Journal of clinical monitoring and computing
-
J Clin Monit Comput · Apr 2017
Practice patterns in the intraoperative use of bispectral index monitoring.
Assessing the depth of anesthesia and reducing intraoperative awareness has become a focus of much technology development and research in the field of anesthesia. Bispectral index (BIS) is the most widely utilized technology that uses electroencephalogram to provide a measurement of anesthetic depth. There are no definitive guidelines on when BIS should be used. ⋯ Factors associated with BIS use included increased age, greater ASA physical status, extremes of BMI, use of TIVA, use of a long-acting paralytic agent, use of an endotracheal tube (ETT), emergency surgery, increasing length of case, and certain surgical services. BIS use was associated with previously documented risk factors for intraoperative awareness. These factors are also indicators of case complexity, which may be a major factor among providers deciding when to apply BIS monitoring in the operating room.
-
J Clin Monit Comput · Apr 2017
Case ReportsFalsely low values of oxygen saturation measured by pulse oximetry in a boy treated with Chinese herb tea.
An 8-year-old boy suffering from progressive glioblastoma was scheduled for neurosurgery. Prior to induction of anaesthesia pulse oximetry measured 64 % saturation of oxygen (SpO2). Arterial blood gas analysis revealed normal oxygen saturation and normal oxygen partial pressure. ⋯ Blood samples were taken and analysed. Absorption spectroscopy from the patient's blood showed an uncommon absorption maximum at 684 nm besides the normal maxima. The normalisation of SpO2 values after stopping Chinese herb tea administration leads to the conclusion that one of its ingredients caused the distorted pulse oximetry measurement.
-
J Clin Monit Comput · Apr 2017
Positive and negative staircase effect during single twitch and train-of-four stimulation: a laboratory study in dogs.
A positive staircase effect is well documented during neuromuscular monitoring. However, the increase in twitch amplitude may not remain stable over time. We compared the staircase phenomenon and twitch stability during single twitch (ST) or train-of-four (TOF) stimulation in anesthetized dogs. ⋯ An initial increase in ST amplitude remained stable over the observation period, but the increase in T1 amplitude during TOF was frequently followed by a decay. A stable twitch amplitude (variation <5 % in 5 min) was observed in all dogs with ST after 15 min of stimulation, which was not the case during TOF stimulation. Therefore, it appears at least in dogs, that ST might offer some advantages over T1 for measuring twitch amplitude.
-
J Clin Monit Comput · Apr 2017
To characterize the incidence of airway misplacement of nasogastric tubes in anesthetized intubated patients by using a manometer technique.
This study characterized the incidence of airway misplacement of nasogastric (NG) tubes in surgical patients, and the benefit of using a manometer to discriminate gastric placement from airway placement of NG tubes. Subjects included adult patients scheduled for abdominal surgery. After tracheal intubation, a 16 Fr. ⋯ For confirmation of gastric placement, the auscultation technique had a sensitivity of 100.0 % and a specificity of 79.3 %. In contrast, the manometer technique had a sensitivity of 100.0 % and a specificity of 100.0 % in the discrimination of gastric placement from airway placement of NG tubes. Airway misplacement of NG tubes is not uncommon in surgical patients, and the manometer technique may be a reliable and safe method to discriminate gastric placement from airway placement of NG tubes.
-
J Clin Monit Comput · Apr 2017
ReviewPrecision diagnosis: a view of the clinical decision support systems (CDSS) landscape through the lens of critical care.
Improving diagnosis and treatment depends on clinical monitoring and computing. Clinical decision support systems (CDSS) have been in existence for over 50 years. While the literature points to positive impacts on quality and patient safety, outcomes, and the avoidance of medical errors, technical and regulatory challenges continue to retard their rate of integration into clinical care processes and thus delay the refinement of diagnoses towards personalized care. ⋯ The aggregate of those processes-CDSS-is currently primitive. Despite technical and regulatory challenges, the apparent clinical and economic utilities of CDSS must lead to greater engagement. These tools play the key role in realizing the vision of a more 'personalized medicine', one characterized by individualized precision diagnosis rather than population-based risk-stratification.