Journal of clinical monitoring and computing
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J Clin Monit Comput · Aug 2022
Meta AnalysisThe use of virtual reality in children undergoing vascular access procedures: a systematic review and meta-analysis.
Venous access procedures are painful and feared by children and their parents. Virtual reality has become increasingly prominent and has been shown to be effective in various procedures. The aim of this meta-analysis was to examine virtual reality's effect on pain and fear in children from 4 to 12 in the context of vascular access. ⋯ This is the first meta-analysis to look at the use virtual reality in young children undergoing vascular access procedures, providing weak to moderate evidence for its use. Although large effect sizes provide evidence for a positive effect of virtual reality in reducing pain and fear, there is significant heterogeneity between studies. More research with larger groups and age stratification is required.
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J Clin Monit Comput · Aug 2022
Ability of short-time low peep challenge to predict fluid responsiveness in mechanically ventilated patients in the intensive care.
Short-time low PEEP challenge (SLPC, application of additional 5 cmH2O PEEP to patients for 30 s) is a novel functional hemodynamic test presented in the literature. We hypothesized that SLPC could predict fluid responsiveness better than stroke volume variation (SVV) in mechanically ventilated intensive care patients. Heart rate, mean arterial pressure, stroke volume index (SVI) and SVV were recorded before SLPC, during SLPC and before and after 500 mL fluid loading. ⋯ The ROC-AUC of SVIΔ%-SLPC was significantly higher than that of SVV (p = 0.0045). The best cut-off value of SVIΔ%-SLPC was 7.5% with 90% sensitivity and 96% specificity. The percentage change in SVI during SLPC predicts fluid responsiveness in intensive care patients who are ventilated with low tidal volumes; the sensitivity and specificity values are higher than those of SVV.
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J Clin Monit Comput · Aug 2022
Reliability of a computational model for evaluating thoracoabdominal mobility in newborns: a cross-sectional study.
The present study aimed to verify the inter and intra-examiner reliability of an interactive custom-made MATLAB® App for bio-photogrammetric analysis of thoracoabdominal mobility in newborns and compare the respiratory rate (RR) results between the automatic MATLAB® App and its manual counterpart. This is a cross-sectional study conducted in 27 healthy newborns of both sexes (gestational age between 37 and 41 weeks and up to 72 h of life) who did not cry during data acquisition. Chest and abdominal areas of the subjects in the supine position were analyzed through 60 s videos, totaling 30,714 photograms. ⋯ Reliability was excellent for intra (ICC 0.81-0.96) and inter-examiner correlations (ICC 0.84-0.99) between the chest and abdominal areas, in both inspiration and expiration, with no differences between them. Evaluation of newborns' thoracoabdominal mobility using the custom-made MATLAB® App for bio-photogrammetric analysis exhibited good to excellent intra- and inter-examiner reliability and an excellent correlation between manual and automatic models for measuring RR. Thus, it proved to be an objective and practical tool for bedside thoracoabdominal mobility assessment in different clinical situations involving neonatal care.
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J Clin Monit Comput · Aug 2022
Multicenter StudyPrediction of blood lactate values in critically ill patients: a retrospective multi-center cohort study.
Elevations in initially obtained serum lactate levels are strong predictors of mortality in critically ill patients. Identifying patients whose serum lactate levels are more likely to increase can alert physicians to intensify care and guide them in the frequency of tending the blood test. We investigate whether machine learning models can predict subsequent serum lactate changes. ⋯ The LSTM models were able to predict deterioration of serum lactate values of MIMIC-III patients with an AUC of 0.77 (95% CI 0.762-0.771) for the normal group, 0.77 (95% CI 0.768-0.772) for the mild group, and 0.85 (95% CI 0.840-0.851) for the severe group, with only a slightly lower performance in the external validation. The LSTM demonstrated good discrimination of patients who had deterioration in serum lactate levels. Clinical studies are needed to evaluate whether utilization of a clinical decision support tool based on these results could positively impact decision-making and patient outcomes.
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J Clin Monit Comput · Aug 2022
Vigilance: the behavioral impact of quantitative monitoring on administration and antagonism of neuromuscular blocking agents.
The aim of this study was to determine whether use of acceleromyography (1) changes dosing of neuromuscular blocking agents (NMBAs), and (2) increases the time between neostigmine administration and extubation, when compared with subjective assessment of neuromuscular blockade. ⋯ The data presented provides insight about the behavioral engineering inherent to the practice of anesthesiology. Introduction of neuromuscular blockade assessment appeared to increase provider vigilance in dosing of NMBAs-regardless of assessment method. The frequency of intraoperative monitoring (quantitative or subjective) was associated with an increased total dose of NMBA administered and decreased time interval between the last dose of neostigmine and extubation.