Journal of clinical monitoring and computing
-
J Clin Monit Comput · Apr 2020
Randomized Controlled TrialInfluence of different PEEP levels on electrical impedance tomography findings in patients under general anesthesia ventilated in the lateral decubitus position.
To determine the effect of various PEEP levels on electrical impedance tomography (EIT) measured differences in regional ventilation, hemodynamics, lung mechanics and parameters of alveolar gas exchange. Thirty three patients scheduled for elective urologic surgery in general anesthesia in lateral decubitus position were randomized into three groups-PEEP 0, 5 and 10 mbar. EIT recording, arterial blood gas analysis and hemodynamic parameters were captured at three timepoints-before induction (T0), 5 min after lateral positioning (T1) and 90 min after positioning (T2). ⋯ In our study, a PEEP level of 10 mbar improved alveolar gas exchange without compromising hemodynamic stability in patients mechanically ventilated in the lateral decubitus position. EIT measured parameters may be used to determine optimal ventilation parameters in these patients with inhomogeneous lung mechanics. Further studies are needed in patients with various lung pathologies.
-
J Clin Monit Comput · Apr 2020
Observational StudyValidation of electrical velocimetry in resuscitation of patients undergoing liver transplantation. Observational study.
Major hemodynamic changes are frequently noted during liver transplantation (LT). We evaluated the performance of electrical velocimetry (EV) as compared to that of TEE in SV optimization during liver transplantation. This was an observational study in 32 patients undergoing LT. ⋯ The absolute values of SV derived from EV did not agree with SV derived from TEE. However, EV was able to track the direction of changes in SV during hemodynamic management of patients undergoing liver transplantation. Clinical trial registration: Clinicaltrials.gov Identifier: NCT03228329 prospectively Registered on 13-July-2017.
-
J Clin Monit Comput · Apr 2020
Machine learning applied to multi-sensor information to reduce false alarm rate in the ICU.
Studies reveal that the false alarm rate (FAR) demonstrated by intensive care unit (ICU) vital signs monitors ranges from 0.72 to 0.99. We applied machine learning (ML) to ICU multi-sensor information to imitate a medical specialist in diagnosing patient condition. We hypothesized that applying this data-driven approach to medical monitors will help reduce the FAR even when data from sensors are missing. ⋯ While the FAR for PER with missing parameters was 0.17-0.39, it was only 0.01-0.02 for RF. When scenarios were examined separately, RF showed clear superiority in almost all combinations of scenarios and numbers of missing parameters. When sensor data are missing, specialist performance worsens with the number of missing parameters, whereas the RF model attains high accuracy and low FAR due to its ability to fuse information from available sensors, compensating for missing parameters.
-
Monitoring level of hypnosis is a major ongoing challenge for anesthetists to reduce anesthetic drug consumption, avoiding intraoperative awareness and prolonged recovery. This paper proposes a novel automated method for accurate assessing of the level of hypnosis with sevoflurane in 17 patients using the electroencephalogram signal. ⋯ Then deep state is identified by extracting the sample entropy feature; and finally light and general states are identified by extracting the three mentioned features of the first step. The accuracy of the proposed method of analyzing the brain activity during anesthesia is 94.11%; which was better than previous studies and also a commercial monitoring system (Response Entropy Index).
-
J Clin Monit Comput · Apr 2020
Observational StudyPharmacodynamic modelling of the effect of remifentanil using the Pupillary Pain Index.
Using a targeted controlled infusion of remifentanil during total intravenous anesthesia, we investigated the effect-site concentrations of remifentanil that correlate with different values of the Pupillary Pain Index and which concentrations were necessary for achieving a Pupillary Pain Index ≤ 4 and its usefulness in titrating opioids. The Pupillary Pain Index was measured in 54 patients prior to surgery under different remifentanil effect-site concentrations and subsequently modeled. ⋯ For the probability of 80% of patients achieving a PPI score ≤ 4 the Ce of remifentanil was 4.39 ng/mL. We conclude that concentrations of remifentanil that have been shown to suppress movement in response to noxious stimulation correspond to a Pupillary Pain Index ≤ 4.