Journal of clinical monitoring and computing
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J Clin Monit Comput · Jun 2019
A motor evoked potential trending system may discriminate outcome: retrospective application with three cases.
This report presents a method for tracking Motor Evoked Potential (MEP) amplitudes over the course of a case using a moving least squares linear regression (LSMAs). During a case, newly obtained MEP amplitudes are compared to those predicted by a just previous linear regression (least squares moving average or LSMA). When detected by this comparison, a set criterion amplitude loss will then trigger linear regression of ensuing MEP amplitudes on an expanding step function which tracks the persistence of the amplitude loss for the remainder of the case. ⋯ In the third case the tracking method again successfully triggered a predictive R-Square despite the limited number of pre-event trials. The R-Square value of the expanding step function regression appears to have discriminative capability with regard to new post-op deficit. Given the importance of the intra-operative MEP for monitoring motor functioning and the high degree of variability that can affect it, the development of new quantitative, statistical methods to detect real from apparent MEP change will be necessary.
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J Clin Monit Comput · Jun 2019
Objectively measured early physical activity after total hip or knee arthroplasty.
Although reduced early physical function after total hip- and knee arthroplasty (THA/TKA) is well-described, the underlying reasons have not been clarified with detailed studies on pathophysiological mechanisms related to recovery, thereby prohibiting advances in rehabilitation. Thus, we aimed to describe early post-THA/TKA physical activity measured by actigraphy and potential underlying pathophysiological mechanisms related to recovery in a well-defined cohort of THA and TKA patients. Daytime-activity was measured from 2 days before until 13 (THA) or 20 (TKA) days after surgery. ⋯ Physical activity was reduced the first weeks following THA/TKA, but with large inter-individual variations in recovery profiles. No single pathogenic factor was associated with a poor recovery. Early risk stratified interventions are needed in patients on a suboptimal course.
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J Clin Monit Comput · Jun 2019
The importance of sensor contacting force for predicting fluid responsiveness in children using respiratory variations in pulse oximetry plethysmographic waveform.
Predicting fluid responsiveness is crucial for adequate fluid management. Respiratory variations in pulse oximetry plethysmographic waveform amplitude (ΔPOP) are used to predict fluid responsiveness, but show inconsistent results when used for children. Contacting force between the measurement site and sensor can affect the ΔPOP value, thereby hindering its reliability as an indicator. ⋯ A significant difference between the responders and non-responders was found only in ΔPOPs at 0.9-1.2N contacting force (P = 0.002) and individually adjusted contacting force (P < 0.000), while other contacting force groups did not show significant differences. ΔVpeak predicted a 15% increase in SVI (P = 0.008), whereas PPV did not. The ability of ΔPOP to predict fluid responsiveness depends on the contacting force in mechanically ventilated children. When contacting force is controlled to an adequate degree, the ability of ΔPOP to predict fluid responsiveness can be improved.
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J Clin Monit Comput · Jun 2019
Observational StudyInvestigation of intraoperative dosing patterns of neuromuscular blocking agents.
There is a growing body of literature documenting the use of deep neuromuscular block (NMB) during surgery. Traditional definitions of depth of NMB rely on train-of-four assessment, which can be less reliable in retrospective studies. The goal of our study was to investigate the real-world practice pattern of dosing of neuromuscular blocking agents (NMBA), utilizing the amount of NMBA used during the course of a case, adjusted for patient weight and case duration, as a surrogate measure of depth of NMB. ⋯ Cases with higher rates of HD may be those that are traditionally technically complex or emergent, would benefit from greater paralysis, or do not use adjunctive medications for muscle relaxation. Age greater than 65 years was shown to have lower rates of HD, likely due to provider awareness of age-related changes in pharmacokinetics and pharmacodynamics. Intraoperative monitoring and NMB antagonism with neostigmine were used more frequently with HD.