Journal of clinical monitoring and computing
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J Clin Monit Comput · Apr 2020
Randomized Controlled TrialEphedrine and phenylephrine induce opposite changes in cerebral and paraspinal tissue oxygen saturation, measured with near-infrared spectroscopy: a randomized controlled trial.
While the effects of phenylephrine (PE) and ephedrine (E) on cerebral oxygen saturation (rScO2) already has been studied, the effect on paraspinal oxygen saturation (rSpsO2) is still unexplored. This study aims to assess the effect of PE and E on rScO2 and rSpsO2, measured with near-infrared spectroscopy. A randomized 4-treatment cross-over trial was designed in 28 patients under BIS-titrated anaesthesia with sevoflurane. ⋯ Compared to E, PE administration was associated with a significant decrease in rScO2 (- 2.1%, 95% CI [- 3.1%, - 1.2%], p < 0.001). In contrast, compared to PE, E was associated with a significant decrease in rSpsO2 at T3-T4, T9-T10 and L1-L2 (- 2.0%, 95% CI [- 2.8, - 1.1], p < 0.001; - 1.4%, 95% CI [- 2.4%, - 0.4%], p = 0.006; and - 1.5%, 95% CI [- 2.3%, - 0.8%], p < 0.001, respectively). An opposite effect on rScO2 and rSpsO2 was observed after bolus administration of PE and E.
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J Clin Monit Comput · Apr 2020
Observational StudyValidation of electrical velocimetry in resuscitation of patients undergoing liver transplantation. Observational study.
Major hemodynamic changes are frequently noted during liver transplantation (LT). We evaluated the performance of electrical velocimetry (EV) as compared to that of TEE in SV optimization during liver transplantation. This was an observational study in 32 patients undergoing LT. ⋯ The absolute values of SV derived from EV did not agree with SV derived from TEE. However, EV was able to track the direction of changes in SV during hemodynamic management of patients undergoing liver transplantation. Clinical trial registration: Clinicaltrials.gov Identifier: NCT03228329 prospectively Registered on 13-July-2017.
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J Clin Monit Comput · Apr 2020
Machine learning applied to multi-sensor information to reduce false alarm rate in the ICU.
Studies reveal that the false alarm rate (FAR) demonstrated by intensive care unit (ICU) vital signs monitors ranges from 0.72 to 0.99. We applied machine learning (ML) to ICU multi-sensor information to imitate a medical specialist in diagnosing patient condition. We hypothesized that applying this data-driven approach to medical monitors will help reduce the FAR even when data from sensors are missing. ⋯ While the FAR for PER with missing parameters was 0.17-0.39, it was only 0.01-0.02 for RF. When scenarios were examined separately, RF showed clear superiority in almost all combinations of scenarios and numbers of missing parameters. When sensor data are missing, specialist performance worsens with the number of missing parameters, whereas the RF model attains high accuracy and low FAR due to its ability to fuse information from available sensors, compensating for missing parameters.
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J Clin Monit Comput · Apr 2020
Correction to: Mathematical arterialisation of peripheral venous blood gas for obtainment of arterial blood gas values: a methodological validation study in the clinical setting.
The corresponding author has identified a calculation mistake in the original publication of the article. The corrected value is given in this Correction. Under the Results section, the median (range) age of the patients in the methodological study should read 76 (26-86) years instead of 56 (26-86) years.
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J Clin Monit Comput · Apr 2020
Observational StudyPharmacodynamic modelling of the effect of remifentanil using the Pupillary Pain Index.
Using a targeted controlled infusion of remifentanil during total intravenous anesthesia, we investigated the effect-site concentrations of remifentanil that correlate with different values of the Pupillary Pain Index and which concentrations were necessary for achieving a Pupillary Pain Index ≤ 4 and its usefulness in titrating opioids. The Pupillary Pain Index was measured in 54 patients prior to surgery under different remifentanil effect-site concentrations and subsequently modeled. ⋯ For the probability of 80% of patients achieving a PPI score ≤ 4 the Ce of remifentanil was 4.39 ng/mL. We conclude that concentrations of remifentanil that have been shown to suppress movement in response to noxious stimulation correspond to a Pupillary Pain Index ≤ 4.