Journal of clinical monitoring and computing
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J Clin Monit Comput · Dec 2022
Effectiveness of preoxygenation by conventional face mask versus non-invasive ventilation in morbidly obese patients: measurable by the oxygen-reserve index?
Preoxygenation is a crucial manoeuvre for patients' safety, particularly for morbidly obese patients due to their reduced pulmonary reserve and increased risk for difficult airway situations. The oxygen reserve index (ORI™) was recently introduced as a new parameter of multiple wavelength pulse oximetry and has been advocated to allow assessment of hyperoxia [quantified by the resulting arterial oxygen partial pressure (PaO2)]. This study investigates if ORI can be used to evaluate the impact of two different preoxygenation manoeuvres on the grade of hyperoxia. ⋯ In contrast, ORI values did not differ significantly (median 0.39 (M1) vs. 0.38 (M3); p = 0.758). Absolute values of ORI cannot be used to assess effectiveness of a preoxygenation procedure in bariatric patients, mainly because its range of discrimination is considerably lower than the high ranges of PaO2 attained by adequate preoxygenation. Trial registration German Clinical Trials Register: DRKS00025023 (retrospectively registered on April 16th, 2021).
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J Clin Monit Comput · Dec 2022
Effect of near real-time feedback tool in the electronic medical record on protocol compliance during laparoscopic cholecystectomy: a single-center retrospective analysis.
Implementation of evidence-based medicine has proved difficult across medical fields. Leveraging the electronic medical record may improve clinician compliance to published best practices. Our hypothesis was that the use of a near real-time feedback tool would improve compliance to the protocol steps. ⋯ Individual protocol component compliance increased from 4994/8418 (59.3%) to 7669/8554 (89.7%) (p < 0.001). The near real-time feedback tool reduced the number of cases with every number of deviations (except zero) at p < 0.001. The near real-time feedback tool significantly improved protocol compliance for patients undergoing laparoscopic cholecystectomy.
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J Clin Monit Comput · Dec 2022
Intraoperative neurophysiological monitoring in Latin America: A bibliometric analysis.
Intraoperative Neurophysiological Monitoring (IOMM) has been used worldwide in the attempt to reduce postsurgical neurological deficits, however, most of the publications are from developed countries. There is a global bibliometric analysis of IOMN in spinal surgery, however, the contribution of Latin America (LA) is not mentioned. The aim of this study is to describe scientific productivity, patterns of publications, and thematic trends of IONM in LA. ⋯ Mexico and Brazil have led IONM publications in LA. The lower reference in publications of visual evoked potentials and brainstem auditory evoked potentials IONM modalities, could be considered in the future to boost tailored research in LA.
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J Clin Monit Comput · Dec 2022
A model-based approach to generating annotated pressure support waveforms.
Large numbers of asynchronies during pressure support ventilation cause discomfort and higher work of breathing in the patient, and are associated with an increased mortality. There is a need for real-time decision support to detect asynchronies and assist the clinician towards lung-protective ventilation. Machine learning techniques have been proposed to detect asynchronies, but they require large datasets with sufficient data diversity, sample size, and quality for training purposes. ⋯ Experienced clinicians were not able to differentiate between the simulated waveforms and clinical data (P = 0.44 by Fisher's exact test). The detection performance of the machine learning trained on clinical data gave an overall comparable true positive rate on clinical data and on simulated data (an overall true positive rate of 94.3% and positive predictive value of 93.5% on simulated data and a true positive rate of 98% and positive predictive value of 98% on clinical data). Our findings demonstrate that it is possible to generate labeled pressure and flow waveforms with different types of asynchronies.