12 research outputs found
Determining the Efficiency of Different Preoperative Difficult Intubation Tests on Patients Undergoing Caesarean Section
Background: Pregnancy-induced anatomical and physiological changes in the airway make airway management difficult in obstetric patients; thus, preoperative evaluation of the airway is important for obstetric patients. Aims: To determine the effectiveness of the modified Mallampati test; the interincisor, sternomental and thyromental distances and the upper limb bite test. The second aim was to assess the effectiveness of the combination of the upper limb bite test with the other tests in obstetric patients. Study Design: Cross-sectional study. Methods: Pregnant women (n=250) scheduled for caesarean section were analysed. The patients' ages, heights and weights were collected. Preoperative airway evaluation was done by using a modified version of the Mallampati test. The interincisor, sternomental and thyromental distances were measured, and the upper limb bite test was performed. The laryngoscopy difficulty was evaluated by using Cormack-Lehane classification. Results: No statistically significant differences were found between groups in age, height or weight (p>0.05). The modified Mallampati test and interincisor, sternomental and thyromental distances revealed a lower number of easy intubations than that determined by the Cormack-Lehane classification and a higher number of difficult intubations than the actual number of cases (p<0.05). The sensitivity and specificity of the modified Mallampati test, the upper limb bite test, the interincisor distance test and the sternomental and thyromental distance tests were found to be 73.08, 57.69, 84.62, 80.77 and 88.46 and 90.62, 99.11, 83.04, 84.37 and 87.05, respectively. When the combinations were examined, the sensitivity and specificity of the combination of the upper limb bite test with the modified Mallampati test were found to be 57.69 and 100, respectively. When the upper limb bite test was combined with the interincisor distance, the sensitivity and specificity were 46.15 and 100, respectively. We found a sensitivity and specificity of 93.75 and 95.30, respectively, for the combination of the upper limb bite test with the thyromental distance test. The sensitivity and specificity of the combination of the upper limb bite test with the modified Mallampati test and interincisor distance test were found to be 46.15 and 100, respectively. For combination of all the tests, the sensitivity and specificity was 42.31 and 100, respectively. Conclusion: When all combinations are evaluated in the decision of difficult intubation, the combination of the upper limb bite test and thyromental distance test is superior to the use of other methods alone to predict difficult intubation in pregnant women
Comparıng pulse pressure varıatıon and pleth varıabılıty ındex in the semı-recumbent and trendelenburg posıtıon ın crıtıcally ıll septıc patıents
Introduction. Dynamic tests for predicting
fluid responsiveness have generated
increased interest in recent years. One of
these tests, pulse pressure variation (PPV),
is a parameter calculated from respiratory
variations of pulse pressure. Another test,
pleth variability index (PVI), is based on
respiratory variations of the perfusion index
and can be measured non-invasively
by pulse oximeter. Previous studies have
shown that both tests are valuable in determining
fluid responsiveness.
Methods. In this observational prospective
study, our aim was to compare the PVI and
PPV in order to identify a convenient tool
for determining fluid responsiveness. Our
study was performed in a surgical and reanimation
intensive care unit. We enrolled
one hundred mechanically ventilated adult
patients diagnosed with sepsis. Exclusion
criteria included brain death, spontaneous
breathing, cardiac arrhythmia, and
impaired peripheral circulation. We measured
the PPV by arterial monitorization
and the PVI by using Masimo Radical 7 in
the 45° semi-recumbent position (SP) and
then 15° Trendelenbug position (TP). We
performed correlation and ROC analysis
using a >13% fluid responsiveness cut-off
value for the PPV and >14% for the PVI.
Results. Between the SP and the TP, we did
not observe significant decreases in PPV
(from 14.17 ± 10.57 to 12.66 ± 9.64; p >
0.05), while we did observe significant decreases
in PVI (from 21.91 ± 13.99 to 20.46
± 14.12; p < 0.05). The PPV fluid responsiveness
cut-off value in the SP and TP was
20% (78.95% sensitivity, 77.05% specificity)
and 18% (76.67% sensitivity, 72.46%
specificity), respectively. The PVI fluid
responsiveness cut-off value in the SP and
TP was 20% (80.49% sensitivity, 81.03%
specificity) and 16% (81.25% sensitivity,
62.69% specificity), respectively. The area
under the ROC of the PPV and PVI was
0.843 and 0.858 in the SP, respectively, and
0.760 and 0.747 in the TP, respectively. The
PPV and PVI were correlated in the SP (r
= 0.578; p = 0.001) and the TP (r = 0.517;
p = 0.001).
Conclusions. Our results showed that the
PPV and PVI were correlated independent
of position change in sepsis patients. Both
tests appear to be equivalently reliable.
However, the ability of the PPV and PVI
to predict fluid responsiveness decreased
in the TP in our study
The prognostic value of cerebral oxygen saturation measurement for assessing prognosis after cardiopulmonary resuscitation
AbstractBackgroundDespite new improvements on cardiopulmonary resuscitation (CPR), brain damage is very often after resuscitation.ObjectiveTo assess the prognostic value of cerebral oxygen saturation measurement (rSO2) for assessing prognosis on patients after cardiopulmonary resuscitation.DesignRetrospective analysis.Measurements and resultsWe analyzed 25 post-CPR patients (12 female and 13 male). All the patients were cooled to a target temperature of 33–34°C. The Glascow Coma Scale (GCS), Corneal Reflexes (CR), Pupillary Reflexes (PR), arterial Base Excess (BE) and rSO2 measurements were taken on admission. The rewarming GCS, CR, PR, BE and rSO2 measurements were made after the patient's temperature reached 36°C.ResultsIn survivors, the baseline rSO2 value was 67.5 (46–70) and the percent difference between baseline and rewarming rSO2 value was 0.03 (0.014–0.435). In non-survivors, the baseline rSO2 value was 30 (25–65) and the percent difference between baseline and rewarming rSO2 value was 0.031 (−0.08 to −20). No statistical difference was detected on percent changes between baseline and rewarming values of rSO2. Statistically significant difference was detected between baseline and rewarming GCS groups (p=0.004). No statistical difference was detected between GCS, CR, PR, BE and rSO2 to determine the prognosis.ConclusionDespite higher values of rSO2 on survivors than non-survivors, we found no statistically considerable difference between groups on baseline and the rewarming rSO2 values. Since the measurement is simple, and not affected by hypotension and hypothermia, the rSO2 may be a useful predictor for determining the prognosis after CPR
The prognostic value of cerebral oxygen saturation measurement for assessing prognosis after cardiopulmonary resuscitation
Abstract Background: Despite new improvements on cardiopulmonary resuscitation (CPR), brain damage is very often after resuscitation. Objective: To assess the prognostic value of cerebral oxygen saturation measurement (rSO2) for assessing prognosis on patients after cardiopulmonary resuscitation. Design: Retrospective analysis. Measurements and results: We analyzed 25 post-CPR patients (12 female and 13 male). All the patients were cooled to a target temperature of 33-34 °C. The Glascow Coma Scale (GCS), Corneal Reflexes (CR), Pupillary Reflexes (PR), arterial Base Excess (BE) and rSO2 measurements were taken on admission. The rewarming GCS, CR, PR, BE and rSO2 measurements were made after the patient's temperature reached 36 °C. Results: In survivors, the baseline rSO2 value was 67.5 (46-70) and the percent difference between baseline and rewarming rSO2 value was 0.03 (0.014-0.435). In non-survivors, the baseline rSO2 value was 30 (25-65) and the percent difference between baseline and rewarming rSO2 value was 0.031 (-0.08 to -20). No statistical difference was detected on percent changes between baseline and rewarming values of rSO2. Statistically significant difference was detected between baseline and rewarming GCS groups (p = 0.004). No statistical difference was detected between GCS, CR, PR, BE and rSO2 to determine the prognosis. Conclusion: Despite higher values of rSO2 on survivors than non-survivors, we found no statistically considerable difference between groups on baseline and the rewarming rSO2 values. Since the measurement is simple, and not affected by hypotension and hypothermia, the rSO2 may be a useful predictor for determining the prognosis after CPR