カプノグラフィで使用される材料期限切れのCO 2モニタリングの利用への障害の一つは、緊急の医師によって使用される材料の格差に格納されています。このような状況を明確にするために、それは患者が人工的に換気または自発的に呼吸しているかどうかを区別することが重要です。残りについては、分析に使用されるさまざまな技術はもはや臨床結果と効率性に影響することはありません。 この文は、副流煙と主流カプノグラフィの間に伝統的な区別の場合に立っている。主流のシステム対策が直接の河口に位置する小さなチャンバー内にCO 2をしながら副流煙システムは、口の中からモニターに位置検出器への輸送CO 2に吸引ポンプを使用して、赤外線波を用いて測定するCO 2これら2つのテクニック患者とケーブルでモニターに接続。伝統的に、副流煙システムは、システムがより軽くなるように自発呼吸患者のために使用され、主流のシステム、少しかさばるが、挿管された患者の気管内チューブに直接接続されています。過去数年間の技術の進歩は、根本的に主流と副流システム間の違いが減少している。新技術は、口と検出チャンバーとの間に小さい移行期間を可能に、CO2の検出器が配置されているチャンバーに到達する前に細い管に沿って移動する&quot;強化された副流システム&quot;の一種であるmicrostreamシステム、向いていますほとんど口で空気の通路と同期しているため、カプノグラフィ曲線。ので、 ビデオシーケンスの後半で説明したように私たちは、材料の選択肢を区別するものを見てみましょう： <ul><li>医師がprecocely無呼吸を（手続き型鎮静中に、または医療中毒後に）検出するように自然換気で患者を監視したい場合は、その曲線の唯一の形態は、それほど重要でいるETCO 2の実際の値が不可欠です。このケースでは、彼の医師は鼻カニューレや酸素投与とCO 2吸引を組み合わせるcapnomask、または古典的なマスクの下に置くことができる薄いCO 2吸引チューブの間で選択することができます。 </li><li>医師が正確に気管内チューブの正しい位置を確認するために、人工呼吸器のパラメータを適応する、または心停止の間に予後を評価するために、ETCO 2を分析することを望む場合、彼はとの使用のために適合することができるよりも、材料を使用する必要があります。気管内チューブ（患者からの分泌物がチューブをブロックしないように常にフィルターの後ろに配置）。 </li></ul>カプノグラフィカーブ three満了時の典型的なカプノグラフィ曲線を図1に示されている。吸気で実質的にCO 2が存在しないように曲線は、それぞれのインスピレーションで、x軸（0値）を取り戻します。 <img src="/files/ftp_upload/2508/2508fig1.jpg" alt="図1" /> 図1：alternanceインスピレーションの有効期限 Paco 2がとETCO 2の間の相違点それは、期限切れのCO 2のその非侵襲的なモニタリングはすべての状況でPACO 2の測定のゴールドスタンダードと考えられて動脈血ガス（ABG）施策の必要性を置き換えることができると信じてeutopicだろう。すべては、期限切れのCO 2と患者の心肺状態の測定のための指標に依存する。表示が鎮静時の低換気と無呼吸を防ぐために、呼吸活性のモニタリングの場合は、曲線の単純な分析で十分です、どんなETCO 2の値。一方、表示は心肺疾患の既往のない頭部外傷患者の適切な換気を監視する場合、我々は、ETCO 2値は、PAO 2の値に近いことを期待することができますが、正確な必要性Paco 2の値はまた私達が実際にETCO 2は、本ケースではPaco 2が近いことを確認することができる少なくとも一つのABGのサンプルを、課している。 最後に、我々が呼吸困難のため挿管と換気された患者の場合に直面している場合は、ETCO 2の値は、明らかにPaco 2がの良い近似にはなりません。理由は簡単です。早急に関係なく、心肺疾患の存在が何であるかの換気血流比の乱れが、あるので、肺によるCO 2の正しい除去に障害物が作成されます。その結果、CO 2は血液中に蓄積し、鼻頬除去は、Paco 2が作成し、削減されます- ETCO 2勾配を。このような状況では、それは前にPACO 2の値を知ることが重要ですETCO 2の値のいずれかの解釈。 ビデオシーケンスの最初の部分は、Paco 2がとETCO 2の違いを解釈するために従うべき手順を説明します。我々は、ETCO 2の措置が直ちに非侵襲的に得られることがわかりますが、この段階では人工呼吸器のパラメータの適応を許可することはできません。これは、ETCO 2と比較することができますパコ2を測定することを意味します。 Paco 2の値は、患者の換気の鑑賞のための紹介の値のまま。 <ul><li> PACO測定2が所望の値よりも大きい場合は、代わりに40mmHgの60mmHg例えば、これは患者がhypoventilatedされていることを示します。呼吸器のパラメータは、適応させることができる。呼吸数や換気量のどちらかは、換気を増加させるため、Paco 2のを減らすために増やすことができます。目的は関係なく、初期ETCO 2値の、20mmHgでETCO 2削減に構成されています。例えば、それは、ETCO 2の値は、心肺疾患の存在によって作成されたPaco 2が - ETCO 2勾配のために、パコ2は 60mmHgで測定されたときに50mmHgされている可能性がすることができます。人工呼吸器のパラメータの適応がETCO 2が 30mmHgに50mmHgから削除することができるときは、我々は安全に患者が適切に40mmHgに60mmHgから落下させてしまったPaco 2の値で換気されているともできます。 </li><li> PACO 2が目標値より低い場合は逆に、、患者はhyperventilatedされ、その結果、呼吸数や換気量は目標値を達成するために縮小されている必要があります。 PACO 2が目標値より20 mmHgの低い場合は、一呼吸のパラメータの変更を介し20mmHgでETCO 2を増加させる必要があります。 </li></ul>カプノグラフィにおけるアーティファクトとトラップ。 CO 2測定のための技術は、監視対象のパラメータとして、それはまだ提示、精度、再現性、応答時間と曲線の品質の面で一定の限度信頼性になっている場合： <ul><li>最初の制限は、テクニックを使うことに消極的である医師によってCO 2の生理病理学に関する正しい知識の欠如によるものです。我々は、この説明と付属のビデオシーケンスは、この制限を解決するのに役立つことを願っています。 </li><li>自発呼吸の患者の場合には、マスクを介してoxygenotherapyの付加が大幅capnogramとETCO 2がドロップされる、変更される期限切れのCO 2を 、希釈される。ビデオシーケンスは、この現象を示しています。 </li><li>保管したいが手続き鎮静中に、低換気、または無呼吸イベントを監視する場合、我々は患者の低換気と並行して増加し、相関のPaco 2のために、ETCO 2を期待しています。 Paradoxally、患者の呼吸における低換気のイベントは、自発的に患者にのみ基本的に気管bronchal空間のデッドボリュームに対応する非常に小さな一回換気量で呼吸しているため、ETCO 2のドロップによって翻訳され、とのように我々知っている、この空間はガス交換に参加するため、非常に少ないCO 2が含まれていません。 </li><li>機械的人工換気中に、落とし穴は1つがETCO 2は必ずしも（前の章を参照）Paco 2が反映されないことを忘れていることです。 </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>

利害の衝突は宣言されません。

生物のためのCO 2の重要性期限切れのCO 2のモニタリングを探索する前に、それは大局的に人体にCO2が果たす一般的な役割を置くことが不可欠です。毎分約200 mlの割合で生産、CO 2は、単に細胞代謝の副産物無駄ではない。 CO 2は、救急医が日常的に遭遇する生体内の他の関数を持っているので、私たちのmedullar化学受容体は40mmHgで動脈二酸化炭素分圧（Paco 2が ） を維持する役割を持っている場合、それは以下のとおりです。 <ul><li> CO 2は、生体による酸の継続的な生産にタンポンのように信じられないほどの予備を構成しており、したがって、適切なpHの維持が可能になります。 </li><li> CO 2の値は、患者の換気を確実に相関し、そしてその対策は、低刺激や患者の過換気を肯定するために重要です。 </li><li> CO 2は、高炭酸ガス血症は、血管拡張、その結果、脳浮腫、その結果、脳血流の調節に重要な役割を果たしており、逆に低炭酸ガス血症を刺激血管収縮と虚血の危険性。 </li><li> CO 2の値は、O 2の値の変化に補完で異なります：過換気に続いて低炭酸ガス血症は、呼吸器疾患や標高の増加に直面して低酸素症に対する生物の最初の反射反応を構成している。 </li></ul>何がCO 2が表す期限切れ CO 2の（1）tissular生産、（2）肺動脈、肺から（3）その除去に静脈系における輸送：口の中で測定されるCO 2の値は、次の3つの基本的なプロセスを反映している。救急医療では、期限切れのCO 2測定の使用のための主な適応症は3番目のプロセスと、より正確に、患者の換気の評価方法を提供するが含まれます。例外は、期限切れのCO 2の測定でも、正しく実施された復活の20分後にETCO 2の連続して低い値が（おそらく）を伝達する程度に循環系におけるCO 2の輸送を、反映した心停止、中です。血液循環の取り返しのつかない不在測定の妥当性は、CO 2の期限切れエンド潮CO 2（ETCO 2）の値は、動脈CO 2（Paco 2の ）値と相関し、したがって、ETCO 2を測定することは、時には困難や痛みを伴う、動脈血ガスのサンプリングを忘れてはならない、繰り返しの必要性を低減。 EtCO 2は、典型的にPACO 2未満を3mmHgている。患者がない肺疾患または欠陥を渡さなければ、この相関関係にのみ有効です。換気すべての状況-血流比を変化させた場合、Paco 2がとETCO 2の間の勾配、およびそのためETCO 2測定は、Paco 2のの本当の価値を得るためにサンプリングをクローラ式と組み合わせる必要があります。

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

人間の体の中で最も重要な気体であることの役割は酸素（O 2）シェアとともに、二酸化炭素（CO 2）。気管内チューブの正しい位置の（2）検証、（3挿管された患者の（1）監視等の監視：口の中で有効期限が切れてCO 2の測定は、様々な適応のための救急外来で医師の間で成長している臨床の関心を募っています心停止の患者の）モニタリング、（4）挿管頭部外傷患者における炭酸正常状態を達成するため、手続き的鎮静​​中（5）監視換気。ビデオでは、医師がカプノグラフィの使用に慣れることができますし、テキストには、理論と関係するプリンシパルのレビューを提供しています。特に、生物のCO 2の重要性は、CO 2の有効期限が切れて測定する妥当性は、動脈と期限切れのCO 2、そのアーティファクトとトラップとのカプノグラフィで使用される材料、の違いが審査されます。期限切れのCO 2測定の使用の主な消極的で、医師によるCO 2の生理病理学に関する正しい知識の欠如が原因なので、我々はこの説明と付属のビデオシーケンスは、この制限を解決するのに役立つことを願っています。

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

このビデオでは、COを実行する方法について説明します。<sub&gt; 2</sub挿管だけでなく、自発呼吸患者の&gt;測定。主な臨床兆候は、緊急事態を参照してください：（1）気管内チューブの適切なポジショニングの検証、（2）外傷患者における炭酸正常状態を達成し、手続きの鎮静の場合（3）モニタリングの換気。

期限切れのCO 2</sub救急部から気管挿管または自発呼吸患者の>の測定

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

Universidad San Sebastian

Research

JoVE Journal

Medicine

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

16.1K ビュー.  Universit Catholique de Louvain Cliniques Universitaires Saint-Luc. このビデオでは、COを実行する方法について説明します。 2測定。主な臨床兆候は、緊急事態を参照してください：（1）気管内チューブの適切なポジショニングの検証、（2）外傷患者における炭酸正常状態を達成し、手続きの鎮静の場合（3）モニタリングの換気。

ビデオ: 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).

強膜ウサギモデルで軸性近視の予防のためのリボフラビンおよび紫外線A放射線を用いて架橋

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

医学

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.

ストロークチームアルゴリズムを設定し、救急部におけるシミュレーションベースのトレーニングを実施 - 実践ガイド

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.

ロボット手術の緊急ドッキング解除: シミュレーション カリキュラム

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

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-成人における局所麻酔下のレーザートンスロマイオン術

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.

心房細動治療における左心房切除中の食道損傷を軽減する食道の冷却または温暖化

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.

血液透析患者における近赤外分光法を用いた組織酸素化の測定

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.

自然呼吸対象における高濃度の一酸化窒素ガスを送達する新規吸入マスクシステム

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 ...

位相角とBIVAのZスコアを用いた急性心不全の予後予測

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.

著者スポットライト:心不全における予後指標の発表 - 位相角と生体電気インピーダンス解析の役割 

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.

急性心不全で救急外来に入院した患者における位相角とBIVA Zスコア分析の臨床応用

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