Journal of clinical monitoring and computing
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J Clin Monit Comput · Aug 2020
Observational StudyUsing real-time location devices (RTLD) to quantify off-unit adult intensive care registrar workload: a 1-year tertiary NHS hospital prospective observational study.
UK national guidelines state deteriorating or at risk hospital ward patients should receive care from trained critical care outreach personnel. In most tertiary hospitals this involves a team led by an Intensive Care Unit (ICU) registrar. The ICU registrar must also review patients referred for possible ICU admission. ⋯ This workload combines to leave the unit unattended at night up to 10% of the time. RTLDs provide a reliable, automated method for quantifying ICU registrar off-unit work patterns. This method may be adopted for quantifying other clinical staff work patterns in suitably equipped hospital environments.
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J Clin Monit Comput · Aug 2020
Facing SpO2 and SaO2 discrepancies in ICU patients: is the perfusion index helpful?
Peripheral oxygen saturation (SpO2) measured by pulse oximetry is an unreliable surrogate marker for arterial oxygenation (SaO2) in critically ill patients. We hypothesized that a higher perfusion index (PFI) would be associated with better accuracy of SpO2 measurement. We retrospectively collected SaO2, SpO2, and PFI data for each arterial blood gas (ABG) analysis in a cohort of intensive care unit patients. ⋯ The accuracy of pulse oximetry for estimating arterial oxygenation was moderate and improved little with increasing PFI values. Thus, the additive value of PFI in clinical decision making is limited. Therefore, we advise performing an ABG before adjusting fraction of inspired oxygen (FiO2) settings.
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J Clin Monit Comput · Aug 2020
A new device for real-time peroperative monitoring of ossicular chain reconstruction during middle ear surgery.
To limit functional surgical failure and reduce the rate of revision surgery in case of surgical ossicular chain reconstruction, a piezoelectric device was developed for assessment of ossicular chain vibrations during the middle ear surgery. The device resembled a pen and consisted of a reusable main body and a disposable sensitive head including piezoelectric polymer sensor. Almost all of components of the device were made of polymer for light weight and for acoustic impedance matching to the middle ear system. ⋯ This light, handheld and low-cost device allows fast, easy and safe assessments of normal ossicular chain mobility and ossicular chain reconstruction efficiency. Primary pre-clinical trial showed very promising performance of the device that could be used to qualitatively control ossiculoplasty during real-time surgical procedure. Clinical assessments will be done to further evaluate the real-life performance of the device.
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J Clin Monit Comput · Aug 2020
Diagnostic accuracy of somatosensory evoked potentials during intracranial aneurysm clipping for perioperative stroke.
Somatosensory evoked potentials (SSEPs) are utilized during aneurysm clipping to detect intraoperative ischemia. We assess the diagnostic accuracy of SSEPs in predicting perioperative stroke during aneurysm clipping. A retrospective review was conducted of 429 consecutive patients who underwent surgical clipping for ruptured and unruptured cerebral aneurysms with intraoperative SSEP monitoring from 2006 to 2013. ⋯ SSEP changes have high specificity and modest sensitivity for perioperative stroke. Stroke risk is a function of both the magnitude of SSEP amplitude loss and the duration of its loss. Given the modest sensitivity, patients may benefit from multimodal monitoring including motor-evoked potentials during cerebral aneurysm surgery.
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J Clin Monit Comput · Aug 2020
Evaluation of continuous flash glucose monitoring in a pediatric ICU setting.
Glucose monitoring is of great importance among patients in intensive care units (ICU). The purpose of this study is to assess the performance of a new flash glucose monitoring (FGM) system in a pediatric ICU setting. Sixteen consecutive patients admitted in pediatric ICU aged > 4 years, expected length stay > 2 days and with no medication or existing diagnosis affecting glucose metabolism were enrolled. ⋯ Significant linear correlations between age and MARD values were observed. Surveillance error grid (SEG) analysis showed 92.04%, 94.67% and 95.52% of the readings in the none or slight risk zone respectively. FreeStyle Libre is well tolerated although not adequately accurate with a tendency to underestimate glucose levels in critically ill pediatric patients.