Journal of clinical monitoring and computing
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J Clin Monit Comput · Feb 2018
Cross-comparisons of trending accuracies of continuous cardiac-output measurements: pulse contour analysis, bioreactance, and pulmonary-artery catheter.
We compared the similarity of cardiac-output (CO) estimates between available bolus thermodilution pulmonary-artery catheters (PAC), arterial pulse-contour analysis (LiDCOplus™, FloTrac™ and PiCCOplus™), and bioreactance (NICOM™). Repetitive simultaneous estimates of CO obtained from the above devices were compared in 21 cardiac-surgery patients during the first 2 h post-surgery. Mean and absolute values for CO across the devices were compared by ANOVA, Bland-Altman, Pearson moment, and linear-regression analyses. ⋯ From Pearson moment analysis, dynamic changes in CO, estimated by each device, showed good cross-correlations. Although all devices studied recorded similar mean CO values, which dynamically changed in similar directions, they have markedly different bias and precision values relative to each other. Thus, results from prior studies that have used one device to estimate CO cannot be used to validate others devices.
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J Clin Monit Comput · Feb 2018
Observational StudyThe effect of mouth prop on endotracheal tube intracuff pressure in children during dental rehabilitation under general anaesthesia.
Although the endotracheal tube (ETT) cuff may be associated with tracheal morbidity, cuffed tubes may reduce the aspiration risk in oral procedures. Dentists must use a mouth prop to facilitate oral visualization and to protect the oral soft tissues during dental rehabilitation under general anaesthesia (DRGA). The aim of this study was to evaluate the effect of mouth prop on endotracheal tube intracuff pressure in children during DRGA. ⋯ No significant differences were observed between the duration of the procedure and intracuff pressure or postoperative complications (P > 0.05). Cough, sore throat and nausea were observed in 4, 1 and 5 patients, respectively. Because a mouth prop may increase the intracuff pressure of ETT, strict measurement and readjustment of cuff pressures should be employed when used in children during DRGA.
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J Clin Monit Comput · Feb 2018
Influences of environmental noise level and respiration rate on the accuracy of acoustic respiration rate monitoring.
We tested the hypothesis that the environmental noise generated by a forced-air warming system reduces the monitoring accuracy of acoustic respiration rate (RRa). Noise levels were adjusted to 45-55, 56-65, 66-75, and 76-85 dB. Healthy participants breathed at set respiration rates (RRset) of 6, 12, and 30/min. ⋯ The RRa of one, nine, and nine participants at 76-85 dB noise agreed with RRset of 6, 12, and 30/min, respectively, which was significantly less than the other noise levels (P < 0.05). Overall, 72.9% of alarm displays highlighted incorrect values of RRa. In a noisy situation involving the operation of a forced-air warming system, the acoustic respiration monitoring should be used carefully especially in patients with a low respiration rate.
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J Clin Monit Comput · Feb 2018
Observational StudyInvestigation of optical neuro-monitoring technique for detection of maintenance and emergence states during general anesthesia.
The American Society of Anesthesiologist recommends peripheral physiological monitoring during general anesthesia, which offers no information regarding the effects of anesthetics on the brain. Since no "gold standard" method exists for this evaluation, such a technique is needed to ensure patient comfort, procedure quality and safety. In this study we investigated functional near infrared spectroscopy (fNIRS) as possible monitor of anesthetic effects on the prefrontal cortex. ⋯ We observed that during maintenance the signal is relatively more stable than during emergence. Maintenance and emergence states were classified with 94.7% accuracy with a non-linear model using the locally derived mean total hemoglobin, standard deviation of HbO2, minimum and range of HbO2 and HHb as features. These features were found to be correlated with the effects of sevoflurane and to carry information that allows real time and automatic classification of the anesthetized state with high accuracy.
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J Clin Monit Comput · Feb 2018
Editorial CommentThe future of intraoperative blood pressure management.