Journal of clinical monitoring and computing
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J Clin Monit Comput · Dec 2021
Anaesthesia and multimodality intraoperative neuromonitoring in carotid endarterectomy. Chronological evolution and effects on intraoperative neurophysiology.
Contingency data was retrospectively collected to evaluate the historical and current ability to provide multimodality intraoperative neurophysiological monitoring during carotid endarterectomy under two conditions: total intravenous anaesthesia (TIVA) and low dose halogenated anaesthesia (SEVO). 229 patients were monitored during carotid endarterectomy procedures under general anaesthesia between 2012 and 2020. 121 Patients were monitored with SEVO at a minimum alveolar concentration less than 0.7 and 108 were monitored using TIVA, according to common anaesthetic practice standards in our hospital across the years. Multimodality IONM was established with electroencephalography, somatosensory evoked potentials and motor evoked potentials. ⋯ When using SEVO, multimodality intraoperative neurophysiological monitoring during carotid endarterectomy could mask or miss a motor isolated change in patients in spite of low dose minimum alveolar concentration and of apparently adequate electroencephalography and somatosensory evoked potentials for monitoring. Given these difficulties, we believe the chronological transfer to TIVA could have improved our ability to establish multimodality intraoperative neurophysiological monitoring during carotid endarterectomy in recent times.
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J Clin Monit Comput · Dec 2021
Non-contact thermography-based respiratory rate monitoring in a post-anesthetic care unit.
In patients at high risk of respiratory complications, pulse oximetry may not adequately detect hypoventilation events. Previous studies have proposed using thermography, which relies on infrared imaging, to measure respiratory rate (RR). These systems lack support from real-world feasibility testing for widespread acceptance. ⋯ Limits of agreement analysis revealed a bias of 1.3 and limits of agreement of 10.8 (95% confidence interval 9.07 to 12.5) and - 8.13 (- 6.41 to - 9.84) between direct measurements and bioimpedance, and a bias of -0.139 and limits of agreement of 2.65 (2.14 to 3.15) and - 2.92 (- 2.41 to 3.42) between direct measurements and thermography. Thermography allowed tracking of the manually measured RR in the post-anesthesia recovery unit without requiring patient contact. Additional work is required for image acquisition automation and nostril identification.
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J Clin Monit Comput · Dec 2021
Train-of-four monitoring with the twitchview monitor electctromyograph compared to the GE NMT electromyograph and manual palpation.
The purpose of this study was to compare train-of-four count and ratio measurements with the GE electromyograph to the TwitchView electromyograph, that was previously validated against mechanomography, and to palpation of train-of-four count. Electrodes for both monitors were applied to the same arm of patients undergoing an unrestricted general anesthetic. Train-of-four measurements were performed with both monitors approximately every 5 min. ⋯ For 7% of data pairs, the GE monitor train-of-four count was 4 when the palpation count was 0. The GE electromyograph may overestimate the train-of-four count and ratio. The GE electromyograph frequently reported 4 twitches when none were actually present due to misinterpretation of artifacts.
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J Clin Monit Comput · Dec 2021
Observational StudyUse of eye tracking in analyzing distribution of visual attention among critical care nurses in daily professional life: an observational study.
Patient safety is a priority in healthcare, yet it is unclear how sources of errors should best be analyzed. Eye tracking is a tool used to monitor gaze patterns in medicine. The aim of this study was to analyze the distribution of visual attention among critical care nurses performing non-simulated, routine patient care on invasively ventilated patients in an ICU. ⋯ Eye tracking is helpful to analyze the distribution of visual attention of critical care nurses. It demonstrates that the respirator, the patient data management system and the patient form cornerstones in the treatment of critically ill patients. This offers insights into complex work patterns in critical care and the possibility of improving work flows, avoiding human error and maximizing patient safety.
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J Clin Monit Comput · Dec 2021
Laser speckle contrast imaging of forehead cutaneous blood flow during carotid endarterectomy as a potential non-invasive method for surrogate monitoring of cerebral perfusion.
Monitoring cerebral perfusion is important for goal-directed anesthesia. Taking advantage of the supply of the supraorbital region and Glabella from the internal carotid artery (ICA), we evaluated changes in cutaneous blood flow using laser speckle contrast imagining (LSCI) as a potential method for indirect real-time monitoring of cerebral perfusion. Nine patients (8 men, mean age 70 years) underwent eversion carotid endarterectomy under local anesthesia. ⋯ The supraorbital cutaneous blood flow did not change significantly following reperfusion of the external carotid artery (ECA) (221 ± 109 to 281 ± 154 AU; p = 0.175) and ICA (281 ± 154 to 310 ± 184 AU; p = 01). A comparable trend for Glabella followed ECA (276 ± 107 to 342 ± 170 AU; p = 0.404) and ICA (342 ± 170 to 352 ± 191 AU; p = 01) reperfusion. In patients undergoing carotid endarterectomy under local anesthesia, LSCI of the supraorbital and Glabella regions reflected clamping of the CCA but did not distinguish reperfusion of the ICA from that of the ECA.