Journal of clinical monitoring and computing
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J Clin Monit Comput · Dec 2023
Review Meta AnalysisConfirming identification of the epidural space: a systematic review of electric stimulation, pressure waveform analysis, and ultrasound and a meta-analysis of diagnostic accuracy in acute pain.
To review the use of epidural electric stimulation test, pressure waveform analysis, and ultrasound assessment of injection as bedside methods for confirming identification of the epidural space in adults with acute pain, the PubMed database was searched for relevant reports between May and August 2022. Studies reporting diagnostic accuracy with conventional Touhy needles and epidural catheters were further selected for meta-analysis. Sensitivity and specificity were estimated using univariate logistic regression for electric stimulation and pressure analysis, and pooling of similar studies for ultrasound. ⋯ Risk of bias was significant and accuracy estimates must be interpreted with caution. Electric stimulation and pressure waveform analysis seem clinically useful, although they must be interpreted cautiously. In the future, clinical trials in patients with difficult anatomy will likely be most useful. Ultrasound requires further investigation.
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J Clin Monit Comput · Dec 2023
Review Meta AnalysisConfirming identification of the epidural space: a systematic review of electric stimulation, pressure waveform analysis, and ultrasound and a meta-analysis of diagnostic accuracy in acute pain.
To review the use of epidural electric stimulation test, pressure waveform analysis, and ultrasound assessment of injection as bedside methods for confirming identification of the epidural space in adults with acute pain, the PubMed database was searched for relevant reports between May and August 2022. Studies reporting diagnostic accuracy with conventional Touhy needles and epidural catheters were further selected for meta-analysis. Sensitivity and specificity were estimated using univariate logistic regression for electric stimulation and pressure analysis, and pooling of similar studies for ultrasound. ⋯ Risk of bias was significant and accuracy estimates must be interpreted with caution. Electric stimulation and pressure waveform analysis seem clinically useful, although they must be interpreted cautiously. In the future, clinical trials in patients with difficult anatomy will likely be most useful. Ultrasound requires further investigation.
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J Clin Monit Comput · Oct 2023
ReviewLinear thinking does not reflect the newer 21st-century anesthesia concepts. A narrative review.
The brain constitutes a good example of a chaotic, nonlinear biological system where large neuronal networks operate chaotically with random connectivity. This critical state is significantly affected by the anesthetic loss of consciousness induced by drugs whose pharmacological behavior has been classically based on linear kinetics and dynamics. Recent developments in pharmacology and brain monitoring during anesthesia suggest a different view that we tried to explore in this article. The concepts of effect-site for hypnotic drugs modeling a maximum effect, electroencephalographic dynamics during induction, maintenance, and recovery from anesthesia are discussed, integrated into this alternative view, and how it may be applied in daily clinical practice.
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Cybersecurity has seen an increasing frequency and impact of cyberattacks and exposure of Protected Health Information (PHI). The uptake of an Electronic Medical Record (EMR), the exponential adoption of Internet of Things (IoT) devices, and the impact of the COVID-19 pandemic has increased the threat surface presented for cyberattack by the healthcare sector. Within healthcare generally and, more specifically, within anaesthesia and Intensive Care, there has been an explosion in wired and wireless devices used daily in the care of almost every patient-the Internet of Medical Things (IoMT); ventilators, anaesthetic machines, infusion pumps, pacing devices, organ support and a plethora of monitoring modalities. ⋯ There has, at the same time, been a chronic underfunding of cybersecurity in healthcare. This lack of cybersecurity investment has left the sector exposed, and with the monetisation of PHI, the introduction of technically unsecure IoT devices for monitoring and direct patient care, the healthcare sector is presenting itself for further devastating cyberattacks or breaches of PHI. Coupled with the immense strain that the COVID-19 pandemic has placed on healthcare and the changes in working patterns of many caregivers, this has further amplified the exposure of the sector to cyberattacks.
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J Clin Monit Comput · Aug 2023
ReviewThe importance of monitoring cerebral oxygenation in non brain injured patients.
Over the past few years, the use of non-invasive neuromonitoring in non-brain injured patients has increased, as a result of the recognition that many of these patients are at risk of brain injury in a wide number of clinical scenarios and therefore may benefit from its application which allows interventions to prevent injury and improve outcome. Among these, are post cardiac arrest syndrome, sepsis, liver failure, acute respiratory failure, and the perioperative settings where in the absence of a primary brain injury, certain groups of patients have high risk of neurological complications. ⋯ At present, current recommendations for standard monitoring during anesthesia or in the general intensive care concentrate mainly on hemodynamic and respiratory monitoring without specific indications regarding the brain, and in particular, brain oximetry. The aim of this manuscript is to provide an up-to-date overview of the pathophysiology and applications of cerebral oxygenation in non brain injured patients as part of non-invasive multimodal neuromonitoring in the early identification and treatment of neurological complications in this population.