Journal of clinical monitoring and computing
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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.
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J Clin Monit Comput · Jan 2025
ReviewAssessing fluid responsiveness by using functional hemodynamic tests in critically ill patients: a narrative review and a profile-based clinical guide.
Fluids are given with the purpose of increasing cardiac output (CO), but approximately only 50% of critically ill patients are fluid responders. Since the effect of a fluid bolus is time-sensitive, it diminuish within few hours, following the initial fluid resuscitation. Several functional hemodynamic tests (FHTs), consisting of maneuvers affecting heart-lung interactions, have been conceived to discriminate fluid responders from non-responders. ⋯ This is due to the random CO fluctuations. Finally, the presence of continuous CO monitoring in ICU patients is not standard and the assessment of fluid responsiveness with surrogate methods is clinically useful, but also challenging. In this review we provide an algorithm for the use of FHTs in different subgroups of ICU patients, according to ventilatory setting, cardiac rhythm and the availability of continuous hemodynamic monitoring.
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J Clin Monit Comput · Jan 2025
The use of the surgical pleth index to guide anaesthesia in gastroenterological surgery: a randomised controlled study.
The measurement of nociception and the optimisation of intraoperative antinociceptive medication could potentially improve the conduct of anaesthesia, especially in the older population. The Surgical Pleth Index (SPI) is one of the monitoring methods presently used for the detection of nociceptive stimulus. Eighty patients aged 50 years and older who were scheduled to undergo major abdominal surgery were randomised and divided into a study group and a control group. ⋯ However, in the subgroup of patients who underwent operation with invasive blood pressure monitoring, there was less severe hypotension (MAP < 55) (0.3% vs. 0.0%, p = 0.02) and intermediate hypotension (MAP < 65) (10.2% vs. 2.6%, p = 0.07) in the treatment group, even though remifentanil consumption was higher (3.5 µg kg- 1h- 1 vs. 5.1 µg kg- 1h- 1p = 0.03). The use of SPI guidance for the administration of remifentanil during surgery did not help to reduce the remifentanil consumption. However, the results from invasively monitored study group suggest more timely administered opioid when SPI was used.
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J Clin Monit Comput · Jan 2025
Decision support guided fluid challenges and stroke volume response during high-risk surgery: a post hoc analysis of a randomized controlled trial.
Intravenous fluid is administered during high-risk surgery to optimize stroke volume (SV). To assess ongoing need for fluids, the hemodynamic response to a fluid bolus is evaluated using a fluid challenge technique. The Acumen Assisted Fluid Management (AFM) system is a decision support tool designed to ease the application of fluid challenges and thus improve fluid administration during high-risk surgery. ⋯ The median rate of fluid responsiveness was greater in the AFM than in the control group (50 [44-71] % vs 33 [20-40] %, p<0.001). The mean increase in SV after fluid challenge was also higher in the AFM than in the control group (12 [9-16] % vs 6 [3-10] %, p<0.001). AFM-initiated fluid challenges were more often associated with the desired increase in SV than were clinician-initiated fluid challenges, and absolute SV increases were greater.
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J Clin Monit Comput · Dec 2024
ReviewAutomated and reference methods for the calculation of left ventricular outflow tract velocity time integral or ejection fraction by non-cardiologists: a systematic review on the agreement of the two methods.
Echocardiography is crucial for evaluating patients at risk of clinical deterioration. Left ventricular ejection fraction (LVEF) and velocity time integral (VTI) aid in diagnosing shock, but bedside calculations can be time-consuming and prone to variability. Artificial intelligence technology shows promise in providing assistance to clinicians performing point-of-care echocardiography. ⋯ The accuracy and precision of these automated methods should be considered within the clinical context and decision-making. Such variability could be acceptable, especially in the hands of trained operators. PROSPERO number CRD42024564868.