Il materiale usato in Capnografia Uno degli ostacoli per l&#39;utilizzo di CO 2 è scaduto il monitoraggio risiede nella diversità del materiale usato dai medici d&#39;emergenza. Per chiarire questa situazione, è importante distinguere se il paziente è ventilato artificialmente o respirare spontaneamente. Per il resto, le diverse tecniche utilizzate per l&#39;analisi non hanno più una implicazione sui risultati clinici e l&#39;efficienza. Questa dichiarazione si trova nel caso della tradizionale distinzione tra sidestream e capnografia mainstream. Queste due tecniche di misura di CO 2 mediante onde infrarosse, il sistema sidestream utilizza una pompa di aspirazione per il trasporto di CO 2 dalla bocca al rivelatore situato nel monitor, mentre le misure sistema tradizionale di CO 2 direttamente in una piccola stanza situata alla foce del paziente e collegato al monitor tramite un cavo. Tradizionalmente, il sistema sidestream viene utilizzato per i pazienti respirare spontaneamente in quanto il sistema è più leggero, e il sistema tradizionale, un po &#39;ingombrante, è collegato direttamente al tubo endotracheale nei pazienti intubati. I progressi tecnologici degli ultimi anni hanno radicalmente ridotto le differenze tra i sistemi mainstream e sidestream. La nuova tecnologia è puntato verso il sistema Microstream, che è una sorta di &#39;sistema sidestream migliorato&#39; in cui CO2 viaggia lungo un sottile tubo, prima di raggiungere la camera dove si trova il rivelatore, permettendo un periodo di transizione più piccola tra la foce e la camera di rilevamento e in tal modo una curva capnografia che è quasi sincronizzato con il passaggio di aria alla bocca. Quindi, diamo uno sguardo a ciò che distingue la scelta del materiale, come spiegato nella seconda metà della sequenza video: <ul><li> Se il medico vuole monitorare un paziente in ventilazione spontanea in modo da rilevare precocely apnea (durante la sedazione procedurale, o dopo l&#39;intossicazione medico), poi solo la forma della curva è essenziale, il valore effettivo di ETCO 2 essendo di minore importanza. In questo caso, medico può scegliere tra cannula nasale o una combinazione di capnomask somministrazione di ossigeno e CO 2 l&#39;aspirazione, o un sottile tubo di aspirazione CO 2 che può essere collocato sotto una maschera classica. </li><li> Se il medico vuole analizzare proprio ETCO 2 al fine di adattare i parametri di un respiratore, per verificare il corretto posizionamento di un tubo endotracheale, o per valutare la prognosi durante l&#39;arresto cardiaco, deve utilizzare il materiale che può essere adattato per l&#39;uso con un tubo endotracheale (sempre posto dietro il filtro in modo da secrezioni del paziente non bloccare il tubo). </li></ul> La Curva Capnografia Una curva capnografia tipico nel corso di tre scadenze è dato in Figura 1. La curva riacquista l&#39;asse x (valore 0) ad ogni ispirazione, come non esiste praticamente alcuna CO 2 in aria ispirata. <img src="/files/ftp_upload/2508/2508fig1.jpg" alt="Figura 1" /> Figura 1: in alternanza inspirazione-espirazione Differenze tra PaCO 2 e ETCO 2 Sarebbe eutopico a credere che non invasivo di monitoraggio delle emissioni di CO 2 scaduto può sostituire in tutte le circostanze la necessità di gas del sangue arterioso (ABG) misure, considerato il gold standard per la misurazione della PaCO 2. Tutto dipende le indicazioni per la misurazione di CO 2 e scaduto il paziente cardio-respiratorio condizione. Se l&#39;indicazione è il monitoraggio dell&#39;attività respiratoria per prevenire ipoventilazione e l&#39;apnea durante sedazione, una semplice analisi della curva è sufficiente, qualunque sia il valore di ETCO 2. D&#39;altra parte, se l&#39;indicazione è di monitorare l&#39;adeguata ventilazione del paziente con trauma cranico senza storia di malattie cardio-respiratorie, possiamo aspettarci che la ETCO 2 valore da vicino al valore di PaO 2, anche se la necessità di una precisa PaCO 2 Valore impone almeno un campione ABG, che ci permette anche di confermare che effettivamente ETCO 2 è vicino alla PaCO 2 nel caso di specie. Infine, se ci troviamo di fronte il caso di un paziente che viene intubato e ventilato a causa di distress respiratorio, ETCO 2 valori che evidentemente non è una buona approssimazione di PaCO 2. La ragione è semplice: non appena vi è un disturbo della ventilazione-perfusione rapporti, indipendentemente da quello cardio-polmonare attuale disordine è un ostacolo alla corretta eliminazione di CO 2 dai polmoni viene creato. Di conseguenza, la CO 2 si accumula nel sangue, e naso-buccale eliminazione si riduce, creando una PaCO 2 - 2 ETCO gradiente. In questa circostanza, è fondamentale conoscere il valore di PaCO 2 primaqualsiasi interpretazione del valore 2 ETCO. La prima parte della sequenza video descrive la procedura da seguire per interpretare la differenza tra la PaCO 2 e ETCO 2. Noi vediamo che la misura di ETCO 2 è ottenuto immediatamente e in modo non invasivo, ma in questa fase non può permettere l&#39;adattamento dei parametri del respiratore. Questo implica la necessità di misurare i 2 PaCO che possono poi essere confrontato con il ETCO 2. La PaCO 2 valore resta il valore di riferimento per l&#39;apprezzamento della ventilazione del paziente. <ul><li> Se PaCO 2 misurato è superiore al valore desiderato, ad esempio 60mmHg invece di 40 mmHg, ciò significa che il paziente è hypoventilated. I parametri del respiratore può poi essere adattata: o la frequenza respiratoria o il volume corrente può essere aumentato per aumentare la ventilazione e quindi diminuire PaCO 2. L&#39;obiettivo consiste nel ridurre il ETCO 2 di 20 mmHg, indipendentemente dal valore iniziale ETCO 2. Per esempio, può essere possibile che il ETCO valore 2 è 50 mmHg quando i 2 PaCO è misurata a 60mmHg, a causa di una PaCO 2-2 ETCO gradiente creato dalla presenza di una malattia cardio-respiratorio. Quando l&#39;adattamento dei parametri del respiratore consente al ETCO 2 a goccia da 50 mmHg a 30 mmHg, possiamo tranquillamente supporre che il paziente sia adeguatamente ventilato con un valore 2 PaCO aver sceso da 60mmHg a 40 mmHg. </li><li> Al contrario, se i 2 PaCO è inferiore al valore di riferimento, il paziente è hyperventilated e la frequenza di conseguenza respiratorie o volume corrente deve essere ridotta di raggiungere i valori target. Se PaCO 2 è 20 mmHg inferiore al valore di destinazione, si deve aumentare la ETCO 2 di 20 mmHg mediante la modifica dei parametri del respiratore. </li></ul> Artefatti e trappole in Capnografia. Se la tecnologia per la misura del CO 2 è diventato affidabile in termini di precisione, riproducibilità, tempo di risposta e la qualità della curva, si presenta ancora, come per ogni parametro monitorato, entro certi limiti: <ul><li> La prima limitazione è dovuta alla mancanza di conoscenze corrette riguardanti la fisiopatologia di CO 2 da parte del medico, che è poi riluttante a utilizzare la tecnica. Ci auguriamo che questa spiegazione e le sequenze video di accompagnamento contribuire a risolvere questa limitazione. </li><li> Nel caso del paziente in respirazione spontanea, la aggiunzione di ossigenoterapia attraverso la maschera diluire la scadenza di CO 2, che modifica sostanzialmente le capnogramma e la ETCO 2 sarà goccia. La sequenza video dimostra questo fenomeno. </li><li> Se si vuole monitorare per ipoventilazione, o un evento apnea, durante la sedazione procedurale, ci aspettiamo ETCO 2, in correlazione con PaCO 2, per aumentare in parallelo alla ipoventilazione del paziente. Paradossalmente, un evento di ipoventilazione nel paziente una respirazione spontanea è tradotto da un calo ETCO 2, perché il paziente è allora solo respirando con un volume molto piccolo di marea, che corrisponde essenzialmente al volume morto del tracheo-Bronchal spazio, e come noi so, questo spazio non partecipare allo scambio gassoso e quindi contiene CO pochissimo 2. </li><li> Durante la ventilazione meccanica, la trappola è che si dimentica che ETCO 2 non riflette necessariamente PaCO 2 (vedi capitolo precedente). </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>

Nessun conflitto di interessi dichiarati.

Importanza di CO 2 per dell&#39;Organismo Prima di esplorare scaduto CO 2 di monitoraggio, è essenziale per mettere in prospettiva il ruolo svolto dal generale di CO2 nel corpo umano. Prodotta ad un ritmo di circa 200 ml al minuto, CO 2 non è solo un spreco di sottoprodotto del metabolismo cellulare. Se i nostri chemocettori midollare hanno il compito di mantenere la pressione arteriosa parziale di CO2 (PaCO 2) a 40 mmHg, è perché di CO 2</s...

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

L&#39;anidride carbonica (CO 2) insieme con l&#39;ossigeno (O 2) condividono il ruolo di essere il gas più importanti del corpo umano. La misurazione del CO 2 scaduto alla foce ha sollecitato crescente interesse clinico tra i medici del pronto soccorso per varie indicazioni: (1) sorveglianza et monitoraggio del paziente intubato, (2) verifica del corretto posizionamento di un tubo endotracheale, (3 monitoraggio) di un paziente in arresto cardiaco, (4) il raggiungimento normocapnia nei pazienti intubati trauma cranico; (5) ventilazione monitoraggio durante sedazione procedurale. Il video consente ai medici di familiarizzare con l&#39;uso di capnografia e il testo propone una revisione della teoria e presidi coinvolti. In particolare, l&#39;importanza di CO 2 per l&#39;organismo, l&#39;importanza di misurare scaduto CO 2, le differenze tra arteriosa e scaduti di CO 2, il materiale usato in capnografia con i loro manufatti e le trappole, sarà rivista. Dal momento che la riluttanza principale nell&#39;uso dei scaduto misura del CO 2 è dovuto alla mancanza di conoscenze corrette riguardanti la fisiopatologia di CO 2 da parte del medico, ci auguriamo che questa spiegazione e le sequenze video di accompagnamento contribuire a risolvere questa limitazione.

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

Questo video descrive come eseguire CO<sub&gt; 2</subMisura&gt; nei pazienti intubati e in respiro spontaneo. Le principali indicazioni cliniche si riferiscono a situazioni di emergenza: (1) verificare il posizionamento adeguato di un tubo endotracheale, (2) il raggiungimento normocapnia in pazienti traumatizzati, (3) il monitoraggio di ventilazione in caso di sedazione procedurale.

CO scaduto 2</subMisura> in pazienti intubati e in respiro spontaneo da parte del Dipartimento di emergenza

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 Views.  Universit Catholique de Louvain Cliniques Universitaires Saint-Luc. Questo video descrive come eseguire CO 2 nei pazienti intubati e in respiro spontaneo. Le principali indicazioni cliniche si riferiscono a situazioni di emergenza: (1) verificare il posizionamento adeguato di un tubo endotracheale, (2) il raggiungimento normocapnia in pazienti traumatizzati, (3) il monitoraggio di ventilazione in caso di sedazione procedurale.

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).

Sclerale reticolazione Utilizzando riboflavina e raggi ultravioletti-A di radiazione per la prevenzione della miopia assiale in un modello di coniglio

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

Ricerca

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 nuovo approccio per la somministrazione di farmaci e fluidi in scenari di emergenza e impostazioni

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.

Impostazione di una Stroke algoritmo squadra e svolgono la formazione basata sulla simulazione nel Dipartimento di Emergenza - Una guida pratica

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.

Disinserimento di emergenza nella chirurgia robotica: un programma di studi di simulazione

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;

L'installazione e l'esecuzione dell'esercizio di formazione con gli occhi bendati codice

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- Lasertonsillotomia sotto anestesia locale negli adulti

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.

Raffreddamento o riscaldamento dell'esofago per ridurre le lesioni esofagehe durante l'ablazione atriale sinistra nel trattamento della fibrillazione atriale

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.

Misura dell'ossigenazione tissutale mediante spettroscopia nel vicino infrarosso in pazienti sottoposti a emodialisi

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 nuovo sistema di maschere per inalazione per fornire alte concentrazioni di gas ossido nitrico in soggetti che respirano spontaneamente

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 ...

Previsione della prognosi nell'insufficienza cardiaca acuta utilizzando l'angolo di fase e i punteggi 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.

Autore in primo piano: Svelare gli indicatori prognostici nell'insufficienza cardiaca - Il ruolo dell'angolo di fase e dell'analisi dell'impedenza bioelettrica 

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.

Applicazione clinica dell'angolo di fase e delle analisi BIVA Z-Score in pazienti ricoverati in un pronto soccorso con insufficienza cardiaca acuta

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

CO scaduto 2 in pazienti intubati e in respiro spontaneo da parte del Dipartimento di emergenza

CO scaduto_{2 in pazienti intubati e in respiro spontaneo da parte del Dipartimento di emergenza}