Journal of clinical monitoring and computing
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J Clin Monit Comput · Jun 2005
Reliability of near-infrared spectroscopy in people with dark skin pigmentation.
Near-infrared spectroscopy (NIRS) is a promising non-invasive technique for the continuous monitoring of tissue oxygen delivery. NIRS detects light absorbance of haemoglobin chromophores to determine tissue oxygen saturation (StO2). As skin colour is also determined by the presence of chromophores, it is plausible that NIRS signal quality may be affected by dark skin pigmentation. ⋯ In patients with a dark pigmented skin, NIRS StO2 measurements should be interpreted with caution, as melanin clearly interferes with the quality of the reflected NIRS signal.
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J Clin Monit Comput · Jun 2005
Randomized Controlled TrialRecovery from paralysis with succinylcholine increased Response entropy and EMG but not State entropy.
It is reported that the electromyogram is an indicator of patient arousal during pain stimulation if anesthesia is inadequate. This may not be true during recovery from succinylcholine induced paralysis. We evaluated State entropy of the electroencephalogram (EEG, 0.8-32 Hz) and Response entropy, a combined measure of the electromyogram (EMG) and EEG (0.8-47 Hz), during recovery from paralysis with succinylcholine. ⋯ Although RE and EMG increased during recovery from paralysis with succinylcholine, SE, an indicator of EEG, was not stimulated. EMG activity may not be an indicator of patient arousal after succinylcholine treatment.
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J Clin Monit Comput · Jun 2005
A stochastic control program to predict outcome and to support therapeutic decisions: a preliminary report.
Early noninvasive hemodynamic monitoring with an outcome predictor and a therapeutic decision support system may be useful to identify and correct hemodynamic deficiencies in emergency patients. The first aim was to apply a stochastic (probability) search and display model to predict outcome as early as possible. The second aim was to explore the usefulness of a therapeutic decision support system to evaluate the relative effectiveness of various therapies. ⋯ The cardiac index, mean arterial pressure, arterial saturation, transcutaneous oxygen and carbon dioxide tensions were appreciably higher in survivors than in nonsurvivors in the initial resuscitation. Heart rate was higher in the nonsurvivors. The calculated Survival Probability (SP) of survivors averaged 81 +/- 1.4% in the first 24-hour observation period. It was 58 +/- 2.2% for nonsurvivors during this period. Misclassifications were 10/100 or 10%.
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J Clin Monit Comput · Jun 2005
Comparative StudyA comparison of graphical and textual presentations of time series data to support medical decision making in the neonatal intensive care unit.
To compare expert-generated textual summaries of physiological data with trend graphs, in terms of their ability to support neonatal Intensive Care Unit (ICU) staff in making decisions when presented with medical scenarios. ⋯ In this experimental task, participants performed better when presented with a textual summary of the medical scenario than when it was presented as a set of trend graphs. If the necessary algorithms could be developed that would allow computers automatically to generate descriptive summaries of physiological data, this could potentially be a useful feature of decision support tools in the intensive care unit.
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J Clin Monit Comput · Jun 2005
Intraoperative monitoring using somatosensory evoked potentials. A position statement by the American Society of Neurophysiological Monitoring.
To provide an educational service to the intraoperative neurophysiologist community by publishing a position statement by the American Society of Neurophysiological Monitoring on the recommended appropriate and correct use of somatosensory evoked potentials as an intraoperative neurophysiological monitoring tool to protect patient well-being during surgery. This position statement presents the somatosensory evoked potential utilization basis, relevant anatomy, patient preparation, important systemic factors, anesthesia considerations, safety and technical considerations, documentation requirements, neurophysiologist credentials and staffing practice patterns, and monitoring applications for protecting brain, spinal nerve root, peripheral nerve, plexus and spinal cord function. In conclusion, a summary of major recommendations regarding the use of somatosensory evoked potentials in intraoperative neurophysiological monitoring is presented.