Journal of clinical monitoring and computing
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J Clin Monit Comput · Feb 2023
Unexpected median SEPs fluctuations during brain cavernous malformation resection with no post-operative deficit.
Median nerve somatosensory evoked potentials (SEPs) may present changes during cavernous malformation (CM) resection unrelated to new post-operative sensory deficits. We performed intraoperative neurophysiological monitoring of median SEPs (m-SEPs) in three patients who underwent CM resection (surgery) near the sensory-motor cortex. The only preoperative clinical manifestations in all patients were seizures. ⋯ None of these patients developed new post-operative clinical deficits. During brain cavernous malformation resection, significant fluctuations in the amplitude of different components of m-SEPs may occur. These changes may be due to excitability variations on m-SEP generators and do not translate into new post-operative neurological deficits.
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J Clin Monit Comput · Feb 2023
Is it feasible to measure intra-abdominal pressure using a balloon-tipped rectal catheter? Results of a validation study.
The gold standard to measure intra-abdominal pressure (IAP) is intra-vesical measurement via the urinary bladder. However, this technique is restricted in ambulatory settings because of the risk of iatrogenic urinary tract infections. Rectal IAP measurements (IAPrect) may overcome these limitations, but requires validation. ⋯ Repeatability of IAPrect was not reliable (R = 0.539, p = 0.315). For both techniques, measurements with the external abdominal pressure belt were significantly higher compared to those without (p < 0.03). IAPrect has important shortcomings making IAP estimation using a rectal catheter unfeasible because the numbers cannot be trusted nor validated.
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J Clin Monit Comput · Feb 2023
Amplitude and phase measurements from harmonic analysis may lead to new physiologic insights: lower body negative pressure photoplethysmographic waveforms as an example.
The photoplethysmographic (PPG) waveform contains hemodynamic information in its oscillations. We provide a new method for quantitative study of the waveform morphology and its relationship to the hemodynamics. A data adaptive modeling of the waveform shape is used to describe the PPG waveforms recorded from ear and finger. ⋯ A more complete harmonic analysis of the PPG appears to provide new hemodynamic information when used during a LBNP experiment. We encourage other investigators who possess modulated clinical waveform data (e.g. PPG, arterial pressure, respiratory, and autonomic) to re-examine their data, using phase information and higher harmonics as a potential source of new insights into underlying physiologic mechanisms.
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Accurate measurement of respiratory rate (RR) in neonates is challenging due to high neonatal RR variability (RRV). There is growing evidence that RRV measurement could inform and guide neonatal care. We sought to quantify neonatal RRV during a clinical study in which we compared multiparameter continuous physiological monitoring (MCPM) devices. ⋯ More research is required to optimize the use of RRV to improve care. When evaluating MCPM devices, accuracy thresholds should be less stringent in newborns due to increased RRV. Lastly, median RR, which discounts the impact of extreme outliers, may be more reflective of the underlying physiological control of breathing.
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J Clin Monit Comput · Dec 2022
Randomized Controlled TrialComparing ventilation modes by electrical impedance segmentography in ventilated children.
Electrical impedance segmentography offers a new radiation-free possibility of continuous bedside ventilation monitoring. The aim of this study was to evaluate the efficacy and reproducibility of this bedside tool by comparing synchronized intermittent mandatory ventilation (SIMV) with neurally adjusted ventilatory assist (NAVA) in critically-ill children. In this prospective randomized case-control crossover trial in a pediatric intensive care unit of a tertiary center, including eight mechanically-ventilated children, four sequences of two different ventilation modes were consecutively applied. ⋯ During NAVA children showed a shift of impedance towards caudal lung segments, compared to SIMV. Electrical impedance segmentography enables dynamic monitoring of transthoracic impedance. The immediate benefit of personalized ventilatory strategies can be seen when using this simple-to-apply bedside tool for measuring lung impedance.