Journal of clinical monitoring and computing
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J Clin Monit Comput · Aug 2010
Masseter muscle oxygen saturation is associated with central venous oxygen saturation in patients with severe sepsis.
This monocentric prospective study was conducted to determine if tissue oxygen saturation measured non invasively over masseter muscle site (Masseter-StO2) can predict the central venous oxygen saturation (ScvO2) level in severe sepsis and septic shock. ⋯ In patients with severe sepsis or septic shock, non invasive recording of Masseter-StO2 was significantly associated with ScvO2 Further studies are required to determine the usefulness of Masseter-StO2 guided management of severe sepsis or septic shock.
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Capnography has become a standard of perioperative monitoring in pediatric anesthesiology. It has also begun to find application in a variety of situations outside the perioperative setting. While the use of capnography has been increasing, the dissemination and acceptability of capnography in all areas of pediatrics has been variable. The purpose of this study was to describe all the applications and interpretations of capnography that have been reported in children. ⋯ Capnography has been proven to be a useful non-invasive perioperative monitor of the physiology and safety of the child. This list of the clinical applications and interpretations of capnography could find use in teaching and simulation in pediatrics.
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J Clin Monit Comput · Aug 2010
Comparative StudySNAP II versus BIS VISTA monitor comparison during general anesthesia.
Effectively monitoring the level of consciousness during general anesthesia is clinically beneficial to both the patient and the physician. An electroencephalogram (EEG)-based level-of-consciousness monitor can help minimize intraoperative awareness as well as the effects of over-sedation. In this study, we compared the SNAP II (Stryker Instruments, Kalamazoo, MI USA) and BIS VISTA (Aspect Medical Systems, Newton, MA USA) monitors' primary metrics (SI and BIS, respectively) in terms of correlation, agreement and responsiveness to return to preoperative baseline in surgical cases involving general anesthesia. ⋯ Although the SI and BIS both can assess a patient's level of consciousness and are correlated, they are not in agreement with each other numerically and therefore are not interchangeable. It is difficult to assess each monitor's true responsiveness to acute changes in consciousness level from our study design. The differences between the metrics we observed in this study are most likely due to differences in signal processing methodologies, EEG frequencies employed and signal filtering utilized in the monitors.
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J Clin Monit Comput · Aug 2010
The effect of skin incision on the electroencephalogram during general anesthesia maintained with propofol or desflurane.
A variety of effects of surgical incision on the electroencephalogram (EEG) during modern general anesthesia have been previously described; including both increases and decreases in both high and low frequencies in the EEG. What are the patterns commonly seen during routine clinical anesthesia? ⋯ During anesthesia maintained with desflurane or propofol, surgical incision has modest effects on the EEG patterns. It does not cause an increase in high frequency power; the most consistent changes are a loss of EFA amplitude and burst suppression patterns. This effect is not strongly modified by the depth of anesthesia--as estimated by the BIS.
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J Clin Monit Comput · Aug 2010
Parallel particle filters for online identification of mechanistic mathematical models of physiology from monitoring data: performance and real-time scalability in simulation scenarios.
Combining mechanistic mathematical models of physiology with quantitative observations using probabilistic inference may offer advantages over established approaches to computerized decision support in acute care medicine. Particle filters (PF) can perform such inference successively as data becomes available. The potential of PF for real-time state estimation (SE) for a model of cardiovascular physiology is explored using parallel computers and the ability to achieve joint state and parameter estimation (JSPE) given minimal prior knowledge tested. ⋯ Parallelized PF's performance makes their application to complex mathematical models of physiology for the purpose of clinical data interpretation, prediction, and therapy optimization appear promising. JSPE in the described extremely underdetermined scenario nevertheless extracted information of potential clinical relevance from the data in this simulation setting. However, fully satisfactory resolution of this problem when minimal prior knowledge about parameter values is available will require further methodological improvements, which are discussed.