Journal of clinical monitoring and computing
-
J Clin Monit Comput · Aug 2022
Observational StudyComparison of cutaneous facial temperature using infrared thermography to standard temperature measurement in the critical care setting.
To assess the accuracy and precision of infrared cameras compared to traditional measures of temperature measurement in a temperature, humidity, and distance controlled intensive care unit (ICU) population. This was a prospective, observational methods comparison study in a single centre ICU in Metropolitan Melbourne, Australia. A convenience sample of 39 patients admitted to a single room equipped with two ceiling mounted thermal imaging cameras was assessed, comparing measured cutaneous facial temperature via thermal camera to clinical temperature standards. ⋯ It has a moderate ability to discriminate fever. It is unclear if this would be sensitive enough for infection screening purposes. Fig. 1 Bland-Altman plots for temperatures measured using clinical standards to infrared camera. a Wide-angle camera versus bladder temperature. b Narrow-angle camera versus bladder temperature.
-
J Clin Monit Comput · Aug 2022
Oesophageal balloon positioning by echocardiography to guide positive pressure ventilation.
Understanding the respiratory mechanics of ARDS patients is crucial to avoid ventilator-induced lung injury (VILI), and this is much more challenging if not only lung compliance is altered but the whole compliance of the respiratory system is abnormal, as in obese patients. We face this problem daily in the ICU, and to optimize ventilation, we estimate respiratory mechanics using an oesophageal balloon. The balloon position is crucial to assess reliable values. In the present technical note, we describe the use of echocardiography to confirm the correct position of this instrument.
-
J Clin Monit Comput · Aug 2022
Outcome in patients with open abdomen treatment for peritonitis: a multidomain approach outperforms single domain predictions.
Numerous patient-related clinical parameters and treatment-specific variables have been identified as causing or contributing to the severity of peritonitis. We postulated that a combination of clinical and surgical markers and scoring systems would outperform each of these predictors in isolation. To investigate this hypothesis, we developed a multivariable model to examine whether survival outcome can reliably be predicted in peritonitis patients treated with open abdomen. ⋯ Marginal effects plots highlight the effect of individual outcomes on the prediction of survival outcome in patients undergoing staged laparotomies for treatment of peritonitis. Although most single indices exhibited moderate performance, we observed that the predictive performance was markedly increased when an integrative prediction model was applied. Our proposed MPPM integrative prediction model may outperform the predictive power of current models.
-
J Clin Monit Comput · Aug 2022
Optimizing the methodology for saphenous nerve somatosensory evoked potentials for monitoring upper lumbar roots and femoral nerve during lumbar spine surgery: technical note.
The demand for intraoperative monitoring (IOM) of lumbar spine surgeries has escalated to accommodate more challenging surgical approaches to prevent perioperative neurologic deficits. Identifying impending injury of individual lumbar roots can be done by assessing free-running EMG and by monitoring the integrity of sensory and motor fibers within the roots by eliciting somatosensory (SEP), and motor evoked potentials. However, the common nerves for eliciting lower limb SEP do not monitor the entire lumbar plexus, excluding fibers from L1 to L4 roots. ⋯ The recording derivation CPz-cCP showed the highest amplitude in 65% of the nerves, followed by CPz-Fz (24%). Distal stimulation for Sap-SEP has advantages over proximal stimulation, including simplicity, lack of movement and higher amplitude responses. The use of two derivations (CPz-cCP, CPz-Fz) optimizes Sap-SEP recording.
-
J Clin Monit Comput · Aug 2022
Clinical TrialThe interest of 100 versus 200 Hz tetanic stimulations to quantify low levels of residual neuromuscular blockade with mechanomyography: a pilot study.
A more sensitive method than the train-of-four ratio seems required to detect low levels of residual neuromuscular blockade before tracheal extubation. The goal of the study was to determine the potential benefit of 5 s of 100 versus 200 Hz tetanic stimulation to quantify the residual block with mechanomyography in anesthetised patients. Twenty informed and consenting 18- to 80-year-old patients undergoing nose surgery were included. ⋯ There were no differences between baseline and post-reversal TFR. The 200 Hz TFR has the potential to better describe low levels of residual neuromuscular blockade than the TOF ratio and 100 Hz TFR and would benefit from further investigations. Retrospectively registered in the Australian and New Zealand Clinical Trials Registry ACTRN12619000273189.