Observational study of perioperative P tc co2 and S p o2 in non-ventilated patients receiving epidural infusion or patient-controlled analgesia using a single earlobe monitor (TOSCA) †

Kopka, A.; Wallace, Emma; Reilly, Gavin; Binning, A.

doi:10.1093/bja/aem206

Cited by 46 publications

(29 citation statements)

References 14 publications

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“…For example, while an abnormal Sp,O 2 reflects, on the whole, inoptimal ventilation, it does not determine the underlying mechanism [11,12]. Moreover, even a ''normal'' Sp,O 2 does not rule out the possibility of nocturnal hypoventilation, particularly if the patient is receiving supplemental oxygen [12][13][14]. Consequently, more specific monitoring is necessary.…”

Section: Discussionmentioning

confidence: 99%

Evaluating noninvasive ventilation using a monitoring system coupled to a ventilator: a bench-to-bedside study

Rabec¹,

Georges²,

Kabeya³

et al. 2009

European Respiratory Journal

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Empirically determined noninvasive ventilation (NIV) settings may not achieve optimal ventilatory support. Some ventilators include monitoring modules to assess ventilatory quality. We conducted a bench-to-bedside study to assess the ventilatory quality of the VPAP TM IIIResLink TM (ResMed, North Ryde, Australia).We tested the accuracy of minute ventilation (MV) and leak calculations given by VPAP TM IIIResLink TM compared to those measured by a bench model at varied leak levels and ventilator settings. We systematically assessed NIV efficacy using this system from 2003 to 2006. Ventilation was considered inadequate if leak (.24 L?min -1 ), continuous desaturation (.30% of the trace) or desaturation dips (.3%) were present. On the bench test, both methods were highly correlated (r50.947, p.0.0001 and r50.959, p,0.0001 for leak and MV, respectively). We performed 222 assessments in 169 patients (aged 66.42¡16 yrs, 100 males). Abnormalities were detected on 147 (66%) out of 222 occasions. Leak was the most common abnormality (34.2%) followed by desaturation dips (23.8%). The most effective therapeutic solutions were a chin strap if leak was detected (61.2%) and expiratory positive airway pressure increase for desaturation dips (59.5%). In 15.7% of cases, when abnormalities persisted, a polygraphy was performed.The systematic use of this device enables NIV to be optimised, limiting the indication of sleep studies to complex cases. KEYWORDS: Bench testing, bi-level positive airway pressure, clinical evaluation, monitoring, noninvasive ventilation, respiratory failure N oninvasive ventilation (NIV) has been demonstrated to be effective treatment in respiratory failure. In some cases, however, the clinical results may be less than expected, despite using the correct technique. When NIV is initiated, the ventilator settings are determined empirically based on clinical evaluation of underlying disease, patient tolerance when awake, and diurnal blood gas variations [1]. However, NIV is predominantly applied at night [2], when profound ventilatory changes may occur, particularly in patients with respiratory failure [3]. Such changes include modifications of ventilatory control, upper airway patency and respiratory muscle recruitment. Consequently, modulating NIV settings during the day and underestimating these physiological differences may lead to suboptimal patientventilator interaction that reduces NIV efficacy.Moreover, NIV uses a non-hermetic technique, which poses the possible risk of leak. Leakage may be absent or minimal when the patient is awake and may worsen during sleep as a result of the loss of voluntary control and decreased muscle tone. Thus, NIV settings chosen empirically on daytime evaluation may not predict optimal nocturnal ventilatory support. Consequently, NIV effectiveness may be more correctly assessed by sleep studies than through daytime assessment [1]. Ideally this requires complete polysomnography (PSG) or ventilatory polygraphy (PG) at the time of initiation to NIV. However, it is n...

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Section: Discussionmentioning

confidence: 99%

Evaluating noninvasive ventilation using a monitoring system coupled to a ventilator: a bench-to-bedside study

Rabec¹,

Georges²,

Kabeya³

et al. 2009

European Respiratory Journal

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“…Cases of respiratory depression related to the use of basal infusions with PCA use have been reported [8][9][10][11]. The risk of respiratory depression was studied by analyzing which background infusion rates were associated with the greatest risk.…”

Section: Introductionmentioning

confidence: 99%

Morphine and its metabolites after patient-controlled analgesia: considerations for respiratory depression

Sam¹,

Mackey²,

Lötsch³

et al. 2011

Journal of Clinical Anesthesia

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“…Oxygen is also used routinely in the absence of any robust evidence in routine surgery, post-operative care and indeed has been found to mask hypoventilation caused by respiratory depression in sedated patients [42]. On-going clinical trials continue to seek to establish the efficacy of oxygen on mortality, surgical site infections, nausea and atelectasis with varying results [43][44][45].…”

Section: Other Areas Of Usementioning

confidence: 99%

To Give or Not To Give - Is that the Question?: The Changing Face of Emergency Oxygen Therapy

Kelly¹,

Lynes

2015

Int J Crit Care Emerg Med

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Observational study of perioperative P tc co2 and S p o2 in non-ventilated patients receiving epidural infusion or patient-controlled analgesia using a single earlobe monitor (TOSCA) †

Cited by 46 publications

References 14 publications

Evaluating noninvasive ventilation using a monitoring system coupled to a ventilator: a bench-to-bedside study

Evaluating noninvasive ventilation using a monitoring system coupled to a ventilator: a bench-to-bedside study

Morphine and its metabolites after patient-controlled analgesia: considerations for respiratory depression

To Give or Not To Give - Is that the Question?: The Changing Face of Emergency Oxygen Therapy

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