Journal of clinical monitoring and computing
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J Clin Monit Comput · Feb 2019
Observational StudyComplexity of preoperative blood pressure dynamics: possible utility in cardiac surgical risk assessment.
Complexity measures are intended to assess the cardiovascular system's capacity to respond to stressors. We sought to determine if decreased BP complexity is associated with increased estimated risk as obtained from two standard instruments: the Society of Thoracic Surgeons' (STS) Risk of Mortality and Morbidity Index and the European System for Cardiac Operative Risk Evaluation Score (EuroSCORE II). In this observational cohort study, preoperative systolic, diastolic, mean (MAP) and pulse pressure (PP) time series were derived in 147 patients undergoing cardiac surgery. ⋯ The mean and SD of BP time series were not significantly associated with the risk index except for a positive association with the SD of the diastolic BP. Lower preoperative BP complexity was associated with a higher estimated risk of adverse cardiovascular outcomes and may provide a novel approach to assessing cardiovascular risk. Future studies are needed to determine whether dynamical risk indices can improve current risk prediction tools.
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J Clin Monit Comput · Feb 2019
Finger and forehead photoplethysmography-derived pulse-pressure variation and the benefits of baseline correction.
To non-invasively predict fluid responsiveness, respiration-induced pulse amplitude variation (PAV) in the photoplethysmographic (PPG) signal has been proposed as an alternative to pulse pressure variation (PPV) in the arterial blood pressure (ABP) signal. However, it is still unclear how the performance of the PPG-derived PAV is site-dependent during surgery. The aim of this study is to compare finger- and forehead-PPG derived PAV in their ability to approach the value and trend of ABP-derived PPV. ⋯ By correcting for the baseline variation, improved agreements were obtained for both the finger and forehead, and the difference between these two agreements was diminished. The tracking abilities for both finger- and forehead-derived PAV still warrant improvement for wide use in clinical practice. Overall, our results show that baseline-corrected finger- and forehead-derived PAV may provide a non-invasive alternative for PPV.
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J Clin Monit Comput · Feb 2019
Real-time, spectral analysis of the arterial pressure waveform using a wirelessly-connected, tablet computer: a pilot study.
Spectral analysis of the arterial pressure waveform, using specialized hardware, has been used for the retrospective calculation of the 'Spectral Peak Ratio' (SPeR) of the respiratory and cardiac arterial spectral peaks. The metric can quantify the cardiovascular response to volume loading by analysing the effect of changing tidal volume (indexed to body weight) (VTI) on pulse pressure variability. In this pilot study, the feasibility of real-time SPeR calculation, using a mobile computer which was wirelessly connected to the patient monitor, was evaluated by examining the determinants of SPeR in 60 cardiac-surgical patients. ⋯ Real-time spectral analysis of the arterial waveform was easily accomplished. The regression of SPeR on VTI was linear. β appeared to represent the slope of the cardiac response curve at the venous return curve equilibrium point. Measurements were possible at a significantly lower VTI than the equivalent time domain metrics.
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J Clin Monit Comput · Feb 2019
Observational StudyComputerized tests to evaluate recovery of cognitive function after deep sedation with propofol and remifentanil for colonoscopy.
The use of sedation for diagnostic procedures including gastrointestinal endoscopy is rapidly growing. Recovery of cognitive function after sedation is important because it would be important for most patients to resume safe, normal life soon after the procedure. Computerized tests have shown being accurate descriptors of cognitive function. ⋯ Cognitive impairment in attention and psychomotor function after propofol and remifentanil sedation was significant and large and could be easily detected by computerized cognitive tests. Even though, patients were fully recovered 40 min after ending the procedure. From a cognitive recovery point of view, larger studies should be undertaken to propose adequate criteria for discharge after sedation.
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J Clin Monit Comput · Feb 2019
Can postoperative deltoid weakness after cervical laminoplasty be prevented by using intraoperative neurophysiological monitoring?
Laminoplasty, frequently performed in patients with cervical myelopathy, is safe and provides relatively good results. However, motor palsy of the upper extremities, which occurs after decompression surgery for cervical myelopathy, often reduces muscle strength of the deltoid muscle, mainly in the C5 myotome. The aim of this study was to investigate prospectively whether postoperative deltoid weakness (DW) can be predicted by performing intraoperative neurophysiological monitoring (IONM) during cervical laminoplasty and to clarify whether it is possible to prevent palsy using IONM. ⋯ Persistent Br(E)-MsEP alerts of the deltoid muscle had a 100% sensitivity and specificity for predicting a postoperative acute deficit. IONM was unable to predict delayed-onset DW. In only 1 patient were we able to prevent postoperative DW by performing a foraminotomy.