Journal of clinical monitoring and computing
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J Clin Monit Comput · Jun 2020
Do cerebral and somatic tissue oxygen saturation measurements correlate with each other during surgery?
Intraoperative maintenance of optimal tissue oxygenation is critical; however, it is uncertain whether measurements of different tissue beds correlate with each other. Cerebral tissue oxygen saturation (SctO2) measured on the forehead and somatic tissue oxygen saturation (SstO2) measured on limbs, using a tissue near-infrared spectroscopy, were simultaneously recorded every 2 s in patients having spine surgery or robotic hysterectomy. Simple linear regression was used to determine the static correlation between SctO2 and SstO2 using the median values of each min for each patient. ⋯ The static correlation between SctO2 and SstO2 was inconsistent (r ranging from - 0.86 to 0.93 in spine surgery and from - 0.74 to 0.85 in robotic hysterectomy). The proportional durations with CC ≤ - 0.3 (negative correlation), - 0.3 < CC < 0.3 (poor correlation) and CC ≥ 0.3 (positive correlation) were 18.3 ± 9.6%, 52.6 ± 12.1% and 29.0 ± 9.6%, respectively, in patients having spine surgery and 19.6 ± 9.0%, 58.6 ± 13.1% and 21.8 ± 8.0%, respectively, in patients having robotic hysterectomy. There are a large discrepancy and inconsistent correlation between intraoperative SctO2 and SstO2 measurements, suggesting their non-interchangeability.
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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.
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J Clin Monit Comput · Jun 2020
Association between intraoperative nociception and postoperative complications in patients undergoing laparoscopic gastrointestinal surgery.
A higher degree of surgical invasiveness, which increases intraoperative nociception, might induce postoperative complications. Although several nociceptive indices for use during surgery are available in clinical practice, association between intraoperative nociception and postoperative complications has not been reported. An index representing intraoperative nociception, which is the averaged value of Nociceptive Response throughout the surgery (mean NR) was applied to examine the association in the present study. ⋯ Then all patients were divided into two propensity score matched groups, based on a mean NR of < 0.85 and ≥ 0.85, with matching for age, ASA-PS, body mass index and duration of surgery. The severity of postoperative complications was significantly higher in the high NR group than in the low NR group (P = 0.005). In conclusion, there was likely an association between intraoperative nociception and postoperative complications in patients without serious preoperative conditions and comorbidities.
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J Clin Monit Comput · Jun 2020
Warning criteria for MEP monitoring during carotid endarterectomy: a retrospective study of 571 patients.
Monitoring of transcranial electrical motor evoked potentials (tcMEP) during carotid endarterectomy (CEA) has been shown to effectively detect intraoperative cerebral ischemia. The unique purpose of this study was to evaluate changes of MEP amplitude (AMP), area under the curve (AUC) and signal morphology (MOR) as additional MEP warning criteria for clamping-associated ischemia during CEA. Therefore, the primary outcome was the number of MEP alerts (AMP, AUC and MOR) in the patients without postoperative motor deficit (false positives). ⋯ In combination of AMP/AUC and AMP/AUC/MOR false positives were found in 9.52% and 9.33% of the patients. This study is the first to evaluate the correctness of the MEP warning criteria AMP, AUC and MOR with regard to false positive monitoring results in the context of CEA. All additional MEP warning criteria investigated produced an unacceptably high number of false positives and therefore may not be useful in carotid surgery for adequate detection of clamping-associated ischemia.