Journal of clinical monitoring and computing
-
J Clin Monit Comput · Aug 2020
Randomized Controlled Trial Comparative StudyComparison between two mathematical methods to estimate arterial occlusion pressure and tourniquet effectiveness in lower limb surgery: a prospective, randomized, double blind, comparative study.
The effectiveness of two different methods for calculating the arterial occlusion pressure (AOP) to set tourniquet inflation pressures were assessed in patients underwent knee arthroscopy. Eighty patients were included in this study. Tourniquet inflation pressure was set by adding 20 mmHg of safety margin above the AOP value which was calculated by either the Tuncali et al. formula or Hong-yun Liu et al. formula. ⋯ Also, there was no significant difference in surgeon rating of the bloodlessness of the surgical field, at the start, middle and end of surgery. Hong-yun Liu et al. mathematical formula was found to be less effective than Tuncali et al. formula to estimate the least effective tourniquet pressure in lower limb surgery and we might consider it invalid to be used in the lower limb. Clinical trials registration number: NCT03706859 (Clinicaltrials.gov) and registration date: January, 2019. https://clinicaltrials.gov/ct2/show/NCT03706859.
-
J Clin Monit Comput · Aug 2020
Detection of intratracheal accumulation of thick secretions by using continuous monitoring of respiratory acoustic spectrum: a preliminary analysis.
The accumulation of tracheobronchial secretions may contribute to a deterioration in pulmonary function and its early detection is important. In this study, we analyzed the respiratory sound spectrum in patients with intratracheal secretion, and compared acoustic characteristics before and after therapeutic endotracheal suctioning. After review of anesthetic records of liver transplant recipients, we included recipients with identified intratracheal secretion during surgery. ⋯ Identifying the presence of intratracheal secretions with power ratio at 80-200 Hz and 300-400 Hz showed the highest area under the curve of 0.955 in receiver operating characteristic curve analysis. We suggest that spectral analysis of breath sounds obtained from the esophageal stethoscope might be a useful non-invasive respiratory monitor for accumulation of intratracheal secretion. Further prospective studies to evaluate the utility of acoustic analysis in surgical patients are warranted.
-
J Clin Monit Comput · Aug 2020
Facing SpO2 and SaO2 discrepancies in ICU patients: is the perfusion index helpful?
Peripheral oxygen saturation (SpO2) measured by pulse oximetry is an unreliable surrogate marker for arterial oxygenation (SaO2) in critically ill patients. We hypothesized that a higher perfusion index (PFI) would be associated with better accuracy of SpO2 measurement. We retrospectively collected SaO2, SpO2, and PFI data for each arterial blood gas (ABG) analysis in a cohort of intensive care unit patients. ⋯ The accuracy of pulse oximetry for estimating arterial oxygenation was moderate and improved little with increasing PFI values. Thus, the additive value of PFI in clinical decision making is limited. Therefore, we advise performing an ABG before adjusting fraction of inspired oxygen (FiO2) settings.
-
J Clin Monit Comput · Aug 2020
Detecting intraoperative gastric regurgitation by using preattached esophageal multichannel intraluminal impedance and pH monitoring on a solid-state manometry: a case series study.
Adequate barrier pressure (BrP), calculated by subtracting intragastric pressure (IGP) from lower esophageal sphincter pressure (LESP), is believed to prevent gastroesophageal regurgitation (GER). However, the occurrence of intraoperative GER, the height and acidity it reached, have rarely been demonstrated simultaneously along with BrP. In this study, we developed preattached multichannel intraluminal impedance monitoring combined with pH-metry (the gold standard for detecting both height and acidity) on a solid-state manometry to continuously detect intraoperative GER as well as BrP changes. ⋯ The mean IGP (3.24 mmHg) at T2 was significantly higher than at T1 and T3 (- 6.10 and - 2.25 mmHg, respectively). The mean BrP scores were comparable from T1 to T3 (T1: 19.34 mmHg; T2: 19.98 mmHg; T3: 21.16 mmHg). Based on our results, the proposed setup is helpful for intraoperative monitoring and management of patients at high risk of GER.
-
J Clin Monit Comput · Aug 2020
Diagnostic accuracy of somatosensory evoked potentials during intracranial aneurysm clipping for perioperative stroke.
Somatosensory evoked potentials (SSEPs) are utilized during aneurysm clipping to detect intraoperative ischemia. We assess the diagnostic accuracy of SSEPs in predicting perioperative stroke during aneurysm clipping. A retrospective review was conducted of 429 consecutive patients who underwent surgical clipping for ruptured and unruptured cerebral aneurysms with intraoperative SSEP monitoring from 2006 to 2013. ⋯ SSEP changes have high specificity and modest sensitivity for perioperative stroke. Stroke risk is a function of both the magnitude of SSEP amplitude loss and the duration of its loss. Given the modest sensitivity, patients may benefit from multimodal monitoring including motor-evoked potentials during cerebral aneurysm surgery.