Journal of clinical monitoring and computing
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J Clin Monit Comput · Dec 2020
Comment LetterThe artificial count of artifacts for thoracic ultrasound: what is the clinical usefulness?
Many works in the literature have shown that the increase in the number of B lines is a nonspecific sign of underlying pulmonary disease. Actually these artifacts are the result of a physical effect of ultrasound between the chest wall and the pulmonary air. Nevertheless the intra- and inter-operator variability in B-lines counting does not only reside only in the count itself but depends also on the type and frequency of the probe used, as well as the ultrasound scan machine setting and the patient's chest shape. In our opinion, proposing a software algorithm to count lines B seems like an unproductive effort.
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J Clin Monit Comput · Dec 2020
Observational StudyPerioperative measurement of core body temperature using an unobtrusive passive heat flow sensor.
Clinicians strive to maintain normothermia, which requires measurement of core-body temperature and may necessitate active warming of patients. Monitoring temperature currently requires invasive probes. This work investigates a novel foam-based flexible sensor worn behind the ear for the measurement of core body temperature. ⋯ The error bias and limits of agreement over these segments were on average of - 0.05 ± 0.28 °C (95% limits of agreement) overall. The dynamic model outperformed the simple heat-flow model for periods of surrounding temperature changes (12.7% of total time) while it had a similar, high, performance for the temperature-stable periods. The results suggest that our proposed topical sensor can replace invasive core temp sensors and provide a means of consistently measuring core body temperature despite surrounding temperature shifts.
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J Clin Monit Comput · Dec 2020
The Peripheral Perfusion Index tracks systemic haemodynamics during general anaesthesia.
Stable intraoperative haemodynamics are associated with improved outcome and even short periods of instability are associated with an increased risk of complications. During anaesthesia intermittent non-invasive blood pressure and heart rate remains the cornerstone of haemodynamic monitoring. Continuous monitoring of systemic blood pressure or even -flow requires invasive or advanced modalities creating a barrier for obtaining important real-time haemodynamic insight. ⋯ After stabilizing a second HUT decreased PPI 59% (49-76), SV 33% (28-37), CO 31% (28-36), and MAP 34% (26-38). Restoration of preload with PE increased PPI by 607% (218-1078), SV by 96% (82-116), CO by 65% (56-99), and MAP by 114% (83-147). During general anaesthesia changes in PPI tracked changes in systemic haemodynamics.
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J Clin Monit Comput · Dec 2020
The effect of prolonged steep head-down laparoscopy on the optical nerve sheath diameter.
Both the steep head-down position and pneumoperitoneum increase the intracranial pressure (ICP), and their combination for a prolonged period during laparoscopic radical prostatectomy (LRP) might influence the central nervous system homeostasis. Changes in optic nerve sheath diameter (ONSD) may reflect those in ICP. This study aims to quantify the change in ONSD in response to peritoneal CO2 insufflation and steep Trendelenburg position during LRP. ⋯ The mean increase was 10.3% (95% CI 7.7-12.9%) in patients versus 7.5% (95% CI 2.5-12.6%) in controls (p = 0.28), and didn't affect the time to recovery from anesthesia. In the studied patients, with a limited increase of end-tidal CO2 and airway pressure, and low volume fluid infusion, the maximal ONSD was always below the cut-off value suspect for increased ICP. ONSD reflects the changes in hydrostatic pressure in response to steep Trendelenburg position, and its increase might be minimized by careful handling of general anesthesia.