Journal of clinical monitoring and computing
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J Clin Monit Comput · May 2021
Dynamic data in the ED predict requirement for ICU transfer following acute care admission.
Misidentification of illness severity may lead to patients being admitted to a ward bed then unexpectedly transferring to an ICU as their condition deteriorates. Our objective was to develop a predictive analytic tool to identify emergency department (ED) patients that required upgrade to an intensive or intermediate care unit (ICU or IMU) within 24 h after being admitted to an acute care floor. We conducted a single-center retrospective cohort study to identify ED patients that were admitted to an acute care unit and identified cases where the patient was upgraded to ICU or IMU within 24 h. ⋯ Our predictive analytic model had a cross-validated area under the receiver operating characteristic of 0.70 (95% CI 0.67-0.72) and identified 10% of early ICU transfers with an alert rate of 1.6 per week (162.2 acute care admits per week, 1.9 early ICU transfers). Predictive analytic monitoring based on data available in the emergency department can identify patients that will require upgrade to ICU or IMU if admitted to acute care. Incorporating this tool into ED practice may draw attention to high-risk patients before acute care admit and allow early intervention.
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Dysnatremia-either hyponatremia or hypernatremia-is frequently encountered in the clinical practice and often poses a diagnostic and therapeutic challenge for physicians. Despite their frequent occurrence, disorders of the water and sodium balance in the human body have puzzled many physicians over the years and often remain elusive for those lacking experience in their interpretation and management. ⋯ As opposed to many existing models, our model takes both input and output into account, and integrates osmolarity and tonicity. Our governing equation should be considered a means for clinicians to get a better qualitative understanding of the relationship between the plasma sodium concentration and the variables that influence it for a wide range of scenarios.
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J Clin Monit Comput · May 2021
Neurally adjusted ventilatory assist preserves cerebral blood flow velocity in patients recovering from acute brain injury.
Neurally adjusted ventilatory assist (NAVA) has never been applied in patients recovering from acute brain injury (ABI) because neural respiratory drive could be affected by intracranial disease with detrimental effects on cerebral blood flow (CBF) velocity. Our primary aim was to assess the impact of NAVA and pressure support ventilation (PSV) on CBF velocity. In fifteen adult patients recovering from ABI and undergoing invasive assisted ventilation, PSV and NAVA were applied over 30-min-lasting trials, in the following sequence: PSV1, NAVA, and PSV2. ⋯ No differences were detected for pH (p = 0.0551), arterial carbon dioxide tension (p = 0.8142), and oxygenation (p = 0.0928) over the entire study duration. NAVA and PSV preserved CBF velocity in patients recovering from ABI. Trial registration: The present trial was prospectively registered at www.clinicatrials.gov (NCT03721354) on October 18th, 2018.
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J Clin Monit Comput · May 2021
Refeeding syndrome: multimodal monitoring and clinical manifestation of an internal severe neurotrauma.
Refeeding syndrome (RFS) is a rare, potentially life-threatening, condition seen in malnourished patients starting refeeding. RFS may provoke seizures and acute encephalopathy and can be considered an internal severe neurotrauma in need of specific treatment. The objective was to describe course of disease, treatment and, for the first time, multimodal monitoring output in a comatose patient suffering RFS. ⋯ RFS was associated with serious deviations in homeostasis, high ICP levels, ECG abnormalities, kidney and lung affections. It is of utmost importance to recognize this rare syndrome and to treat appropriately. Despite the severe clinical state, cerebral autoregulation and compensatory reserve were generally normal, questioning the applicability of indirect measurements such as PRx and RAP during neuro-intensive care treatment of RFS patients with cerebral engagement.
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J Clin Monit Comput · May 2021
Case ReportsLocating stridor caused by tumor compression by using a multichannel electronic stethoscope: a case report.
A 67-year-old male patient with chronic obstructive pulmonary disease was admitted to a hospital in northern Taiwan for progressive dyspnea and productive cough with an enlarged left upper lobe tumor (5.3 × 6.8 × 3.9 cm3). Previous chest auscultation on outpatient visits had yielded diffuse wheezes. A localized stridor (fundamental frequency of 125 Hz) was captured using a multichannel electronic stethoscope comprising four microelectromechanical system microphones. ⋯ We demonstrated a potential diagnostic aid for pulmonary diseases through sound-source localization technology based on respiratory monitoring. The proposed technique can facilitate detection when advanced imaging tools are not immediately available. Continuing effort on the development of more precise estimation is warranted.