Journal of clinical monitoring and computing
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J Clin Monit Comput · Apr 2017
To characterize the incidence of airway misplacement of nasogastric tubes in anesthetized intubated patients by using a manometer technique.
This study characterized the incidence of airway misplacement of nasogastric (NG) tubes in surgical patients, and the benefit of using a manometer to discriminate gastric placement from airway placement of NG tubes. Subjects included adult patients scheduled for abdominal surgery. After tracheal intubation, a 16 Fr. ⋯ For confirmation of gastric placement, the auscultation technique had a sensitivity of 100.0 % and a specificity of 79.3 %. In contrast, the manometer technique had a sensitivity of 100.0 % and a specificity of 100.0 % in the discrimination of gastric placement from airway placement of NG tubes. Airway misplacement of NG tubes is not uncommon in surgical patients, and the manometer technique may be a reliable and safe method to discriminate gastric placement from airway placement of NG tubes.
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J Clin Monit Comput · Apr 2017
ReviewPrecision diagnosis: a view of the clinical decision support systems (CDSS) landscape through the lens of critical care.
Improving diagnosis and treatment depends on clinical monitoring and computing. Clinical decision support systems (CDSS) have been in existence for over 50 years. While the literature points to positive impacts on quality and patient safety, outcomes, and the avoidance of medical errors, technical and regulatory challenges continue to retard their rate of integration into clinical care processes and thus delay the refinement of diagnoses towards personalized care. ⋯ The aggregate of those processes-CDSS-is currently primitive. Despite technical and regulatory challenges, the apparent clinical and economic utilities of CDSS must lead to greater engagement. These tools play the key role in realizing the vision of a more 'personalized medicine', one characterized by individualized precision diagnosis rather than population-based risk-stratification.
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J Clin Monit Comput · Apr 2017
Randomized Controlled TrialSugammadex at both high and low doses does not affect the depth of anesthesia or hemodynamics: a randomized double blind trial.
Previous studies have shown that sugammadex decreases the anesthetic depth when administered to reverse the neuromuscular blockade produced by rocuronium/vecuronium. The aim of the present study was to investigate the effect of sugammadex alone on anesthetic depth and hemodynamics. Sixty patients scheduled for abdominal surgery participated in the study. ⋯ Also, the secondary endpoints, namely RE, BIS, SAP and DAP, HR and SpO2 did not differ between the three groups. Comparisons between Group-2 versus Group-4, Group-2 versus Group-16 and Group-4 versus Group-16 showed no differences (p > 0.05) for all the studied variables. Sugammadex alone at low, medium or high clinical doses has no effect on anesthetic depth as assessed by Entropy and BIS or on hemodynamics.
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J Clin Monit Comput · Apr 2017
ReviewA sneak peek into digital innovations and wearable sensors for cardiac monitoring.
Many mobile phone or tablet applications have been designed to control cardiovascular risk factors (obesity, smoking, sedentary lifestyle, diabetes and hypertension) or to optimize treatment adherence. Some have been shown to be useful but the long-term benefits remain to be demonstrated. Digital stethoscopes make easier the interpretation of abnormal heart sounds, and the development of pocket-sized echo machines may quickly and significantly expand the use of ultrasounds. ⋯ They have the potential to change the way we monitor and treat patients with cardiovascular diseases in the hospital and beyond. Some may have the ability to improve quality of care, decrease the number of medical visits and hospitalization, and ultimately health care costs. Validation and outcome studies are needed to clarify, among the growing number of digital innovations and wearable sensors, which tools have real clinical value.
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J Clin Monit Comput · Apr 2017
Randomized Controlled Trial Observational StudyPerioperative risk factors and cumulative duration of "triple-low" state associated with worse 30-day mortality of cardiac valvular surgery.
Hospital stay and mortality in high-risk patients after noncardiac surgery has been associated with a triple low anesthesia. However, the association between anesthesia-related factors and perioperative outcome after cardiac surgery remains unclear. We tested the effect of a novel triple low state: low mean arterial pressure (MAP) <65 mmHg and low bispectral index (BIS) <45 during a low target effect-site concentration (Ce) <1.5 μg ml-1 of propofol anesthesia on postoperative duration of hospitalization and 30-day mortality in cardiac valvular patients. ⋯ Compared to a triple-low duration of <15 min, a duration >60 min increased the 30-day mortality rate by 8 times. After adjusting for patient- and procedure-related characteristics, the cumulative duration of a triple-low state (intraoperative low MAP, low BIS, and low Ce) was associated with poorer 30-day mortality, but not with prolonged duration of hospital stay. The mortality risk was even greater when a cumulative time >60 min.