Journal of clinical monitoring and computing
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J Clin Monit Comput · Jun 2022
Bioreactance and fourth-generation pulse contour methods in monitoring cardiac index during off-pump coronary artery bypass surgery.
The pulmonary artery catheter (PAC) is considered the gold standard for cardiac index monitoring. Recently new and less invasive methods to assess cardiac performance have been developed. The aim of our study was to assess the reliability of a non-invasive monitor utilizing bioreactance (Starling SV) and a non-calibrated mini-invasive pulse contour device (FloTrac/EV1000, fourth-generation software) compared to bolus thermodilution technique with PAC (TDCO) during off-pump coronary artery bypass surgery (OPCAB). ⋯ In comparison with TDCO, FloTrac was associated with a bias of 0.01 L min-1 m-2 (95% CI - 0.05 to 0.06), wide LOA (- 1.27 to 1.29 L min-1 m-2), a PE of 56.8% and poor trending ability. Both Starling SV and fourth-generation FloTrac showed acceptable mean bias but imprecision due to wide LOA and high PE, and poor trending ability. These findings indicate limited reliability in monitoring cardiac index in patients undergoing OPCAB.
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J Clin Monit Comput · Jun 2022
ReviewDescription of the validity of the Analgesia Nociception Index (ANI) and Nociception Level Index (NOL) for nociception assessment in anesthetized patients undergoing surgery: a systematized review.
Maintaining optimum analgesia in anesthetized patients is challenging due to the inability to self-report pain or exhibit pain-related behaviours. The Analgesia Nociception Index (ANI) (based on heart rate variability [HRV]) and the Nociception Level Index (NOL) (based on HRV, photoplethysmography, skin conductance, and temperature) both include HRV and provide continuous index monitoring for nociception assessment. The research question was: "What are the validation strategies of the NOL and ANI for nociception assessment in anesthetized patients?". ⋯ Both technologies performed superiorly in detecting nociceptive stimuli compared to individual monitoring of HR and blood pressure. Although the aforementioned validation strategies are deemed appropriate, in the absence of a gold standard, criterion validation findings should be interpreted with caution. Moreover, reliability could be examined using test-retest with consistent ANI/NOL values during a stable time-interval.
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J Clin Monit Comput · Jun 2022
Volatile anesthetic gas concentration sensing using flow sensor fusion for use in Austere settings.
Flow sensors are often sensitive to the presence of volatile anesthetics. However, this sensitivity provides a unique opportunity to combine flow sensors of differing technological principles as an alternative to measuring volatile anesthetic gas concentration, particularly for austere settings. To determine the feasibility of flow sensor fusion for volatile anesthetic concentrations monitoring, eight flow sensors were tested with isoflurane, sevoflurane, and desflurane, ranging in concentrations from 0-4.5%, 0-3.5%, and 0-18%, respectively. ⋯ Conclusion: Measuring volatile anesthetic gases using flow sensor fusion is a feasible low-cost, low-maintenance alternative to infrared spectroscopy. In this study, testing was done under steady-state conditions in 100% oxygen. Further testing is necessary to ensure sensor fusion performance under conditions that are more reflective of the clinical use case.
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J Clin Monit Comput · Jun 2022
Observational StudyUltrasonic cardiac output monitor provides effective non-invasive bedside measurements of neonatal cardiac output.
This study determined the accuracy and validity for the haemodynamic parameters of haemodynamically stable neonates after postnatal circulatory adaptation using the ultrasonic cardiac output monitor (USCOM) in comparison with echocardiography. We conducted a prospective, observational study of neonates born at 23-41 weeks of gestation. They all underwent both echocardiography and USCOM assessments for comparison purposes. ⋯ A larger bias was observed in cases with higher left ventricular output. Bland-Altman analysis confirmed no significant bias, with acceptable limits of agreement between these two methods. There was a very good correlation between the USCOM and echocardiographic methods when we used them to measure cardiac output in neonates.
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J Clin Monit Comput · Jun 2022
Perfusion index as an objective measure of postoperative pain in children undergoing adenotonsillectomy: a cohort study.
Postoperative pain in children is usually undertreated because of their inability to complain. While several pain assessment scales have been developed, they have shortcomings such as subjectivity and being observer-dependent. This study aimed to assess the validity of the perfusion index as an objective measure of postoperative pain in children undergoing adenotonsillectomy. ⋯ The ΔPI-pre was an excellent predictor of postoperative pain (AUROC 0.83 with 71% sensitivity, 83% specificity, and a cut-off value of ≥ 0.26). The perfusion index is a good objective measure for predicting the presence of postoperative pain in children undergoing adenotonsillectomy under general anesthesia. Trial registration: ClinicalTrials.gov; ID: (NCT03854604) registered on February 2019.