Journal of clinical monitoring and computing
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J Clin Monit Comput · Aug 2017
The venous-arterial difference in CO2 should be interpreted with caution in case of respiratory alkalosis in healthy volunteers.
The venous-arterial difference in CO2 (ΔCO2) has been proposed as an index of the adequacy of tissue perfusion in shock states. We hypothesized that the variation in PaCO2 (hyper- or hypocapnia) could impact ΔCO2, partly through microcirculation adaptations. Fifteen healthy males volunteered to participate. ⋯ HCO2 induced a moderate increase of the resaturation slope of NIRS oxygenation. Skin microcirculatory blood flow significantly dropped with hCO2, while it remained unchanged with hypercapnia. Our results warrant cautious interpretation of ΔCO2 as an indicator of tissue perfusion during respiratory alkalosis.
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J Clin Monit Comput · Aug 2017
Electromyographic activation reveals cortical and sub-cortical dissociation during emergence from general anesthesia.
During emergence from anesthesia patients regain their muscle tone (EMG). In a typical population of surgical patients the actual volatile gas anesthetic concentrations in the brain (CeMAC) at which EMG activation occurs remains unknown, as is whether EMG activation at higher CeMACs is correlated with subsequent severe pain, or with cortical activation. Electroencephalographic (EEG) and EMG activity was recorded from the forehead of 273 patients emerging from general anesthesia following surgery. ⋯ Patients emerging from general anesthesia with an endotracheal tube in place are more likely to have an EMG activation at higher CeMAC concentrations. These activations are not associated with subsequent high-pain, nor with cortical arousal, as evidenced by continuing delta waves in the EEG. Conversely, patients emerging from general anesthesia with a laryngeal mask demonstrate marked neural inertia-EMG activation occurs at a low CeMAC, and is closely temporally associated with return of consciousness.
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J Clin Monit Comput · Aug 2017
ReviewCommentary : The value of intraoperative neurophysiological monitoring: evidence, equipoise and outcomes.
The use of intraoperative neurophysiological monitoring (IONM) has grown despite an absence of randomized controlled trials that might unequivocally demonstrate improved outcomes. At issue is how to demonstrate value when other evidence indicates patient harms (opportunity cost) if IONM is withheld for the sake of randomization. ⋯ We also examine how clinical equipoise may resolve whether (or not) an anticipated controlled study is ethical. We conclude that the value of IONM in a particular surgical setting should be determined by a benefits/harms analysis based on all the available evidence.
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J Clin Monit Comput · Aug 2017
Ability and efficiency of an automatic analysis software to measure microvascular parameters.
Analysis of the microcirculation is currently performed offline, is time consuming and operator dependent. The aim of this study was to assess the ability and efficiency of the automatic analysis software CytoCamTools 1.7.12 (CC) to measure microvascular parameters in comparison with Automated Vascular Analysis (AVA) software 3.2. 22 patients admitted to the cardiothoracic intensive care unit following cardiac surgery were prospectively enrolled. Sublingual microcirculatory videos were analysed using AVA and CC software. ⋯ The time required for the analysis was shorter with CC than with AVA system [2'42″ (2'12″, 3'31″) vs. 16'12″ (13'38″, 17'57″), p < 0.001]. TVD is comparable between the two softwares, although faster with CC software. The values for PVD and PPV are not interchangeable given the different approach to assess microcirculatory flow.