Journal of clinical monitoring and computing
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J Clin Monit Comput · Oct 2015
Using the multi-parameter variability of photoplethysmographic signals to evaluate short-term cardiovascular regulation.
Transient changes in cardiovascular regulatory activities are valuable for clinical monitoring and pathophysiological research. However, there is a lack of effective methods to evaluate short-term cardiovascular regulation. This study explores a photoplethysmography (PPG)-based multi-parameter analytical approach using the period, amplitude and baseline of PPG signals to quantitatively assess cardiovascular regulation over a 30 s period. ⋯ The results showed that compared with spontaneous respiration, SD1 of PPG amplitude increased significantly but the correlations between any two parameters or between the first differences of any two parameters decreased significantly during paced respiration; SD1 and SD1/SD2 of all PPG parameters as well as the correlations of the first differences between any two PPG parameters reduced significantly during breath holding. The results indicate the respiratory induced alterations in cardiovascular autonomic function could be identified by the variability of various PPG parameters or their correlations over 30 s periods. Moreover, the indicators used to quantify the variability of the PPG parameters in this study may provide a feasible and effective way to evaluate short-term cardiovascular regulation.
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J Clin Monit Comput · Oct 2015
Utility of near infrared light to determine tissue oxygenation during hepato-biliary surgery.
Near-infrared spectrophotometry assesses cerebral oxygen saturation (ScO2) based on the absorption spectra of oxygenated and deoxygenated hemoglobin, and the translucency of biological tissue, in the near-infrared band. There is increasing evidence that optimising cerebral oxygenation, guided by ScO2, is associated with improved outcomes in a variety of high risk surgical settings. However, in patients with liver disease, bilirubin can potentially render cerebral oximetry inaccurate. ⋯ However, those patients with low ScO2 (≤51%) maintained a similar trend in cerebral oximetry values both at induction and intraoperatively to those with a normal ScO2. We conclude that the pattern of cerebral oximetry is similar in patients undergoing major pancreatic surgery regardless of their underlying liver dysfunction. Therefore, cerebral oximetry may have a role in monitoring neurological function in this high risk group of patients.
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J Clin Monit Comput · Oct 2015
A web-based Italian survey of current trends, habits and beliefs in hemodynamic monitoring and management.
Significant evidence outlines that the management of the high-risk surgical patient with perioperative hemodynamic optimization leads to significant benefits. This study aimed at studying the current practice of hemodynamic monitoring and management of Italian anesthesiologists. An invitation to participate in a web-based survey was published on the web site of the Società Italiana di Anestesia Analgesia Rianimazione Terapia Intensiva. ⋯ The most used parameter in clinical practice to assess the effects of volume loading were an increase in urine output and arterial blood pressure together with a decrease in heart rate and blood lactates. The 45.1% or the respondents outlined that hemodynamic optimization in the high risk patients is of major clinical value. Our study outlines an important gap between available evidence and clinical practice emphasizing the need for a better awareness, more information and knowledge on the specific topic.