Journal of clinical monitoring and computing
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J Clin Monit Comput · Apr 2016
Bioelectrical impedance spectroscopy to estimate fluid balance in critically ill patients.
Fluid management is a crucial issue in intensive-care medicine. This study evaluated the feasibility and reproducibility of bioimpedance spectroscopy to measure body-water composition in critically ill patients, and compared fluid balance and daily changes in total body water (TBW) measured by bioimpedance. This observational study included 25 patients under mechanical ventilation. ⋯ Regardless of the technique used to estimate volume status, important limits of agreement were observed. Non-invasive determination of body-water composition using bioimpedance spectroscopy is feasible in critically ill patients but requires knowledge of the patient's weight. The best method to assess volume status after fluid resuscitation and the value gained from information about body composition provided by bioimpedance techniques needs further evaluation.
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J Clin Monit Comput · Apr 2016
ReviewJournal of Clinical Monitoring and Computing 2015 end of year summary: tissue oxygenation and microcirculation.
Last year we started this series of end of year summaries of papers published in the 2014 issues of the Journal Of Clinical Monitoring And Computing with a review on near infrared spectroscopy (Scheeren et al. in J Clin Monit Comput 29(2):217-220, 2015). This year we will broaden the scope and include papers published in the field of tissue oxygenation and microcirculation, or a combination of both entities. We present some promising new technologies that might enable a deeper insight into the (patho)physiology of certain diseases such as sepsis, but also in healthy volunteers. These may help researchers and clinicians to evaluate both tissue oxygenation and microcirculation beyond macro-hemodynamic measurements usually available at the bedside.
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J Clin Monit Comput · Apr 2016
Assessment of the time-dependent need for stay in a high dependency unit (HDU) after major surgery by using data from an anesthesia information management system.
Admittance to a high dependency unit (HDU) is expensive. Patients who receive surgical treatment with 'low anterior resection of the rectum' (LAR) or 'abdominoperineal resection of the rectum' (APR) at our hospital are routinely treated in an HDU the first 16-24 h of the postoperative (PO) period. The aim of this study was to describe the extent of HDU-specific interventions given. ⋯ Another one-third of the patients had a need for HDU-specific therapies for more than ten consecutive hours, primarily an infusion of nor-epinephrine. Most patients treated with LAR or APR was in need of an HDU-specific intervention during the first 6 h of the PO-period, with a marked decline after this time period. The applied methodology, using an AIMS, demonstrates that there is great variability in individual patients' postoperative needs after major surgery, and that these needs are dynamic in their nature.
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J Clin Monit Comput · Apr 2016
Case ReportsEndovascular coil detachment causing EMG artefact in BIS: a mechanistic exploration.
Deployment of endovascular coils used in interventional neuroradiology commonly involves electrolytic detachment of the coil from the pusher catheter. This report describes a case of artefactual increase in electromyography (EMG) values of bispectral index (BIS) monitor during coil detachment. An explanation of this event is provided connecting mechanism of coil detachment and derivation of EMG values in a BIS monitor. While rising EMG values are thought to arise from frontalis contraction, they may as well be an unrecognized electrical artefact, especially in context of undistorted electroencephalography waveform.
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J Clin Monit Comput · Apr 2016
Comparative StudyComparison of foot finding methods for deriving instantaneous pulse rates from photoplethysmographic signals.
The suitability of different methods of finding the foot point of a pulse as measured using earlobe photoplethysmography during stationary conditions was investigated. Instantaneous pulse period (PP) values from PPG signals recorded from the ear in healthy volunteer subjects were compared with simultaneous ECG-derived cardiac periods (RR interval). Six methods of deriving pulse period were used, each based on a different method of finding specific landmark points on the PPG waveform. ⋯ No significant differences between PP and RR were seen for all PPG methods, however the PRV variables derived using all methods showed significant differences to HRV, attributable to the sensitivity of PRV parameters to pulse transients and artifacts. The results suggest that the intersecting tangents method shows the most promise for extracting accurate pulse rate variability data from PPG datasets. This work has applications in other areas where pulse arrival time is a key measurement including pulse wave velocity assessment.