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Journal of Clinical Monitoring and Computing

Mads Lumholdt, Kjeld Asbjørn Damgaard, Erika Frischknecht Christensen, Peter Derek Christian Leutscher
Arterial blood gas (ABG) analysis is an essential tool in the clinical assessment of acutely ill patients. Venous to arterial conversion (v-TAC), a mathematical method, has been developed recently to convert peripheral venous blood gas (VBG) values to arterialized VBG (aVBG) values. The aim of this study was to test the validity of aVBG compared to ABG in an emergency department (ED) setting. Twenty ED patients were included in this study. ABG and three aVBG samples were collected from each patient. The aVBG samples were processed in three different ways to investigate appropriate sample handling...
September 8, 2018: Journal of Clinical Monitoring and Computing
Bernd Saugel, Alexandre Joosten, Thomas W L Scheeren
No abstract text is available yet for this article.
August 23, 2018: Journal of Clinical Monitoring and Computing
Gang Li, Liang Lin, Feng Dai, Xiangyang Guo, Lingzhong Meng
The relationship between muscular tissue oxygen saturation (SmtO2 ) during surgery and postoperative nausea and vomiting (PONV) remains to be determined. Patients undergoing robotic hysterectomy participated in this prospective cohort study. SmtO2 of the brachioradialis muscle in the forearm was continuously monitored during surgery. Thresholds based on relative changes or absolute values were systematically assigned. The relationship between thresholds and PONV was investigated based on threshold analysis (i...
August 20, 2018: Journal of Clinical Monitoring and Computing
Caroline M Ruminski, Matthew T Clark, Douglas E Lake, Rebecca R Kitzmiller, Jessica Keim-Malpass, Matthew P Robertson, Theresa R Simons, J Randall Moorman, J Forrest Calland
Predictive analytics monitoring, the use of patient data to provide continuous risk estimation of deterioration, is a promising new application of big data analytical techniques to the care of individual patients. We tested the hypothesis that continuous display of novel electronic risk visualization of respiratory and cardiovascular events would impact intensive care unit (ICU) patient outcomes. In an adult tertiary care surgical trauma ICU, we displayed risk estimation visualizations on a large monitor, but in the medical ICU in the same institution we did not...
August 18, 2018: Journal of Clinical Monitoring and Computing
Achmet Ali, Taner Abdullah, Pulat Akin Sabanci, Lerzan Dogan, Mukadder Orhan-Sungur, Ibrahim Ozkan Akinci
We aimed to compare the ability of pulse pressure variation (PPV) to predict fluid responsiveness in prone and supine positions and investigate effect of body mass index (BMI), intraabdominal pressure (IAP) and static respiratory compliance (CS) on PPV. A total of 88 patients undergoing neurosurgery were included. After standardized anesthesia induction, patients' PPV, stroke volume index (SVI), CS and IAP values were recorded in supine (T1) and prone (T2) positions and after fluid loading (T3). Also, PPV change percentage (PPVΔ% ) between T2 and T1 times was calculated...
August 16, 2018: Journal of Clinical Monitoring and Computing
Jing Liu, Chunyu Ai, Bowen Zhang, Yun Wang, Lara M Brewer, Chien-Kun Ting, Desheng Huang, Lu Yu
Apnea should be monitored continuously in the post anesthesia care unit (PACU) to avoid serious complications. It has been confirmed that tracheal sounds can be used to detect apnea during sedation in healthy subjects, but the performance of this acoustic method has not been evaluated in patients with frequent apnea events in the PACU. Tracheal sounds were acquired from the patients in the PACU using a microphone encased in a plastic bell. Concurrently, a processed nasal pressure signal was used as a reference standard to identify real respiratory events...
August 11, 2018: Journal of Clinical Monitoring and Computing
Sarah Palsen, Albert Wu, Sascha S Beutler, Robert Gimlich, H Keri Yang, Richard D Urman
There is a growing body of literature documenting the use of deep neuromuscular block (NMB) during surgery. Traditional definitions of depth of NMB rely on train-of-four assessment, which can be less reliable in retrospective studies. The goal of our study was to investigate the real-world practice pattern of dosing of neuromuscular blocking agents (NMBA), utilizing the amount of NMBA used during the course of a case, adjusted for patient weight and case duration, as a surrogate measure of depth of NMB. We also aimed to identify case factors associated with larger NMBA doses...
August 9, 2018: Journal of Clinical Monitoring and Computing
Mariana F Lima, Luiz Antonio Mondadori, Aline Y Chibana, Daniel B Gilio, Eduardo Henrique Giroud Joaquim, Frederic Michard
Hemodynamic and depth of anesthesia (DOA) monitoring are used in many high-risk surgical patients without well-defined indications and objectives. We implemented monitoring guidelines to rationalize hemodynamic and anesthesia management during major cancer surgery. In early 2014, we developed guidelines with specific targets (Mean arterial pressure > 65 mmHg, stroke volume variation < 12%, cardiac index > 2.5 l min-1  m-2 , central venous oxygen saturation > 70%, 40 < bispectral index < 60) for open abdominal cancer surgeries > 2 h...
August 3, 2018: Journal of Clinical Monitoring and Computing
Junichi Saito, Kishiko Nakai, Jun Kawaguchi, Daiki Takekawa, Kazuyoshi Hirota
The authors report a case of a 14-day-old infant patient with patent ductus arteriosus (PDA) with pulmonary hypertension. Accidental clipping of the left pulmonary artery (LPA) during intended PDA closure was revealed, and subsequent urgent PDA closure and releasing a clip of the LPA were conducted. During surgeries we measured somatic regional oxyhemoglobin saturation (rSO2 ) values and change in those might be a key for early diagnosis of accidental clipping of the LPA. These findings suggest that we should understand the risk of accidental closure of the LPA during PDA surgery and somatic rSO2 values will provide information for early diagnosis of critical complication...
August 3, 2018: Journal of Clinical Monitoring and Computing
D Baumann, N Dibbern, S Sehner, C Zöllner, W Reip, J C Kubitz
Medication errors occur frequently and are a risk to patient safety. To reduce mistakes in the medication process in emergencies, a mobile app has been developed supporting the calculation of doses and administration of drugs. A simulation study was performed to validate the app as a tool to reduce medication errors. This was a randomised crossover study conducted in the Academic Hospital. The participants included were residents and attendings in anaesthesiology. 74 Participants performed four simulation scenarios in which they had to calculate and administer drugs for emergencies...
August 2, 2018: Journal of Clinical Monitoring and Computing
Jingwen Wang, Zhenbo Su, Jun Oto, Robert M Kacmarek, Yandong Jiang, Shujie Liu
Recently, we developed a novel endotracheal catheter with functional cuff (ECFC). Using such an ECFC and a regular ICU ventilator, we were able to generate clinically relevant tidal volume in a lung model and adult human sized animal. This ECFC allows co-axial ventilation without using a jet ventilator. The aim of this study was to determine if ECFC also could generate clinically relevant positive end expiratory pressure (PEEP). The experiment was conducted on a model lung and artificial trachea. Lung model respiratory mechanics were set to simulate those of an adult human being...
August 2, 2018: Journal of Clinical Monitoring and Computing
Hilary P Grocott
No abstract text is available yet for this article.
August 1, 2018: Journal of Clinical Monitoring and Computing
Julien Raft, Anne-Sophie Lamotte, Bruno Maury, Isabelle Clerc-Urmès, Cédric Baumann, Philippe Richebé, Hervé Bouaziz
Cuff pressure gauges are the only recommended instrument to perform controls on endotracheal tube cuff pressure during anesthesia. No calibration is mandatory for these devices. The aim of this study was to describe the level of conformity of various cuff pressure gauges. The single-center measurements were performed with a cuff pressure calibrator on all cuff pressure gauges that were usually used in the operating room. Seven measurements (repeat three times) on each cuff pressure gauges at different levels of pressures (i...
July 30, 2018: Journal of Clinical Monitoring and Computing
Iben Engelund Luna, Henrik Kehlet, Heidi Raahauge Wede, Susanne Jung Hoevsgaard, Eske Kvanner Aasvang
Although reduced early physical function after total hip- and knee arthroplasty (THA/TKA) is well-described, the underlying reasons have not been clarified with detailed studies on pathophysiological mechanisms related to recovery, thereby prohibiting advances in rehabilitation. Thus, we aimed to describe early post-THA/TKA physical activity measured by actigraphy and potential underlying pathophysiological mechanisms related to recovery in a well-defined cohort of THA and TKA patients. Daytime-activity was measured from 2 days before until 13 (THA) or 20 (TKA) days after surgery...
July 23, 2018: Journal of Clinical Monitoring and Computing
Hai-Yan Liu, Tian-Jiao Xia, Ze-Zhang Zhu, Xing Zhao, Yue Qian, Zheng-Liang Ma, Xiao-Ping Gu
Transcranial electric motor evoked potentials (TCeMEPs) play an important role in reducing the risk of iatrogenic paraplegia. TCeMEPs could be obviously suppressed by neuromuscular blockade (NMB). The aims of this study were to examine the effects of NMB on TCeMEPs and to determine an appropriate level of partial neuromuscular blockade (pNMB) for TCeMEPs during surgical correction of idiopathic scoliosis under total intravenous anesthesia (TIVA). All patients were maintained with TIVA. The pNMB levels were classified into five phases: one or two train-of-four (TOF) counts (TOF1 ); three TOF counts, or T4 /T1 (TOFR, T1,4 , first or four twitch height of TOF) ≤ 15% (TOF2 ); TOFR at 16-25% (TOF3 ); TOFR at 26-50% (TOF4 ); and TOFR at 51-75% (TOF5 )...
July 20, 2018: Journal of Clinical Monitoring and Computing
Jonghyun Park, Seungman Yang, Ji-Hyun Lee, Jin-Tae Kim, Hee-Soo Kim, Hee Chan Kim
Predicting fluid responsiveness is crucial for adequate fluid management. Respiratory variations in pulse oximetry plethysmographic waveform amplitude (ΔPOP) are used to predict fluid responsiveness, but show inconsistent results when used for children. Contacting force between the measurement site and sensor can affect the ΔPOP value, thereby hindering its reliability as an indicator. We studied the influence of contacting force on the efficacy of ΔPOP as a fluid responsiveness indicator in children. In total, 43 mechanically ventilated children aged 1 month-5 years were studied...
July 14, 2018: Journal of Clinical Monitoring and Computing
Paul Jasiukaitis, Russ Lyon
This report presents a method for tracking Motor Evoked Potential (MEP) amplitudes over the course of a case using a moving least squares linear regression (LSMAs). During a case, newly obtained MEP amplitudes are compared to those predicted by a just previous linear regression (least squares moving average or LSMA). When detected by this comparison, a set criterion amplitude loss will then trigger linear regression of ensuing MEP amplitudes on an expanding step function which tracks the persistence of the amplitude loss for the remainder of the case...
July 13, 2018: Journal of Clinical Monitoring and Computing
Michael T Kuntz, Roman Dudaryk, Richard R McNeer
Injection ports used to administer medications and draw blood samples have inherent dead-volume. This volume can potentially lead to inadvertent drug administration, contribute to erroneous laboratory values by dilution of blood samples, and increase the risk of vascular air embolism. We sought to characterize provider practice in management of intravenous (IV) and arterial lines and measure dead-volumes of various injection ports. A survey was circulated to anesthesiology physicians and nurses to determine practice habits when administering medications and drawing blood samples...
July 10, 2018: Journal of Clinical Monitoring and Computing
Hessam H Kashani, Hilary P Grocott
No abstract text is available yet for this article.
July 4, 2018: Journal of Clinical Monitoring and Computing
Wei-Nung Teng, Chien-Kun Ting, Yu-Tzu Wang, Kuang-Yao Yang, Mei-Yung Tsou, Joseph A Orr, Kyle M Burk, Huihua Chiang, Chun-Li Lin
Drug-induced respiratory depression is a major cause of serious adverse events. Adequate oxygenation is very important during sedated esophagogastroduodenoscopy (EGD). Nasal breathing often shifts to oral breathing during open mouth EGD. A mandibular advancement bite block was developed for EGD using computer-assisted design and three-dimensional printing techniques. The mandible is advanced when using this bite block to facilitate airway opening. The device is composed of an oxygen inlet with one opening directed towards the nostril and another opening directed towards the oral cavity...
July 4, 2018: Journal of Clinical Monitoring and Computing
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