Journal of clinical monitoring and computing
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Electronic medical records now store a wealth of intraoperative hemodynamic data. However, analysis of such data is plagued by artifacts related to the monitoring environment. Here, we present an algorithm for automated identification of artifacts and replacement using interpolation of arterial line blood pressures. ⋯ The average difference between manual review and algorithm in identifying the start of arterial line monitoring was 0.17, and 2.1 min for the end of monitoring. Application of the algorithm decreased the percent of time below 55 mmHg from 4.3 to 2.0% (2.1% with manual review) and time above 100 mmHg from 8.8 to 7.3% (7.3% manual). This algorithm's performance was comparable to manual review by a human anesthesiologist and reduced the incidence of abnormal MAP values identified using a sample analysis tool.
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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.
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J Clin Monit Comput · Jun 2019
Comparative StudyTwo different methods to assess sympathetic tone during general anesthesia lead to different findings.
Noxious stimulation influences the autonomic nervous system activity. Sympathetic tone monitoring is currently used to assess the adequacy of the balance between nociception and anti-nociception during general anesthesia. The Surgical Plethysmographic Index (SPI) and the EBMi software (Custos©) are commercial devices that use different algorithms to measure it. ⋯ Longer SPI ≥ 60 episodes were associated with lower anti-nociception anesthetic regimen. Different methods of sympathetic tone assessment during general anesthesia provide conflicting information. Prospective studies should be undertaken to clarify the clinical indications of both techniques.
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J Clin Monit Comput · Jun 2019
Observational StudyTracheal sounds accurately detect apnea in patients recovering from anesthesia.
Apnea should be monitored continuously in the post anesthesia care unit (PACU) to avoid serious complications. It has been confirmed that tracheal sounds can be used to detect apnea during sedation in healthy subjects, but the performance of this acoustic method has not been evaluated in patients with frequent apnea events in the PACU. Tracheal sounds were acquired from the patients in the PACU using a microphone encased in a plastic bell. ⋯ The log-var apnea detection algorithm detected apnea with 92% sensitivity, 98% specificity, 46 PLR and 0.08 NLR. The performance of apnea detection in the PACU using the log-var tracheal sounds method proved to be reliable and accurate. Tracheal sounds could be used to minimize the potential risks from apnea in PACU patients.
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J Clin Monit Comput · Jun 2019
Acute pain intensity monitoring with the classification of multiple physiological parameters.
Current acute pain intensity assessment tools are mainly based on self-reporting by patients, which is impractical for non-communicative, sedated or critically ill patients. In previous studies, various physiological signals have been observed qualitatively as a potential pain intensity index. On the basis of that, this study aims at developing a continuous pain monitoring method with the classification of multiple physiological parameters. ⋯ With facial electromyogram, the adaptivity of this method to a new subject was improved as the recognition accuracy of moderate/severe pain in leave-one-subject-out cross-validation was promoted from 74.9 ± 21.0 to 76.3 ± 18.1%. Among healthy volunteers, GSR, HR and BR were better correlated to pain intensity variations than facial muscle activities. The classification of multiple accessible physiological parameters can potentially provide a way to differentiate among no, mild and moderate/severe acute experimental pain.