Journal of clinical monitoring and computing
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J Clin Monit Comput · Aug 2020
Comparative StudyComparison of multiple cardiac signal acquisition technologies for heart rate variability analysis.
Heart rate variability analysis is a recognized non-invasive tool that is used to assess autonomic nervous system regulation in various clinical settings and medical conditions. A wide variety of HRV analysis methods have been proposed, but they all require a certain number of cardiac beats intervals. There are many ways to record cardiac activity: electrocardiography, phonocardiography, plethysmocardiography, seismocardiography. ⋯ We therefore tested the evolution of several HRV parameters computed from several sensors before, during and after a postural change. The main findings of our study is that even if most sensors were suitable for mean HR computation, some of them demonstrated limited agreement for several HRV analyses methods. We also demonstrated that piezoplethysmocardiography showed better agreement with ECG than other sensors for most HRV indexes.
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J Clin Monit Comput · Aug 2020
A novel method for transpulmonary pressure estimation using fluctuation of central venous pressure.
The objective of the study is to develop a correction method for estimating the change in pleural pressure (ΔPpl) and plateau transpulmonary pressure (PL) by using the change in central venous pressure (ΔCVP). Seven children (aged < 15 years) with acute respiratory failure (PaO2/FIO2 < 300 mmHg), who were paralyzed and mechanically ventilated with a PEEP of < 10 cmH2O and had central venous catheters and esophageal balloon catheters placed for clinical purposes, were enrolled prospectively. ⋯ The plateau PL calculated using the cΔCVP-derived ΔPpl (17.6 ± 2.6 cmH2O) correlated well with the ΔPes-derived plateau PL (18.1 ± 2.3 cmH2O) (R2 = 0.90, p = 0.001). Our correction method can estimate ΔPpl and plateau PL from ΔCVP with a reasonable accuracy in paralyzed and mechanically ventilated pediatric patients with respiratory failure.
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J Clin Monit Comput · Aug 2020
SAVIOR ICU: sonification and vibrotactile interface for the operating room and intensive care unit.
Alarm fatigue is an issue for healthcare providers in the intensive care unit, and may result from desensitization of overbearing and under-informing alarms. To directly increase the overall identification of medical alarms and potentially contribute to a downstream decrease in the prevalence of alarm fatigue, we propose advancing alarm sonification by combining auditory and tactile stimuli to create a multisensory alarm. Participants completed four trials-two multisensory (auditory and tactile) and two unisensory (auditory). ⋯ Specifically, the multisensory group had better performance in correctly identifying parameter (p < 0.05) and point of change (p < 0.05) compared to the unisensory group. Participants demonstrated a higher accuracy of identification with the use of multisensory alarms. Therefore, multisensory alarms may relieve the auditory burden of the medical environment and increase the overall quality of care and patient safety.
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J Clin Monit Comput · Aug 2020
Observational StudyPreoperative transcranial Doppler and cerebral oximetry as predictors of delirium following valvular heart surgery: a case-control study.
Delirium is a frequent and serious complication after cardiac surgery with cerebral hypoperfusion as one from the key pathophysiological mechanisms. Middle cerebral artery (MCA) mean blood flow velocity (MFV) measured by transcranial Doppler has been used as a marker of cerebral perfusion, and cerebral oximetry (rSO2) value as a marker of its adequacy. This prospective observational trial examined the predictive value of MCA MFV and rSO2, measured immediately before induction of anesthesia, for delirium after valvular heart surgery in elderly patients. ⋯ Preoperative statin use, geriatric depression scale score, and low preoperative rSO2 (< 60%) showed association with delirium occurrence in univariable analysis. After multivariable analysis, only the low preoperative rSO2 (< 60%) (OR 6.748, 95% CI 1.647-27.652, P = 0.008) remained as an independent predictor of delirium. Preoperative MCA MFV was not significantly associated with delirium after valvular heart surgery in elderly patients, while a low baseline rSO2 value was associated with a sevenfold increased risk of delirium.
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J Clin Monit Comput · Aug 2020
Observational StudyUsing real-time location devices (RTLD) to quantify off-unit adult intensive care registrar workload: a 1-year tertiary NHS hospital prospective observational study.
UK national guidelines state deteriorating or at risk hospital ward patients should receive care from trained critical care outreach personnel. In most tertiary hospitals this involves a team led by an Intensive Care Unit (ICU) registrar. The ICU registrar must also review patients referred for possible ICU admission. ⋯ This workload combines to leave the unit unattended at night up to 10% of the time. RTLDs provide a reliable, automated method for quantifying ICU registrar off-unit work patterns. This method may be adopted for quantifying other clinical staff work patterns in suitably equipped hospital environments.