Tag: BP monitoring - Part 2

Seventy-nine patients were enrolled in this study from September 2003 to June 2005 as a convenience sample. Nine patients were excluded from the analysis as they failed to meet study asthma criteria following post hoc inspection of both outpatient and inpatient records. Of the remaining 70 patients, 19 (27.1%) were admitted to the hospital from the ED. Three patients relapsed within 72 h after hospital discharge and sought medical care. Thus, 48 patients (68.6%) had a good outcome, and 22 patients (31.4%) had a poor outcome. The median length of stay for admitted patients was 2 days. PP was successfully acquired from 63 patients during […]

PP was induced in a healthy adult using an established technique by having him breathe through a fixed resistance connected to a two-way nonrebreathing valve (Hans Rudolph; Kansas City, MO) that was attached to a manometer (OEM Medical; Marshalltown, IA). Airflow resistance occurred during inspiration, whereas expiration was unimpeded. The reference subject’s BP and oximetry plethysmograph findings were recorded continuously in the sitting position while he sequentially generated inspiratory mouth pressures from — 5 to — 20 mm Hg in 5-mm Hg increments. The subject controlled the generated mouth pressures by observing manometer readings. The respiratory rate was 20 breaths/min. Continuous BP was recorded noninvasively […]

The cost of appropriate outpatient care was determined in the same way based on one ED visit without patient relapse, which was defined as an unscheduled medical office or ED visit within 72 h of hospital discharge. The cost of inappropriate inpatient care was based on the average cost in 2004 for conditions denoted by ICD-9 codes 49390 and 49392 for a 1-day hospital admission. This cost also included the ED charges. These patients were identified in the study cohort as those patients who had received a level of care that was low and could have been rendered as an outpatient. The cost of inappropriate […]

All variable distributions were assessed for violation of the assumption of normality based on skewness, the Shapiro-Wilk statistic (a = 0.01), and visualization. Variables having a significant deviation from normal via the Shapiro-Wilk statistic were submitted to the following three linear transformations: square root; natural logarithm; and inverse. The linear transformation that improved the distribution the most was selected. In addition, both the untransformed and transformed distributions were visually inspected to verify normality. The interrater reliability of the objective scoring composite and subscales (transformed where necessary) was estimated using the intraclass correlation coefficients (ICCs) as described by Shrout and Fleiss. A mixed model was used, […]

Continuous BP measurements were obtained noninvasively with a wrist mounted arterial tonometer (NCAT; Nellcor; Pleasanton, CA). The analog output of this device was digitized via an eight-bit analog-to-digital converter (DAQ-500; National Instruments; Austin, TX) [Fig 1]. The sampling rate was 200 Hz. A peak-seeking periodic amplitude analysis algorithm was designed (LabVIEW; National Instruments) that would identify local maxima of the BP from the data stream. Beat-to-beat systolic BP (SBP) was identified using the algorithm recursively. Finally, the algorithm was applied again to the beat-to-beat SBP data to determine the variation in SBP with respiration. The algorithm calculates PP by keeping a moving average of the […]

Patients and Protocol: Adult patients who were 18 to 70 years of age, had a documented history of asthma, and were presenting with shortness of breath and probable asthma exacerbation were approached for study enrollment by trained clinical research assistants. Informed consent was obtained during the ED triage process or shortly thereafter, before ED treatment was initiated. Following patient consent, ED treatment was standardized and completed within 60 min according to NAEPP guidelines, as follows: three sequential nebulized albuterol treatments; and either IV solumedrol, 125 mg, or oral prednisone, 60 mg. Just prior to the initiation of ED treatment and at the end of ED […]

Pulsus paradoxus (PP) is a pathophysiologic vital sign that historically has been a cornerstone in the evaluation of patients with acute asthma.2, However, the measurement of PP is rarely performed, and the accuracy of its measurement via sphygmo-manometry is questionable. Despite this, PP has been used in a number of asthma studies and continues to be a recommended metric by the National Asthma Education and Prevention Program (NAEPP) expert panel report 2. The value of PP as a pathophysiologic measure is well established. Acute asthma is attributable to airway inflammation and reversible airflow limitation leading to dynamic lung hyperinflation.” PP is a measure of inspiratory […]