Journal of clinical monitoring and computing
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J Clin Monit Comput · Dec 2020
Observational StudyThe ability of perfusion index to detect segmental ulnar nerve sparing after supraclavicular nerve block.
Supraclavicular nerve block (SCB) is a commonly used regional block for upper extremity surgery. The most common form of failure of SCB is ulnar segmental sparing. We aimed to evaluate the accuracy of perfusion index (PI) in early detection of segmental sparing of the ulnar component of SCB. ⋯ An increase of 71% in PI at the little finger 5 min after SCB could accurately rule out ulnar sparing. Clinical trial identifier NCT03880201. Clinical trial registration https://clinicaltrials.gov/ct2/show/NCT03880201?term=NCT03880201&draw=2&rank=1 .
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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.
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J Clin Monit Comput · Dec 2020
Observational StudyEstimation of respiratory rate using infrared video in an inpatient population: an observational study.
Respiratory rate (RR) is one of the most sensitive markers of a deteriorating patient. Despite this, there is significant inter-observer discrepancy when measured by clinical staff, and modalities used in clinical practice such as ECG bioimpedance are prone to error. This study utilized infrared thermography (IRT) to measure RR in a critically ill population in the Intensive Care Unit. ⋯ Correlation between counting and ECG-derived RR demonstrated significance only at > 19 bpm (r = 0.562, p = 0.029). Overall agreement between IRT-derived RR at distances of 0.4-0.6 m and gold standard counting was satisfactory, and outperformed ECG derived bioimpedance. Contactless IRT derived RR may be feasible as a routine monitoring modality in wards and subacute inpatient settings.
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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
Prognostic value of a bilateral motor threshold criterion for facial corticobulbar MEP monitoring during cerebellopontine angle tumor resection.
In intraoperative neuromonitoring (IONM), facial nerve motor function (FaNMF) is assessed by facial muscle corticobulbar motor evoked potentials (FMcoMEP). Mostly only amplitude decrease is used as warning criterion. We related a refined criterion for FMcoMEP consisting of a bilateral final-to-baseline motor threshold ratio with standard criteria and postoperative FaNMF. 79 patients (45 females; 48 ± 16 years) undergoing IONM-guided cerebellopontine angle tumor surgery were retrospectively analyzed. ⋯ Diagnostic odds ratios were highest for bfBMT20 compared to iAMT20 and iAR50 for D1 (172.5 vs. 8.7 vs. 0.45) and D7 (51.4 vs. 6.1 vs. 0.8). The refined parameter bFBMT20 provides a valuable contribution to the prognostic assessment of FaNMF. Due to its bihemispheric character, it might thus circumvent false-positive events which affect FMcoMEP bilaterally.