Journal of clinical monitoring and computing
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J Clin Monit Comput · Feb 2019
Assessment of cerebral hemodynamic parameters using pulsatile versus non-pulsatile cerebral blood outflow models.
Prior methods evaluating the changes in cerebral arterial blood volume (∆CaBV) assumed that brain blood transport distal to big cerebral arteries can be approximated with a non-pulsatile flow (CFF) model. In this study, a modified ∆CaBV calculation that accounts for pulsatile blood flow forward (PFF) from large cerebral arteries to resistive arterioles was investigated. The aim was to assess cerebral hemodynamic indices estimated by both CFF and PFF models while changing arterial blood carbon dioxide concentration (EtCO2) in healthy volunteers. ⋯ Our results suggest that the pulsatile flow forward model better reflects changes in CrCP and in τ induced by controlled alterations in EtCO2.
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J Clin Monit Comput · Feb 2019
Observational StudyQuantitative computed tomography in comparison with transpulmonary thermodilution for the estimation of pulmonary fluid status: a clinical study in critically ill patients.
Extravascular lung water (index) (EVLW(I)) can be estimated using transpulmonary thermodilution (TPTD). Computed tomography (CT) with quantitative analysis of lung tissue density has been proposed to quantify pulmonary edema. We compared variables of pulmonary fluid status assessed using quantitative CT and TPTD in critically ill patients. ⋯ There was no significant correlation between TVI and EVLWI before CT, EVLWI after CT, or mean EVLWI. CT-derived variables did not predict elevated TPTD-derived EVLWI values. In unselected critically ill patients, variables of pulmonary fluid status assessed using quantitative CT cannot be used to predict EVLWI.
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J Clin Monit Comput · Feb 2019
Intraoperative feasibility of bulbocavernosus reflex monitoring during untethering surgery in infants and children.
Bulbocavernosus reflex (BCR) monitoring is used to assess the integrity of urinary and bowel function. In this study, we evaluated the feasibility of BCR monitoring during untethering surgery in infants and children to predict postoperative urinary and bowel dysfunction. The records of 22 patients ranging from 4 days to 10 years old (mean 2.7 ± 3.3 years) were reviewed. ⋯ The results of intraoperative BCR monitoring included three true-positives, twelve true-negatives, five false-positives, and zero false-negatives. Therefore, the sensitivity and specificity of BCR monitoring used to predict postoperative urinary and bowel dysfunction were 100 and 70.6%, respectively. BCR monitoring during untethering surgery in infants and children under general anesthesia was found to be a feasible method to prevent postoperative urinary and bowel dysfunction.
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J Clin Monit Comput · Feb 2019
Observational StudyEvaluation of the novel non-invasive zero-heat-flux Tcore™ thermometer in cardiac surgical patients.
Tcore™ Sensor is a novel zero-heat-flux thermometer that estimates core temperature from skin over forehead. We tested the hypothesis that this system estimates core temperature to an accuracy within 0.5 °C. 40 cardiac surgical patients were enrolled (960 measurements). Reference core temperatures were measured in nasopharynx, pulmonary artery and the arterial branch of the oxygenator of the cardiopulmonary bypass (CPB) circuit. 95% Bland-Altman limits of agreement for repeated measurement data was used to study the agreement between Tcore™ thermometer and the reference methods. ⋯ The proportion of differences within 0.5 °C was 54.40% (95% CI 48.80-60.00%). LCCC was 0.74 (0.69-0.79). Cutaneous forehead zero-flux temperatures were not sufficiently accurate for routine clinical use in the cardiac surgical population.
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J Clin Monit Comput · Feb 2019
Editorial CommentImplementation of goal-directed therapy needs a boost, and it is called assisted fluid management.
Abstract