Journal of clinical monitoring and computing
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J Clin Monit Comput · Jun 2015
Trending ability and limitations of transpulmonary thermodilution and pulse contour cardiac output measurement in cats as a model for pediatric patients.
The present study evaluated transpulmonary thermodilution (TPTD) and pulse contour cardiac output (PCCO) both measured by the PiCCO Plus™ monitor (Pulsion Medical Systems, Munich, Germany) against pulmonary artery thermodilution (PATD) in cats as a hemodynamic model for small children. A wide range of cardiac outputs (CO) was simultaneously measured. Accuracy and trending abilities were critically evaluated. ⋯ Both tested methods constantly overestimated simultaneous PATD measurements. The small size, low flows and the relative short catheter not reaching the abdominal aorta may explain that. However TPTD tracked changes accurately opposed to a poor trending ability of the PCCO measurement.
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J Clin Monit Comput · Jun 2015
Increasing signal processing sophistication in the calculation of the respiratory modulation of the photoplethysmogram (DPOP).
DPOP (∆POP or Delta-POP) is a non-invasive parameter which measures the strength of respiratory modulations present in the pulse oximetry photoplethysmogram (pleth) waveform. It has been proposed as a non-invasive surrogate parameter for pulse pressure variation (PPV) used in the prediction of the response to volume expansion in hypovolemic patients. Many groups have reported on the DPOP parameter and its correlation with PPV using various semi-automated algorithmic implementations. ⋯ Through increasingly advanced pre-processing and post-processing enhancements to the algorithm, the correlation coefficient between DPOP and PPV improved from a baseline value of R = 0.347 to R = 0.852 for the stable data set, and, correspondingly, R = 0.225 to R = 0.728 for the more challenging global data set. Marked gains in algorithm performance are achievable for manually selected stable regions of the signals using relatively simple algorithm enhancements. Significant additional algorithm enhancements, including a correction for low perfusion values, were required before similar gains were realised for the more challenging global data set.
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J Clin Monit Comput · Jun 2015
Randomized Controlled TrialEarly goal-directed therapy based on endotracheal bioimpedance cardiography: a prospective, randomized controlled study in coronary surgery.
The objective was to compare the impact of an early goal-directed hemodynamic therapy based on cardiac output monitoring (Endotracheal Cardiac Output Monitor, ECOM) with a standard of care on postoperative outcome following coronary surgery. This prospective, controlled, parallel-arm trial randomized 100 elective primary coronary artery bypass grafting patients to a study group (ECOM; n = 50) or a control group (control; n = 50). In the ECOM group, hemodynamic therapy was guided by respiratory stroke volume variation and cardiac index given by the ECOM system. ⋯ The time to reach extubation was reduced in the ECOM group: 510 min [360-1,110] versus 570 min [320-1,520], P = 0.005. No significant differences were found between both groups for possible hospital discharge [Hazard Ratio = 0.96 (95 % CI 0.64-1.45)] and hospital discharge [Hazard Ratio = 1.20 (95 % CI 0.79-1.81)]. A mini-invasive early goal-directed hemodynamic therapy based on ECOM can reduce the time to reach extubation but fails to significantly reduce the length of stay in hospital and the rate of major cardiac morbidity.
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J Clin Monit Comput · Jun 2015
Design and implementation of a hospital wide waveform capture system.
The use of telemetry and invasive monitoring is exceptionally common in modern healthcare. To date the vast majority of this information is not stored for more than a brief duration on the local monitor. This prohibits extensive investigation into waveform data. ⋯ The average single day data collection consisted of 8.6 GB of data. Entire hospital waveform data collection is possible using internally developed software enabling research on waveform data with minimal technical burden. Further research is required to determine the long-term storage and processing of such data.
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J Clin Monit Comput · Jun 2015
Observational StudyAccuracy of the transpulmonary ultrasound dilution method for detection of small anatomic shunts.
The purpose of this study was to investigate the qualitative and quantitative accuracy of transpulmonary ultrasound dilution (UD) (COstatus™, Transonic Systems) for the detection of small anatomic shunts. It was a prospective, observational study in a multi-disciplinary pediatric intensive care unit. Seventy-three critically ill children (67 post cardiac surgery), with a median (IQR) age of 10 (3-50.3) months and a median (IQR) weight of 8 (3.43-13) kg were enrolled. ⋯ Shunt was detected by UD alone in eight children; six of these had clinical conditions known to compromise dilution curve analysis (valve regurgitation, asymmetric pulmonary blood flow). Shunt was detected by echocardiography alone in two children; in both cases the shunt was tiny. UD is an accurate method for the detection of small anatomical shunts, both qualitatively and quantitatively.