Journal of clinical monitoring and computing
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J Clin Monit Comput · Jun 2020
ReviewJournal of Clinical Monitoring and Computing 2019 end of year summary: monitoring tissue oxygenation and perfusion and its autoregulation.
Tissue perfusion monitoring is increasingly being employed clinically in a non-invasive fashion. In this end-of-year summary of the Journal of Clinical Monitoring and Computing, we take a closer look at the papers published recently on this subject in the journal. ⋯ Given the importance of cerebral autoregulation in the analyses performed in most of the studies discussed here, this end-of-year summary also includes a short description of cerebral hemodynamic physiology and its autoregulation. Finally, we review articles on somatic tissue oxygenation and its possible association with outcome.
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J Clin Monit Comput · Jun 2020
Randomized Controlled TrialEffects of vascular morphological features and ultrasound-guided vascular cannulation techniques on the success of femoral artery catheterisation in newborns.
Ultrasound-guided vascular access is a technique that can increase safety as well as technical and procedural success when performing invasive cardiovascular procedures. The aim of this study was to evaluate the effects of two cannulation techniques and vascular morphological properties on the success of femoral artery catheterisation in neonatal patients. We recruited 65 consecutive patients requiring femoral artery catheterisation and randomly divided them into two groups: Group 1, in-plane technique (n = 31) and Group 2, out-of-plane technique (n = 34). ⋯ Hematoma was strongly correlated with the number of venous punctures (r = 0.632; p = 0.001) and the number of needle advancements (r = 0.415; p = 0.001). In terms of artery-vein position, patients whose artery overlapped the vein by > 50% required clearly longer artery cannulation durations than the other patients (p < 0.001). Although the in-plane technique has a steep learning curve, it was found superior in terms of procedure-related factors such as the number of trials, the incidence of hematoma and arterial puncture counts, as it offers advantages such as the ability to evaluate the lumen and a better control of the needle advancement direction.
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J Clin Monit Comput · Jun 2020
Randomized Controlled TrialDetection of gastric inflation using transesophageal echocardiography after different level of pressure-controlled mask ventilation: a prospective randomized trial.
This study aimed to assess the technique of using transesophageal echocardiography (TEE) to detect gastric inflation and to determine the optimal level of inspiratory pressure during face mask ventilation (FMV). In this prospective and randomized trial, seventy-five adults scheduled for cardiac surgery were enrolled to one of the three groups (P12, P15, P20) defined by the applied inspiratory pressure during FMV. After induction, mask ventilation was performed with the corresponding level of pressure-control ventilation for 2 min in each patient. ⋯ Peak airway pressure of 12-20 cmH2O could provide acceptable sufficient ventilation during mask ventilation, but 20 cmH2O result in higher incidence of gastric inflation. TEE is useful to detect the gastric inflation related to the entry of air into the stomach during pressure-controlled face mask ventilation. Trial Registration Number ChiCTR-IOR-14005325.
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J Clin Monit Comput · Jun 2020
Observational StudyBio-electrical impedance analysis for perioperative fluid evaluation in open major abdominal surgery.
Water retention and intercompartmental redistribution occur frequently in association with adverse postoperative outcomes, yet the available strategies for non-invasive assessment are limited. One such approach for evaluating body water composition in various circumstances is bio-electrical impedance analysis (BIA). This study aims to appraise the usefulness of the Body Composition Monitor (BCM, Fresenius Medical Care, Germany) in assessing body fluid composition and intercompartmental shifts before and after open major abdominal surgery. ⋯ Intraoperative fluid balance significantly correlated with TBW change (r = 0.23, p = 0.04) and with AFO change (r = 0.31, p < 0.01). A significant correlation was found between pre- and postoperative AFO and RFO on one hand, and ICU-LOS on the other. BIA may be a useful tool for the perioperative assessment of volume status.
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J Clin Monit Comput · Jun 2020
Optimizing the use of point of care testing devices for screening patients.
Point of Care Testing (POCT) devices are regularly used to improve clinical workflows in the hospital setting despite generally having inferior performance when compared to standardized laboratory analyzers. We describe a method to improve the efficacy of using a POCT device as a screening test when the laboratory values occur over a continuum and applied this methodology to the process of International Normalized Ratios (INR) screening on day of surgery. Following IRB approval, laboratory INR values on the day of surgery were extracted from the University of Vermont Medical Center operating room's electronic health record. ⋯ The sensitivities and specificities over a range of values were determined, and the optimal cutoff values were identified for each device separately. Calculating the sensitivities and specificities over a range of values can optimize the clinical efficacy of a POCT device. By optimizing the use of POCT devices, hospitals may be able to improve clinical processes and reduce costs.