Journal of clinical monitoring and computing
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J Clin Monit Comput · Dec 2020
Prognostic value of a bilateral motor threshold criterion for facial corticobulbar MEP monitoring during cerebellopontine angle tumor resection.
In intraoperative neuromonitoring (IONM), facial nerve motor function (FaNMF) is assessed by facial muscle corticobulbar motor evoked potentials (FMcoMEP). Mostly only amplitude decrease is used as warning criterion. We related a refined criterion for FMcoMEP consisting of a bilateral final-to-baseline motor threshold ratio with standard criteria and postoperative FaNMF. 79 patients (45 females; 48 ± 16 years) undergoing IONM-guided cerebellopontine angle tumor surgery were retrospectively analyzed. ⋯ Diagnostic odds ratios were highest for bfBMT20 compared to iAMT20 and iAR50 for D1 (172.5 vs. 8.7 vs. 0.45) and D7 (51.4 vs. 6.1 vs. 0.8). The refined parameter bFBMT20 provides a valuable contribution to the prognostic assessment of FaNMF. Due to its bihemispheric character, it might thus circumvent false-positive events which affect FMcoMEP bilaterally.
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J Clin Monit Comput · Dec 2020
Insights into postoperative respiration by using continuous wireless monitoring of respiratory rate on the postoperative ward: a cohort study.
Change of respiratory rate (RespR) is the most powerful predictor of clinical deterioration. Brady- (RespR ≤ 8) and tachypnea (RespR ≥ 31) are associated with serious adverse events. Simultaneously, RespR is the least accurately measured vital parameter. ⋯ However, in the present study we did not validate the measurements against a reference method. Rather, we attempted to demonstrate the feasibility of achieving continuous wireless measurement in patients on surgical postoperative wards. As the technology used is based on impedance pneumography, obstructive apnoea might have been missed, namely in those patients receiving opioids post-operatively.
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J Clin Monit Comput · Dec 2020
Optimized electrical bioimpedance measurements of abdominal wall on a porcine model for the continuous non-invasive assessment of intra-abdominal pressure.
This work describes the optimization of electrical bioimpedance measurements for indirect intra-abdominal pressure (IAP) assessment. The experimental run was performed on a female Sus scrofa domesticus (domestic pig). Different values of IAP were induced by inflation of the abdominal cavity, using a trocar placed near the umbilicus over the linea alba. ⋯ An exponential trend linking between the bioimpedance values at 99.8 kHz and the IAP was found. Non-optimized electrode placement presented a strongly reduced sensitivity to IAP changes above 7 mmHg. Upon optimization and placing the electrodes with a separation of about 3.6 times the measured abdominal wall thickness, the sensitivity for high IAP drastically increased, allowing continuous non-invasive monitoring of IAP, confirming the optimization method proposed in this work.
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J Clin Monit Comput · Dec 2020
Reliability of B-line quantification by different-level observers and a software algorithm using point-of-care lung ultrasound.
Quantification of B-lines on lung ultrasonographs is operator-dependent and considered a semi-quantitative method. To avoid this variability, we designed a software algorithm for counting B-lines. We compared the number of B-lines obtained in real-time by observers with three different levels of experience and by the software algorithm, and analyzed intra-rater variability in terms of the estimated number of B-lines in two successive examinations. ⋯ For all lung zones, the intraclass correlation for B-lines counting between OB1 and OB2 was 0.663; between OB1 and OB3, 0.559; and between OB1 and OBS, 0.710. OBS had a better concordance coefficient (0.752) between the first and the second measurements than did the human observers. Our results show that the software algorithm for B-lines counting is a potentially promising alternative when observers have little lung ultrasound experience.