Respiratory monitoring tools in the intensive care unit

Current Opinion in Critical Care

Volumn 9, Issue 3, 2003, Pages 230-235

  Caples, Sean M ^a   Hubmayr, Rolf D ^a  

^a MAYO CLINIC   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ACCURACY; ARTERIAL CARBON DIOXIDE TENSION; ARTERIAL GAS; CAPNOGRAPHY; CARBON DIOXIDE TENSION; CLINICAL PRACTICE; COMPUTER ASSISTED IMPEDANCE TOMOGRAPHY; EVALUATION; GAS EXCHANGE; HUMAN; INTENSIVE CARE; LUNG VENTILATION; MONITORING; OXYGEN TENSION; PATIENT CARE; PH; POSITIVE END EXPIRATORY PRESSURE; PRESSURE VOLUME CURVE; PULSE OXIMETRY; RELIABILITY; REVIEW;

ADULT; ANIMALS; AUSCULTATION; BLOOD GAS ANALYSIS; CHILD; ELECTRIC IMPEDANCE; HUMANS; INTENSIVE CARE; MODELS, ANIMAL; MONITORING, PHYSIOLOGIC; OXIMETRY; RESPIRATORY FUNCTION TESTS; RESPIRATORY PHYSIOLOGY; SWINE; TOMOGRAPHY;

EID: 0037865658     PISSN: 10705295     EISSN: None     Source Type: Journal    
DOI: 10.1097/00075198-200306000-00011     Document Type: Review

References (39)

1. Severinghaus JW, Astrup PB. History of blood gas analysis: IV. Leland Clark's oxygen electrode. J Clin Monit 1985, 2:125-139.
2. Clark LC: Monitor and control of blood and tissue oxygen tensions. Trans Am Soc Artif Intern Organs 1956, 2:41-48.
3. Rais-Bahrami K, Rivera O, Mikesell GT, et al.: Continuous blood gas monitoring using an in-dwelling optode method: comparison to intermittent arterial blood gas sampling in ECMO patients. J Perinatol 2002, 22:472-4. An evaluation of an indwelling device in pediatric patients that shows good correlation with standard blood gas analysis. It may be of use in a limited population of patients.
4. Wouters, PF, Gehring H, Meyfroidt G, et al.: Accuracy of pulse oximeters: the European Multi-Center Trial. Anesth Analg 2002, 94(suppl):S13-S16. This large prospective comparison of oximetry and standard blood gas analysis shows fairly good accuracy and identifies confounders. The paper is one of several in an excellent supplement to Anesthesia & Analgesia, which addresses nearly every aspect of pulse oximetry.
5. Jubran A: Pulse oximetry. In Principles and Practice of Intensive Care Monitoring. Edited by Tobin MJ. New York: McGraw-Hill; 1998:261-287.
6. Shamir M, Eidelman LA, Floman Y, et al.: Pulse oximetry plethysmographic waveform during changes in blood volume. Br J Anaesth 1999, 82:178-181.
7. Nickerson BG, Sarkisian C, Tremper KK: Bias and precision of pulse oximeters and arterial oximeters. Chest 1988, 93:515-517.
8. 2 levels in neonates. Time will tell whether this will affect practice standards in this setting.
9. Kober A, Scheck T, Lieba F, et al.: The influence of active warming on signal quality of pulse oximetry in prehospital trauma care. Anesth Analg 2002, 95:961-966. Head-to-head comparison of oximeter signal quality between actively and passively warmed trauma patients during transport to the hospital. The devices of warmer patients exhibited fewer alerts and shorter duration of signal loss.
10. Pinto Lima A, Beelen P, Bakker J: Use of a peripheral perfusion index derived from the pulse oximetry signal as a noninvasive indicator of perfusion. Crit Care Med 2002, 30:1210-1213. The investigators used a ratio of oximetry signal intensities during differing states of peripheral perfusion in both critically ill and normal subjects. The median value in normal subjects was used as a standard. Although this technique may indicate changes in peripheral circulation, it appears to offer little benefit above and beyond simple physical examination.
11. Hutchison D, Gray BJ: Transcutaneous and transconjunctival oxygen monitoring. In Principles and Practice of Intensive Care Monitoring. Edited by Tobin MJ. New York: McGraw-Hill; 1998:289-302.
12. Isenberg SJ, Neumann D, Fink S, et al.: Continuous oxygen monitoring of the conjunctiva in neonates. J Perinatol 2002, 22:46-49. Although compared with oximetry rather than ABG, the conjunctival probe was well tolerated in 10 neonates. Correlation with oximetry was established, but comparison with blood gas analysis may have rendered the data more compelling.
13. Hanly PJ: Transcutaneous monitoring of carbon dioxide tension. In Principles and Practice of Intensive Care Monitoring. Edited by Tobin MJ. New York: McGraw-Hill; 1998:401-414.
14. 2 and is less costly in determining brain death by apnea testing.
15. 2 with conventional ABG measurements in a group of patients on high-frequency ventilation. Precision and accuracy were established. The investigators suggest, although data are still lacking, that this method of monitoring will result in clinical benefit because of more rapid assessment and possible intervention.
16. Hess DR: Capnometry. In Principles and Practice of Intensive Care Monitoring. Edited by Tobin MJ. New York: McGraw-Hill; 1998:377-400.
17. Russell GB, Graybeal JM: Reliability of the arterial to end-tidal carbon dioxide gradient in mechanically ventilated patients with multi-system trauma. J Trauma 1994, 36:317-322.
18. Garnett AR, Gervin CA, Gervin AS: Capnographic waveforms in esophageal intubation: effect of carbonated beverages. Ann Emerg Med 1989, 18:387-390.
19. Linko K, Paloheimo M, Tammisto T: Capnography for detection of accidental oesophageal intubation. Acta Anaesthesiol Scand 1983, 27:199-202.
20. Puntervoll SA, Soreide E, Jacewicz W, et al.: Rapid detection of oesophageal intubation: take care when using colorimetric capnometry. Acta Anaesthesiol Scand 2002, 46:455-457. This study demonstrates the high sensitivity of colorimetric capnometers in detecting carbon dioxide, although, in this case, the carbon dioxide gas originated from protocol-based esophageal placement. Capnography was found to be more specific than capnometry.
21. Grmec S: Comparison of three different methods to confirm tracheal tube placement in emergency intubation. Intensive Care Med 2002, 28:701-704. Capnometry and capnography were found to be equally superior to auscultation in assessing proper endotracheal tube placement in nonarrest emergency situations. However, during cardiopulmonary arrest, capnometry was less sensitive than capnography. The outcome may be affected, however, by the effectiveness of resuscitation techniques.
22. Araujo-Preza CE, Melhado ME, Gutierrez FJ, et al.: Use of capnometry to verify feeding tube placement. Crit Care Med 2002, 30:2255-2259. Capnometry was highly sensitive and specific for proper placement of feeding tubes in this population of mechanically ventilated patients. This may allow less time- and cost-intensive protocols for placement of enteral feeding tubes.
23. Brochard L: Respiratory pressure-volume curves. In Principles and Practice of Intensive Care Monitoring. Edited by Tobin MJ. New York: McGraw-Hill; 1998:597-616.
24. Matamis D, Lemaire F, Harf A, et al.: Total respiratory pressure-volume curve in the adult respiratory distress syndrome. Chest 1984, 86:58-66.
25. Hickling K: Reinterpreting the pressure-volume curve in patients with acute respiratory distress syndrome. Curr Opin Crit Care 2002, 8:32-38. A thorough review of current research that calls into question the traditional interpretation of the pressure-volume curve.
26. Hubmayr R: Perspective on lung injury and recruitment. Am J Respir Crit Care Med 2002, 165:1647-1653. A discussion of current controversies about ventilation strategies with an emphasis oh the uncertainties of physiologic changes on an acinar level. The theory of alveolar collapse in derecruitment is questioned, and the interpretation of the pressure-volume curve and the best PEEP is argued.
27. 2/fraction of inspired oxygen ratios. However, changes in venous admixture also were noted and were suggested to result from blood flow redistribution. Benefit in patient clinical outcome has yet to be demonstrated.
28. Servillo G, De Robertis E, Maggiore S, et al.: The upper inflection point of the pressure-volume curve. Influence of methodology and of different modes of ventilation. Intensive Care Med 2002, 28:842-849. A comparison of static and dynamic methods of obtaining the upper inflection point of the pressure-volume curve. Although no difference was found between differing flow rates, there appeared to be an effect dictated by tidal volumes. We may need to reevaluate the conventional analysis of the pressure-volume curve in this era of protective ventilation.
29. Hermle G, Mols G, Zugel A, et al.: Intratidal compliance-volume curve as an alternative basis to adjust positive end-expiratory pressure: a study in isolated perfused rabbit lungs. Crit Care Med 2002, 30:1589-1597. The investigators developed and applied a novel tool for guidance of PEEP settings in this animal model, which may be less cumbersome to use. Shunt seemed to increase in the static pressure-volume group compared with the compliance-volume curve group.
30. Ward NS, Lin DY, Nelson DL, et al.: Successful determination of lower inflection point and maximal compliance in a population of patients with acute respiratory distress syndrome. Crit Care Med 2002, 30:963-968. This study exemplifies the difficulties that may be encountered in determining a true lower inflection point on a pressure-volume curve. The investigators also attempted to determine the best PEEP by using a maximal compliance curve. Although the results are based on occasionally subjective data, they may discredit the traditional use of the pressure-volume curve.
31. Rimensberger PC, Cox PN, Cheng A, et al.: Ventilation with PEEP above the inflection point increases the risk of air leaks. Am J Respir Crit Care Med 1995, 151:121-128.
32. Ganzert S, Guttmann J, Kersting K, et al.: Analysis of respiratory pressure-volume curves in intensive care medicine using inductive machine learning. Artif Intell Med 2002, 26:69-86. The investigators used inductive machine learning tools to assess pressure-volume curve methodology and to investigate the modeling of curves for possible future clinical use.
33. Amato MBP, Barbas CSV, Medeiros DM, et al.: Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome. N Engl J Med 1998, 338:347-354.
34. 2 oscillations (resulting from shunt) were measured and found to be as much a function of respiratory rate as external PEEP. These experimental data could catalyze clinical studies that best modify factors that lead to ventilator-induced lung injury.
35. Barber DC, Brown BH: Applied potential tomography. J Physiol E Sci Instrum 1984, 17:723-733.
36. Frerichs I, Schiffmann H, Hahn G, et al.: Non-invasive radiation-free monitoring of regional lung ventilation in critically ill infants. Intensive Care Med 2001, 27:1385-1394. Alterations in thoracic impedance were demonstrated after clinical interventions in this group of patients. This seemed to correlate with physiologic changes noted on conventional monitoring devices.
37. Smit HJ, Vonk Noordegraaf A, Roeleveld RJ, et al.: Epoprostenol-induced pulmonary vasodilatation in patients with pulmonary hypertension measured by electrical impedance tomography. Physiol Meas 2002, 23:237-243. Electric impedance tomography was shown to correlate with some hemodynamic measurements obtained by right heart catheterization after the use of a pulmonary vasodilator. Only one of eight patients had a true response to the drug, leaving in question the clinical utility of this tool.
38. Donnerberg RL, Druzgalski CK, Hamlin RL, et al.: Sound transfer function of the congested canine lung. Br J Dis Chest 1980, 74:23-31.
39. Rasanen J, Gavriely N: Detection of porcine oleic acid-induced acute lung injury using pulmonary acoustics. J Appl Physiol 2002, 93:51-57. Dependent changes in lung sound transmission correlated well with histologic and physiologic markers of lung injury in this animal model. Monitoring of lung injury in this manner is provocative but has not yet been proven to be beneficial.