Journal of clinical monitoring and computing
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J Clin Monit Comput · Aug 2017
Observational StudyUsing extra systoles to predict fluid responsiveness in cardiothoracic critical care patients.
Fluid responsiveness prediction is an unsettled matter for most critical care patients and new methods relying only on the continuous basic monitoring are desired. It was hypothesized that the post-ectopic beat, which is associated with increased preload, could be analyzed in relation to preceding sinus beats and that the change in cardiac performance (e.g. systolic blood pressure) at the post-ectopic beat could predict fluid responsiveness. Cardiothoracic critical care patients scheduled for a 500 ml volume expansion were observed. ⋯ The change in pre-ejection period predicted fluid responsiveness in 22 patients correctly with 67 % specificity and 83 % sensitivity (optimal threshold: 19 ms pre-ejection period decrease), ROC area: 0.81 (CI [0.66;0.96]). Pulse pressure variation had ROC area of 0.57 (CI [0.39;0.75]). Based on standard critical care monitoring, analysis of the extra systolic post-ectopic beat predicts fluid responsiveness in cardiothoracic critical care patients with good accuracy.
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J Clin Monit Comput · Aug 2017
Case ReportsInsertion of intra-oral electrodes for cranial nerve monitoring using a Crowe-Davis retractor.
Acoustic neuroma resection is an example of a neurosurgical procedure where the brainstem and multiple cranial nerves are at risk for injury. Electrode placement for monitoring of the glossopharyngeal and hypoglossal nerves during acoustic neuroma resection can be challenging. The purpose of this report is to illustrate the use of a device for intra-oral electrode placement for intraoperative monitoring of the glossopharyngeal and hypoglossal nerves. ⋯ The tumor was resected successfully. Monitoring of the cranial nerves (including the glossopharyngeal and hypoglossal nerves) revealed no concerning responses. The Crowe-Davis retractor and the technique described allowed insertion of electrodes for neural monitoring, contributing to neural preservation.
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J Clin Monit Comput · Aug 2017
Comparative Study Observational StudyComparison of smartphone application-based vital sign monitors without external hardware versus those used in clinical practice: a prospective trial.
Use of healthcare-related smartphone applications is common. However, there is concern that inaccurate information from these applications may lead patients to make erroneous healthcare decisions. The objective of this study is to study smartphone applications purporting to measure vital sign data using only onboard technology compared with monitors used routinely in clinical practice. ⋯ The degree of correlation between monitors routinely used in clinical practice and the smartphone-based applications studied is insufficient to recommend clinical utilization. This lack of correlation suggests that the applications evaluated do not provide clinically meaningful data. The inaccurate data provided by these applications can potentially contribute to patient harm.
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J Clin Monit Comput · Aug 2017
Design and validation of a questionnaire to evaluate the usability of computerized critical care information systems.
The implementation of computerized critical care information systems (CCIS) can improve the quality of clinical care and staff satisfaction, but also holds risks of disrupting the workflow with consecutive negative impacts. The usability of CCIS is one of the key factors determining their benefits and weaknesses. However, no tailored instrument exists to measure the usability of such systems. ⋯ We tested validity and reliability of the digital version of the questionnaire in a sample population. In the sample population of 535 participants both usability evaluation models showed a strong correlation with the overall rating of the system (multiple correlation coefficients ≥0.80) as well as a very high internal consistency (Cronbach's alpha ≥0.93). The novel questionnaire is a valid and reliable instrument to measure the usability of CCIS and can be used to study the influence of the usability on their implementation benefits and weaknesses.
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J Clin Monit Comput · Aug 2017
ReviewA systematic review of pulse pressure variation and stroke volume variation to predict fluid responsiveness during cardiac and thoracic surgery.
This systematic review aims to summarize the published data on the reliability of pulse pressure variation (PPV) and stroke volume variation (SVV) to predict fluid responsiveness in an open-chest setting during cardio-thoracic surgery. The analysis included studies reporting receiver operating characteristics or correlation coefficients between PPV/SVV and change in any hemodynamic variables after a fluid challenge test in open-chest conditions. The literature search included seven studies. ⋯ The great heterogeneity between studies was due to small sample size and differences among protocol designs (different monitor devices, mechanical ventilation settings, fluid challenge methodologies, surgical incisions, and end-point variables). PPV and SVV seem to be inaccurate in predicting fluid responsiveness in an open-chest setting during cardio-thoracic surgery. Given the high heterogeneity of published data, more studies are needed to define the role of PPV/SVV in this context.