Journal of clinical monitoring and computing
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J Clin Monit Comput · Apr 2024
Autonomic dysfunction as a predictor of infection in neurocritical care unit: a prospective cohort study.
Infection in the neurocritical care unit ( NCCU) can cause significant mortality and morbidity. Autonomic nervous system plays an important role in defense against infection. Autonomic dysfunction causing inflammatory dysregulation can potentiate infection. We aimed to study the relationship between autonomic dysfunction and occurrence of infection in neurologically ill patients. ⋯ AD assessment can be used as a tool to predict development of infection in NCCU. This can help triage and institute early investigation and treatment.
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We review the study by Xu et al. (J Clin Monit Comput 37(4):985-992, 2023. https://doi.org/10.1007/s10877-022-00968-1 ) on ultrasound-guided regional blocks in clavicle surgery, assessing the effects on anaesthesia and postoperative outcomes. However, there are concerns. The defined population of the study differs from the registered title (Xu et al. ⋯ In addition, the method of measuring the diaphragm is not clear (Xu et al. J Clin Monit Comput 37(4):985-992, 2023. https://doi.org/10.1007/s10877-022-00968-1 ). This affects the accurate interpretation of their results.
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Dynamic preload parameters are used to guide perioperative fluid management. However, reported cut-off values vary and the presence of a gray zone complicates clinical decision making. Measurement error, intrinsic to the calculation of pulse pressure variation (PPV) has not been studied but could contribute to this level of uncertainty. ⋯ The predicted range in reference PPV-value changes for a measured absolute change of 1% was [- 1.3%, 3.3%] and [- 1.9%, 4%] for these two methods. We showed that all methods that calculate PPV come with varying degrees of uncertainty. Accounting for bias and precision may have important implications for the interpretation of measured PPV-values or PPV-changes.
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J Clin Monit Comput · Apr 2024
Automatic assessment of left ventricular function for hemodynamic monitoring using artificial intelligence and transesophageal echocardiography.
We have developed a method to automatically assess LV function by measuring mitral annular plane systolic excursion (MAPSE) using artificial intelligence and transesophageal echocardiography (autoMAPSE). Our aim was to evaluate autoMAPSE as an automatic tool for rapid and quantitative assessment of LV function in critical care patients. In this retrospective study, we studied 40 critical care patients immediately after cardiac surgery. ⋯ AutoMAPSE was more precise than manual measurements if it averaged more heartbeats. AutoMAPSE had acceptable trending ability (concordance rate 81%) during hemodynamic alterations. In conclusion, autoMAPSE is feasible as an automatic tool for rapid and quantitative assessment of LV function, indicating its potential for hemodynamic monitoring.
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J Clin Monit Comput · Apr 2024
Observational StudyMonitoring persistent pulmonary hypertension of the newborn using the arterial to end tidal carbon dioxide gradient.
Persistent pulmonary hypertension of the newborn (PPHN) can be monitored theoretically by the difference of the partial pressure of arterial (PaCO2) to end-tidal CO2 (EtCO2). We aimed to test the hypothesis that the PaCO2-EtCO2 gradient in infants with PPHN would be higher compared to infants without PPHN. Prospective, observational study of term-born ventilated infants with echocardiographically-confirmed PPHN with right-to-left shunting and term-born control infants without respiratory disease. ⋯ The median difference in the gradient was significantly higher in infants with PPHN (6.2 mmHg) compared to infants without PPHN (-3.2 mmHg, p = 0.022). The PaCO2-EtCO2 gradient was higher in infants with PPHN compared to term born infants without PPHN and decreased over the first week of life in infants with PPHN. The gradient might be utilised to monitor the evolution and resolution of PPHN.