Journal of clinical monitoring and computing
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J Clin Monit Comput · Aug 2024
The modern anesthesiologist's manual: the development and maintenance of an anesthesia case reference application.
Anesthesia clinicians care for patients undergoing a wide range of procedures, making access to reliable references crucial. However, existing resources have key limitations. This technical report describes the development of an in-house anesthesia case reference application designed for use in a tertiary academic hospital. ⋯ The most popular articles centered around procedures with diverse and specific surgeon preferences. Currently, the reported case reference application is routinely utilized by anesthesia clinicians at our institution. Future endeavors will concentrate on establishing a robust content management workflow to broaden the coverage of topics.
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J Clin Monit Comput · Aug 2024
Review Meta AnalysisIs EIT-guided positive end-expiratory pressure titration for optimizing PEEP in ARDS the white elephant in the room? A systematic review with meta-analysis and trial sequential analysis.
Electrical Impedance Tomography (EIT) is a novel real-time lung imaging technology for personalized ventilation adjustments, indicating promising results in animals and humans. The present study aimed to assess its clinical utility for improved ventilation and oxygenation compared to traditional protocols. Comprehensive electronic database screening was done until 30th November, 2023. ⋯ Our search retrieved five controlled cohort studies and two RCTs with 515 patients and overall reduced risk of mortality [RR = 0.68; 95% CI: 0.49 to 0.95; I2 = 0%], better dynamic compliance [MD = 3.46; 95% CI: 1.59 to 5.34; I2 = 0%] with no significant difference in PaO2/FiO2 ratio [MD = 6.5; 95%CI -13.86 to 26.76; I2 = 74%]. The required information size except PaO2/FiO2 was achieved for a power of 95% based on the 50% reduction in risk of mortality, 10% improved compliance as the cumulative Z-score of the said outcomes crossed the alpha spending boundary and did not dip below the inner wedge of futility. EIT-guided individualized PEEP titration is a novel modality; further well-designed studies are needed to substantiate its utility.
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J Clin Monit Comput · Aug 2024
ReviewAlternative sensor montage for Index based EEG monitoring. A systematic review.
The main objective of this systematic review is to assess the reliability of alternative positions of processed electroencephalogram sensors for depth of anesthesia monitoring and its applicability in clinical practice. A systematic search was conducted in PubMed, Embase, Cochrane Library, Clinical trial.gov in accordance with reporting guidelines of PRISMA statement together with the following sources: Google and Google Scholar. We considered eligible prospective studies, written in the English language. ⋯ Most studies had a low risk of bias but due to lack of information in one key domain of bias (Bias due to missing data) the overall judgement would be No Information. However, there is no clear indication that the studies are at serious or critical risk of bias. Bearing in mind, the heterogeneity and small sample size of the included studies, current evidence suggests that the alternative infraorbital sensor position is the most comparable for clinical use when the standard sensor position in the forehead is not possible.
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J Clin Monit Comput · Aug 2024
Randomized Controlled TrialElectroencephalographic guided propofol-remifentanil TCI anesthesia with and without dexmedetomidine in a geriatric population: electroencephalographic signatures and clinical evaluation.
Elderly and multimorbid patients are at high risk for developing unfavorable postoperative neurocognitive outcomes; however, well-adjusted and EEG-guided anesthesia may help titrate anesthesia and improve postoperative outcomes. Over the last decade, dexmedetomidine has been increasingly used as an adjunct in the perioperative setting. Its synergistic effect with propofol decreases the dose of propofol needed to induce and maintain general anesthesia. ⋯ This pilot study demonstrates that the two proposed anesthetic regimens can be safely used to slowly induce anesthesia and avoid EEG burst suppression patterns. Despite the patients being elderly and at high risk, we did not observe postoperative neurocognitive deficits. The reduced alpha power in the dexmedetomidine-treated group was not associated with adverse neurocognitive outcomes.
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J Clin Monit Comput · Aug 2024
Multicenter StudyICP wave morphology as a screening test to exclude intracranial hypertension in brain-injured patients: a non-invasive perspective.
Intracranial hypertension (IH) is a life-threating condition especially for the brain injured patient. In such cases, an external ventricular drain (EVD) or an intraparenchymal bolt are the conventional gold standard for intracranial pressure (ICPi) monitoring. However, these techniques have several limitations. ⋯ To conclude, the P2/P1 ratio of the noninvasive ICP waveform showed in this study a high Negative Predictive Value and Likelihood Ratio in different acute neurological conditions to rule out IH. As a result, this parameter may be beneficial in situations where invasive methods are not feasible or unavailable and to screen high-risk patients for potential invasive ICP monitoring. Trial registration: At clinicaltrials.gov under numbers NCT05121155 (Registered 16 November 2021-retrospectively registered) and NCT03144219 (Registered 30 September 2022-retrospectively registered).