Journal of clinical monitoring and computing
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J Clin Monit Comput · Feb 2021
Evaluation of accuracy of capillary refill index with pneumatic fingertip compression.
Capillary refill time (CRT) is a method of measuring a patient's peripheral perfusion status through a visual assessment performed by a clinician. We developed a new method of measuring CRT using standard pulse oximetry sensor, which was designated capillary refill index (CRI). We evaluated the accuracy of CRI in comparison to CRT image analysis. ⋯ The same difference and correlation patterns were verified in the ED setting. CRI was as reliable as CRT by image analysis. The values of CRI was approximately 1 s higher than CRT.
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J Clin Monit Comput · Feb 2021
Comparison of arterial CO2 estimation by end-tidal and transcutaneous CO2 measurements in intubated children and variability with subject related factors.
Transcutaneous PCO2 (PTCCO2) and end-tidal PCO2 (PETCO2) measurement methods serve as alternatives to arterial PCO2 (PaCO2), providing continuous non-invasive monitoring. The objective of this study was to evaluate the PTCCO2 and PETCO2 methods with actual PaCO2 levels, and to assess the variability of measurements in relation to subject-related factors, such as skin and subcutaneous adipose tissue thickness and presence of pulmonary diseases. PTCCO2, PETCO2 and PaCO2 were measured at the same time in intubated pediatric subjects. ⋯ Multiple linear regression demonstrated that increased subcutaneous adipose tissue thickness, core body temperature and inotropic index were related with higher PTCCO2 values relative to the actual PCO2 values. Other factors, such as skin tissue thickness, presence of pulmonary disease, measurement location and measurement times were non-significant. The PTCCO2 method has higher reliability than the PETCO2 method, and PTCCO2 measurements are not influenced by most subject-related factors; however, core body temperature, inotropic index and subcutaneous adipose tissue thickness can lead to significant differences in PCO2 measurement.
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J Clin Monit Comput · Feb 2021
Ultrasonographic evaluation of lung and heart in predicting successful weaning in mechanically ventilated neurosurgical patients.
In critically ill neurosurgical patients, delayed and premature extubation increases the risk of morbidity and mortality. Assessment of critically ill patients before and during spontaneous breathing trial (SBT) is crucial in predicting weaning failure. We explored the trend of changes with integrated lung and cardiac ultrasonography in predicting success of weaning in neurosurgical patients. ⋯ There was significant increase in the LV filling pressure (increase E/A and E/E', decrease in DTE) after 30 and 120 min of SBT in failure group compared to the success group. Point of care lung and cardiac ultrasonography may be useful in detecting cardiopulmonary changes induced by SBT. Higher lung aeration loss and LV filling pressure were observed with SBT failure group.
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J Clin Monit Comput · Feb 2021
Increase in regional cerebral saturation after elective electrical cardioversion of atrial fibrillation is only transient and without beneficial effects on neuropsychological functioning: cerebral saturation during electrical cardioversion.
We aimed to confirm the positive association between a successful electrical cardioversion (ECV) and increase in SctO2 and investigated whether this increase is persisting or not. Secondary, the influence of a successful ECV on the neuropsychological function and the association with SctO2 was assessed as well. SctO2 was measured continuously during elective ECV using near-infrared spectroscopy. ⋯ A transient, instant SctO2 increase was observed after successful ECV. This temporary increase in SctO2 did not influence the neuropsychological functioning of the patients. Though, the quality of life of patients with a successful ECV improved.
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J Clin Monit Comput · Feb 2021
Improper monitoring and deviations from physiologic treatment goals in patients with brain injury in the early phases of emergency care.
Severe traumatic brain injury (TBI), out-of-hospital cardiac arrest (OHCA) and intracerebral- and subarachnoid hemorrhage (ICH/SAH) are conditions associated with high mortality and morbidity. The aim of this study was to investigate the feasibility of obtaining continuous physiologic data and to identify possible harmful physiological deviations in these patients, in the early phases of emergency care. Patients with ICH/SAH, OHCA and severe TBI treated by the Physician-staffed Emergency Medical Service (P-EMS) between September and December 2016 were included. ⋯ Continuous physiological data was not possible to obtain in this study of critically ill and injured patients with brain injury. The patients had frequent deviations in blood pressure, SpO2 and end tidal CO2-levels, and measurements were frequently missing. There is a potential for improved monitoring as a tool for quality improvement in pre-hospital critical care.