Journal of clinical monitoring and computing
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J Clin Monit Comput · Aug 2020
Letter Case ReportsCapnography-sample line leak and incremental positive end expiratory pressure (PEEP); an interesting interplay.
The capnography is an important monitor to assess the patient's respiratory status. Importance of education for clinicians in interpretation of alarms and various capnography waveforms in different clinical scenarios and equipment malfunction is an understatement. Capnography waveforms due to sample line tube leak is described well in literature. This report describes an interesting effect of incremental positive end expiratory pressure (PEEP) on capnography waveforms linked to sample line leak.
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J Clin Monit Comput · Aug 2020
Detecting intraoperative gastric regurgitation by using preattached esophageal multichannel intraluminal impedance and pH monitoring on a solid-state manometry: a case series study.
Adequate barrier pressure (BrP), calculated by subtracting intragastric pressure (IGP) from lower esophageal sphincter pressure (LESP), is believed to prevent gastroesophageal regurgitation (GER). However, the occurrence of intraoperative GER, the height and acidity it reached, have rarely been demonstrated simultaneously along with BrP. In this study, we developed preattached multichannel intraluminal impedance monitoring combined with pH-metry (the gold standard for detecting both height and acidity) on a solid-state manometry to continuously detect intraoperative GER as well as BrP changes. ⋯ The mean IGP (3.24 mmHg) at T2 was significantly higher than at T1 and T3 (- 6.10 and - 2.25 mmHg, respectively). The mean BrP scores were comparable from T1 to T3 (T1: 19.34 mmHg; T2: 19.98 mmHg; T3: 21.16 mmHg). Based on our results, the proposed setup is helpful for intraoperative monitoring and management of patients at high risk of GER.
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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
Behavior of a dual closed-loop controller of propofol and remifentanil guided by the bispectral index for postoperative sedation of adult cardiac surgery patients: a preliminary open study.
A dual-loop controller permits the automated titration of propofol and remifentanil during anesthesia; it has never been used in intensive care after cardiac surgery. The goal of this preliminary study was to determine the efficacy of this controller to provide postoperative sedation in 19 adult cardiac surgery patients with a Bispectral Index target of 50. Results are presented as numbers (percentages) or medians [25th-75th percentiles]. ⋯ Automated sedation device was discontinued in two patients for hemodynamic instability. No patient had awareness of the postoperative sedation period. Dual closed-loop can provide postoperative sedation after cardiac surgery but the choice of the depth of sedation should take into account the risk of hypotension.
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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.