Journal of clinical monitoring and computing
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J Clin Monit Comput · Dec 2024
Prognostic value of heart rate variability for risk of serious adverse events in continuously monitored hospital patients.
Technological advances allow continuous vital sign monitoring at the general ward, but traditional vital signs alone may not predict serious adverse events (SAE). This study investigated continuous heart rate variability (HRV) monitoring's predictive value for SAEs in acute medical and major surgical patients. Data was collected from four prospective observational studies and two randomized controlled trials using a single-lead ECG. ⋯ In the medical subgroup, thresholds for all-cause mortality, cardiovascular, infectious, and neurologic SAEs had moderate prognostic ability, and the best performing threshold had an AUROC of 0.85 (95% CI 0.76-0.95) for predicting neurologic SAEs. Predicting SAEs based on the accumulated time below thresholds for individual continuously measured HRV parameters demonstrated overall low prognostic ability in high-risk hospitalized patients. Certain HRV thresholds had moderate prognostic ability for prediction of specific SAEs in the medical subgroup.
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J Clin Monit Comput · Dec 2024
Letter ReviewMonitor smart, use better: the future of haemodynamic monitoring.
The review article "Haemodynamic Monitoring During Noncardiac Surgery" offers valuable insights but lacks evidence linking specific haemodynamic strategies to improved outcomes. There's a need for standardized protocols, ongoing clinician education, and further validation of new technologies. Additionally, balancing the use of invasive versus noninvasive methods and addressing cost-effectiveness and sustainability are essential. Continued research and adaptive practices are crucial for optimizing perioperative care.
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J Clin Monit Comput · Dec 2024
Randomized Controlled TrialThe impact of a lung-protective ventilation mode using transpulmonary driving pressure titrated positive end-expiratory pressure on the prognosis of patients with acute respiratory distress syndrome.
This study aimed to assess the impact of a lung-protective ventilation strategy utilizing transpulmonary driving pressure titrated positive end-expiratory pressure (PEEP) on the prognosis [mechanical ventilation duration, hospital stay, 28-day mortality rate and incidence of ventilator-associated pneumonia (VAP), survival outcome] of patients with Acute Respiratory Distress Syndrome (ARDS). ⋯ Lung-protective mechanical ventilation using transpulmonary driving pressure titrated PEEP effectively improves lung function, reduces mechanical ventilation duration and hospital stay, and enhances survival outcomes in patients with ARDS. However, further study is needed to facilitate the wider adoption of this approach.
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J Clin Monit Comput · Dec 2024
Imitating the respiratory activity of the brain stem by using artificial neural networks: exploratory study on an animal model of lactic acidosis and proof of concept.
Artificial neural networks (ANNs) are versatile tools capable of learning without prior knowledge. This study aims to evaluate whether ANN can calculate minute volume during spontaneous breathing after being trained using data from an animal model of metabolic acidosis. Data was collected from ten anesthetized, spontaneously breathing pigs divided randomly into two groups, one without dead space and the other with dead space at the beginning of the experiment. ⋯ The best architecture of ANN had 17 intermediate neurons; the best performance of the finally trained ANN had a linear regression with R2 of 0.99, an MSE of 0.001 [L/min], a B-A analysis with bias ± standard deviation of 0.006 ± 0.039 [L/min]. ANNs can accurately estimate ΔVM using the same information that arrives at the respiratory centers. This performance makes them a promising component for the future development of closed-loop artificial ventilators.
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J Clin Monit Comput · Dec 2024
Comparative StudyComparing the compensatory reserve metric obtained from invasive arterial measurements and photoplethysmographic volume-clamp during simulated hemorrhage.
The compensatory reserve metric (CRM) is a novel tool to predict cardiovascular decompensation during hemorrhage. The CRM is traditionally computed using waveforms obtained from photoplethysmographic volume-clamp (PPGVC), yet invasive arterial pressures may be uniquely available. We aimed to examine the level of agreement of CRM values computed from invasive arterial-derived waveforms and values computed from PPGVC-derived waveforms. ⋯ There is generally good agreement between CRM values obtained from invasive arterial waveforms and values obtained from PPGVC waveforms. Invasive arterial waveforms may serve as an alternative for computation of the CRM.