Capnography에 사용 재료 만료 CO 2 모니터링의 활용에 장애물 중 하나는 응급 의사에 의해 사용되는 재료의 불균형에 있습니다. 이러한 상황을 명확히하기 위해, 그것은 환자가 인위적으로 통풍 또는 자발적 호흡 여부를 구별하는 것이 중요합니다. 나머지에 관해서는 더 이상 분석에 사용되는 다른 기술은 임상 결과와 효율성에 내포되어 있습니다. 이 문장은 sidestream와 주류 capnography 사이의 전통적인 구별의 경우 선다. 이 두 기법을 측정 CO 2 적외선 파장을 사용하고, 주류 시스템 조치 작은 챔버에서 직접 2 CO 동안 sidestream 시스템의 입에 위치, 모니터에 위치한 감지기에 입에서 CO 2 수송을 열망 펌프를 사용하여 환자와 케이블로 모니터에 연결되어 있습니다. 전통적으로, sidestream 시스템은 시스템이 밝은이므로 자발적 호흡 환자에 사용되며, 주요 시스템, 조금 같아서 다루기가 좀 힘들어은 intubated 환자의 endotracheal 튜브에 직접 연결되어 있습니다. 지난 몇 년 동안 기술 발전 근본적으로 주류와 sidestream 시스템 사이의 차이를 감소했습니다. 새로운 기술은 입 및 감지 챔버 사이에 작은 변화 기간을 허용, CO2는 검출기가있는 챔버에 도달하기 전에 얇은 튜브를 따라 여행하는 &#39;강화된 sidestream 시스템&#39;의 일종입니다 microstream 시스템쪽으로 향하고있다 따라서 거의 입에 공기의 통로와 동기화되는 capnography 곡선. 그래서, 우리와 같은 비디오 시퀀스의 후반에 설명, 재료의 선택을 구별 한 번 봅시다 : <ul><li> 의사들이 자발적으로 환기에서 환자를 모니터하기를 원하는 경우에는 않도록 precocely 가사 (절차적 진정 작용하는 동안, 또는 의료 중독증 후) 감지, 다음 곡선의 유일한 양식, ETCO 2 이하 중요성되는 실제 값은 중요합니다. 이 경우에는 그 의사는 비강 접지 단자 또는 산소 관리 및 CO 2 열망을 결합 capnomask, 또는 고전적인 마스크 아래에 설치할 수 있습니다 얇은 CO 2 흡인 튜브 중에서 선택할 수 있습니다. </li><li> 의사가 정확하게 endotracheal 튜브의 정확한 위치를 확인하기 위해, 인공 호흡기에 매개 변수를 적응, 또는 심장 마비 동안 예후를 평가하기 위해 ETCO 2 분석하고자한다면, 그는 함께 사용하기위한 적응하는 것보다 재료를 사용해야합니다 endotracheal 튜브 (환자의 분비물이 튜브를 차단하지 않도록 항상 필터 뒤에 위치). </li></ul> Capnography 커브 세 만료 기간 동안 일반 capnography 곡선은 그림 1에 있습니다. 영감을 공중에 실질적으로 CO 2가 없습니다와 같은 곡선은 각각의 영감에서 X 축 (0 값)을 차릴. <img src="/files/ftp_upload/2508/2508fig1.jpg" alt="그림 1" /> 그림 1 : alternance 영감 - 만료 파코 2 ETCO 2의 차이점 그것은 유효 기간이 만료 CO 2의 비침습 감시는 모든 상황에서 동맥혈 가스에 대한 필요성 (ABG) 파코 2 측정을위한 황금 표준으로 간주 조치를 바꿀 수 있습니다 믿고 eutopic 것입니다. 모두가 만료 CO 2와 환자의 심장 - 호흡 상태의 측정에 대한 징후에 따라 달라집니다. 표시가 진정 작용 동안 hypoventilation와 가사 방지하기 위해 호흡 활동의 모니터링 경우, 곡선의 간단한 분석은 충분합니다, 뭐든간에 ETCO 2의 값. 반면에, 표시가 심장 - 호흡 장애없이 역사를 가진 머리의 외상 환자의 적절한 환기를 모니터링하는 경우, 우리는 ETCO이 값이 파오 두 값에 가까운 것으로 기대할 수 있지만 정확한의 필요성 파코이 가치는 우리가 실제로 ETCO 2 현재 경우에 파코 2 가까운 것을 확인하실 수 있습니다 최소한 하나 ABG 샘플을 부과. 우리가 intubated 및 인한 호흡 곤란으로 통풍이있는 환자의 경우에 직면하는 경우 마지막으로, ETCO이 값은 분명히 파코 2 좋은 근사치되지 않습니다. 그 이유는 간단하다, 즉시 관계없이 심장 - 폐 장애 선물이 무엇인지의 환기 - 관류 비율의 방해가있을 때, 폐에 의해 CO 2의 올바른 제거에 장애물이 만들어집니다. 그 결과, CO 2는 혈액에 축적 및하에 - 구강 철폐는 파코이 생성, 감소 - ETCO이 그라데이션합니다. 이 상황에서, 그것은 전에 파코 2의 가치를 아는 것이 매우 중요합니다ETCO이 가치의 해석. 비디오 시퀀스의 첫 번째 부분은 파코 2 ETCO 2 사이의 차이를 해석하는 따라야하는 절차를 설명합니다. 우리는 ETCO 2의 측정은 즉시 비침습적인 방법으로 얻은 것을 볼 수 있지만,이 단계에서 인공 호흡기의 매개 변수의 적응을 허용 수 없습니다. 이것은 다음 ETCO 2 비교할 수 있습니다 파코 2를 측정하는 데 의미합니다. 파코이 가치는 환자 환기의 감사에 대한 추천 값 남아 있습니다. <ul><li> 파코 측정이 원하는 가치보다 높은 경우, 대신 40mmHg 60mmHg의 예를 들면, 이것은 환자가 hypoventilated 것을 의미합니다. 호흡기의 매개 변수는 다음 적용할 수 있습니다, 호흡 속도 또는 조수의 볼륨 중 하나는 통풍을 증가하기 때문에 파코 2 감소하기 위하여 증가 수 있습니다. 목적에 관계없이 초기 ETCO이 가치의 20mmHg로 ETCO 2 감소로 구성되어 있습니다. 예를 들어, ETCO이 값은 인해 파코 2 ETCO 심장 - 호흡기 질환의 존재에 의해 만들어진이 그라데이션로, 파코 2가 60mmHg에서 측정 때 50mmHg 것을 가능하실 수 있습니다. 호흡기의 매개 변수의 적응이 ETCO 2 30mmHg로 50mmHg에서 드롭 수있게되면, 우리는 안전하게 환자가 적절하게 40mmHg로 60mmHg에서 제외하는 데 파코이 값을 통풍이 있다고 가정해 수 있습니다. </li><li> 파코 2 대상의 가치보다 낮은 경우에는 반대로, 환자는 hyperventilated되고 결과적으로 호흡 속도 또는 갯벌 볼륨이 대상의 가치를 달성하기 위해 감소되어야합니다. 파코 2 목표치보다 20 mmHg 낮은 경우, 하나는 인공 호흡기의 매개 변수의 수정을 통해 20mmHg로 ETCO 2 증가했다. </li></ul> 유물과 Capnography에 트랩. CO 2 측정을위한 기술이 정밀, 재현성, 응답 시간과 곡선 품질 측면에서 신뢰성이되고있다면, 그것은 여전히 어떤 모니터링 매개 변수를 특정 한계에 대해서, 선물 : <ul><li> 첫 번째 제한은 다음 기술을 사용하기를 꺼려있는 의사에 의해 CO 2의 physiopathology에 관한 올바른 지식의 부족으로 인한 것입니다. 우리는이 설명과 함께 비디오 시퀀스가​​이 제한을 해결하는 데 도움이되기를 바랍니다. </li><li> 자발적 호흡 환자의 경우에는 마스크를 통해 oxygenotherapy의 adjunction 상당히 capnogram과 ETCO 2 드롭됩니다 수정됩니다 만료 CO 2를 희석합니다. 비디오 시퀀스는 이러한 현상을 보여줍니다. </li><li> 한 소원이 절차 진정 작용하는 동안, hypoventilation, 또는 가사 이벤트 모니터링하는 경우, 우리는 환자의 hypoventilation에 병렬로 증가, 상관 관계에 파코 2, ETCO 2 기대하고 있습니다. Paradoxally, 환자 호흡에 hypoventilation 이벤트가 저절로 환자는 본질적으로 tracheo - bronchal 공간의 죽은 볼륨에 해당하는 매우 작은 갯벌 볼륨과 호흡 그리고 있기 때문에, ETCO 2 방울로 번역되며대로와 우리 알아,이 공간은 가스 교환에 참가하기 때문에 거의 CO 2를 포함하지 않습니다. </li><li> 기계 환기 동안 함정 하나는 ETCO 2 반드시 ​​(이전 챕터 참조) 파코 2 반영하지 않는 잊을 것입니다. </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>

관심 없음 충돌 선언하지 않습니다.

생물체에 대한 CO 2의 중요성 만료 CO 2 모니터링을 탐구하기 전에, 그것은 관점에 인체에 CO2에 의해 연주의 일반적인 역할을 넣어하는 것이 필수적입니다. 분당 약 200 ML의 비율로 생산, CO 2는 세포 대사의 부산물 낭비하지 않습니다. 우리 medullar chemoreceptors이 40mmHg에서 동맥 이산화탄소 분압 (파코 2) 유지의 역할이있다면 CO 2의 비상 의사...

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

산소와 함께 이산화탄소 (CO 2) (O 2) 인체에서 가장 중요한 가스되는 역할을 공유할 수 있습니다. 입가에 CO 2를 만료의 측정은 다양한 징후에 대한 응급 부서에서 의사 간의 임상 관심을 증가 유혹했다 : (1) 감시 동부 표준시 intubated 환자의 모니터링, endotracheal 튜브의 정확한 위치 (2) 확인, (3 심장 마비 환자) 모니터링 (4) intubated 두부 외상 환자에서 normocapnia을 달성, 절차적 진정 작용하는 동안 (5) 모니터링 환기. 비디오 의사가 capnography의 사용과 함께 자신을 숙지 수 있으며 텍스트 이론 및 관련 원칙의 리뷰를 제공합니다. 특히, 유기체에 대한 CO 2의 중요성은 CO 2를 만료 측정의 타당성은 간선 및 만료 CO 2, 그들의 유물과 함정과 함께 capnography에 사용되는 재료, 차이가 검토됩니다. 만료 CO 2 측정의 사용의 주요 내키지 않는다는 의사에 의해 CO 2의 physiopathology에 관한 올바른 지식의 부족으로 인한 것이므로, 우리는이 설명과 함께 비디오 시퀀스가이 제한을 해결하는 데 도움이되기를 바랍니다.

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

이 동영상은 CO를 수행하는 방법에 대해 설명합니다<sub&gt; 2</subintubated뿐만 아니라 자발적 호흡 환자&gt; 측정. 주요 임상 징후는 응급 상황에 참조 (1) endotracheal 튜브의 적절한 위치를 확인, (2) 외상 환자 normocapnia을 달성, 절차 진정 작용의 경우 (3) 모니터링 환기.

만료 CO 2</sub응급실에서 Intubated 또는 자연스럽게 호흡 환자> 측정

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 조회수.  Universit Catholique de Louvain Cliniques Universitaires Saint-Luc. 이 동영상은 CO를 수행하는 방법에 대해 설명합니다 2 측정. 주요 임상 징후는 응급 상황에 참조 (1) endotracheal 튜브의 적절한 위치를 확인, (2) 외상 환자 normocapnia을 달성, 절차 진정 작용의 경우 (3) 모니터링 환기.

비디오: 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).

공막 래빗 모델에 축 방향 근시의 예방 리보플라빈 및 자외선-A 방사선을 사용하여 교차 결합

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

연구

의학

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.

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.

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.

로봇 수술에 긴급 도킹 해제: 시뮬레이션 커리큘럼

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;

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.

성인의 국소 마취하에 CO2-Lasertonsillotomy

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.

심방 세동 의 치료에 왼쪽 심방 절제 동안 식도 부상을 줄이기 위해 식도를 냉각 또는 온난화

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.

혈액 투석을받는 환자에서 근적외선 분광법을 사용한 조직 산소화 측정

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.

자연적으로 호흡하는 과목에서 고농도의 산화산화물 가스를 전달하는 새로운 흡입 마스크 시스템

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 ...

위상각 및 BIVA Z-Scores를 사용한 급성 심부전의 예후 예측

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.

저자 스포트라이트: Unveiling Prognostic Indicators in Heart Failure - The Role of Phase Angle and Bioelectrical Impedance Analysis (심부전의 예후 지표 발표 - 위상각 및 생체 전기 임피던스 분석의 역할) 

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.

급성 심부전으로 응급실에 입원한 환자에서 위상각 및 BIVA Z-점수 분석의 임상 적용

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