotracheal suction and closed suction. Included were articles that compared the open and closed suction systems used in adult humans and that were randomized and controlled trials. Results: From the 78 articles identified, only 15 were accepted and described in this review. Nine compared incidence of ventilator-associated pneumonia, six compared oxygen saturation, four compared blood pressure and heart rate, three compared pulmonary volumes, two compared secretion removal and four compared costs. No difference was found in these variables compared: incidence of ventilator associated pneumonia, mortality, intensive care unit length of stay, duration of mechanical ventilation, PaCO2, PaO 2 , mean blood pressure, heart rate and secretion removal. However, there were always SpO 2 and pulmonary volume decreases when using the open suction system; and costs were lower in most of the studies that used the closed suction system. Conclusions: Closed suction system seems to increase the risk of colonization, but has the advantage of not reducing the pulmonary volumes and not entailing a drop of saturation, especially in patients with severe respiratory failure and in the use of higher levels of positive end expiratory pressure.
RESUMO JUSTIFICATIVA E OBJETIVOS:A ventilação mecâni-ca não-invasiva (VMNI) tem sido utilizada rotineiramente como método para auxiliar o desmame da ventilação mecânica. Uma das aplicações mais comuns é a sua utilização em pacientes que evoluem com quadro de insuficiência respiratória aguda (IRpA) após a extubação traqueal, embora as evidências científicas para esta indicação ainda sejam controversas. Os objetivos deste estudo foram identificar o número de pacientes que evoluem para IRpA após a extubação, avaliar a eficácia da VMNI para reverter este quadro e promover IRpA após a extubação foi um recurso seguro e eficaz para evitar a re-intubação. Unitermos: desmame, insuficiência respiratória aguda após a extubação, ventilação mecânica não-invasiva SUMMARY BACKGROUND AND OBJECTIVES: Noninvasive positive pressure ventilation (NPPV) has been routinely used to assist the weaning of the mechanical ventilation. One of the applications most common is in patients who had acute respiratory failure after extuba-
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.