Journal of clinical monitoring and computing
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J Clin Monit Comput · Jun 2017
ReviewUrine biochemistry assessment in critically ill patients: controversies and future perspectives.
In the past, urine biochemistry was a major tool in acute kidney injury (AKI) management. Classic papers published some decades ago established the values of the urine indices which were thought to distinguish "pre-renal" (functional) AKI attributed to low renal perfusion and "renal" (structural) AKI attributed to acute tubular necrosis (ATN). However, there were a lot of drawbacks and limitations in these studies and some recent articles have questioned the utility of measuring urine electrolytes especially because they do not seem to adequately inform about renal perfusion nor AKI duration (transient vs. persistent). ⋯ Some studies have suggested standardized changes in the urine electrolyte composition preceding increases in serum creatinine independently of AKI subsequent duration, which might actually be due to intra-renal microcirculatory changes and activation of sodium-retaining mechanisms even in the absence of impaired global renal blood flow. In the present review, the points of controversy regarding urine biochemistry assessment were evaluated as well as future perspectives for its role in AKI monitoring. An alternative approach for the interpretation of measured urine electrolytes is proposed which needs further larger studies to be validated and incorporated in daily ICU practice.
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J Clin Monit Comput · Jun 2017
Analysis of central venous pressure (CVP) signals using mathematical methods.
Central venous pressure (CVP) is an important clinical parameter for physicians but only the absolute CVP value is typically monitored in the intensive care unit (ICU). In this study, we propose a novel mathematical method to present and analyze CVP signals. ⋯ The statistical features of time and frequency domain, wavelet, and empirical mode decomposition of these signals were extracted. We found no significant difference among the CVP signals regarding sex, smoking, coronary disease, and respiration mode of the samples.
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J Clin Monit Comput · Jun 2017
Clinical TrialEfficacy of bioelectrical impedance analysis during the perioperative period in children.
We evaluated the efficacy of bioelectrical impedance analysis (BIA) during the perioperative period by estimating the preoperative and postoperative body fluid status. After obtaining informed consent, we enrolled 100 children (3-12 years of age) scheduled for elective surgeries. All children had been fasted preoperatively. ⋯ The baseline and postoperative ICW showed a strong positive correlation (Pearson correlation coefficient = 0.992, P < 0.001), as did the baseline and postoperative ECW (Pearson correlation coefficient = 0.990, P < 0.001). Also there was no dehydration and irritability on medical recording preoperatively. BIA may be an alternative method for estimating the perioperative fluid status in children and determining details of fluid administration.
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J Clin Monit Comput · Jun 2017
Monitoring of total positive end-expiratory pressure during mechanical ventilation by artificial neural networks.
Ventilation treatment of acute lung injury (ALI) requires the application of positive airway pressure at the end of expiration (PEEPapp) to avoid lung collapse. However, the total pressure exerted on the alveolar walls (PEEPtot) is the sum of PEEPappand intrinsic PEEP (PEEPi), a hidden component. To measure PEEPtot, ventilation must be discontinued with an end-expiratory hold maneuver (EEHM). ⋯ ANN agreement with reference PEEPtotwas assessed with the Bland-Altman method. Bland Altman analysis of estimation error by ANN showed -0.40 ± 2.84 (expressed as bias ± precision) and ±5.58 as limits of agreement (data expressed as cmH2O). The ANNs estimated the PEEPtotwell at different levels of PEEPappunder dynamic conditions, opening up new possibilities in monitoring PEEPiin critically ill patients who require ventilator treatment.
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J Clin Monit Comput · Jun 2017
Observational StudyConsistency of cardiac function index and global ejection fraction with global end-diastolic volume in patients with femoral central venous access for transpulmonary thermodilution: a prospective observational study.
Global ejection fraction (GEF) and cardiac function index (CFI) are transpulmonary thermodilution (TPTD)-derived indices of the systolic function. Their validity relies on an accurate determination of the global end-diastolic volume (GEDV). Due to an overestimation of GEDV using a femoral central venous catheter (CVC) a correction formula for indexed GEDV (GEDVI) has been implemented in the latest PiCCO™-algorithm. ⋯ By contrast, GEFcalculated (23.1 ± 8.7 %) was not substantially different from GEFdisplayed (22.4 ± 8.6 %). Although GEDV and GEF are corrected for femoral CVC site, this does not apply to CFI. However, all indices derived from GEDV should be calculated consistently.