Journal of clinical monitoring and computing
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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
Comparative StudyIn vitro efficiency of 16 different Ca(OH)2 based CO2 absorbent brands.
Data directly comparing CO2 absorbents tested in identical and clinically relevant conditions are scarce or non-existent. We therefore tested and compared the efficiency of 16 different brands of Ca(OH)2 based CO2 absorbents used as loose fill or a cartridge in a refillable canister under identical low flow conditions. CO2 absorbents efficiency was tested by flowing 160 mL/min CO2 into the tip of a 2 L balloon that was ventilated with an ADU anesthesia machine (GE, Madison, WI, USA) with a tidal volume of 500 mL and a respiratory rate of 10/min while running an O2/air FGF of 300 mL/min. ⋯ The efficiency of Ca(OH)2 based CO2 absorbent differs up to 100% on a volume basis. Macroscopic arrangement (cylindrical wrap with preformed channels versus granules), chemical composition (NaOH content), and granular shape all affect efficiency per volume of product. The data can be used to compare costs of the different products.
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J Clin Monit Comput · Dec 2019
Comparative StudyEconomic and operational impact of an improved pathway using rapid molecular diagnostic testing for patients with influenza-like illness in a German emergency department.
To evaluate the economic and operational effects of implementing a shorted diagnostic pathway during influenza epidemics. This retrospective study used emergency department (ED) data from the 2014/2015 influenza season. Alere i influenza A & B rapid molecular diagnostic test (RDT) was compared with the polymerase chain reaction (PCR) pathway. ⋯ In patients with a negative diagnosis, the RDT was also estimated to reduce the total diagnostic costs by 41.52 € per patient compared with PCR. The total cost difference was projected to be 31,892 € across a 14-week influenza season. The improved process and earlier diagnosis with the RDT pathway compared with conventional PCR resulted in considerable savings in ED, inpatient room occupancy time and cost across the influenza season.
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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.
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J Clin Monit Comput · Dec 2019
Non-sinusoidal waves in the EEG and their simulated effect on anaesthetic quantitative EEG monitors.
The effect of anaesthetic drugs on the cortex are commonly estimated from the electroencephalogram (EEG) by quantitative EEG monitors such as the Bispectral Index (BIS). These monitors use ratios of high to low frequency power which assumes that each neurological process contributes a unique frequency pattern. However, recent research of the effect of deep brain stimulation on EEG beta oscillations suggests that wave shape, a non-sinusoidal feature that is only measurable in the time-domain, can change the frequency 'signature' of a neurological rhythmical process by the inclusion or removal of harmonic frequencies. ⋯ Age was found to be the only significant predictor of alpha wave triangularity. The artificially modified square-alpha waves increased the power in the frequency spectrum at 26 Hz by 1-5 dB, and increased the BetaRatio by 0.7. The alpha-wave of anaesthetised patients contains non-sinusoidal components which likely impact depth of anaesthesia calculations.