Journal of clinical monitoring and computing
-
J Clin Monit Comput · Aug 2020
Comparative StudyCardiac output estimation using multi-beat analysis of the radial arterial blood pressure waveform: a method comparison study in patients having off-pump coronary artery bypass surgery using intermittent pulmonary artery thermodilution as the reference method.
Pulse wave analysis enables stroke volume to be estimated from an arterial blood pressure waveform. Multi-beat analysis is a novel pulse wave analysis method. We aimed to investigate cardiac output (CO) estimations using multi-beat analysis of the radial arterial blood pressure waveform in patients undergoing off-pump coronary artery bypass surgery (OPCAB) using intermittent pulmonary artery thermodilution (PATD) as the reference method. ⋯ The mean of the differences between PATD-CO and MBA-CO was - 0.20 L/min with a standard deviation of ± 1.14 L/min and 95% limits of agreement of - 2.48 to + 2.08 L/min. The concordance rate for CO changes between PATD-CO and MBA-CO was 89%. CO estimations using multi-beat analysis (Argos monitor) show reasonable agreement and trending ability compared with PATD-CO as the reference method in adult patients during OPCAB.
-
J Clin Monit Comput · Aug 2020
Continuous hemoglobin and plethysmography variability index monitoring can modify blood transfusion practice and is associated with lower mortality.
To determine the effect of implementing an algorithm of fluid and blood administration based on continuous monitoring of hemoglobin (SpHb) and PVI (plethysmography variability index) on mortality and transfusion on a whole hospital scale. This single-center quality program compared transfusion at 48 h and mortality at 30 days and 90 days after surgery between two 11-month periods in 2013 and 2014 during which all the operating and recovery rooms and intensive care units were equipped with SpHb/PVI monitors. The entire team was trained to use monitors and the algorithm. ⋯ G3 Patients had a lower risk of death at 30 days post-surgery [OR 0.67 (0.49-0.92) p = 0.01] but not G2 patients [OR 1.01, (0.78-1.29), p = 0.96]. In 2015, mortality at 30 days and 90 days increased again to similar levels as those of 2013, respectively 2.18 and 3.09%. Monitoring SpHb and PVI integrated in a vascular filling algorithm is associated with earlier transfusion and reduced 30 and 90-day mortality on a whole hospital scale.
-
J Clin Monit Comput · Aug 2020
Behavior of a dual closed-loop controller of propofol and remifentanil guided by the bispectral index for postoperative sedation of adult cardiac surgery patients: a preliminary open study.
A dual-loop controller permits the automated titration of propofol and remifentanil during anesthesia; it has never been used in intensive care after cardiac surgery. The goal of this preliminary study was to determine the efficacy of this controller to provide postoperative sedation in 19 adult cardiac surgery patients with a Bispectral Index target of 50. Results are presented as numbers (percentages) or medians [25th-75th percentiles]. ⋯ Automated sedation device was discontinued in two patients for hemodynamic instability. No patient had awareness of the postoperative sedation period. Dual closed-loop can provide postoperative sedation after cardiac surgery but the choice of the depth of sedation should take into account the risk of hypotension.
-
J Clin Monit Comput · Aug 2020
Ultrasonographic measurement of the ligamentum flavum at different angles in the lateral tilt position.
The aim of this study was to take ultrasonographic measurements of the length of the ligamentum flavum (LF), the LF-skin distance and the interspinous distance, which are critical for the application of neuraxial anaesthesia, with volunteers in the sitting position and with lateral tilt of the operating table at different angles to evaluate whether the target structures in neuraxial anaesthesia can be better visualised with the lateral tilt position and to determine whether or not these measurements change at different angles. The study included 29 volunteers. For the measurements, the operation table was first set into the neutral position and the length of the LF, the skin-LF distance and the interlaminar distance were measured at between L1-S1 spaces with a paramedian oblique sagittal approach with a linear ultrasound probe. ⋯ In the ultrasonographic measurements of the skin-LF distance, at L3-4 and L4-5 intervertebral interspaces, there was a statistically significant increase. With lateral tilt applied to the table, there was determined to be an increase in ultrasonographic measurements of the LF length in the lumbar intervertebral interspaces. Therefore, for neuraxial blocks applied in the sitting position, the procedure may be facilitated with lateral tilt of the operating table.