Journal of clinical monitoring and computing
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J Clin Monit Comput · Dec 2019
Predicting tachycardia as a surrogate for instability in the intensive care unit.
Tachycardia is a strong though non-specific marker of cardiovascular stress that proceeds hemodynamic instability. We designed a predictive model of tachycardia using multi-granular intensive care unit (ICU) data by creating a risk score and dynamic trajectory. A subset of clinical and numerical signals were extracted from the Multiparameter Intelligent Monitoring in Intensive Care II database. ⋯ Risk trajectory analysis showed average risks for tachycardia group evolved to 0.78 prior to the tachycardia episodes, while control group risks remained < 0.3. Among the three models, the internal control model demonstrated evolving trajectory approximately 75 min before tachycardia episode. Clinically relevant tachycardia episodes can be predicted from vital sign time series using machine learning algorithms.
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J Clin Monit Comput · Dec 2019
Randomized Controlled TrialUsefulness of combining clinical and biochemical parameters for prediction of postoperative pulmonary complications after lung resection surgery.
Early detection of patients with a high risk of postoperative pulmonary complications (PPCs) could improve postoperative strategies. We investigated the role of monitoring systemic and lung inflammatory biomarkers during surgery and the early postoperative period to detect patients at high risk of PPCs after lung resection surgery (LRS). This is a substudy of a randomized control trial on the inflammatory effects of anaesthetic drugs during LRS. ⋯ Model 3 had had an IDI of 0.29 (p < 0.001) and a net reclassification index of 0.28 (p = 0.007). A mathematical model combining inflammation biomarkers with clinical variables predicts PPCs after LRS better than a model that includes only clinical data. Clinical registration number Clinical Trial Registration NCT02168751; EudraCT 2011-002294-29.
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J Clin Monit Comput · Dec 2019
Using the capnogram to assess pulmonary perfusion during a lobectomy: case studies.
Capnography is an effective and non-invasive method for monitoring patients during general anesthesia and can reflect the changes in both the respiratory function as well as the circulatory function. In this paper, we present four cases of lobectomy in which we observed a "chair-like" waveform on performing capnography after the surgery. ⋯ This suggests that during lobectomy, capnography can help confirm that the pulmonary circulation is unobstructed. We believe that it is very important to observe the changes of end-tidal carbon dioxide pressure and capnogram during one-lung ventilation, particularly in cases of pulmonary artery anastomosis.
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J Clin Monit Comput · Dec 2019
Observational StudyDetermining the accuracy of zero-flux and ingestible thermometers in the peri-operative setting.
Accurately monitoring peri-operative core temperature is a cornerstone of good practice. Relatively invasive devices such as oesophageal temperature probes and pulmonary artery catheters facilitate this, but are inappropriate for many patients. There remains a need for accurate monitors of core temperature that can be used in awake patients. ⋯ The bias for the zero flux electrode compared to oesophageal probe was + 0.02 °C with 95% limits of agreement - 0.5 °C to 0.5 °C. 97.7% of readings were within ± 0.5 °C of the oesophageal probe. The study findings suggest the zero-flux thermometer is sufficiently accurate for clinical use, whereas the ingestible sensor is not. Trial registration The study was registered at http://www.clinicaltrials.gov , NCT Number: NCT02121574.
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J Clin Monit Comput · Dec 2019
Barriers to ultrasound guidance for central venous access: a survey among Dutch intensivists and anaesthesiologists.
Accumulating evidence shows that ultrasound (US) guidance improves effectiveness and safety of central venous catheter (CVC) placement. Several international guidelines therefore recommend the use of US for placement of CVCs. However, surveys show that the landmark-based technique is still widely used, while the percentage of physicians using US is increasing less than expected. ⋯ Personality traits most likely do not play a major role in the acceptance of US guidance for central venous catheterization. A potential intervention to increase US use could be formalizing local hospital policies mandating compliance with US guidance. Future research can perhaps focus on cognitive biases that currently limit more widespread use of US guidance.