Journal of clinical monitoring and computing
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J Clin Monit Comput · Apr 2021
LetterAnti-decubitus bed mattress may interfere with cerebrovascular pressure reactivity measures due to induced ICP and ABP cyclic peaks.
Severe traumatic brain injury (TBI) patients are monitored with continuous arterial blood pressure (ABP) and intracranial pressure (ICP). The pressure reactivity index (PRx) is a frequently used correlation coefficient between ABP and ICP to inform clinicians at the bedside about trends in global cerebrovascular pressure regulation status. We present an unexpected influence of cyclic anti-decubitus mattress inflations and deflations on invasive ICP, ABP and PRx calculations in our TBI patients. ⋯ In our database, 23% (9/39) of the patients show recurrent peaks in the monitoring signals. We hypothesize that these peaks are caused by (a combination) of hydrostatic change, local (cervical) compression and/or incorrect sensor zeroing due to positional changes induced by the anti-decubitus mattress. This warrants further investigation by the manufacturer and exploration of data filters.
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J Clin Monit Comput · Apr 2021
Performance of a closed-loop glucose control system, comprising a continuous glucose monitoring system and an AI-based controller in swine during severe hypo- and hyperglycemic provocations.
Intensive care unit (ICU) patients develop stress induced insulin resistance causing hyperglycemia, large glucose variability and hypoglycemia. These glucose metrics have all been associated with increased rates of morbidity and mortality. The only way to achieve safe glucose control at a lower glucose range (e.g., 4.4-6.6 mmol/L) will be through use of an autonomous closed loop glucose control system (artificial pancreas). ⋯ The total percent time within tight glucose control range, 4.4-6.6 mmol/L, was 32.8% (32.4-47.1) for Controls and 55.4% (52.9-59.4) for Treated (p < 0.034). Data are median and quartiles. The artificial pancreas system abolished severe hypoglycemia and outperformed the experienced ICU physician in avoiding clinically significant hypoglycemic excursions.
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J Clin Monit Comput · Apr 2021
ReviewPerioperative echocardiography-guided hemodynamic therapy in high-risk patients: a practical expert approach of hemodynamically focused echocardiography.
The number of high-risk patients undergoing surgery is growing. To maintain adequate hemodynamic functioning as well as oxygen delivery to the vital organs (DO2) amongst this patient population, a rapid assessment of cardiac functioning is essential for the anesthesiologist. Pinpointing any underlying cardiovascular pathophysiology can be decisive to guide interventions in the intraoperative setting. ⋯ Hemodynamic focused echocardiography, as a rapid diagnostic method, offers an excellent opportunity to examine signs of filling impairment, cardiac preload, myocardial contractility and the function of the heart valves. We thus propose a 6-step-echocardiographic approach to assess high-risk patients in order to improve and maintain perioperative DO2. The summary of all echocardiographic based findings allows a differentiated assessment of the patient's cardiovascular function and can thus help guide a (patho)physiological-orientated and individualized hemodynamic therapy.