Journal of clinical monitoring and computing
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J Clin Monit Comput · Jun 2015
Design and implementation of a hospital wide waveform capture system.
The use of telemetry and invasive monitoring is exceptionally common in modern healthcare. To date the vast majority of this information is not stored for more than a brief duration on the local monitor. This prohibits extensive investigation into waveform data. ⋯ The average single day data collection consisted of 8.6 GB of data. Entire hospital waveform data collection is possible using internally developed software enabling research on waveform data with minimal technical burden. Further research is required to determine the long-term storage and processing of such data.
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J Clin Monit Comput · Jun 2015
Observational StudyAccuracy of the transpulmonary ultrasound dilution method for detection of small anatomic shunts.
The purpose of this study was to investigate the qualitative and quantitative accuracy of transpulmonary ultrasound dilution (UD) (COstatus™, Transonic Systems) for the detection of small anatomic shunts. It was a prospective, observational study in a multi-disciplinary pediatric intensive care unit. Seventy-three critically ill children (67 post cardiac surgery), with a median (IQR) age of 10 (3-50.3) months and a median (IQR) weight of 8 (3.43-13) kg were enrolled. ⋯ Shunt was detected by UD alone in eight children; six of these had clinical conditions known to compromise dilution curve analysis (valve regurgitation, asymmetric pulmonary blood flow). Shunt was detected by echocardiography alone in two children; in both cases the shunt was tiny. UD is an accurate method for the detection of small anatomical shunts, both qualitatively and quantitatively.
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J Clin Monit Comput · Jun 2015
Observational StudyDynamic device properties of pulse contour cardiac output during transcatheter aortic valve implantation.
This prospective single-center study aimed to determine the responsiveness and diagnostic performance of continuous cardiac output (CCO) monitors based on pulse contour analysis compared with invasive mean arterial pressure (MAP) during predefined periods of acute circulatory deterioration in patients undergoing transcatheter aortic valve implantation (TAVI). The ability of calibrated (CCO(CAL)) and self-calibrated (CCO(AUTOCAL)) pulse contour analysis to detect the hemodynamic response to 37 episodes of balloon aortic valvuloplasty enabled by rapid ventricular pacing was quantified in 13 patients undergoing TAVI. A "low" and a "high" cut-off limit were predefined as a 15 or 25 % decrease from baseline respectively. ⋯ In conclusion, CCO(CAL) and MAP provided equivalent responsiveness and diagnostic performance to detect acute circulatory depression, whereas CCO(AUTOCAL) appeared to be less appropriate. In contrast to CCO(CAL) the amplitude response of MAP was poor. Consequently even small response amplitudes of MAP could indicate severe decreases in CO.
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J Clin Monit Comput · Jun 2015
Case ReportsFall in inspired oxygen and anaesthetic agent concentrations during change of soda lime absorber.
Following an episode of reduction in inspired oxygen concentration (FiO(2)) and inhalational agent concentration (Fi agent) during the changing of a soda lime absorber, We conducted an in vitro experiment to understand the impact of disconnection of the absorber on inspired gas dilution at different fresh gas flows. We found that both in Dräger Fabius GS and Primus anaesthesia work stations, disconnection of the absorber caused progressive reduction in FiO(2) and Fi agent as the FGF was decreased. The operating principle of fresh gas decoupling (FGD) valve is a potential source of this complication, which must be kept in mind while changing the soda lime during the course of surgery where an anaesthetic work stations utilizing FGD valves are used.
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J Clin Monit Comput · Jun 2015
Observational StudyCan short-term heart rate variability be used to monitor fentanyl-midazolam induced changes in ANS preceding respiratory depression?
Opioids have an occasional but high-risk side effect of respiratory depression. The detection of critical respiratory depression usually occurs after the event. Earlier detection would be beneficial in preventing increased morbidity and mortality of 0.01 % patients receiving analgesic opioids. ⋯ No significant change before critical respiratory events was observed in traditional, spectral power, respiratory or other indices. One index, PolVar20, indicated a burst of sympathetic activity preceding respiratory depression similar to sleep apnoea arousals that restore airway patency. Before its usefulness in early detection of airway tone can be determined, PolVar20 requires further work: a statistical method for highly skewed distributions, auto adjustment for baseline variability, and detecting a range of sympathetic responses to apnea.