No abstract

In this model, the systolic pressure and pulse pressure variations, and inferior vena cava flow fluctuations were dependent on IAP values which caused changes in pleural pressure swing, and this dependency was more marked during hypovolaemia. The present study suggests that dynamic indices are not exclusively related to volaemia in the presence of increased IAP. However, their fluid responsiveness predictive value could not be ascertained as no fluid challenge was performed.

Objective: To evaluate a monitor of pulmonary gas exchange (Deltatrac, Datex) in a clinical setting. Design: After in vitro evaluation, comparison over 2 min between ~rO 2 and VCO2 values measured by the Deltatrac and the Douglas bag technique. Comparisons were also achieved over 8 h periods between the Deltatrac and a system using a mass-spectrometer. Setting: Polyvalent intensive care unit (ICU 15 beds) in a 1200 bed general hospital. Patients: Comparison with the Douglas bag technique in I0 patients undergoing controlled ventilation. Comparison with the massspectrometer system in 25 other patients undergoing controlled or pressure support ventilation.Measurements and results: Compared to the results obtained by the Douglas bag technique, the bias (+2SD) for VO2 and VCO2 was -3.5 _+ 26.6 and 6.1 + 12.7 ml' min -i, respectively. By comparison with the mass-spectrometer system, the bias for VO2 and RQ was -5.8_+ 16.0 ml.min -1 and 0.018 + 0.048, respectively. No drift between the two systems was observed over time. Conclusions:The Deltatrac appears suitable for go 2 and VCO2 measurements in ventilated patients and equivalent to a mass-spectrometer system for long term measurements.

Designing new operating room (OR) facilities implies many decisions on the number of ORs, postanesthesia care unit (PACU) beds, and on the staff of nurses and porters. To make these decisions, managers can use rules of thumb or recommendations. Our study highlights the interest of using flow simulation to validate these choices. In this case study we determine the number of PACU beds and porter staff and assess the impact of decreasing the number of porters on PACU bed requirements.

The addition of clonidine to epidural levobupivacaine and sufentanil for patient-controlled epidural analgesia in labour improved analgesia, reduced the supplementation rate and reduced pruritus without improvement in maternal satisfaction. Blood pressure was significantly lower in the clonidine group over time but without clinical consequence.