Journal of clinical monitoring and computing
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J Clin Monit Comput · Apr 2017
A risk stratification algorithm using non-invasive respiratory volume monitoring to improve safety when using post-operative opioids in the PACU.
Late detection of respiratory depression in non-intubated patients compromises patient safety. SpO2 is a lagging indicator of respiratory depression and EtCO2 has proven to be unreliable in non-intubated patients. A decline in minute ventilation (MV) is the earliest sign of respiratory depression. ⋯ At discharge, 29/150 patients had Low MV and those receiving opioids were 50 % more likely to display Low MV (23 vs. 16 %). The RVM can identify patients at-risk for opioid-induced respiratory depression and/or experiencing POA. Monitoring of MV can guide opioid-dosing regimens and may increase patient safety across the continuum of care.
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J Clin Monit Comput · Apr 2017
Comparative StudyA head to head evaluation of 8 biochemical scanning tools for unmeasured ions.
We aimed to evaluate the sensitivity and specificity of 8 biochemical scanning tools in signalling the presence of unmeasured anions. We used blood gas and biochemical data from 15 patients during and after cardio-pulmonary bypass. Sampling time-points were pre-bypass (T1), 2 min post equilibration with priming fluid containing acetate and gluconate anions (T2), late bypass (T3) and 4 h after surgery (T4). ⋯ At an [XA] threshold of 6 mEq/L, areas under receiver -operator characteristic curves in rank order were IPEua and UIX (0.88 and 0.87 respectively), SIG (0.81), AGc (0.79), standard BE gap (0.77), plasma BE gap (0.71), BE gap (0.70) and AG (0.59). Similar ranking hierarchies applied to positive and negative predictive values. We conclude that during acute hemodilution UIX and IPEua are superior to the anion gap (with and without albumin correction) and 4 other indices as scanning tools for unmeasured anions.
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J Clin Monit Comput · Apr 2017
LetterEffects of indigo carmine intravenous injection on noninvasive and continuous total hemoglobin measurement with using the Revision L sensor.
The effects of intravenous injection of indigo carmine on noninvasive and continuous total hemoglobin (SpHb) measurement were retrospectively evaluated with the Revision L sensor. The subjects were 18 patients who underwent elective gynecologic surgery under general anesthesia. During surgery, 5 mL of 0.4 % indigo carmine was injected intravenously, and changes in SpHb concentrations between before and after the injection were evaluated. ⋯ Before injection, the median SpHb level was 10.1 (range, 6.8-13.4) g/dL. The results demonstrated no change in SpHb concentration between before and after indigo carmine injection as detected by the Revision L sensor. SpHb measurements as determined with the Revision L sensor were not affected, even after the intravenous injection of indigo carmine.
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This paper addresses the problem of patient model synthesis in anesthesia. Recent advanced drug infusion mechanisms use a patient model to establish the proper drug dose. However, due to the inherent complexity and variability of the patient dynamics, difficulty obtaining a good model is high. ⋯ Then, an adaptive strategy that uses genetic algorithms is implemented. The validation of the modeling technique was done using real data obtained from real patients in the operating room. Results show that the proposed method based on artificial intelligence appears to be an improved alternative to existing compartmental methodologies.
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J Clin Monit Comput · Apr 2017
The effects of ventricular drainage on the intracranial pressure signal and the pressure reactivity index.
In subarachnoid hemorrhage (SAH) patients intracranial pressure (ICP) is usually monitored via an extraventricular drain (EVD), which can produce false readings when the drain is open. It is established that both the ICP cardiac pulse frequency and long term trends over several hours are often seriously corrupted. The aim of this study was to establish whether or not the intermediate frequency bands [respiratory, Mayer wave and very low frequency (VLF)] were also corrupted. ⋯ We found a small but statistically significant decrease during open-drain periods. Based on analysis of the change in the PRx distribution during open drainage we concluded that this decrease also represented physiological changes rather than artifact. In summary the ICP respiratory, Mayer wave, and VLF frequency bands are not corrupted when the EVD is open, and it safe to use these for autoregulation studies.