Material utilizado en la capnografía Uno de los obstáculos a la utilización de CO 2 expirado control reside en la disparidad de los materiales utilizados por los médicos de emergencia. Para aclarar esta situación, es importante distinguir si el paciente está con ventilación artificial o la respiración espontánea. En cuanto al resto, las diferentes técnicas utilizadas para el análisis ya no tienen una implicación en los resultados clínicos y la eficiencia. Esta declaración se encuentra en el caso de la distinción tradicional entre lateral y la capnografía convencional. Estas dos técnicas de medida de CO 2 a través de las ondas de infrarrojos, el sistema lateral utiliza una bomba de aspiración para el transporte de CO 2 desde la boca hasta el detector situado en el monitor, mientras que las medidas del sistema convencional de CO 2 directamente en una pequeña cámara situada en la desembocadura de la paciente y se conecta al monitor mediante un cable. Tradicionalmente, el sistema lateral se utiliza para pacientes con respiración espontánea como el sistema es más ligero, y el sistema de corriente, un voluminoso poco, se conecta directamente al tubo endotraqueal en pacientes intubados. Los avances tecnológicos en los últimos años han fundamentalmente reducido las diferencias entre la corriente principal y los sistemas de flujo lateral. La nueva tecnología está dirigida hacia el sistema Microstream, que es una especie de &quot;sistema de lateral reforzada&quot; en las que el CO2 se desplaza por un tubo delgado que antes de llegar a la cámara donde se encuentra el detector, lo que permite un período de transición más pequeña entre la boca y la cámara de detección y por tanto, una curva de capnografía que es casi sincronizado con el paso del aire por la boca. Por lo tanto, vamos a echar un vistazo a lo que distingue a la elección del material, como se explica en la segunda mitad de la secuencia de vídeo: <ul><li> Si el médico desea monitorear a un paciente en ventilación espontánea con el fin de detectar precocely apnea (durante la sedación procesal, o después de la intoxicación médica), sólo la forma de la curva es esencial, el valor real de la ETCO 2 siendo de menor importancia. En este caso, el médico puede elegir entre la cánula nasal o una combinación de capnomask la administración de oxígeno y aspiración de CO 2, o una fina CO 2 tubo de aspiración que puede ser colocado bajo una máscara clásica. </li><li> Si el médico desea analizar con precisión ETCO 2 con el fin de adaptar los parámetros a un respirador, para comprobar la correcta colocación de un tubo endotraqueal, o para evaluar el pronóstico durante el paro cardiaco, se debe utilizar el material que se puede adaptar para su uso con un tubo endotraqueal (siempre se coloca detrás del filtro de manera que las secreciones del paciente de no bloquear el tubo). </li></ul> La curva de capnografía Una típica curva de capnografía durante tres vencimientos se da en la figura 1. La curva recupera el eje x (valor 0) en cada inspiración, ya que prácticamente no CO 2 en el aire inspirado. <img src="/files/ftp_upload/2508/2508fig1.jpg" alt="Figura 1" /> Figura 1: alternancia inspiración-espiración Las diferencias entre la PaCO 2 y ETCO 2 Sería eutópico a creer que el seguimiento no invasivo de CO expirado dos puede sustituir en todos los casos la necesidad de gases en sangre arterial (ABG) las medidas, que se considera el estándar de oro para la medición de la PaCO 2. Todo depende de las indicaciones para la medición de CO expirado 2 y la condición del paciente cardio-respiratorio. Si la indicación es el monitoreo de la actividad respiratoria para evitar la hipoventilación y apnea durante la sedación, un simple análisis de la curva es suficiente, cualquiera que sea el valor de ETCO 2. Por otro lado, si la indicación es para controlar la ventilación adecuada de un paciente de trauma en la cabeza, sin antecedentes de trastornos cardio-respiratorio, podemos esperar que el valor de ETCO 2 para estar cerca de la PaO 2 valor, a pesar de la necesidad de una precisa valor de la PaCO 2 impone al menos una muestra ABG, que también nos permite confirmar que, efectivamente, ETCO 2 se encuentra cerca de la PaCO 2 en el presente caso. Por último, si nos encontramos ante el caso de un paciente que está intubado y ventilado debido a la dificultad respiratoria, ETCO 2 valores, evidentemente, no ser una buena aproximación de la PaCO 2. La razón es simple, tan pronto como hay una alteración en la relación ventilación-perfusión, independientemente de lo que el presente desorden cardio-pulmonar, un obstáculo para la correcta eliminación de CO 2 por los pulmones se crea. Como resultado de ello, el CO 2 se acumula en la sangre, y naso-bucal eliminación se reduce, la creación de una PaCO 2 - ETCO 2 gradiente. En este caso, es fundamental conocer el valor de la PaCO 2, antes decualquier interpretación de la ETCO 2 de valor. La primera parte de la secuencia de vídeo se describe el procedimiento a seguir para la interpretación de la diferencia entre la PaCO 2 y ETCO 2. Vemos que la medida de la ETCO 2 se obtiene de inmediato y de manera no invasiva, pero en este momento no se puede permitir la adaptación de los parámetros del respirador. Esto implica tener que medir la PaCO 2 que se puede comparar con la ETCO 2. El valor de la PaCO 2 se mantiene el valor de referencia para la apreciación de la ventilación del paciente. <ul><li> Si la PaCO 2 medida es mayor que el valor deseado, por ejemplo 60 mm Hg en lugar de 40 mm Hg, esto significa que el paciente está hypoventilated. Parámetros del respirador puede ser adaptado, ya sea la frecuencia respiratoria o el volumen corriente se puede aumentar con el fin de aumentar la ventilación y así disminuir la PaCO 2. El objetivo consiste en reducir la ETCO 2 de 20 mmHg, a pesar de la inicial de ETCO 2 de valor. Por ejemplo, puede ser posible que el valor de ETCO 2 es 50 mmHg cuando la PaCO 2 se mide a 60 mm Hg, debido a la PaCO 2, ETCO 2 gradiente creado por la presencia de una enfermedad cardio-respiratorio. Cuando la adaptación de los parámetros del respirador permite la ETCO 2 a caer de 50 mmHg a 30 mmHg, con seguridad se puede suponer que el paciente está adecuadamente ventilado, con un valor de PaCO 2 descendió de 60 mm Hg a 40 mm Hg. </li><li> Inversamente, si la PaCO 2 es menor que el valor objetivo, el paciente está hiperventilado y en consecuencia la tasa respiratoria y volumen corriente debe ser reducido a alcanzar el valor objetivo. Si la PaCO 2 es de 20 mmHg por debajo del valor objetivo, hay que aumentar la ETCO 2 de 20 mmHg mediante la modificación de los parámetros del respirador. </li></ul> Artefactos y trampas en capnografía. Si la tecnología para la medición de CO 2 se ha convertido en fiable en términos de precisión, reproducibilidad tiempo de respuesta y calidad de la curva, todavía presenta, como para cualquier parámetro de control, con ciertas limitaciones: <ul><li> La primera limitación se debe a la falta de conocimiento correcto sobre la fisiopatología de CO 2 por el médico, quien se niega a utilizar la técnica. Esperamos que esta explicación y las secuencias de vídeo que lo acompaña le ayudará a resolver esta limitación. </li><li> En el caso de que el paciente respira espontáneamente, la adjunción de oxigenoterapia a través de la máscara, se diluirá el vencimiento de CO 2, lo cual permitirá modificar el capnograma y la ETCO 2 caerá. La secuencia de vídeo se muestra este fenómeno. </li><li> Si se quiere controlar de hipoventilación, o un evento de apnea, durante la sedación procesal, esperamos ETCO 2, en correlación con la PaCO 2, para aumentar de forma paralela a la hipoventilación del paciente. Paradójicamente, un evento de hipoventilación en un paciente respirando espontáneamente se traduce en una disminución de ETCO 2, debido a que el paciente es sólo respirar con un volumen corriente muy pequeña, que básicamente se corresponde con el volumen muerto del espacio traqueo-Bronchal, y como sabe, este espacio no participa en el intercambio gaseoso y por lo tanto contiene muy poco CO 2. </li><li> Durante la ventilación mecánica, el peligro es que se olvida que el ETCO 2 no refleja necesariamente la PaCO 2 (véase el capítulo anterior). </li></ul>

<ol>
	<li>Gravenstein, J. S., Jaffe, M. B., Paulus, D. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Capnography, Clinical aspects. , (2004).</li><li>Kupnik, D., Skok, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Capnometry+in+the+prehospital+setting:+are+we+using+its+potential.">Capnometry in the prehospital setting: are we using its potential.</a> Emerg Med J. 24, 614-617 (2007).</li><li>Delorio, N. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Continuous+end-tidal+carbon+dioxide+monitoring+for+confirmation+of+endotracheal+tube+placement+is+neither+widely+available+nor+consistently+applied+by+emergency+physicians.">Continuous end-tidal carbon dioxide monitoring for confirmation of endotracheal tube placement is neither widely available nor consistently applied by emergency physicians.</a> Emerg Med J. 22, 490-493 (2005).</li><li>Burton, J. H., Harrah, J. D., Germann, C. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Does+end-tidal+carbon+dioxide+monitoring+detect+respiratory+events+prior+to+current+sedation+monitoring+practices?.">Does end-tidal carbon dioxide monitoring detect respiratory events prior to current sedation monitoring practices?.</a> Acad Emerg Med. 13, 500-504 (2006).</li><li>Fletcher, R., Jonson, B., Cumming, G., Brew, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+concept+of+deadspace+with+special+reference+to+the+single+breath+test+for+carbon+dioxide.">The concept of deadspace with special reference to the single breath test for carbon dioxide.</a> Br J Anaesth. 53, 77-78 (1981).</li></ol>

Importancia de CO 2 para el organismo Antes de explorar expirado CO 2 de vigilancia, es esencial para poner en perspectiva el papel general desempeñado por el CO2 en el cuerpo humano. Produce a un ritmo de aproximadamente 200 ml por minuto, el CO 2 no es sólo un desperdicio de subproductos del metabolismo celular. Si nuestros quimiorreceptores medulares tienen la función de mantener la presión parcial del CO2 arterial (PaCO 2) en 40 mm Hg, es por...

expired co2 measurement in intubated or spontaneously breathing patients from the emergency department

El dióxido de carbono (CO 2) junto con el oxígeno (O 2) comparten el papel de ser los gases más importantes en el cuerpo humano. La medición de CO 2 expirado en la boca ha solicitado un creciente interés entre los médicos clínicos en el departamento de emergencia para varias indicaciones: (1) la vigilancia et seguimiento de la paciente intubado, (2) la verificación de la correcta colocación de un tubo endotraqueal, (3 ) el seguimiento de un paciente en paro cardíaco; (4) lograr normocapnia en los pacientes intubados traumatismo craneal, (5) la ventilación de monitoreo durante la sedación procesal. El video permite a los médicos se familiaricen con el uso de la capnografía y el texto ofrece una revisión de la teoría y los directores involucrados. En particular, la importancia de CO 2 para el organismo, la importancia de la medición de CO 2 expirado, las diferencias entre las arterias y que expiró el CO 2, el material utilizado en la capnografía con sus artefactos y trampas, será revisado. Dado que la resistencia principal en el uso de CO 2 expirado medida se debe a la falta de conocimiento correcto sobre la fisiopatología de CO 2 por parte del médico, esperamos que esta explicación y las secuencias de vídeo que lo acompaña le ayudará a resolver esta limitación.

Watch this Scientific Journal Video about Expired CO2 Measurement in Intubated or Spontaneously Breathing Patients from the Emergency Department at JoVE.com

Expired CO2 Measurement in Intubated or Spontaneously Breathing Patients from the Emergency Department

Este vídeo se describe cómo realizar CO<sub&gt; 2</sub&gt; Medición en pacientes intubados y con respiración espontánea. Las indicaciones clínicas principales se refieren a situaciones de emergencia: (1) verificar la posición adecuada del tubo endotraqueal, (2) lograr normocapnia en los pacientes de trauma, (3) control de ventilación en el caso de los procedimientos de sedación.

CO expirado 2 Medición en pacientes intubados o con respiración espontánea del Servicio de Urgencias

Carbon dioxide (CO2) along with oxygen (O2) share the role of being the most important gases in the human body. The measuring of expired CO2 at the mouth ...

expired-co2-measurement-intubated-or-spontaneously-breathing-patients

Research

JoVE Journal

Medicine

Expired CO2 Measurement in Intubated or Spontaneously Breathing Patients from the Emergency Department

16.1K vistas.  Universit Catholique de Louvain Cliniques Universitaires Saint-Luc. Este vídeo se describe cómo realizar CO 2 Medición en pacientes intubados y con respiración espontánea. Las indicaciones clínicas principales se refieren a situaciones de emergencia: (1) verificar la posición adecuada del tubo endotraqueal, (2) lograr normocapnia en los pacientes de trauma, (3) control de ventilación en el caso de los procedimientos de sedación.

Video: Expired CO2 Measurement in Intubated or Spontaneously Breathing Patients from the Emergency Department

Scleral Cross-linking Using Riboflavin and Ultraviolet-A Radiation for Prevention of Axial Myopia in a Rabbit Model

Myopic individuals, especially those with severe myopia, are at higher-than-normal risk of cataract, glaucoma, retinal detachment and chorioretinal abnormalities. In addition, pathological myopia is a common irreversible cause of visual impairment and blindness1-3. Our study demonstrates the effect of scleral crosslinking using riboflavin and ultraviolet-A radiation on the development of axial myopia in a rabbit model. The axial length of the eyeball was measured by A-scan ultrasound in New Zealand white rabbits aged 13 days (male and female). The eye then underwent 360&#176; conjunctival peritomy with scleral crosslinking, followed by tarsorrhaphy. Axial elongation was induced in 13 day-old New Zealand rabbits by suturing their right eye eyelids (tarsorrhaphy). The eyes were divided into quadrants, and every quadrant had two scleral irradiation zones, each with an area of 0.2 cm&#178; and a radius of 4 mm. Crosslinking was performed by dropping 0.1% dextran-free riboflavin-5-phosphate onto the irradiation zones 20 sec before ultraviolet-A irradiation and every 20 sec during the 200 sec irradiation time. UVA radiation (370 nm) was applied perpendicular to the sclera at 57 mW/cm&#178; (total UVA light dose, 57 J/cm&#178;). Tarsorrhaphies were removed on day 55, followed by repeated axial length measurements. This study demonstrates that scleral crosslinking with riboflavin and ultraviolet-A radiation effectively prevents occlusion-induced axial elongation in a rabbit model.

We demonstrate the effect of scleral crosslinking with riboflavin and UVA on an axial elongation rabbit eye. Axial elongation was induced in 13 day-old New Zealand rabbits (male and female) by suturing their right eye eyelids (tarsorrhaphy).

Escleral Entrecruzamiento El uso de riboflavina y Ultravioleta-A de la radiación para la Prevención de la miopía axial en un modelo de conejo

Myopic individuals, especially those with severe myopia, are at higher-than-normal risk of cataract, glaucoma, retinal detachment and chorioretinal ...

Investigación

Medicina

A Novel Approach for the Administration of Medications and Fluids in Emergency Scenarios and Settings

The available routes of administration commonly used for medications and fluids in the acute care setting are generally limited to oral, intravenous, or intraosseous routes, but in many patients, particularly in the emergency or critical care settings, these routes are often unavailable or time-consuming to access. A novel device is now available that offers an easy route for administration of medications or fluids via rectal mucosal absorption (also referred to as proctoclysis in the case of fluid administration and subsequent absorption). Although originally intended for the palliative care market, the utility of this device in the emergency setting has recently been described. Specifically, reports of patients being treated for dehydration, alcohol withdrawal, vomiting, fever, myocardial infarction, hyperthyroidism, and cardiac arrest have shown success with administration of a wide variety of medications or fluids (including water, aspirin, lorazepam, ondansetron, acetaminophen, methimazole, and buspirone). Device placement is straightforward, and based on the observation of expected effects from the medication administrations, absorption is rapid. The rapidity of absorption kinetics are further demonstrated in a recent report of the measurement of phenobarbital pharmacokinetics. We describe here the placement and use of this device, and demonstrate methods of pharmacokinetic measurements of medications administered by this method.

This study presents a novel device that offers an easy route to quickly provide medications and fluids in patients with limited or difficult IV access. This small-diameter device is placed in the distal third of the rectum, allowing for ongoing medication and fluids administration.

Un nuevo enfoque para la administración de medicamentos y líquidos en situaciones de emergencia y ajustes

The available routes of administration commonly used for medications and fluids in the acute care setting are generally limited to oral, intravenous, or ...

Setting Up a Stroke Team Algorithm and Conducting Simulation-based Training in the Emergency Department - A Practical Guide

Time is of the essence when caring for an acute stroke patient. The ultimate goal is to restore blood flow to the ischemic brain. This can be&#160;achieved by either&#160;thrombolysis with recombinant tissue-plasminogen activator (rt-PA), the standard therapy for stroke patients who present within the first hours of symptom onset without contraindications, or by an endovascular approach, if a proximal brain vessel occlusion is detected. As the efficacy of both therapies declines over time, every minute saved along the way will improve the patient&#39;s outcome.
This critical situation requires thorough work and precise communication with the patient, the family and colleagues from different professions to acquire all relevant information and reach the right decision while carefully monitoring the patient. This is a high fidelity situation. In nonmedical high-fidelity environments such as aviation, Crew Resource Management (CRM) is used to enhance safety and team efficiency.
This guide shows how a Stroke Team algorithm, which is transferable to other hospital settings, was established and how regular simulation-based trainings were performed. It requires determination and endurance to maintain these time-consuming simulation trainings on a regular basis over the course of time. However, the resulting improvement of team spirit and excellent door-to-needle times will benefit both the patients and the work environment in any hospital.
A dedicated Stroke Team of 7 persons who are notified 24/7 by a collective call via speed dial and run a binding algorithm that takes approximately 20 min, was established. To train everybody involved in this algorithm, a simulation-based team training for all new Stroke Team members was conceived and conducted at monthly intervals. This led to a relevant and sustained reduction of the mean door-to-needle time to 25 min, and enhanced the feeling of stroke readiness especially in junior doctors and nurses.

Every min counts in acute stroke care. This guide shows how to establish a Stroke Team algorithm and enhance its performance with regular simulation training. The principles of Crew Resource Management (CRM) facilitate a straight workflow, reduce door-to-needle times and increase staff satisfaction.

Configuración de un equipo de carrera Algoritmo y que imparta una formación basada en la simulación en el Departamento de Emergencia - Una Guía Práctica

Time is of the essence when caring for an acute stroke patient. The ultimate goal is to restore blood flow to the ischemic brain. This can ...

Emergency Undocking in Robotic Surgery: A Simulation Curriculum

The following is a training platform to allow robotic surgeons to develop the skills necessary to lead an interprofessional team in emergency undocking of a robotic system. In traditional robotic training for surgeons, a brief web based overview of performing an emergency undocking is provided during initial introductory training to the robotics system. During such a process, there is no training in delineation of interdisciplinary roles for operating room (OR) personnel. The training presented here uses formative simulation and debriefing followed by a lecture. For the simulation, a modified gynecologic simulator is draped in a steep trendelenburg position consistent with most gynecologic laparoscopic surgery. The training torso is modified using tubing hooked to pressure bags of red food colored IV fluid used to simulate a catastrophic vessel injury on demand. Positioned throughout the operating room setting is an interprofessional team consisting of embedded standardized persons (ESPs) to fulfill the roles of a circulating nurse, scrub nurse, anesthesiologist, and bedside assist surgeon. Robotic surgeons are presented a case scenario necessitating emergency undocking, and given control of the robotic instruments. The scenario is terminated following either successful completion of an emergency undock, or at five minutes due to the emergent nature of the case. A debriefing session with hands on training of the steps to emergency undocking, necessary equipment, troubleshooting techniques, and operating room personnel roles follows the simulation. The learners are presented with a short lecture reemphasizing the material presented in the debriefing for their own self-study. This training results in improved time accessing the patient, improved knowledge, confidence, and completion of critical actions, and can be replicated in most institutions. All robotic surgeons should be able to demonstrate competence in this crucial intervention. A limitation of the curriculum is ability to access the in-situ environment for training purposes.

This training platform is designed to allow robotic surgeons to develop the skills necessary to lead an interprofessional team in emergency undocking of the robotic system. Training includes the utilization of the technology and equipment to perform an emergency undocking, as well as delineation of roles for such a scenario.

Desacoplamiento de emergencia en cirugía robótica: un plan de estudios de simulación

The following is a training platform to allow robotic surgeons to develop the skills necessary to lead an interprofessional team in emergency undocking of ...

Setup and Execution Of the Blindfolded Code Training Exercise

Miscommunication is the most common cause of preventable patient harm in medicine. Currently, there is limited knowledge of innovative techniques to improve resident physician communication and leadership strategies in high-acuity situations. The blindfolded code training exercise removes visual stimuli from the team leader, forcing the team leader to effectively utilize closed-loop communication. The simple act of blindfolding the team leader creates a learning environment where the leader must utilize a conceptual framework and critical thinking strategies to organize the team and manage the resuscitation. An advantage to this teaching technique is that it does not require any special simulation equipment, making it a low-cost approach. The blindfolded code training exercise can be applied to the management of any critically ill patient where the primary objective is to focus on developing communication skills in acute resuscitations. The purpose of the description of the blindfolded code training exercise is to provide guidance on how to perform this innovative teaching technique to force effective closed-loop communication.

The blindfolded code training exercise, which blindfolds the team leader in a code resuscitation simulation, is an advanced teaching technique to improve closed-loop communication, organizational skills, and critical thinking.&#160;

Configuración y ejecución del ejercicio de entrenamiento de código con los ojos vendados

Miscommunication is the most common cause of preventable patient harm in medicine. Currently, there is limited knowledge of innovative techniques to ...

CO2-Lasertonsillotomy Under Local Anesthesia in Adults

Tonsil-related complaints are very common among the adult population. Tonsillectomy under general anesthesia is currently the most performed surgical treatment in adults for such complaints. Unfortunately, tonsillectomy is an invasive treatment associated with a high complication rate and a long recovery time. Complications and a long recovery time are mostly related to removing the vascular and densely innervated capsule of the tonsils. Recently, CO2-lasertonsillotomy under local anesthesia has been demonstrated to be a viable alternative treatment for tonsil-related disease with a significantly shorter and less painful recovery period. The milder side-effect profile of CO2-lasertonsillotomy is likely related to leaving the tonsil capsule intact. The aim of the current report is to present a concise protocol detailing the execution of CO2-lasertonsillotomy under local anesthesia. This intervention has been performed successfully in our hospital in more than 1,000 patients and has been found to be safe and to be associated with a steep learning curve.

CO2-Lasertonsillotomy Under Local Anesthesia in Adults

CO2-lasertonsillotomy under local anesthesia is an interesting alternative treatment method for tonsillectomy under general anesthesia for tonsil-related complaints in adults. This report presents a step-by-step protocol detailing the execution of CO2-lasertonsillotomy under local anesthesia.

CO2-Lasertonsillotomía bajo anestesia local en adultos

Tonsil-related complaints are very common among the adult population. Tonsillectomy under general anesthesia is currently the most performed surgical ...

Cooling or Warming the Esophagus to Reduce Esophageal Injury During Left Atrial Ablation in the Treatment of Atrial Fibrillation

Ablation of the left atrium using either radiofrequency (RF) or cryothermal energy is an effective treatment for atrial fibrillation (AF) and is the most frequent type of cardiac ablation procedure performed. Although generally safe, collateral injury to surrounding structures, particularly the esophagus, remains a concern. Cooling or warming the esophagus to counteract the heat from RF ablation, or the cold from cryoablation, is a method that is used to reduce thermal esophageal injury, and there are increasing data to support this approach. This protocol describes the use of a commercially available esophageal temperature management device to cool or warm the esophagus to reduce esophageal injury during left atrial ablation. The temperature management device is powered by standard water-blanket heat exchangers, and is shaped like a standard orogastric tube placed for gastric suctioning and decompression. Water circulates through the device in a closed-loop circuit, transferring heat across the silicone walls of the device, through the esophageal wall. Placement of the device is analogous to the placement of a typical orogastric tube, and temperature is adjusted via the external heat-exchanger console.

The goal of this protocol is to describe the use of esophageal temperature modulation to counteract esophageal thermal injury from left atrial ablation for the treatment of atrial fibrillation.

Enfriar o calentar el esófago para reducir la lesión esofágica durante la ablación auricular izquierda en el tratamiento de la fibrilación auricular

Ablation of the left atrium using either radiofrequency (RF) or cryothermal energy is an effective treatment for atrial fibrillation (AF) and is the most ...

Measurement of Tissue Oxygenation Using Near-Infrared Spectroscopy in Patients Undergoing Hemodialysis

Near-infrared spectroscopy (NIRS) has recently been applied as a tool to measure regional oxygen saturation (rSO2), a marker of tissue oxygenation, in clinical settings including cardiovascular and brain surgery, neonatal monitoring and prehospital medicine. The NIRS monitoring devices are real-time and noninvasive, and have mainly been used for evaluating cerebral oxygenation in critically ill patients during an operation or intensive care. Thus far, the use of NIRS monitoring in patients with chronic kidney disease (CKD) including hemodialysis (HD) has been limited; therefore, we investigated rSO2 values in some organs during HD. We monitored rSO2 values using a NIRS device transmitting near-infrared light at 2 wavelengths of attachment. The HD patients were placed in a supine position, with rSO2 measurement sensors attached to the foreheads, the right hypochondrium and the lower legs to evaluate rSO2 in the brain, liver and lower leg muscles, respectively. NIRS monitoring could be a new approach to clarify changes in organ oxygenation during HD or factors affecting tissue oxygenation in CKD patients. This article describes a protocol to measure tissue oxygenation represented by rSO2 as applied in HD patients.

We present a protocol to measure regional oxygen saturation (rSO2) in hemodialysis (HD) patients by using a near-infrared spectroscopy monitor. The rSO2 value is an index of tissue oxygenation. This noninvasive and real-time monitoring could be useful for confirming changes in organ oxygenation during HD.

Medición de la oxigenación tisular mediante espectroscopia de infrarrojo cercano en pacientes sometidos a hemodiálisis

Near-infrared spectroscopy (NIRS) has recently been applied as a tool to measure regional oxygen saturation (rSO2), a marker of tissue oxygenation, in ...

A Novel Inhalation Mask System to Deliver High Concentrations of Nitric Oxide Gas in Spontaneously Breathing Subjects

Nitric Oxide (NO) is administered as gas for inhalation to induce selective pulmonary vasodilation. It is a safe therapy, with few potential risks even if administered at high concentration. Inhaled NO gas is routinely used to increase systemic oxygenation in different disease conditions. The administration of high concentrations of NO also exerts a virucidal effect in vitro. Owing to its favorable pharmacodynamic and safety profiles, the familiarity in its use by critical care providers, and the potential for a direct virucidal effect, NO is clinically used in patients with coronavirus disease-2019 (COVID-19). Nevertheless, no device is currently available to easily administer inhaled NO at concentrations higher than 80 parts per million (ppm) at various inspired oxygen fractions, without the need for dedicated, heavy, and costly equipment. The development of a reliable, safe, inexpensive, lightweight, and ventilator-free solution is crucial, particularly for the early treatment of non-intubated patients outside of the intensive care unit (ICU) and in a limited-resource scenario. To overcome such a barrier, a simple system for the non-invasive NO gas administration up to 250 ppm was developed using standard consumables and a scavenging chamber. The method has been proven safe and reliable in delivering a specified NO concentration while limiting nitrogen dioxide levels. This paper aims to provide clinicians and researchers with the necessary information on how to assemble or adapt such a system for research purposes or clinical use in COVID-19 or other diseases in which NO administration might be beneficial.

This simple and highly adaptable system device for the inhalation of high-concentration nitric oxide (NO) gas does not require mechanical ventilators, positive pressure, or high gas flows. Standard medical consumables and a snug-fitting mask are used to safely deliver NO gas to spontaneously breathing subjects.

Un nuevo sistema de máscara de inhalación para administrar altas concentraciones de gas de óxido nítrico en sujetos que respiran espontáneamente

Nitric Oxide (NO) is administered as gas for inhalation to induce selective pulmonary vasodilation. It is a safe therapy, with few potential risks even if ...

Predicción del pronóstico en la insuficiencia cardíaca aguda mediante el ángulo de fase y las puntuaciones Z BIVA

Clinical Application of Phase Angle and BIVA Z-Score Analyses in Patients Admitted to an Emergency Department with Acute Heart Failure

Acute heart failure is characterized by neurohormonal activation, which leads to sodium and water retention and causes alterations in body composition, such as increased body fluid congestion or systemic congestion. This condition is one of the most common reasons for hospital admission and has been associated with poor outcomes. The phase angle indirectly measures intracellular status, cellular integrity, vitality, and the distribution of spaces between intracellular and extracellular body water. This parameter has been found to be a predictor of health status and an indicator of survival and other clinical outcomes. In addition, phase angle values of &lt;4.8&#176; upon admission were associated with higher mortality in patients with acute heart failure. However, low phase angle values may be due to alterations-such as the shifting of fluids from an intracellular body water (ICW) compartment to an ECW (extracellular body water) compartment and a concurrent decrease in body-cell mass (which can reflect malnutrition)-that are present in heart failure. Thus, a low phase angle may be due to overhydration and/or malnutrition. BIVA provides additional information about the body-cell mass and congestion status with a graphical vector (R-Xc graph). In addition, a BIVA Z-score analysis (the number of standard deviations from the mean value of the reference group) that has the same pattern as that of the ellipses for the percentiles on the original R-Xc graph can be used to detect changes in soft-tissue mass or tissue hydration and can help researchers compare changes in different study populations. This protocol explains how to obtain and interpret phase angle values and BIVA Z-score analyses, their clinical applicability, and their usefulness as a predictive marker for the prognosis of a 90-day event in patients admitted to an emergency department with acute heart failure.

Autor destacado: Revelando indicadores pronósticos en insuficiencia cardíaca: el papel del análisis de ángulo de fase e impedancia bioeléctrica 

In this protocol, we explain how to obtain and interpret phase angle values and bioelectrical impedance vectorial analysis (BIVA) Z-score obtained by bioelectrical impedance in patients with acute heart failure admitted to the Emergency Department and their clinical applicability as a predictive marker for the prognosis of a 90-day event.

Aplicación clínica de los análisis de ángulo de fase y puntuación Z BIVA en pacientes ingresados en un servicio de urgencias con insuficiencia cardíaca aguda

Acute heart failure is characterized by neurohormonal activation, which leads to sodium and water retention and causes alterations in body composition, ...