Journal of clinical monitoring and computing
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J Clin Monit Comput · Jun 2018
ReviewA review of recent advances in data analytics for post-operative patient deterioration detection.
Most deaths occurring due to a surgical intervention happen postoperatively rather than during surgery. The current standard of care in many hospitals cannot fully cope with detecting and addressing post-surgical deterioration in time. For millions of patients, this deterioration is left unnoticed, leading to increased mortality and morbidity. ⋯ This work also aims to highlight the opportunities that lie in personalizing the models developed for patient deterioration for these particular post-surgical patients and make the output more actionable. The integration of pre- and intra-operative data, e.g. comorbidities, vitals, lab data, and information about the procedure performed, in post-operative early warning algorithms would lead to more contextualized, personalized, and adaptive patient modelling. This, combined with careful integration in the clinical workflow, would result in improved clinical decision support and better post-surgical care outcomes.
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J Clin Monit Comput · Jun 2018
Case ReportsMechanical ventilation guided by electrical impedance tomography in pediatric acute respiratory distress syndrome.
Mechanical ventilation strategies in pediatric acute respiratory distress syndrome (pARDS) continue to advance. Optimizing positive end expiratory pressure (PEEP) and ventilation to recruitable lung can be difficult to clinically achieve. This is in part, due to disease evolution, unpredictable changes in lung compliance, and the inability to assess regional tidal volumes in real time at the bedside. Here we report the utilization of thoracic electrical impedance tomography to guide daily PEEP settings and recruitment maneuvers in a child with pARDS.
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J Clin Monit Comput · Jun 2018
Clinical TrialA smartphone application to determine body length for body weight estimation in children: a prospective clinical trial.
The aim of this study was to test the feasibility and accuracy of a smartphone application to measure the body length of children using the integrated camera and to evaluate the subsequent weight estimates. A prospective clinical trial of children aged 0-<13 years admitted to the emergency department of the University Children's Hospital Zurich. The primary outcome was to validate the length measurement by the smartphone application «Optisizer». ⋯ The body weight estimations based upon length corresponded to known data and limitations. Precision of body weight estimations by paediatric physicians and nurses were comparable and not different to length based estimations. In this non-emergency setting, parental weight estimation was significantly better than all other means of estimation (paediatric physicians and nurses, length based estimations) in terms of precision and absolute difference.
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J Clin Monit Comput · Jun 2018
Observational StudyEffects of hypnosis on the relative parasympathetic tone assessed by ANI (Analgesia/Nociception Index) in healthy volunteers: a prospective observational study.
Hypnosis has shown an effect on the regulation of the autonomic nervous system by increasing parasympathetic activity. The Analgesia/Nociception Index (ANI) is derived from heart rate variability and represents the relative parasympathetic tone. We investigated the effects of hypnosis on ANI in healthy volunteers. ⋯ The median [25th-75th percentile] RR at T1 (16 [14-18] breaths/min) and T2 (14 [12-16] breaths/min) were significantly smaller than at T0 (18 [16-20] breaths/min) and T3 (18 [16-20] breaths/min). This study shows that hypnosis induces an increase in the relative parasympathetic tone assessed by ANI in healthy volunteers, with greater ANI values observed in women. These results suggest that ANI monitoring may provide an objective tool for the measurement of the intensity of the hypnotic process, although this should be confirmed by further studies.
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J Clin Monit Comput · Jun 2018
Randomized Controlled TrialAnalgesia nociception index (ani) monitoring in patients with thoracic paravertebral block: a randomized controlled study.
The goal of the study was to evaluate the effectiveness of analgesia nociception index (ANI) monitoring during intraoperative period for patients with thoracic paravertebral block (TPVB) undergoing breast surgery under general anesthesia. This prospective randomized trial was performed after receiving ethics committee approval in 44 patients who were scheduled to undergo breast surgery under general anesthesia. TPVB was performed in the preoperative period using 20 mL of bupivacaine 0.25% at T4 level. ⋯ There were no significant difference in demographic data, intraoperative hemodynamic parameters, post-anesthesia recovery time and requirement of additional analgesic drug. There was a statistically significant difference between groups in total remifentanil consumption (Group ANI: 629.6 ± 422.4 mcg, Group control: 965.2 ± 543.6 mcg) (p = 0.027). In patients under general anesthesia ANI monitorisation can help optimisation of opioid consumption and provide data about nociception/antinociception intraoperatively but further experimental and clinical trials in a large scale are needed.