A Comparison of Measurements of Change in Respiratory Status in Spontaneously Breathing Volunteers by the ExSpiron Noninvasive Respiratory Volume Monitor Versus the Capnostream Capnometer.

BACKGROUND: Current respiratory monitoring technologies such as pulse oximetry and capnography have been insufficient to identify early signs of respiratory compromise in nonintubated patients. Pulse oximetry, when used appropriately, will alert the caregiver to an episode of dangerous hypoxemia. However, desaturation lags significantly behind hypoventilation and alarm fatigue due to false alarms poses an additional problem. Capnography, which measures end-tidal CO2 (EtCO2) and respiratory rate (RR), has not been universally used for nonintubated patients for multiple reasons, including the inability to reliably relate EtCO2 to the level of impending respiratory compromise and lack of patient compliance. Serious complications related to respiratory compromise continue to occur as evidenced by the Anesthesiology 2015 Closed Claims Report. The Anesthesia Patient Safety Foundation has stressed the need to improve monitoring modalities so that "no patient will be harmed by opioid-induced respiratory depression." A recently available, Food and Drug Administration-approved noninvasive respiratory volume monitor (RVM) can continuously and accurately monitor actual ventilation metrics: tidal volume, RR, and minute ventilation (MV). We designed this study to compare the capabilities of capnography versus the RVM to detect changes in respiratory metrics. METHODS: Forty-eight volunteer subjects completed the study. RVM measurements (MV and RR) were collected simultaneously with capnography (EtCO2 and RR) using 2 sampling methods (nasal scoop cannula and snorkel mouthpiece with in-line EtCO2 sensor). For each sampling method, each subject performed 6 breathing trials at 3 different prescribed RRs (slow [5 min-1], normal [12.6 +/- 0.6 min-1], and fast [25 min-1]). All data are presented as mean +/- SEM unless otherwise indicated. RESULTS: Following transitions in prescribed RRs, the RVM reached a new steady state value of MV in 37.7 +/- 1.4 seconds while EtCO2 changes were notably slower, often failing to reach a new asymptote before a 2.5-minute threshold. RRs as measured by RVM and capnography during steady breathing were strongly correlated (R = 0.98 +/- 0.01, bias = Capnograph-based RR - RVM-based RR = 0.21 +/- 1.24 [SD] min-1). As expected, changes in MV were negatively correlated with changes in EtCO2. However, large changes in MV following transitions in prescribed RR resulted in relatively small changes in EtCO2 (instrument sensitivity = [DELTA]EtCO2/[DELTA]MV = -0.71 +/- 0.11 and -0.55 +/- 0.11 mm Hg per 1 L/min for nasal and in-line sampling, respectively). Nasal cannula EtCO2 measurements were on average 4 mm Hg lower than in-line measurements. CONCLUSIONS: RVM measurements of MV change more rapidly and by a greater degree than capnography in response to respiratory changes in nonintubated patients. Earlier detection could enable earlier intervention that could potentially reduce frequency and severity of complications due to respiratory depression. (C) 2016 International Anesthesia Research Society

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In Response.

No abstract available

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In Response.

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Anesthesia Emergencies.

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Ectopic lymphocytic thyroiditis: A case report and treatment options

2016-07-07T01-47-11Z
Source: Archives of Clinical and Experimental Surgery (ACES)
Irami Araújo-Filho, Amália Cínthia Meneses Rêgo, Francisco Irochima Pinheiro.
The presence of ectopic thyroid tissue is a rare entity. Non-gland migration occurs during the early stages of embryogenesis to the normal cervical location. Thus, ectopic tissue is lodged, in general, in the path of the thyroglossal duct in the middle line of the neck. The most common location is in the lingual zone, being the lingual thyroid. This, in most cases, will be asymptomatic. However, it is able to manifest itself with symptoms of dysphagia, dysphonia, obstruction of the upper airways or hemorrhage at any moment between childhood and adulthood. This article is a review of this disease, targeting mainly conduct, still very controversial in the literature.


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Effect of obesity on cost per quality adjusted life years gained following anterior cervical discectomy and fusion in elective degenerative pathology

Obese patients have greater comorbidities along with higher risk of complications and greater costs after spine surgery, which may result in increased cost and lower quality of life compared to their non-obese counterparts.

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Young Texas man meets paramedics who saved his life, two years later

By Ryan Osborne
Fort Worth Star-Telegram

FORT WORTH,Texas — Zach Malwitz was 19 when he went into cardiac arrest in the parking lot of a CVS pharmacy on April 3, 2014. His heart stopped two more times that day, and each time it did, two paramedics resuscitated him.

On Wednesday, Malwitz, now 21, met the men who saved his life.

"I don't know what to say — I'm shaking real bad right now," Malwitz told MedStar paramedics Eddie Fuller and Tim Statum.

Malwitz, who lives in North Richland Hills, thanked Fuller and Statum in person for the first time Wednesday during a ceremony at MedStar headquarters in west Fort Worth.

Two mothers were also there to meet the MedStar dispatchers who talked them through baby deliveries over the phone in May.

Allison Marquardt was with her baby boy, Augustine, while Ashlie Williams brought along her baby girl, Carter.

Marquardt was home alone the morning of May 13 when she went into labor.

MedStar dispatcher Kate Gillinger talked Marquardt through the delivery, and Augustine arrived healthy.

Four days later, on May 17, Williams went into labor at her home about 3:15 a.m. Her mother called 911 and was connected with dispatcher Jamey Clark.

Clark, who thought the call would be routine, tried to keep Williams and her mother calm, thinking paramedics would arrive before the baby. Then Williams' mother, Debbie Tuley, saw Carter on her way.

The baby's coming. The water has broke and the baby is coming. Debbie Tuley to a MedStar dispatcher in May, when her daughter was giving birth

"The baby's coming," Tuley told Clark. "The water has broke and the baby is coming."

At times, Tuley sounded worried on the call. But she said Clark's clear instructions calmed the process.

"Everything just went one step after another," Tuley said. "It was amazing how it was all just under control."

Carter arrived safely with her mom laying on the bathroom floor.

"We actually call her the bathroom baby," Williams said.

Malwitz, who nearly the died before the MedStar paramedics saved him two years, said he often thinks about how emergency workers deal with similar experiences on a regular basis.

"I couldn't imagine doing it," he said. "I care for everyone — I try to, at least. And it sure seems like they do. But they lose a lot of people, and they win a lot of people. I couldn't do that. My heart's not big enough to be able to accept that you did everything you could and you still lost someone."

Copyright 2016 the Fort Worth Star-Telegram

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