Journal of clinical monitoring and computing
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J Clin Monit Comput · Feb 2018
Beat-by-beat assessment of cardiac afterload using descending aortic velocity-pressure loop during general anesthesia: a pilot study.
Continuous cardiac afterload evaluation could represent a useful tool during general anesthesia (GA) to titrate vasopressor effect. Using beat to beat descending aortic pressure(P)/flow velocity(U) loop obtained from esophageal Doppler and femoral pressure signals might allow to track afterload changes. Methods We defined three angles characterizing the PU loop (alpha, beta and Global After-Load Angle (GALA)). ⋯ After vasopressors, MAP increase was associated with a decrease in Ctot, an increase in AIx and PVR and an increase in alpha, beta and GALA (p < 0.001 for all). Changes in GALA and Ctot after vasopressors were strongly associated (p = 0.004). Conclusions PU Loop assessment from routine invasive hemodynamic optimization management during GA and especially GALA parameter could monitor cardiac afterload continuously in anesthetized patients, and may help clinicians to titrate vasopressor therapy.
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J Clin Monit Comput · Feb 2018
Randomized Controlled Trial Retracted PublicationChanges in the first postoperative night bispectral index of patients after thyroidectomy with different types of primary anesthetic management: a randomized controlled trial.
Despite major advances in anesthesia management and developments in anesthetic agents, postoperative sleep disturbances remain dissatisfactory for many patients. We hypothesized that propofol might have a subtle influence on sleep after thyroidectomy compared to sevoflurane. A randomized, single-blinded, controlled trial was conducted at the First Hospital of China Medical University from October 2014 to October 2015. ⋯ The BIS-area under the curve was decreased, the sleep efficiency index was significantly increased, and the durations of postoperative sleep and sleep stage N3 were increased by 110.5 and 36.5 min per patient, respectively, in the propofol compared to the sevoflurane group. Propofol might preserve sleep time immediately after thyroidectomy. Clinical Trials.gov identifier: NCT 02146976.
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J Clin Monit Comput · Feb 2018
Linshom thermodynamic sensor is a reliable alternative to capnography for monitoring respiratory rate.
Monitoring ventilation accurately is a technically challenging, yet indispensable aspect of patient care in the intra- and post-procedural settings. A new prototypical device known as the Linshom Respiratory Monitoring Device (LRMD) has been recently designed to non-invasively, inexpensively, and portably measure respiratory rate. The purpose of this study was to measure the accuracy and variability of LRMD measurements of respiratory rate relative to the measurement of capnography. ⋯ At higher breathing rates indicative of hyperventilation, the variance of the test device was 4.52, still less than that of capnography at 5.73. This study demonstrated a promising correlation between the LRMD and capnography for use as a respiratory rate monitor. The LRMD technology may be a significant addition to monitoring vital signs because it offers a minimally intrusive opportunity to detect respiratory rate and apnea, without expensive or complex anesthetic equipment, before the need for life-saving resuscitation arises.
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J Clin Monit Comput · Feb 2018
Observational StudyA critical assessment of early warning score records in 168,000 patients.
The national early warning score (NEWS) is recommended to detect deterioration in hospitalised patients. In 2013, a NEWS-based system was introduced in a hospital service with over 250,000 annual admissions, generating large amounts of NEWS data. The quality of such data has not been described. ⋯ In a large set of NEWS data, 10% of the records were incomplete. In a system where data were manually entered into an electronic medical record, digit preferences and the accumulation of pulse rate records below 91 beats per minute, which is the limit for NEWS point generation, showed that staff practice influenced the recorded values. This indicates a potential limitation of transferability of research results obtained in such systems to fully automated systems.
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J Clin Monit Comput · Feb 2018
Feasibility of automated titration of vasopressor infusions using a novel closed-loop controller.
Blood pressure management is a central concern in critical care patients. For a variety of reasons, titration of vasopressor infusions may be an ideal use-case for computer assistance. Using our previous experience gained in the bench-to-bedside development of a computer-assisted fluid management system, we have developed a novel controller for this purpose. ⋯ The managed group had an MAP of 70.5 ± 3.2 mmHg (p < 0.00001 compared to unmanaged group) and spent 88.6% of case time in-target (p < 0.00001 compared to unmanaged group), with 6.4% of case time over and 5.1% of case time under target. Increasing infusion lag increased coefficient of variation by about 10% per 15 s of lag (p = 0.001). This study demonstrated that this novel controller for vasopressor administration is able to main a target mean arterial pressure in a simulated physiologic model in the face of random disturbances and infusion-line lag.