Endobronchial intubation detected by insertion depth of endotracheal tube, bilateral auscultation, or observation of chest movements: randomised trial

Objective To determine which bedside method of detecting inadvertent endobronchial intubation in adults has the highest sensitivity and specificity

Acoustic monitoring – super sonics?

Vesicular breath sounds, wheezes, rhonchi, and crackles possess acoustic 'signatures' amenable to detection, quantification, and moment-by-moment visual display. Despite technical hurdles, new methods for sonic evaluation, once perfected, should offer innovative diagnostic and monitoring tools that add clinical value. These emerging options complement current 'static/global' monitoring of mechanics and gas exchange with dynamic regional information long missing from the optimal care of the ventilated patient with critical illness

Respiratory sound analysis as a diagnosis tool for breathing disorders

This paper provides an overview of respiratory sound analysis (RSA) and its functionality as a diagnostic tool for breathing disorders. A number of respiratory conditions and the techniques used to diagnose them, including sleep apnoea, lung sound analysis (LSA), wheeze detection and phase estimation are discussed. The technologies used, from multi-channel bespoke recording systems to using a smart phone application are explained. A new study that focusses on developing a non-invasive tool for the detection and characterisation of inducible laryngeal obstruction (ILO) is presented. ILO is a debilitating condition, caused by malfunctioning structures of the upper airway, commonly triggered by exertion, leaving children feeling out of breath and unable to exercise normally. In rare cases it can lead to critical laryngeal obstruction and admission to intensive care for endotracheal intubation. The current definitive method of diagnosis is by inserting a camera through the nose while the person is exercising. This approach is invasive, uncomfortable (in particular for young children) subjective and relies on the consultant's expertise. There are only a handful of consultants with the appropriate level of expertise in the UK to diagnose this condition

High-Performance Accelerometer Based On Asymmetric Gapped Cantilevers For Physiological Acoustic Sensing

Continuous or mobile monitoring of physiological sounds is expected to play important role in the emerging mobile healthcare field. Because of the miniature size, low cost, and easy installation, accelerometer is an excellent choice for continuous physiological acoustic signal monitoring. However, in order to capture the detailed information in the physiological signals for clinical diagnostic purpose, there are more demanding requirements on the sensitivity/noise performance of accelerometers. In this thesis, a unique piezoelectric accelerometer based on the asymmetric gapped cantilever which exhibits significantly improved sensitivity is extensively studied. A meso-scale prototype is developed for capturing the high quality cardio and respiratory sounds on healthy people as well as on heart failure patients. A cascaded gapped cantilever based accelerometer is also explored for low frequency vibration sensing applications such as ballistocardiogram monitoring. Finally, to address the power issues of wireless sensors such as wireless wearable health monitors, a wide band vibration energy harvester based on a folded gapped cantilever is developed and demonstrated on a ceiling air condition unit

Doctor of Philosophy

dissertationPatients sometimes suffer apnea during sedation procedures or after general anesthesia. Apnea presents itself in two forms: respiratory depression (RD) and respiratory obstruction (RO). During RD the patients' airway is open but they lose the drive to breathe. During RO the patients' airway is occluded while they try to breathe. Patients' respiration is rarely monitored directly, but in a few cases is monitored with a capnometer. This dissertation explores the feasibility of monitoring respiration indirectly using an acoustic sensor. In addition to detecting apnea in general, this technique has the possibility of differentiating between RD and RO. Data were recorded on 24 subjects as they underwent sedation. During the sedation, subjects experienced RD or RO. The first part of this dissertation involved detecting periods of apnea from the recorded acoustic data. A method using a parameter estimation algorithm to determine the variance of the noise of the audio signal was developed, and the envelope of the audio data was used to determine when the subject had stopped breathing. Periods of apnea detected by the acoustic method were compared to the periods of apnea detected by the direct flow measurement. This succeeded with 91.8% sensitivity and 92.8% specificity in the training set and 100% sensitivity and 98% specificity in the testing set. The second part of this dissertation used the periods during which apnea was detected to determine if the subject was experiencing RD or RO. The classifications determined from the acoustic signal were compared to the classifications based on the flow measurement in conjunction with the chest and abdomen movements. This did not succeed with a 86.9% sensitivity and 52.6% specificity in the training set, and 100% sensitivity and 0% specificity in the testing set. The third part of this project developed a method to reduce the background sounds that were commonly recorded on the microphone. Additive noise was created to simulate noise generated in typical settings and the noise was removed via an adaptive filter. This succeeded in improving or maintaining apnea detection given the different types of sounds added to the breathing data

Primjena ultrazvuka u jedinici intenzivnog liječenja djece

OBJECTIVE: This narrative review provides an overview of the use of ultrasound in pediatric intensive care. It investigates point-of-care ultrasound (POCUS), which is a goal-directed approach for rapid clinical decision making and provides a multiorgan approach for assessment of complex disease states. This review is organized by integrating point-of-care ultrasonography for pediatric intensive care into the A-Airway, B-Breathing, C-Circulation, D-Disability resuscitation sequence in the primary assessment of critically ill patients after the paragon of the ABCD curriculum by Lichtenstein et al. ----- METHODS: Data is collected by literature research on Pubmed and referencing literature of found articles. Educational literature is taken from chapters in edited books. Point-of-care ultrasound represents an extensively used tool by different fields, therefore taken literature spans various specialities including emergency medicine, anaesthesiology, intensive care, pediatrics, and cardiology. ----- DISCUSSION: Point-of-care ultrasound in pediatric critical care is an emerging field and further studies are required. In relation to the ABCD assessment, research needs to be conducted for POCUS in pediatric patients with congenital malformations and patients after cardiac surgery. Different protocols and approaches for the same clinical presentation need to be compared in order to define a standard. Assessment of inferior vena cava is still controversial and requires a standard. ----- CONCLUSION: Point-of-care ultrasound in pediatric intensive care is the leading method for accurate assessment and timely intervention. It enhances decision-making, management and intervention as an extension of traditional physical examination. Due to its established use in clinical practice and its development potentials, it should be integrated into medical school curriculum.CILJEVI: Spomenuti osvrt omogućava pregled korištenja ultrazvuka u pedijatrijskoj intezivnoj njezi. Istražuje „point of care“ ultrazvuk (POCUS), koji ima ciljani pristup brzog kliničkog odlučivanja i omogućuje multiorganski pristup za određivanje kompliciranih bolesti. Ovaj osvrt je organiziran tako da je POCUS uključen u pedijatrijsku intezivnu njegu kao dio ABCD slijeda (A-dišni putevi, B-disanje, C-cirkulacija, D-kratki neurološki pregled) tijekom oživljavanja u primarnom određivanju stanja kritičnih bolesnika nakon ABCD plana Lichtensteina i drugih. ----- METODE: Podaci su prikupljeni pretragom literature Pubmed-a i literature spomenute u određenim člancima. Edukacijska literatura je uzeta iz poglavlja uređenih knjiga. POCUS predstavlja alat koji se opsežno koristi u različitim poljima medicine te zbog toga spomenuta literatura obuhvaća različite grane specijalizacije poput hitne medicine, anesteziologije, intezivne medicine, pedijatrije i kardiologije. ----- RASPRAVA: POCUS u pedijatrijskoj intezivnoj njezi je polje u nastajanju i zbog toga su potrebne daljnje studije. U odnosu na određivanje ABCD slijeda, studija bi trebala biti provedena za POCUS u pedijatrijskih bolesnika s kongenitalnim malformacijama i bolesnika nakon operacije srca. Različiti protokoli i pristupi za isti klinički prikaz trebaju biti uspoređeni da bi se odredio standard. Metoda procjene donje šuplje vene je još uvijek kontroverzna i zahtjeva standard. ----- ZAKLJUČAK: "Point of care" ultrazvuk u pedijatrijskoj intezivnoj njezi je vodeća metoda za točnu procjenu i pravovremenu intervenciju. Poboljšava proces odlučivanja, upravljanja i intervencije kao dodatak tradicionalnom liječničkom pregledu. Zbog utvrđene koristi u kliničkoj praksi i potencijala za razvoj, trebalo bi biti uključeno u program medicinskog fakulteta

Primjena ultrazvuka u jedinici intenzivnog liječenja djece

OBJECTIVE: This narrative review provides an overview of the use of ultrasound in pediatric intensive care. It investigates point-of-care ultrasound (POCUS), which is a goal-directed approach for rapid clinical decision making and provides a multiorgan approach for assessment of complex disease states. This review is organized by integrating point-of-care ultrasonography for pediatric intensive care into the A-Airway, B-Breathing, C-Circulation, D-Disability resuscitation sequence in the primary assessment of critically ill patients after the paragon of the ABCD curriculum by Lichtenstein et al. ----- METHODS: Data is collected by literature research on Pubmed and referencing literature of found articles. Educational literature is taken from chapters in edited books. Point-of-care ultrasound represents an extensively used tool by different fields, therefore taken literature spans various specialities including emergency medicine, anaesthesiology, intensive care, pediatrics, and cardiology. ----- DISCUSSION: Point-of-care ultrasound in pediatric critical care is an emerging field and further studies are required. In relation to the ABCD assessment, research needs to be conducted for POCUS in pediatric patients with congenital malformations and patients after cardiac surgery. Different protocols and approaches for the same clinical presentation need to be compared in order to define a standard. Assessment of inferior vena cava is still controversial and requires a standard. ----- CONCLUSION: Point-of-care ultrasound in pediatric intensive care is the leading method for accurate assessment and timely intervention. It enhances decision-making, management and intervention as an extension of traditional physical examination. Due to its established use in clinical practice and its development potentials, it should be integrated into medical school curriculum.CILJEVI: Spomenuti osvrt omogućava pregled korištenja ultrazvuka u pedijatrijskoj intezivnoj njezi. Istražuje „point of care“ ultrazvuk (POCUS), koji ima ciljani pristup brzog kliničkog odlučivanja i omogućuje multiorganski pristup za određivanje kompliciranih bolesti. Ovaj osvrt je organiziran tako da je POCUS uključen u pedijatrijsku intezivnu njegu kao dio ABCD slijeda (A-dišni putevi, B-disanje, C-cirkulacija, D-kratki neurološki pregled) tijekom oživljavanja u primarnom određivanju stanja kritičnih bolesnika nakon ABCD plana Lichtensteina i drugih. ----- METODE: Podaci su prikupljeni pretragom literature Pubmed-a i literature spomenute u određenim člancima. Edukacijska literatura je uzeta iz poglavlja uređenih knjiga. POCUS predstavlja alat koji se opsežno koristi u različitim poljima medicine te zbog toga spomenuta literatura obuhvaća različite grane specijalizacije poput hitne medicine, anesteziologije, intezivne medicine, pedijatrije i kardiologije. ----- RASPRAVA: POCUS u pedijatrijskoj intezivnoj njezi je polje u nastajanju i zbog toga su potrebne daljnje studije. U odnosu na određivanje ABCD slijeda, studija bi trebala biti provedena za POCUS u pedijatrijskih bolesnika s kongenitalnim malformacijama i bolesnika nakon operacije srca. Različiti protokoli i pristupi za isti klinički prikaz trebaju biti uspoređeni da bi se odredio standard. Metoda procjene donje šuplje vene je još uvijek kontroverzna i zahtjeva standard. ----- ZAKLJUČAK: "Point of care" ultrazvuk u pedijatrijskoj intezivnoj njezi je vodeća metoda za točnu procjenu i pravovremenu intervenciju. Poboljšava proces odlučivanja, upravljanja i intervencije kao dodatak tradicionalnom liječničkom pregledu. Zbog utvrđene koristi u kliničkoj praksi i potencijala za razvoj, trebalo bi biti uključeno u program medicinskog fakulteta

Ultrasound for the Anesthesiologists: Present and Future

Ultrasound is a safe, portable, relatively inexpensive, and easily accessible imaging modality, making it a useful diagnostic and monitoring tool in medicine. Anesthesiologists encounter a variety of emergent situations and may benefit from the application of such a rapid and accurate diagnostic tool in their routine practice. This paper reviews current and potential applications of ultrasound in anesthesiology in order to encourage anesthesiologists to learn and use this useful tool as an adjunct to physical examination. Ultrasound-guided peripheral nerve blockade and vascular access represent the most popular ultrasound applications in anesthesiology. Ultrasound has recently started to substitute for CT scans and fluoroscopy in many pain treatment procedures. Although the application of airway ultrasound is still limited, it has a promising future. Lung ultrasound is a well-established field in point-of-care medicine, and it could have a great impact if utilized in our ORs, as it may help in rapid and accurate diagnosis in many emergent situations. Optic nerve sheath diameter (ONSD) measurement and transcranial color coded duplex (TCCD) are relatively new neuroimaging modalities, which assess intracranial pressure and cerebral blood flow. Gastric ultrasound can be used for assessment of gastric content and diagnosis of full stomach. Focused transthoracic (TTE) and transesophageal (TEE) echocardiography facilitate the assessment of left and right ventricular function, cardiac valve abnormalities, and volume status as well as guiding cardiac resuscitation. Thus, there are multiple potential areas where ultrasound can play a significant role in guiding otherwise blind and invasive interventions, diagnosing critical conditions, and assessing for possible anatomic variations that may lead to plan modification. We suggest that ultrasound training should be part of any anesthesiology training program curriculum