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Effect of incremental PEEP titration on postoperative pulmonary complications in patients undergoing emergency laparotomy: a randomized controlled trial
AbstractPostoperative pulmonary complications (PPC) has a significant negative impact and are associated with increased length of hospital stay and cost of care. Emergency surgery is a well-established risk factor for PPC. Previous studies reported that personalized positive end-expiratory pressure (PEEP) might reduce postoperative atelectasis and postoperative pulmonary complications.N = 168 adult patients undergoing major emergency laparotomy under general anesthesia were recruited in this study. A minimum driving pressure based incremental PEEP titration was compared to a fixed PEEP of 5 cmH2O. The primary outcome w...
Source: Journal of Clinical Monitoring and Computing - April 1, 2024 Category: Information Technology Source Type: research

Diagnostic utility of perfusion index in identifying radial artery embolism during hyperthermic intraperitoneal chemotherapy procedure: a case report
AbstractInvasive arterial cannulation is a widely used method in intensive care units and operating rooms. However it has potential complications such as thrombosis, peripheral embolism, hematoma formation, and infection. The Masimo Root Radical-7 Pulse CO-Oximeter ® (Masimo Corporation, Irvine, CA, USA) is a non-invasive hemodynamic monitoring device that measures perfusion index and pleth variability index, provides guidance to anaesthesiologists in the cases where hemodynamic fluctuations are expected. In this particular case, the perfusion index played a crucial role in the immediate diagnosis of radial artery embolis...
Source: Journal of Clinical Monitoring and Computing - April 1, 2024 Category: Information Technology Source Type: research

Design of a flow modulation device to facilitate individualized ventilation in a shared ventilator setup
This study aims to resolve the unmet need for ventilator surge capacity by developing a prototype device that can alter patient-specific flow in a shared ventilator setup. The device is designed to deliver a predictable tidal volume (VT), requiring minimal additional monitoring and workload. The prototyped device was tested in an in vitro bench setup for its performance against the intended use and design criteria. The ventilation parameters: VT and airway pressures, and ventilation profiles: pressure, flow and volume were measured for different ventilator and device settings for a healthy and ARDS simulated lung pathology...
Source: Journal of Clinical Monitoring and Computing - April 1, 2024 Category: Information Technology Source Type: research

The evaluation of a non-invasive respiratory monitor in ards patients in supine and prone position
Conclusions: The RVM is accurate in assessing tidal volume and respiratory rate in prone compared to supine position. There fore, the RVM could be applied in non-intubated patients with acute respiratory failure receiving prone positioning to monitor respiratory function. (Source: Journal of Clinical Monitoring and Computing)
Source: Journal of Clinical Monitoring and Computing - March 26, 2024 Category: Information Technology Source Type: research

Non-invasive technology for brain monitoring: definition and meaning of the principal parameters for the International PRactice On TEChnology neuro-moniToring group (I-PROTECT)
AbstractTechnologies for monitoring organ function are rapidly advancing, aiding physicians in the care of patients in both operating rooms (ORs) and intensive care units (ICUs). Some of these emerging, minimally or non-invasive technologies focus on monitoring brain function and ensuring the integrity of its physiology. Generally, the central nervous system is the least monitored system compared to others, such as the respiratory, cardiovascular, and renal systems, even though it is a primary target in most therapeutic strategies. Frequently, the effects of sedatives, hypnotics, and analgesics are entirely unpredictable, ...
Source: Journal of Clinical Monitoring and Computing - March 21, 2024 Category: Information Technology Source Type: research

Estimation of the transpulmonary pressure from the central venous pressure in mechanically ventilated patients
AbstractTranspulmonary pressure (PL) calculation requires esophageal pressure (PES) as a surrogate of pleural pressure (Ppl), but its calibration is a cumbersome technique. Central venous pressure (CVP) swings may reflect tidal variations in Ppl and could be used instead of PES, but the interpretation of CVP waveforms could be difficult due to superposition of heartbeat-induced pressure changes. Thus, we developed a digital filter able to remove the cardiac noise to obtain a filtered CVP (f-CVP). The aim of the study was to evaluate the accuracy of CVP and filtered CVP swings ( ΔCVP and Δf-CVP, respectively) in estimatin...
Source: Journal of Clinical Monitoring and Computing - March 21, 2024 Category: Information Technology Source Type: research

Early prediction of ventricular peritoneal shunt dependency in aneurysmal subarachnoid haemorrhage patients by recurrent neural network-based machine learning using routine intensive care unit data
AbstractAneurysmal subarachnoid haemorrhage (aSAH) can lead to complications such as acute hydrocephalic congestion. Treatment of this acute condition often includes establishing an external ventricular drainage (EVD). However, chronic hydrocephalus develops in some patients, who then require placement of a permanent ventriculoperitoneal (VP) shunt. The aim of this study was to employ recurrent neural network (RNN)-based machine learning techniques to identify patients who require VP shunt placement at an early stage. This retrospective single-centre study included all patients who were diagnosed with aSAH and treated in t...
Source: Journal of Clinical Monitoring and Computing - March 21, 2024 Category: Information Technology Source Type: research

Correction: Clinical performance of lung ultrasound in predicting time-dependent changes in lung aeration in ARDS patients
(Source: Journal of Clinical Monitoring and Computing)
Source: Journal of Clinical Monitoring and Computing - March 16, 2024 Category: Information Technology Source Type: research

Electronic health record data is unable to effectively characterize measurement error from pulse oximetry: a simulation study
AbstractLarge data sets from electronic health records (EHR) have been used in journal articles to demonstrate race-based imprecision in pulse oximetry (SpO2) measurements. These articles do not appear to recognize the impact of the variability of the SpO2 values with respect to time ( “deviation time”). This manuscript seeks to demonstrate that due to this variability, EHR data should not be used to quantify SpO2 error.  Using the MIMIC-IV Waveform dataset, SpO2 values are sampled from 198 patients admitted to an intensive care unit and used as reference samples. The error derived from the EHR data is simulated using...
Source: Journal of Clinical Monitoring and Computing - March 9, 2024 Category: Information Technology Source Type: research

Visual lung ultrasound protocol (VLUP) in acute respiratory failure: description and application in clinical cases
AbstractLung ultrasound (LUS) is widely used as a diagnostic and monitoring tool in critically ill patients. Lung ultrasound score (LUSS) based on the examination of twelve thoracic regions has been extensively validated for pulmonary assessment. However, it has revealed significant limitations: when applied to heterogeneous lung diseases with intermediate LUSS pattern (LUSS 1 and 2), for instance, intra-observer consistency is relatively low. In addition, LUSS is time-consuming and a more rapid overview of the extent of lung pathology and residual lung aeration is often required, especially in emergency setting. We propos...
Source: Journal of Clinical Monitoring and Computing - March 9, 2024 Category: Information Technology Source Type: research

Electroencephalographic guided propofol-remifentanil TCI anesthesia with and without dexmedetomidine in a geriatric population: electroencephalographic signatures and clinical evaluation
AbstractElderly and multimorbid patients are at high risk for developing unfavorable postoperative neurocognitive outcomes; however, well-adjusted and EEG-guided anesthesia may help titrate anesthesia and improve postoperative outcomes. Over the last decade, dexmedetomidine has been increasingly used as an adjunct in the perioperative setting. Its synergistic effect with propofol decreases the dose of propofol needed to induce and maintain general anesthesia. In this pilot study, we evaluate two highly standardized anesthetic regimens for their potential to prevent burst suppression and postoperative neurocognitive dysfunc...
Source: Journal of Clinical Monitoring and Computing - March 7, 2024 Category: Information Technology Source Type: research

Predicted effect-site concentrations of remimazolam for i-gel insertion: a prospective randomized controlled study
This study is the first to report 50% and 95% effect-site concentrations (EC50 and EC95, respectively) of the new short-acting benzodiazepine, remimazolam, for the successful insertion of i-gels with co-administration of fentanyl. Thirty patients (38  ± 5 years old, male/female = 4/26) were randomly assigned into five groups to receive one of five different remimazolam doses (0.1, 0.15, 0.2, 0.25, and 0.3 mg/kg bolus followed by infusion of 1, 1.5, 2, 2.5, and 3 mg/kg/h, respectively, for 10 min), which were designed to maintain a co nstant effect-site concentration of remimazolam at the time of i-gel insertion...
Source: Journal of Clinical Monitoring and Computing - March 5, 2024 Category: Information Technology Source Type: research

When nociception monitoring becomes predictive of surgical outcomes : has the future already become real ?
(Source: Journal of Clinical Monitoring and Computing)
Source: Journal of Clinical Monitoring and Computing - March 5, 2024 Category: Information Technology Source Type: research

Optimal bispectral index exists in healthy patients undergoing general anesthesia: A validation study
ConclusionsFindings here carry implications for the adaptation of the individualized physiologic BISopt concept to non-neural injury populations, both within critical care and the operative theater. However, this work is currently exploratory, and future work is required. (Source: Journal of Clinical Monitoring and Computing)
Source: Journal of Clinical Monitoring and Computing - March 4, 2024 Category: Information Technology Source Type: research

Can the values of the venous-to-arterial PCO2 difference (pCO2 gap) be negative?
AbstractIn this manuscript, we discussed if it is physiologically sound that the difference between venous-to-arterial carbon dioxide partial pressure difference (pCO2 gap) can yield negative values. (Source: Journal of Clinical Monitoring and Computing)
Source: Journal of Clinical Monitoring and Computing - March 4, 2024 Category: Information Technology Source Type: research