Journal of clinical monitoring and computing
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J Clin Monit Comput · Jun 2016
Review Meta AnalysisAccuracy of pleth variability index to predict fluid responsiveness in mechanically ventilated patients: a systematic review and meta-analysis.
To systemically evaluate the accuracy of pleth variability index to predict fluid responsiveness in mechanically ventilated patients. A literature search of PUBMED, OVID, CBM, CNKI and Wanfang Data for clinical studies in which the accuracy of pleth variability index to predict fluid responsiveness was performed (last update 5 April 2015). Related journals were also searched manually. ⋯ No statistical differences were found between OR subgroup and ICU subgroup in the AUC [0.89 (95 % CI 0.85-0.92) versus 0.90 (95 % CI 0.82-0.94); P = 0.97], and in the specificity [0.84 (95 % CI 0.75-0.86) vs. 0.84 (95 % CI 0.75-0.91); P = 1.00]. Sensitivity was higher in the OR subgroup than the ICU subgroup [0.84 (95 % CI 0.78-0.88) vs. 0.56 (95 % CI 0.47-0.64); P = 0.00004]. The pleth variability index has a reasonable ability to predict fluid responsiveness.
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J Clin Monit Comput · Jun 2016
Real time noninvasive estimation of work of breathing using facemask leak-corrected tidal volume during noninvasive pressure support: validation study.
We describe a real time, noninvasive method of estimating work of breathing (esophageal balloon not required) during noninvasive pressure support (PS) that uses an artificial neural network (ANN) combined with a leak correction (LC) algorithm, programmed to ignore asynchronous breaths, that corrects for differences in inhaled and exhaled tidal volume (VT) from facemask leaks (WOBANN,LC/min). Validation studies of WOBANN,LC/min were performed. Using a dedicated and popular noninvasive ventilation ventilator (V60, Philips), in vitro studies using PS (5 and 10 cm H2O) at various inspiratory flow rate demands were simulated with a lung model. ⋯ For the in vivo study, WOBANN,LC/min and WOBPHYS/min ranged from 3 to 12 J/min and there was an excellent relationship between WOBANN,LC/breath and WOBPHYS/breath, r = 0.93, r(2) = 0.86 (p < 0.01). An ANN combined with a facemask LC algorithm provides noninvasive and valid estimates of work of breathing during noninvasive PS. WOBANN,LC/min, automatically and continuously estimated, may be useful for assessing inspiratory muscle loads and guiding noninvasive PS settings as in a decision support system to appropriately unload inspiratory muscles.
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J Clin Monit Comput · Jun 2016
Clinical practice in perioperative monitoring in adult cardiac surgery: is there a standard of care? Results from an national survey.
This study was to investigate and define what is considered as a current clinical practice in hemodynamic monitoring and vasoactive medication use after cardiac surgery in Italy. A 33-item questionnaire was sent to all intensive care units (ICUs) admitting patients after cardiac surgery. 71 out of 92 identified centers (77.2 %) returned a completed questionnaire. Electrocardiogram, invasive blood pressure, central venous pressure, pulse oximetry, diuresis, body temperature and blood gas analysis were identified as routinely used hemodynamic monitoring, whereas advanced monitoring was performed with pulmonary artery catheter or echocardiography. ⋯ Standard, routinely used monitoring consists of ECG, SpO2, etCO2, invasive BP, CVP, diuresis, body temperature, and BGA. It also shows that there is large variability among the various Centers regarding hemodynamic monitoring of fluid therapy and inotropes administration. Further research is required to better standardize and define the indicators to improve the standards of intensive care after cardiac surgery among Italian cardiac ICUs.
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J Clin Monit Comput · Jun 2016
Comment LetterPaper or plastic? Simulation based evaluation of two versions of a cognitive aid for managing pediatric peri-operative critical events by anesthesia trainees: evaluation of the society for pediatric anesthesia emergency checklist.
Cognitive aids (CA), including emergency manuals and checklists, are tools designed to assist users in prioritizing and performing complex tasks during time sensitive, high stress situations (Marshall in Anesth Analgesia 117(5):1162-1171, 2013; Marshall and Mehra in Anaesthesia 69(7):669-677, 2014). The society for pediatric anesthesia (SPA) has developed a series of emergency checklists tailored for use by pediatric perioperative teams that cover a wide range of intraoperative critical events (Shaffner et al. in Anesth Analgesia 117(4):960-979, 2013). In this study, we evaluated user preferences for a CA (SPA checklist) using two different presentation formats, paper and electronic, during management of simulated critical events. ⋯ In this study, anesthesia trainees had a favorable opinion of the content and perceived clinical relevance of both versions of the CA. In both quantitative and qualitative analysis, the paper version of the CA was preferred over the electronic version by participants. Despite overall favorable responses to the CA, a sizeable number of participants chose not to use either version the CA during the crisis.
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J Clin Monit Comput · Jun 2016
Effects of indigo carmine intravenous injection on noninvasive and continuous total hemoglobin measurement.
The effects of an intravenous injection of indigo carmine on noninvasive and continuous total hemoglobin (SpHb) measurement were retrospectively evaluated. The subjects were 21 patients who underwent elective gynecologic surgery under general anesthesia. During surgery, 5 mL of 0.4 % indigo carmine was intravenously injected, and subsequent changes in SpHb concentrations were evaluated. ⋯ The time to reach the minimum value was 4 min, and the time to return to the pre-injection value was 15 min. The decrease in SpHb was greater in the group with a perfusion index (PI) < 1.4 than in the group with a PI > 1.4. The assessment of SpHb after an intravenous injection of indigo carmine necessitates caution.