Journal of clinical monitoring and computing
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J Clin Monit Comput · Oct 2016
Comparative StudyComparison of end-tidal CO2 measured by transportable capnometer (EMMA™ capnograph) and arterial pCO2 in general anesthesia.
An end-tidal CO2 monitor (capnometer) is used most often as a noninvasive substitute for PaCO2 in anesthesia, anesthetic recovery, and intensive care. Additionally, the wide spread on-site use of portable capnometers in emergency and trauma situations is now observed. This study was conducted to compare PaCO2 measurement between the EMMA™ portable-capnometer and sidestream capnometry. ⋯ The percent error was 13.0 %. Significant differences between the PETCO2 and PaCO2 values of the EMMA™ portable-capnometer were not observed for patients undergoing general anesthesia. ClinicalTrials.gov identifier NCT02184728.
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J Clin Monit Comput · Oct 2016
Comparative StudyComparison of the ability of two continuous cardiac output monitors to measure trends in cardiac output: estimated continuous cardiac output measured by modified pulse wave transit time and an arterial pulse contour-based cardiac output device.
Estimated continuous cardiac output (esCCO), a noninvasive technique for continuously measuring cardiac output (CO), is based on modified pulse wave transit time, which in turn is determined by pulse oximetry and electrocardiography. However, its trending ability has never been evaluated in patients undergoing non-cardiac surgery. Therefore, this study examined esCCO's ability to detect the exact changes in CO, compared with currently available arterial waveform analysis methods, in patients undergoing kidney transplantation. ⋯ And corrected precision for repeated measures was 1.37 L min(-1) (percentage error for repeated measures, 42.5 %). The concordance rate was 89.7 %, with a mean angular bias of -3.3° and radial limits of agreement of ±42.2°. This study demonstrated that the trending ability of the esCCO system is not clinically acceptable, as judged by polar plots analysis; however, its trending ability is clinically acceptable based on a concordance analysis, and is comparable with currently available arterial waveform analysis methods.
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J Clin Monit Comput · Oct 2016
Does using two Doppler cardiac output monitors in tandem provide a reliable trend line of changes for validation studies?
The demise of the pulmonary artery catheter as a gold standard in cardiac output measurement has created the need for new standard. Doppler cardiac output can be measured suprasternally (USCOM) and via the oesophagus (CardioQ). Use in tandem they may provide a reliable trend line of cardiac output changes against which new technologies can be assessed. ⋯ The regression line between Doppler methods was offset with a slope of 0.9, thus CardioQ CI readings increased relative to USCOM. Both Doppler methods trended cardiac output reliably. Used in tandem they provide a new standard to assess cardiac output trending.
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J Clin Monit Comput · Oct 2016
Randomized Controlled TrialAlgorithms that eliminate the effects of calibration artefact and trial-imposed offsets of Masimo oximeter in BOOST-NZ trial.
The displayed readings of Masimo pulse oximeters used in the Benefits Of Oxygen Saturation Targeting (BOOST) II and related trials in very preterm babies were influenced by trial-imposed offsets and an artefact in the calibration software. A study was undertaken to implement new algorithms that eliminate the effects of offsets and artefact. In the BOOST-New Zealand trial, oxygen saturations were averaged and stored every 10 s up to 36 weeks' post-menstrual age. ⋯ The resulting distributions were very close to those obtained from the Siemens oximeter. The artefact and offsets of the Masimo oximeter's software had been addressed to determine the true saturation readings through the use of novel algorithms. The implementation would enable New Zealand data be included in the meta-analysis of BOOST II trials, and be used in neonatal oxygen studies.
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J Clin Monit Comput · Oct 2016
Observational StudyNon-invasive measurements of pulse pressure variation and stroke volume variation in anesthetized patients using the Nexfin blood pressure monitor.
Nexfin beat-to-beat arterial blood pressure monitoring enables continuous assessment of hemodynamic indices like cardiac index (CI), pulse pressure variation (PPV) and stroke volume variation (SVV) in the perioperative setting. In this study we investigated whether Nexfin adequately reflects alterations in these hemodynamic parameters during a provoked fluid shift in anesthetized and mechanically ventilated patients. The study included 54 patients undergoing non-thoracic surgery with positive pressure mechanical ventilation. ⋯ The median bias between PPV and SVV was different for patients younger [-1.5 % (-3 to 0)] or older [+2 % (0-4.75)] than 55 years (P < 0.001), while there were no gender differences in the bias between PPV and SVV. The Nexfin monitor adequately reflects alterations in PPV and SVV during a provoked fluid shift, but the level of agreement between PPV and SVV was low. The SVV tended to be superior over PPV or Eadyn in predicting fluid responsiveness in our population.