Journal of clinical monitoring and computing
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J Clin Monit Comput · Dec 2016
Multi-parameter vital sign database to assist in alarm optimization for general care units.
Continual vital sign assessment on the general care, medical-surgical floor is expected to provide early indication of patient deterioration and increase the effectiveness of rapid response teams. However, there is concern that continual, multi-parameter vital sign monitoring will produce alarm fatigue. The objective of this study was the development of a methodology to help care teams optimize alarm settings. ⋯ Plots of vital sign distributions in the cloud-hosted database were similar to other large databases published by different authors. The cloud-hosted database can be used to run simulations for various alarm thresholds and annunciation delays to predict the total alarm burden experienced by nursing staff. This methodology might, in the future, be used to help reduce alarm fatigue without sacrificing the ability to continually monitor all vital signs.
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J Clin Monit Comput · Dec 2016
Comparative StudyAccuracy and precision of transcardiopulmonary thermodilution in patients with cardiogenic shock.
Hemodynamic monitoring plays a crucial role in the supportive treatment of critically ill patients. In this setting, the use of the pulmonary artery catheter (PAC) is a standard procedure. In this study we prospectively compare the accuracy and precision of pulmonary thermodilution (PTD) by PAC and transcardiopulmonary thermodilution (TC-PTD) in patients with cardiogenic shock following an acute cardiac event. ⋯ In contrast, pulmonary arterial occlusion pressure showed no significant difference. Hemodynamic measurements by PTD and TC-PTD are interchangeable during therapy of CS, including patients IABP, TH, mitral or tricuspid regurgitation. Preload parameters measured by TC-PTD seem to be more accurate in these patients than pressure parameters of PTD to gather the acute hemodynamic situation.
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J Clin Monit Comput · Dec 2016
ReviewCerebral near-infrared spectroscopy in the care of patients during cardiological procedures: a summary of the clinical evidence.
Patients undergoing cardiological procedures generally have significant cardiovascular morbidity, and therefore these patients might be at risk for major periprocedural complications. The ability to closely monitor the hemodynamic status would present a major advantage to optimize patient care in this setting. The aim of this review is to assess the available evidence for the use of near-infrared spectroscopy (NIRS) in the care of patients during cardiological procedures. ⋯ Six studies evaluated NIRS during supraventricular and ventricular arrhythmias, one during transcatheter aortic valve implantations, and four studies assessed the use of NIRS in pediatric catheterization procedures. Overall, the studies demonstrated that NIRS provides a very quick representation of cerebral oxygen saturation and that it might identify changes that could not be predicted from standard hemodynamic monitoring. However, the evidence is currently too low to conclude that NIRS can optimize patient care during cardiological procedures.
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J Clin Monit Comput · Dec 2016
Comparative StudyPerformance of computer simulated inhalational anesthetic uptake model in comparison with real time isoflurane concentration.
Gas Man software was developed to enhance our understanding of the pharmacokinetics of inhalational anaesthetics. To date the Gas Man software has not been validated in humans. In this study we compared the Gas Man software with real time measured end tidal isoflurane concentrations while using a semi closed circle system in anesthetised patients. ⋯ The end-tidal concentration values of isoflurane in real patients are very close to those predicted by Gas Man software. The pharmocokinetics of inhalational anesthetic administration in patients can be taught accurately using Gas Man technology. This technology may also help in developing different kinetic models of inhalational agents in the body.
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J Clin Monit Comput · Dec 2016
Utility of the bispectral index for assessing natural physiological sleep stages in children and young adults.
Polysomnography (PSG) is the gold standard for the analysis of sleep architecture but is not always available in routine practice, as it is time consuming and cumbersome for patients. Bispectral index (BIS), developed to quantify the deepness of general anesthesia, may be used as a simplified tool to evaluate natural sleep depth. We objectively recorded sleep architecture in young patients using the latest BIS Vista monitor and correlated BIS values with PSG sleep stages in order to determine BIS thresholds. ⋯ BIS threshold that identified stage N3 was <55 (AUC = 0.964, p < 0.001) with an 87 %-sensitivity and a 93 %-specificity. BIS identified stage N3 with satisfactory sensitivity and specificity but is limited by its inability to distinguish REM sleep from wake. Further studies combining BIS with chin electromyogram and/or electrooculogram could be of interest.