Journal of clinical monitoring and computing
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J Clin Monit Comput · Aug 2017
Gradient adjustment method for better discriminating correlating and non-correlating regions of physiological signals: application to the partitioning of impaired and intact zones of cerebral autoregulation.
Cerebral blood flow (CBF) is regulated over a range of systemic blood pressures by the cerebral autoregulation (CA) control mechanism. This range lies within the lower and upper limits of autoregulation (LLA, ULA), beyond which blood pressure drives CBF, and CA function is considered impaired. A standard method to determine autoregulation limits noninvasively using NIRS technology is via the COx measure: a moving correlation index between mean arterial pressure and regional oxygen saturation. ⋯ It is shown that the derived GACOx indices exhibit a mean difference between the intact/impaired regions of 1.54 ± 0.26 (mean ± SD), compared to 0.14 ± 0.10 for the traditional COx method. The GACOx effectively polarizes the COx data in order to better differentiate the intact and impaired zones and, in doing so, makes the determination of the LLA and ULA points a simpler and more consistent task. The method lends itself to the automation of the robust determination of autoregulation zone limits.
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J Clin Monit Comput · Aug 2017
Automated, continuous and non-invasive assessment of pulse pressure variations using CNAP(®) system.
Non-invasive respiratory variations in arterial pulse pressure using infrared-plethysmography (PPVCNAP) are able to predict fluid responsiveness in mechanically ventilated patients. However, they cannot be continuously monitored. The present study evaluated a new algorithm allowing continuous measurements of PPVCNAP (PPVCNAPauto) (CNSystem, Graz, Austria). ⋯ A 15 % baseline PPVCNAPauto threshold discriminated responders with a sensitivity of 76% (95 % CI 53-92 %) and a specificity of 93 % (95 % CI 66-99 %). Area under the ROC curves for PPVCNAPauto was 0.91 (95 % CI 0.76-0.98), which was not different from that for PPVART. When compared with PPVART, PPVCNAPauto performs satisfactorily in assessing fluid responsiveness in hemodynamically stable surgical patients.
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J Clin Monit Comput · Aug 2017
Comparative Study Observational StudyComparison of smartphone application-based vital sign monitors without external hardware versus those used in clinical practice: a prospective trial.
Use of healthcare-related smartphone applications is common. However, there is concern that inaccurate information from these applications may lead patients to make erroneous healthcare decisions. The objective of this study is to study smartphone applications purporting to measure vital sign data using only onboard technology compared with monitors used routinely in clinical practice. ⋯ The degree of correlation between monitors routinely used in clinical practice and the smartphone-based applications studied is insufficient to recommend clinical utilization. This lack of correlation suggests that the applications evaluated do not provide clinically meaningful data. The inaccurate data provided by these applications can potentially contribute to patient harm.
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J Clin Monit Comput · Aug 2017
Randomized Controlled Trial Comparative StudyWhich imaging method should be used for genicular nerve radio frequency thermocoagulation in chronic knee osteoarthritis?
This study aimed to perform genicular nerve RF neurotomy using two different imaging methods, fluoroscopy and ultrasound, and to compare the clinical effects and reliability of the two methods. Fifty patients with osteoarthritis were included in this study. Patients were randomly allocated into group 1 (fluoroscopy imaging) and group 2 (ultrasound imaging). ⋯ There was no difference in pain relief and functional status between the ultrasound and fluoroscopy groups. Decrease in VAS score and WOMAC total score in the first and third months was significant in both groups (p < 0.001). GNRFT under ultrasound guidance was easily applicable, safe and dynamic, and required no radiation to achieve the same benefit as the fluoroscopy-guided interventions.