Journal of clinical monitoring and computing
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J Clin Monit Comput · Aug 2017
ReviewCommentary : The value of intraoperative neurophysiological monitoring: evidence, equipoise and outcomes.
The use of intraoperative neurophysiological monitoring (IONM) has grown despite an absence of randomized controlled trials that might unequivocally demonstrate improved outcomes. At issue is how to demonstrate value when other evidence indicates patient harms (opportunity cost) if IONM is withheld for the sake of randomization. ⋯ We also examine how clinical equipoise may resolve whether (or not) an anticipated controlled study is ethical. We conclude that the value of IONM in a particular surgical setting should be determined by a benefits/harms analysis based on all the available evidence.
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J Clin Monit Comput · Aug 2017
ReviewA systematic review of pulse pressure variation and stroke volume variation to predict fluid responsiveness during cardiac and thoracic surgery.
This systematic review aims to summarize the published data on the reliability of pulse pressure variation (PPV) and stroke volume variation (SVV) to predict fluid responsiveness in an open-chest setting during cardio-thoracic surgery. The analysis included studies reporting receiver operating characteristics or correlation coefficients between PPV/SVV and change in any hemodynamic variables after a fluid challenge test in open-chest conditions. The literature search included seven studies. ⋯ The great heterogeneity between studies was due to small sample size and differences among protocol designs (different monitor devices, mechanical ventilation settings, fluid challenge methodologies, surgical incisions, and end-point variables). PPV and SVV seem to be inaccurate in predicting fluid responsiveness in an open-chest setting during cardio-thoracic surgery. Given the high heterogeneity of published data, more studies are needed to define the role of PPV/SVV in this context.
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J Clin Monit Comput · Aug 2017
Comparative StudyComparison of minute distribution frequency for anesthesia start and end times from an anesthesia information management system and paper records.
Use of an anesthesia information management system (AIMS) has been reported to improve accuracy of recorded information. We tested the hypothesis that analyzing the distribution of times charted on paper and computerized records could reveal possible rounding errors, and that this effect could be modulated by differences in the user interface for documenting certain event times with an AIMS. We compared the frequency distribution of start and end times for anesthesia cases completed with paper records and an AIMS. ⋯ For case end times, the distribution of minutes recorded with AIMS was almost evenly distributed, unlike those from paper records that still showed significant end-digit preference. The accuracy of anesthesia case start times and case end times, as inferred by statistical analysis of the distribution of the times, is enhanced with the use of an AIMS. Furthermore, the differences in AIMS user interface for documenting case start and case end times likely affects the degree of end-digit preference, and likely accuracy, of those times.
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J Clin Monit Comput · Aug 2017
Case ReportsInsertion of intra-oral electrodes for cranial nerve monitoring using a Crowe-Davis retractor.
Acoustic neuroma resection is an example of a neurosurgical procedure where the brainstem and multiple cranial nerves are at risk for injury. Electrode placement for monitoring of the glossopharyngeal and hypoglossal nerves during acoustic neuroma resection can be challenging. The purpose of this report is to illustrate the use of a device for intra-oral electrode placement for intraoperative monitoring of the glossopharyngeal and hypoglossal nerves. ⋯ The tumor was resected successfully. Monitoring of the cranial nerves (including the glossopharyngeal and hypoglossal nerves) revealed no concerning responses. The Crowe-Davis retractor and the technique described allowed insertion of electrodes for neural monitoring, contributing to neural preservation.
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J Clin Monit Comput · Aug 2017
Ability and efficiency of an automatic analysis software to measure microvascular parameters.
Analysis of the microcirculation is currently performed offline, is time consuming and operator dependent. The aim of this study was to assess the ability and efficiency of the automatic analysis software CytoCamTools 1.7.12 (CC) to measure microvascular parameters in comparison with Automated Vascular Analysis (AVA) software 3.2. 22 patients admitted to the cardiothoracic intensive care unit following cardiac surgery were prospectively enrolled. Sublingual microcirculatory videos were analysed using AVA and CC software. ⋯ The time required for the analysis was shorter with CC than with AVA system [2'42″ (2'12″, 3'31″) vs. 16'12″ (13'38″, 17'57″), p < 0.001]. TVD is comparable between the two softwares, although faster with CC software. The values for PVD and PPV are not interchangeable given the different approach to assess microcirculatory flow.