Journal of clinical monitoring and computing
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J Clin Monit Comput · Feb 2025
Personalized intraoperative arterial pressure management and mitochondrial oxygen tension in patients having major non-cardiac surgery: a pilot substudy of the IMPROVE trial.
The "Cellular Oxygen METabolism" (COMET) system (Photonics Healthcare, Utrecht, The Netherlands) non-invasively measures mitochondrial oxygen tension (mitoPO2) in the skin. The effects of general anesthesia and major non-cardiac surgery on mitoPO2 remain unknown. In this pre-planned pilot substudy of the "Intraoperative blood pressure Management based on the individual blood PRessure profile: impact on postOperatiVE organ function" (IMPROVE) trial, we measured mitoPO2 from induction of general anesthesia until the end of surgery in 19 major non-cardiac surgery patients (10 assigned to personalized and 9 to routine intraoperative arterial pressure management). ⋯ MitoPO2 under general anesthesia was about a quarter lower than preoperative awake mitoPO2, substantially fluctuated during major non-cardiac surgery, and transiently decreased below 20 mmHg in about two-thirds of the patients. Personalized - compared to routine - intraoperative arterial pressure management did not increase intraoperative mitoPO2. Whether intraoperative decreases in mitoPO2 are clinically meaningful warrants further investigation.
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J Clin Monit Comput · Feb 2025
Characterizing drivers of change in intraoperative cerebral saturation using supervised machine learning.
Regional cerebral oxygen saturation (rSO2) is used to monitor cerebral perfusion with emerging evidence that optimization of rSO2 may improve neurological and non-neurological outcomes. To manipulate rSO2 an understanding of the variables that drive its behavior is necessary, and this can be accomplished using supervised machine learning. This study aimed to establish a hierarchy by which various hemodynamic and ventilatory variables contribute to intraoperative changes in rSO2. ⋯ CO2 is a significant mediator of changes in rSO2 in an intraoperative setting, through its established effects on cerebral blood flow. This study furthers our overall understanding of the complex physiologic process that governs cerebral oxygenation by quantifying the hierarchy by which rSO2 is affected. Clinical Trial Number NCT01838733 (ClinicalTrials.gov).
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J Clin Monit Comput · Jan 2025
Effect of postoperative peripheral nerve blocks on the analgesia nociception index under propofol anesthesia: an observational study.
The analgesia nociception index (ANI), also referred to as the high frequency variability index (HFVI), is reported to be an objective measure of nociception. This study investigated changes in ANI after peripheral nerve blocks (PNB) under general anesthesia. Understanding these changes could enhance assessment of PNB efficacy before emergence from general anesthesia. ⋯ The increased ANI value after PNB under propofol anesthesia may be a valuable indicator for assessing PNB efficacy.
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J Clin Monit Comput · Jan 2025
Accuracy of remote, video-based supraventricular tachycardia detection in patients undergoing elective electrical cardioversion: a prospective cohort.
Unobtrusive pulse rate monitoring by continuous video recording, based on remote photoplethysmography (rPPG), might enable early detection of perioperative arrhythmias in general ward patients. However, the accuracy of an rPPG-based machine learning model to monitor the pulse rate during sinus rhythm and arrhythmias is unknown. We conducted a prospective, observational diagnostic study in a cohort with a high prevalence of arrhythmias (patients undergoing elective electrical cardioversion). ⋯ For pulse rate measurement, the bias and limits of agreement for sinus rhythm were 1.21 [- 8.60 to 11.02], while for arrhythmia, they were - 7.45 [- 35.75 to 20.86]. The machine learning model accurately identified sinus rhythm and arrhythmias using rPPG in real-world conditions. Heart rate underestimation during arrhythmias highlights the need for optimization.
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J Clin Monit Comput · Jan 2025
Cost-effectiveness of data driven personalised antibiotic dosing in critically ill patients with sepsis or septic shock.
This study provides an economic evaluation of bedside, data-driven, and model-informed precision dosing of antibiotics in comparison with usual care among critically ill patients with sepsis or septic shock. ⋯ Data-driven personalised antibiotic dosing in critically ill patients as implemented in the AutoKinetics trial cannot be recommended for implementation as a cost-effective intervention.