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Estimation of pulse pressure variation and cardiac output in patients having major abdominal surgery: a comparison between a mobile application for snapshot pulse wave analysis and invasive pulse wave analysis
AbstractPulse pressure variation (PPV) and cardiac output (CO) can guide perioperative fluid management. Capstesia (Galenic App, Vitoria-Gasteiz, Spain) is a mobile application for snapshot pulse wave analysis (PWAsnap) and estimates PPV and CO using pulse wave analysis of a snapshot of the arterial blood pressure waveform displayed on any patient monitor. We evaluated the PPV and CO measurement performance of PWAsnap in adults having major abdominal surgery. In a prospective study, we simultaneously measured PPV and CO using PWAsnap installed on a tablet computer (PPVPWAsnap, COPWAsnap) and using invasive internally calib...
Source: Journal of Clinical Monitoring and Computing - August 4, 2020 Category: Information Technology Source Type: research

Iterative heuristic design of temporal graphic displays with clinical domain experts
AbstractConventional electronic health record information displays are not optimized for efficient information processing. Graphical displays that integrate patient information can improve information processing, especially in data-rich environments such as critical care. We propose an adaptable and reusable approach to patient information display with modular graphical components (widgets). We had two study objectives. First, reduce numerous widget prototype alternatives to preferred designs. Second, derive widget design feature recommendations. Using iterative human-centered design methods, we interviewed experts to hone...
Source: Journal of Clinical Monitoring and Computing - August 2, 2020 Category: Information Technology Source Type: research

Computerized 4-choice reaction time test for the measurement of psychomotor recovery after general anesthesia
AbstractThe recovery of patients after general anesthesia is usually estimated by using clinical scores. Since there is a lack of objective methods for assessing psychomotor recovery, the aim of this study was to evaluate three psychological tests for this purpose. Patients, scheduled for ambulatory gynecological surgery, underwent 3 standard psychological tests before (T1), 15  min after the surgery (T2) and on discharge from the recovery room (T3). The tests used were Wechsler memory scale (test 1, working memory capacity), d2 —test (test 2, concentration endurance) and computer-based 4-choice-reaction time (4...
Source: Journal of Clinical Monitoring and Computing - July 18, 2020 Category: Information Technology Source Type: research

A new device for real-time peroperative monitoring of ossicular chain reconstruction during middle ear surgery
AbstractTo limit functional surgical failure and reduce the rate of revision surgery in case of surgical ossicular chain reconstruction, a piezoelectric device was developed for assessment of ossicular chain vibrations during the middle ear surgery. The device resembled a pen and consisted of a reusable main body and a disposable sensitive head including piezoelectric polymer sensor. Almost all of components of the device were made of polymer for light weight and for acoustic impedance matching to the middle ear system. Several frequencies can be analyzed simultaneously and several measures can be taken by time. The result...
Source: Journal of Clinical Monitoring and Computing - July 18, 2020 Category: Information Technology Source Type: research

Preoperative transcranial Doppler and cerebral oximetry as predictors of delirium following valvular heart surgery: a case –control study
AbstractDelirium is a frequent and serious complication after cardiac surgery with cerebral hypoperfusion as one from the key pathophysiological mechanisms. Middle cerebral artery (MCA) mean blood flow velocity (MFV) measured by transcranial Doppler has been used as a marker of cerebral perfusion, and cerebral oximetry (rSO2) value as a marker of its adequacy. This prospective observational trial examined the predictive value of MCA MFV and rSO2, measured immediately before induction of anesthesia, for delirium after valvular heart surgery in elderly patients. In 113 patients, delirium was evaluated for 7  days postop...
Source: Journal of Clinical Monitoring and Computing - July 18, 2020 Category: Information Technology Source Type: research

Detecting intraoperative gastric regurgitation by using preattached esophageal multichannel intraluminal impedance and pH monitoring on a solid-state manometry: a case series study
In this study, we developed preattached multichannel intraluminal impedance monitoring combined with pH-metry (the gold standard for detecting both height and acidity) on a solid-state manometry to continuously detect intraoperative GER as well as BrP changes. We used this system to record LESP, IGP, and changes in impedance through multichannel sensors and pH in patients receiving elective gynecological laparoscopy with laparoscopic pneumoperitoneum and Trendelenburg (LPT) positioning. Changes in BrP were analyzed at three time points (T1: before LPT; T2: during LPT when LESP reached its peak; and T3: after the offset of ...
Source: Journal of Clinical Monitoring and Computing - July 18, 2020 Category: Information Technology Source Type: research

Towards development of alert thresholds for clinical deterioration using continuous predictive analytics monitoring
AbstractPatients who deteriorate while on the acute care ward and are emergently transferred to the Intensive Care Unit (ICU) experience high rates of mortality. To date, risk scores for clinical deterioration applied to the acute care wards rely on static or intermittent inputs of vital sign and assessment parameters. We propose the use of continuous predictive analytics monitoring, or data that relies on real-time physiologic monitoring data captured from ECG, documented vital signs, laboratory results, and other clinical assessments to predict clinical deterioration. A necessary step in translation to practice is unders...
Source: Journal of Clinical Monitoring and Computing - July 18, 2020 Category: Information Technology Source Type: research

Detection of intratracheal accumulation of thick secretions by using continuous monitoring of respiratory acoustic spectrum: a preliminary analysis
In this study, we analyzed the respiratory sound spectrum in patients with intratracheal secretion, and compared acoustic characteristics before and after therapeutic endotracheal suctioning. After review of anesthetic records of liver transplant recipients, we included recipients with identified intratracheal secretion during surgery. Intraoperative breath sounds recorded through esophageal stethoscope were sampled in 20  s-period before and after suctioning of secretion and analyzed using fast Fourier transform. We also analyzed normal breath sounds from recipients without any respiratory problem as control group. T...
Source: Journal of Clinical Monitoring and Computing - July 18, 2020 Category: Information Technology Source Type: research

Intracranial pressure variability: relation to clinical outcome, intracranial pressure –volume index, cerebrovascular reactivity and blood pressure variability
In this study, we aimed to further investigate the explanatory variables for ICPV and its relation to outcome. Data from 362 TBI patients were retrospectively analyzed day 2 to 5 post-injury. ICPV was evaluated in three ways. First, variability in the sub-minute time interval (similar to B waves) was calculated as the amplitude of the ICP slow waves using a bandpass filter, limiting the analysis to oscillations of 55 to 15  s (ICP AMP 55–15). The second and third ICPV measures were calculated as the deviation from the mean ICP averaged over 30 min (ICPV-30m) and 4 h (ICPV-4h), respectively. All ICPV me...
Source: Journal of Clinical Monitoring and Computing - July 18, 2020 Category: Information Technology Source Type: research

Feasibility evaluation of non-invasive cardiac function technology during echocardiography-based cardiac stress testing
AbstractEvaluation of cardiac function during periods of stress is of key importance for the perioperative setting. Non-invasive hemodynamic monitors provide markers of cardiac function. This pilot study sought to evaluate the ability of a non-invasive hemodynamic monitor to detect cardiac stress during formal stress echocardiography testing. The primary goal was to compare the change in hemodynamic values during the pre/during/post phases of stress echocardiography testing in patients who had results negative versus positive for myocardial ischemia. Adult patients scheduled for outpatient cardiac stress testing were scree...
Source: Journal of Clinical Monitoring and Computing - July 18, 2020 Category: Information Technology Source Type: research

Comparison between two mathematical methods to estimate arterial occlusion pressure and tourniquet effectiveness in lower limb surgery: a prospective, randomized, double blind, comparative study
AbstractThe effectiveness of two different methods for calculating the arterial occlusion pressure (AOP) to set tourniquet inflation pressures were assessed in patients underwent knee arthroscopy. Eighty patients were included in this study. Tourniquet inflation pressure was set by adding 20  mmHg of safety margin above the AOP value which was calculated by either the Tuncali et al. formula or Hong-yun Liu et al. formula. Primary outcome measures were the initial and maximum SBP, initial and maximum tourniquet inflation pressure, the secondary outcomes were the surgeon rating of the bl oodlessness of the surgical fiel...
Source: Journal of Clinical Monitoring and Computing - July 18, 2020 Category: Information Technology Source Type: research

Cardiac output estimation using multi-beat analysis of the radial arterial blood pressure waveform: a method comparison study in patients having off-pump coronary artery bypass surgery using intermittent pulmonary artery thermodilution as the reference method
AbstractPulse wave analysis enables stroke volume to be estimated from an arterial blood pressure waveform. Multi-beat analysis is a novel pulse wave analysis method. We aimed to investigate cardiac output (CO) estimations using multi-beat analysis of the radial arterial blood pressure waveform in patients undergoing off-pump coronary artery bypass surgery (OPCAB) using intermittent pulmonary artery thermodilution (PATD) as the reference method. This was a prospective clinical method comparison study. In 58 patients, we measured CO using PATD (PATD-CO; reference method) and simultaneously recorded the radial arterial blood...
Source: Journal of Clinical Monitoring and Computing - July 18, 2020 Category: Information Technology Source Type: research

A novel method for transpulmonary pressure estimation using fluctuation of central venous pressure
The objective of the study is to develop a correction method for estimating the change in pleural pressure ( ΔPpl) and plateau transpulmonary pressure (PL) by using the change in central venous pressure ( ΔCVP). Seven children (aged
Source: Journal of Clinical Monitoring and Computing - July 18, 2020 Category: Information Technology Source Type: research

Comparison of multiple cardiac signal acquisition technologies for heart rate variability analysis
In this study, we developed a technology allowing the simultaneous monitoring of electrocardiography, phonocardiography, seismocardiography, photoplethysmocardiography and piezoplethysmocardiography and investigated whether these sensors could be used for HRV analysis. We therefore tested the evolution of several HRV parameters computed from several sensors before, during and after a postural change. The main findings of our study is that even if most sensors were suitable for mean HR computation, some of them demonstrated limited agreement for several HRV analyses methods. We also demonstrated that piezoplethysmocardiogra...
Source: Journal of Clinical Monitoring and Computing - July 18, 2020 Category: Information Technology Source Type: research

Perioperative intelligence: applications of artificial intelligence in perioperative medicine
(Source: Journal of Clinical Monitoring and Computing)
Source: Journal of Clinical Monitoring and Computing - July 18, 2020 Category: Information Technology Source Type: research

Shedding light on perioperative hemodynamic monitoring
AbstractGiven the number of clinical studies and meta-analyses investigating the impact of cardiac output-guided hemodynamic management on the postoperative outcome of patients undergoing high-risk surgery, clinicians should already have a fair idea of the clinical and economic benefits. However, this is still a matter of debate, there are still large outcome studies going on, and surveys and audits have shown that clinical adoption remains low. Rational patient selection, more affordable monitoring solutions, and the personalization of therapeutic strategies are desirable to ensure that cardiac output monitoring adds valu...
Source: Journal of Clinical Monitoring and Computing - July 18, 2020 Category: Information Technology Source Type: research

Capnography-sample line leak and incremental positive end expiratory pressure (PEEP); an interesting interplay
AbstractThe capnography is an important monitor to assess the patient ’s respiratory status. Importance of education for clinicians in interpretation of alarms and various capnography waveforms in different clinical scenarios and equipment malfunction is an understatement. Capnography waveforms due to sample line tube leak is described well in literature. This repor t describes an interesting effect of incremental positive end expiratory pressure (PEEP) on capnography waveforms linked to sample line leak. (Source: Journal of Clinical Monitoring and Computing)
Source: Journal of Clinical Monitoring and Computing - July 18, 2020 Category: Information Technology Source Type: research

Using real-time location devices (RTLD) to quantify off-unit adult intensive care registrar workload: a 1-year tertiary NHS hospital prospective observational study
AbstractUK national guidelines state deteriorating or at risk hospital ward patients should receive care from trained critical care outreach personnel. In most tertiary hospitals this involves a team led by an Intensive Care Unit (ICU) registrar. The ICU registrar must also review patients referred for possible ICU admission. These two responsibilities require work away from the ICU. To our knowledge the burden of this work has not been described, despite its importance in ICU workforce management and patient safety. A 12-month, prospective, observational study was carried out. The primary outcome measure was ICU registrar...
Source: Journal of Clinical Monitoring and Computing - July 18, 2020 Category: Information Technology Source Type: research

Conductive heating mattress leads to ECG changes that mimic pacemaker spikes
AbstractHypothermia is a common perioperative complication. To prevent perioperative hypothermia amongst other things electrical heating mattresses are used. We have made an observation with the use of an electrical heating mattress that may confuse users. In this case the ECG monitoring suddenly showed spikes that looked like spikes from an implanted pacemaker. When turning off the heating mattress the spikes disappeared and returned after turning on the heating mattress again. (Source: Journal of Clinical Monitoring and Computing)
Source: Journal of Clinical Monitoring and Computing - July 15, 2020 Category: Information Technology Source Type: research

Trans-ocular brain impedance index for assessment of cerebral autoregulation in a porcine model of cerebral hemodynamic perturbation
In this study, we monitored impedance metrics such as respiratory-induced impedance amplitude changes (dz) as well as a novel impedance index (DZx), which is a moving Pearson correlation between mean arterial pressure (MAP) anddz. Yorkshire swine were instrumented to continuously record ICP, MAP, and cerebral blood flow (CBF). TOBI was recorded by placement of standard ECG electrodes on closed eyelids and connected to a data acquisition system. MAP, ICP and CBF were manipulated utilizing an intravenous vasopressor challenge. TOBI indices (dz and DZx) were compared to the hemodynamic indicators as well as pressure reactivit...
Source: Journal of Clinical Monitoring and Computing - July 14, 2020 Category: Information Technology Source Type: research

Quantitative assessment of consciousness during anesthesia without EEG data
AbstractAssessing the depth of anesthesia (DoA) is a daily challenge for anesthesiologists. The best assessment of the depth of anesthesia is commonly thought to be the one made by the doctor in charge of the patient. This evaluation is based on the integration of several parameters including epidemiological, pharmacological and physiological data. By developing a protocol to record synchronously all these parameters we aim at having this evaluation made by an algorithm. Our hypothesis was that the standard parameters recorded during anesthesia (without EEG) could provide a good insight into the consciousness level of the ...
Source: Journal of Clinical Monitoring and Computing - July 13, 2020 Category: Information Technology Source Type: research

A new implementation of EN1839 method T mixture preparation to prepare calibration gas mixtures for anesthetic gas monitors
In this study different mixtures from anesthetic liquids vapours in air and O2—sevoflurane/air, sevoflurane/O2 and isoflurane/O2—were prepared according to EN1839 method T. The gases mixtures were used to calibrate anesthetic gas monitors. The targeted concentrations (TCs) from sevoflurane and isoflurane in air and O2 were 0 vol%, 0.15 vol%, 0.7 vol%, 1 vol%, 1.5 vol%, 2.5 vol%, 5 vol%, 6 vol% and 8 vol%. The values of liquids, air and O2 flow rates which are corresponding theoretically to the TCs were calculated. The results showed that the measured concentrations by anesthetic gas monitor are in good agreemen...
Source: Journal of Clinical Monitoring and Computing - July 8, 2020 Category: Information Technology Source Type: research

First, do no harm: bilateral radial artery occlusion in a COVID-19 patient
ConclusionsSince COVID-19 patients are at increased risk for arterial occlusion, it appears advisable to meticulously check for adequacy of collateral (hand-) perfusion, avoiding the harm of hand ischemia if interventions (e.g., catheterizations) at the radial or ulnar artery are intended. (Source: Journal of Clinical Monitoring and Computing)
Source: Journal of Clinical Monitoring and Computing - July 6, 2020 Category: Information Technology Source Type: research

Cautionary findings for motor evoked potential monitoring in intracranial aneurysm surgery after a single administration of rocuronium to facilitate tracheal intubation
This study demonstrates that the duration of relaxation for MEP monitoring purposes is well-beyond the routinely recognized clinical duration of rocuronium. Residual neuromuscular blockade could result in lower amplitude MEP signals and/or lead to higher required MEP stim ulus intensities which can both compromise monitoring sensitivity. (Source: Journal of Clinical Monitoring and Computing)
Source: Journal of Clinical Monitoring and Computing - July 2, 2020 Category: Information Technology Source Type: research

Non-invasive assessment of respiratory muscle activity during pressure support ventilation: accuracy of end-inspiration occlusion and least square fitting methods
AbstractPressure support ventilation (PSV) should be titrated considering the pressure developed by the respiratory muscles (Pmusc) to prevent under- and over-assistance. The esophageal pressure (Pes) is the clinical gold standard for Pmusc assessment, but its use is limited by alleged invasiveness and complexity. Theleast square fitting method and theend-inspiratory occlusion method have been proposed as non-invasive alternatives for Pmusc assessment. The aims of this study were: (1) to compare the accuracy of Pmusc estimation using theend-inspiration occlusion (Pmusc,index) and theleast square fitting (Pmusc,lsf) against...
Source: Journal of Clinical Monitoring and Computing - July 2, 2020 Category: Information Technology Source Type: research

On some factors determining the pressure drop across tracheal tubes during high-frequency percussive ventilation: a flow-independent model
AbstractTo provide an in vitro estimation of the pressure drop across tracheal tubes ( ΔPTT) in the face of given pulsatile frequencies and peak pressures (Pwork) delivered by a high-frequency percussive ventilator (HFPV) applied to a lung model. Tracheal tubes (TT) 6.5, 7.5 and 8.0 were connected to a test lung simulating the respiratory system resistive (R  = 5, 20, 50 cmH2O/L/s) and elastic (C  = 10, 20, and 50 mL/cmH2O) loads. The model was ventilated by HFPV with a pulse inspiratory peak pressure (work pressure Pwork) augmented in 5-cmH2O steps from 20 to 45 cmH2O, yielding 6 diverse ...
Source: Journal of Clinical Monitoring and Computing - June 25, 2020 Category: Information Technology Source Type: research

COVID-19: Pulse oximeters in the spotlight
AbstractFrom home to intensive care units, innovations in pulse oximetry are susceptible to improve the monitoring and management of patients developing acute respiratory failure, and particularly those with the coronavirus disease 2019 (COVID-19). They include self-monitoring of oxygen saturation (SpO2) from home, continuous wireless SpO2 monitoring on hospital wards, and the integration of SpO2 as the input variable for closed-loop oxygen administration systems. The analysis of the pulse oximetry waveform may help to quantify respiratory efforts and prevent intubation delays. Tracking changes in the peripheral perfusion ...
Source: Journal of Clinical Monitoring and Computing - June 23, 2020 Category: Information Technology Source Type: research

Comparing the effect of positioning on cerebral autoregulation during radical prostatectomy: a prospective observational study
ConclusionCompared with open radical prostatectomy in the supine position, robot-assisted surgery in the extreme Trendelenburg position with capnoperitoneum did not lead to an impairment of cerebral autoregulation during the perioperative period in our study population.Trial registration number: DRKS00010014, date of registration: 21.03.2016, retrospectively registered. (Source: Journal of Clinical Monitoring and Computing)
Source: Journal of Clinical Monitoring and Computing - June 20, 2020 Category: Information Technology Source Type: research

Heart-rate tuned comb filters for processing photoplethysmogram (PPG) signals in pulse oximetry
In this study, we compare two$${\text{SpO}}_{{\text{2}}}$$-level calculation techniques, and measure the effect of pre-filtering by a heart-rate tuned comb peak filter on their performance. These techniques are: (1) “Red over Infrared,” calculating the ratios of AC and DC components of the red and infrared PPG signals,$$\frac{(AC/DC)_{red}}{(AC/DC)_{infrared}}$$, followed by the use of a calibration curve to determine the$${\text{SpO}}_{{\text{2}}}$$ level Webster (in: Design of pulse oximeters, CRC Press, Boca Raton, 1997); and (2) a motion-resistant algorithm which uses the Discrete Saturation Transform (DST)...
Source: Journal of Clinical Monitoring and Computing - June 17, 2020 Category: Information Technology Source Type: research

Ultrasound prediction for vocal cord dysfunction in patients scheduled for anterior cervical spine surgeries: a prospective cohort study
This study aimed to detect the validity of transcutaneous laryngeal ultrasonography by both anterior and novel lateral approaches for prediction of vocal cord edema and paralysis after anterior cervical spine surgeries. A prospective cohort study conducted on 90 patients scheduled for anterior cervical spine surgeries underwent consecutive pre and postoperative vocal cord examination for edema and paralysis by both anterior and lateral approaches laryngeal ultrasonography. Rigid laryngoscopy was the standard confirmatory tool. For postoperative vocal cord edema, the anterior ultrasonography approach diagnostic sensitivity ...
Source: Journal of Clinical Monitoring and Computing - June 15, 2020 Category: Information Technology Source Type: research

A new reliable acoustic respiratory monitoring technology during upper gastrointestinal tract therapeutic endoscopy with CO 2 insufflation
In this study, we compare a new device with acoustic monitoring technology to standard capnography monitoring. We retrospectively analyzed 49 patients who underwent endoscopic resection of early upper gastrointestinal tract cancer between December 2013 and October 2014. All 49 patients were monitored using both acoustic monitoring technology and standard capnography. We investigated the duration of the periods with unmeasurable respiratory rate during the overall procedure. When comparing standard capnography monitoring to the new acoustic monitoring technology, the ratio of the unmeasurable time was significantly lower in...
Source: Journal of Clinical Monitoring and Computing - June 15, 2020 Category: Information Technology Source Type: research

The case for a 3rd generation supraglottic airway device facilitating direct vision placement
AbstractAlthough 1st and 2nd generation supraglottic airway devices (SADs) have many desirable features, they are nevertheless inserted in a similar ‘blind’ way as their 1st generation predecessors. Clinicians mostly still rely entirely on subjective indirect assessments to estimate correct placement which supposedly ensures a tight seal. Malpositioning and potential airway compromise occurs in more than half of placements. Vision-guided ins ertion can improve placement. In this article we propose the development of a 3rd generation supraglottic airway device, equipped with cameras and fiberoptic illumination, ...
Source: Journal of Clinical Monitoring and Computing - June 15, 2020 Category: Information Technology Source Type: research

Assessment of spontaneous breathing during pressure controlled ventilation with superimposed spontaneous breathing using respiratory flow signal analysis
AbstractIntegrating spontaneous breathing into mechanical ventilation (MV) can speed up liberation from it and reduce its invasiveness. On the other hand, inadequate and asynchronous spontaneous breathing has the potential to aggravate lung injury. During use of airway-pressure-release-ventilation (APRV), the assisted breaths are difficult to measure. We developed an algorithm to differentiate the breaths in a setting of lung injury in spontaneously breathing ewes. We hypothesized that differentiation of breaths into spontaneous, mechanical and assisted is feasible using a specially developed for this purpose algorithm. Ve...
Source: Journal of Clinical Monitoring and Computing - June 13, 2020 Category: Information Technology Source Type: research

Predictive value of the respiratory exchange ratio for the occurrence of postoperative complications in laparoscopic surgery: a prospective and observational study
AbstractIndirect measurement of the respiratory exchange ratio (RER) has been shown to predict the occurrence of postoperative complications after major open non-cardiac surgery. Our main objective was to demonstrate the ability of the RER, indirectly measured by the anaesthesia respirator, to predict the occurrence of postoperative complications following laparoscopic surgery. We performed an observational, prospective and monocentric study. Haemodynamic and respiratory parameters were collected at several timepoints to calculate the RER by a non-volumetric method: RER  = (FetCO2–FiCO2)/(FiO2–Fet...
Source: Journal of Clinical Monitoring and Computing - June 12, 2020 Category: Information Technology Source Type: research

Performance of closed-loop resuscitation in a pig model of haemorrhagic shock with fluid alone or in combination with norepinephrine, a pilot study
AbstractWe evaluated the performance of a new device to control the administration of fluid alone or co-administration of fluid and norepinephrine in a pig model of haemorrhagic shock in two sets of experiments. In the first one, resuscitation was guided using continuous arterial pressure measurements (three groups: resuscitation with fluid by a physician, CL resuscitation with fluid, and CL resuscitation with fluid and norepinephrine). In the second one, resuscitation was guided using discontinuous arterial pressure measurements (three groups: CL resuscitation with fluid alone, CL resuscitation with fluid and moderate dos...
Source: Journal of Clinical Monitoring and Computing - June 12, 2020 Category: Information Technology Source Type: research

A new approach to complicated and noisy physiological waveforms analysis: peripheral venous pressure waveform as an example
AbstractWe introduce a recently developed nonlinear-type time –frequency analysis tool, synchrosqueezing transform (SST), to quantify complicated and noisy physiological waveform that has time-varying amplitude and frequency. We apply it to analyze a peripheral venous pressure (PVP) signal recorded during a seven hours aortic valve replacement procedure. In addition to showing the captured dynamics, we also quantify how accurately we can estimate the instantaneous heart rate from the PVP signal. (Source: Journal of Clinical Monitoring and Computing)
Source: Journal of Clinical Monitoring and Computing - June 11, 2020 Category: Information Technology Source Type: research

Cardiovascular dynamics during peroral endoscopic myotomy for esophageal achalasia: a prospective observational study using non-invasive finger cuff-derived pulse wave analysis
AbstractPeroral endoscopic myotomy (POEM) is natural orifice transluminal endoscopic surgery to treat esophageal achalasia. During POEM, cardiovascular dynamics can be impaired by capnoperitoneum, capnomediastinum, and systemic carbon dioxide accumulation. We systematically investigated changes in cardiovascular dynamics during POEM. We included 31 patients having POEM in this single-center prospective observational study. Before and every 5 min during POEM we measured mean arterial pressure (MAP), heart rate (HR), cardiac index (CI), stroke volume index (SVI), and systemic vascular resistance index (SVRI) using non-invasi...
Source: Journal of Clinical Monitoring and Computing - June 5, 2020 Category: Information Technology Source Type: research

Comparison of haemodynamic- and electroencephalographic-monitored effects evoked by four combinations of effect-site concentrations of propofol and remifentanil, yielding a predicted tolerance to laryngoscopy of 90%
AbstractThis prospective study evaluates haemodynamic and electroencephalographic effects observed when administering four combinations of effect-site concentrations of propofol (CePROP) and remifentanil (CeREMI), all yielding a single predicted probability of tolerance of laryngoscopy of 90% (PTOL = 90%) according to the Bouillon interaction model. We aimed to identify combinations of CePROP and CeREMI along a single isobole of PTOL that result in favourable hypnotic and haemodynamic conditions. This knowledge could be of advantage in the development of drug advisory monitoring technology. 80 patients (18 &n...
Source: Journal of Clinical Monitoring and Computing - June 3, 2020 Category: Information Technology Source Type: research

Accuracy and precision of zero-heat-flux temperature measurements with the 3M ™ Bair Hugger™ Temperature Monitoring System: a systematic review and meta-analysis
AbstractZero-heat-flux thermometers provide clinicians with the ability to continuously and non-invasively monitor body temperature. These devices are increasingly being used to substitute for more invasive core temperature measurements during surgery and in critical care. The aim of this review was to determine the accuracy and precision of zero-heat-flux temperature measurements from the 3M ™ Bair Hugger™ Temperature Monitoring System. Medline and EMBASE were searched for studies that reported on a measurement of core or peripheral temperature that coincided with a measurement from the zero-heat-flux device. ...
Source: Journal of Clinical Monitoring and Computing - June 2, 2020 Category: Information Technology Source Type: research

Evaluation of a new wireless technique for continuous electroencephalography monitoring in neurological intensive care patients
AbstractA novel wireless eight-channel electroencephalography (EEG) headset specially developed for ICUs was tested in regard of comparability with standard 10/20 EEG systems. The continuous EEG (cEEG) derivations via CerebAir EEG headset (Nihon Kohden Europe, Rosbach, Germany) and internationally standardized 10/20 reference EEGs as the diagnostic standard were performed in a mixed collective on a neurointensive care unit (neuro-ICU). The derivations were verified for comparability in detection of EEG background activity, epileptiform discharges, and seizure patterns. Fifty-two patients with vigilance reduction following ...
Source: Journal of Clinical Monitoring and Computing - June 2, 2020 Category: Information Technology Source Type: research

Variations in respiratory rate do not reflect changes in tidal volume or minute ventilation after major abdominal surgery
AbstractMonitoring of postoperative pulmonary function usually includes respiratory rate and oxygen saturation measurements. We hypothesized that changes in postoperative respiratory rate do not correlate with changes in tidal volume or minute ventilation. In addition, we hypothesized that variability of minute ventilation and tidal volume is larger than variability of respiratory rate. Respiratory rate and changes in tidal volume and in minute ventilation were continuously measured in 27 patients during 24  h following elective abdominal surgery, using an impedance-based non-invasive respiratory volume monitor (ExSpi...
Source: Journal of Clinical Monitoring and Computing - June 1, 2020 Category: Information Technology Source Type: research

The value of a superior vena cava collapsibility index measured with a miniaturized transoesophageal monoplane continuous echocardiography probe to predict fluid responsiveness compared to stroke volume variations in open major vascular surgery: a prospective cohort study
AbstractSuperior vena cava collapsibility index (SVC-CI) and stroke volume variation (SVV) have been shown to predict fluid responsiveness. SVC-CI has been validated only with conventional transoesophageal echocardiography (TEE) in the SVC long axis, on the basis of SVC diameter variations, but not in the SVC short axis or by SVC area variations. SVV was not previously tested in vascular surgery patients. Forty consecutive adult patients undergoing open major vascular surgical procedures received 266 intraoperative volume loading tests (VLTs), with 500  ml of gelatine over 10 min. The hSVC-CI was measured using a...
Source: Journal of Clinical Monitoring and Computing - May 7, 2020 Category: Information Technology Source Type: research

Early changes in diaphragmatic function evaluated using ultrasound in cardiac surgery patients: a cohort study
AbstractLittle is known about the evolution of diaphragmatic function in the early post-cardiac surgery period. The main purpose of this work is to describe its evolution using ultrasound measurements of muscular excursion and thickening fraction (TF). Single-center prospective study of 79 consecutive uncomplicated elective cardiac surgery patients, using motion-mode during quiet unassisted breathing. Excursion and TF were measured sequentially for each patient [pre-operative  (D1), 1 day (D2) and 5 days (D3) after surgery]. Pre-operative median for right and left hemidiaphragmatic excursions were 1.8 (IQR 1...
Source: Journal of Clinical Monitoring and Computing - May 7, 2020 Category: Information Technology Source Type: research

Event-triggered averaging of electrical impedance tomography (EIT) respiratory waveforms as compared to low-pass filtering for removal of cardiac related impedance changes
AbstractElectrical impedance tomography (EIT) is used for bedside ventilation monitoring; cardiac related impedance changes represent a source of noise superimposed on the ventilation signal, commonly removed by low-pass filtering (LPF). We investigated if an alternative approach, based on an event-triggered averaging (ETA) process, is more effective at preserving the actual ventilation waveform. Ten paralyzed patients undergoing volume-controlled ventilation were studied; 30 breaths for each patient were identified to compare LPF and ETA. For ETA the identified breaths were temporally aligned on the beginning of inspirati...
Source: Journal of Clinical Monitoring and Computing - May 7, 2020 Category: Information Technology Source Type: research

Improving the prognostic value of ∆PCO 2 following cardiac surgery: a prospective pilot study
AbstractConflicting results have been published on prognostic significance of central venous to arterial PCO2 difference ( ∆PCO2) after cardiac surgery. We compared the prognostic value of ∆PCO2 on intensive care unit (ICU) admission to an original algorithm combining ∆PCO2, ERO2 and lactate to identify different risk profiles. Additionally, we described the evolution of ∆PCO2 and its correlations with ERO2 and lactate during the first postoperative day (POD1). In this monocentre, prospective, and pilot study, 25 patients undergoing conventional cardiac surgery were included. Central venous and arterial blood gases...
Source: Journal of Clinical Monitoring and Computing - May 7, 2020 Category: Information Technology Source Type: research

Warning criteria for MEP monitoring during carotid endarterectomy: a retrospective study of 571 patients
This study is the first to evaluate the correctness of the MEP warning criteria AMP, AUC and MOR with regard to false positive monitoring results in the context of CEA. All additional MEP warning criteria investigated produced an unacceptably high number of false positives and therefore may not be useful in carotid surgery for adequate detection of clamping-associated ischemia. (Source: Journal of Clinical Monitoring and Computing)
Source: Journal of Clinical Monitoring and Computing - May 7, 2020 Category: Information Technology Source Type: research

Validity and reliability of pocket-sized ultrasound devices in measurement of optic nerve sheath diameter in ICU patients
AbstractThe measurement of the optic nerve sheath diameter (ONSD) by ultrasonography (USG) is particularly important for intracranial pressure (ICP) monitoring when invasive measurements are not possible or are contraindicated. Standard USG (SUDs) devices can be bulky and may break down the workflow. The validity and reliability of pocket-sized USG devices (PSUDs) compared to SUDs for ONSD measurement has not been investigated, yet. We compared the reliability and validity of PSUDs with SUDs for ONSD measurement. 35 patients were included in the study. ONSD measurements with PSUDs and SUDs were performed by two clinicians ...
Source: Journal of Clinical Monitoring and Computing - May 7, 2020 Category: Information Technology Source Type: research