Journal of clinical monitoring and computing
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J Clin Monit Comput · Oct 2021
Letter Meta AnalysisComparison between laryngeal handshake and palpation techniques in the identification of cricothyroid membrane: a meta-analysis.
Because the use of conventional digital palpation technique for the identification of cricothyroid membrane (CTM) has been widely believed to be unreliable, the 'laryngeal handshake' technique (LH) has been introduced for CTM identification in the event of cricothyroidotomy. To provide evidence for clinical practice, this pilot meta-analysis aimed at investigating whether identification of CTM with the LH is superior to that with the palpation technique. Studies that evaluated the accuracy of CTM identification by using LH or palpation techniques (i.e., LH group vs. ⋯ Four studies published from 2018 to 2020 were considered relevant and were read in full. We found no significant difference in success rate of CTM identification [Risk Ratio (RR) 1.09, 95% CI 0.89-1.34, p = 0.41] between the two groups. These preliminary results of the current study demonstrated no significant differences in success rate between the laryngeal handshake and conventional palpation techniques in cricothyroid membrane identification.
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J Clin Monit Comput · Oct 2021
Quantitative assessment of consciousness during anesthesia without EEG data.
Assessing the depth of anesthesia (DoA) is a daily challenge for anesthesiologists. The best assessment of the depth of anesthesia is commonly thought to be the one made by the doctor in charge of the patient. This evaluation is based on the integration of several parameters including epidemiological, pharmacological and physiological data. ⋯ This protocol constitutes the very first step on the way towards a multimodal approach of anesthesia. The fact that our first classifier already demonstrated a good predictability is very encouraging for the future. Indeed, this first model was merely a proof of concept to encourage research ways in the field of machine learning and anesthesia.
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J Clin Monit Comput · Oct 2021
Randomized Controlled TrialEffects of anesthetics on microvascular reactivity measured by vascular occlusion tests during off-pump coronary artery bypass surgery: a randomized controlled trial.
Microvascular function may be modulated by various anesthetics. Desflurane and propofol anesthesia have different effects on microvascular function. However, there are few reports on the effects of sevoflurane and desflurane on microvascular function during cardiac surgery. ⋯ Microvascular reactivity, as measured by the VOT during OPCAB, showed no difference between the sevoflurane and desflurane groups. Also, there were no group differences in macrohemodynamics or the rate of postoperative adverse events. TRIAL REGISTRATION : Clinicaltrials.gov, identifier NCT03209193; registered on July 3, 2017.
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J Clin Monit Comput · Oct 2021
Iterative heuristic design of temporal graphic displays with clinical domain experts.
Conventional electronic health record information displays are not optimized for efficient information processing. Graphical displays that integrate patient information can improve information processing, especially in data-rich environments such as critical care. We propose an adaptable and reusable approach to patient information display with modular graphical components (widgets). ⋯ Participants stated graphical widgets would be used to identify correlating patterns and compare abnormal measures across related data elements at a specific time. Combining theoretical principles and validated design methods was an effective and reproducible approach to designing widgets for healthcare displays. The findings suggest our widget design features and recommendations match critical care clinician expectations for graphical information display of continuous and frequently updated patient data.
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J Clin Monit Comput · Oct 2021
A simple method of mechanical power calculation: using mean airway pressure to replace plateau pressure.
The reference method for mechanical power (MP) calculation proposed by Gattinoni et al. is based on plateau pressure (Pplat) which needs an inspiratory hold. This study aims to introduce and validate a simple surrogate for MP calculation without any intervention in ventilated patients with or without acute respiratory distress syndrome (ARDS). The introduced equation is as:[Formula: see text]where Pmean is mean airway pressure, VE is minute ventilation, PEEP is positive end-expiratory pressure, and Te/Ti is expiratory-to-inspiratory ratio. 50 patients with ARDS and 50 post-operative patients without ARDS were enrolled. ⋯ At both Tplat levels, the Pmean-derived MP correlated well with the reference MP both in patients with or without ARDS (non-ARDS: slopes = 1.05, 0.94, R2 = 0.95, 0.93, bias + 0.76, + 0.51; ARDS: slopes = 1.03, 0.95, R2 = 0.96, 0.96, bias + 0.97, + 0.78. P < 0.0001 for all). In patients with or without ARDS, Pmean-derived MP allows rapid and dynamic estimation of mechanical power without any intervention at the bedside.