Multisite point-of-care potassium testing for patient-focused care.

In the past two decades, a dominant paradigm has been the main laboratory, which is often located far from the patient and characterized by slow response times. The invention of whole blood biosensors and the innovation of point-of-care testing have initiated a paradigm shift in diagnostic medicine that supports the trend toward patient-focused care. The objective of this study was to compare point-of-care potassium testing performed with a handheld potassium analyzer (STAT K, PDx Technologies Inc, Westlake Village, Calif) in the cardiac and intensive care units with potassium measurements obtained similarly in the main laboratory. Two critical care nurses performed point-of-care testing for critically ill patients. In a series of 56 specimens, the mean +/- SD potassium levels were 3.91 +/- 0.53 and 3.94 +/- 0.57 mmol/L when testing was performed at the bedside and in the main laboratory, respectively. The mean paired difference, -0.03 mmol/L, between point-of-care and main laboratory results was not statistically or clinically significant. Point-of-care potassium testing is accurate and precise, as well as clinically efficient for use in patient-focused care settings.

Helium-oxygen mixture in the treatment of postextubation stridor in pediatric trauma patients.

OBJECTIVE: To assess the effectiveness of a helium-oxygen mixture in reducing post-extubation stridor in children hospitalized for burns or trauma. DESIGN: Randomized, controlled crossover trial. SETTING: Harborview Medical Center's Burn and Trauma ICUs from March to September 1989. PATIENTS: Children less than 15 yr old who were electively extubated and had symptoms of postextubation stridor, but required less than or equal to 35% oxygen. INTERVENTION: Each treatment (helium-oxygen and oxygen-supplemented room air) was given in random order for 15 min after extubation. MEASUREMENTS: Respiratory distress was assessed by a physician blinded to treatment order using a standard stridor score and clinical judgment. RESULTS: There were 13 children with 15 extubations; seven (47%) of 15 patients required subsequent treatment with racemic epinephrine or reintubation. Stridor scores were lower with helium-oxygen than with oxygen-supplemented room air (2.8 vs. 3.7, p less than .005), and helium-oxygen was preferred in eight of nine trials in which one treatment was clearly favored by the physician. CONCLUSION: Because helium-oxygen therapy can reduce stridor scores and is clinically preferred by physicians caring for stridorous children, it may be a useful adjunctive therapy in pediatric trauma patients with postextubation stridor.