Journal of clinical monitoring and computing
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J Clin Monit Comput · Aug 2022
Multicenter StudyPrediction of blood lactate values in critically ill patients: a retrospective multi-center cohort study.
Elevations in initially obtained serum lactate levels are strong predictors of mortality in critically ill patients. Identifying patients whose serum lactate levels are more likely to increase can alert physicians to intensify care and guide them in the frequency of tending the blood test. We investigate whether machine learning models can predict subsequent serum lactate changes. ⋯ The LSTM models were able to predict deterioration of serum lactate values of MIMIC-III patients with an AUC of 0.77 (95% CI 0.762-0.771) for the normal group, 0.77 (95% CI 0.768-0.772) for the mild group, and 0.85 (95% CI 0.840-0.851) for the severe group, with only a slightly lower performance in the external validation. The LSTM demonstrated good discrimination of patients who had deterioration in serum lactate levels. Clinical studies are needed to evaluate whether utilization of a clinical decision support tool based on these results could positively impact decision-making and patient outcomes.
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J Clin Monit Comput · Aug 2022
ReviewAccuracy of pulse oximeters in measuring oxygen saturation in patients with poor peripheral perfusion: a systematic review.
One of the most significant limitations of oximeters is their performance under poor perfusion conditions. This systematic review examines pulse oximeter model accuracy in adults under poor perfusion conditions. A multiple database search was conducted from inception to December 2020. ⋯ Only one study controlled for skin pigmentation, and none strictly followed Food and Drug Association recommendations for experiments to determine oximeter accuracy. Oximeters are accurate in poorly perfused patients, especially newer oximeter models and those placed on earlobes. Further studies are needed that examine multiple oximeter models used on a diverse selection of patients while following FDA recommendations to examine oximeter accuracy.
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J Clin Monit Comput · Aug 2022
Ability of short-time low peep challenge to predict fluid responsiveness in mechanically ventilated patients in the intensive care.
Short-time low PEEP challenge (SLPC, application of additional 5 cmH2O PEEP to patients for 30 s) is a novel functional hemodynamic test presented in the literature. We hypothesized that SLPC could predict fluid responsiveness better than stroke volume variation (SVV) in mechanically ventilated intensive care patients. Heart rate, mean arterial pressure, stroke volume index (SVI) and SVV were recorded before SLPC, during SLPC and before and after 500 mL fluid loading. ⋯ The ROC-AUC of SVIΔ%-SLPC was significantly higher than that of SVV (p = 0.0045). The best cut-off value of SVIΔ%-SLPC was 7.5% with 90% sensitivity and 96% specificity. The percentage change in SVI during SLPC predicts fluid responsiveness in intensive care patients who are ventilated with low tidal volumes; the sensitivity and specificity values are higher than those of SVV.
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J Clin Monit Comput · Aug 2022
Reliability of a computational model for evaluating thoracoabdominal mobility in newborns: a cross-sectional study.
The present study aimed to verify the inter and intra-examiner reliability of an interactive custom-made MATLAB® App for bio-photogrammetric analysis of thoracoabdominal mobility in newborns and compare the respiratory rate (RR) results between the automatic MATLAB® App and its manual counterpart. This is a cross-sectional study conducted in 27 healthy newborns of both sexes (gestational age between 37 and 41 weeks and up to 72 h of life) who did not cry during data acquisition. Chest and abdominal areas of the subjects in the supine position were analyzed through 60 s videos, totaling 30,714 photograms. ⋯ Reliability was excellent for intra (ICC 0.81-0.96) and inter-examiner correlations (ICC 0.84-0.99) between the chest and abdominal areas, in both inspiration and expiration, with no differences between them. Evaluation of newborns' thoracoabdominal mobility using the custom-made MATLAB® App for bio-photogrammetric analysis exhibited good to excellent intra- and inter-examiner reliability and an excellent correlation between manual and automatic models for measuring RR. Thus, it proved to be an objective and practical tool for bedside thoracoabdominal mobility assessment in different clinical situations involving neonatal care.
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J Clin Monit Comput · Aug 2022
EditorialFeatures of new vision-incorporated third-generation video laryngeal mask airways.
Numerous studies have shown that blindly inserted supraglottic airway devices (SADs) are sub-optimally placed in 50 to 80% of all cases. Placement under direct vision has been recommended. We describe the very first two new SADs of the third generation that incorporate a videoscope with flexible tip. ⋯ This article describes the two new devices' physical characteristics, features, rationale for use, advantages and limitations in comparison to existing devices. Each of the two new devices-the Video Laryngeal Mask (VLMTM, UE Medical®) and the SafeLM® Video Laryngeal Mask System (SafeLMTM VLMS, Magill Medical Technology®) consist of two parts: (a) a disposable 2nd generation SAD with a silicone cuff and an anatomically curved tube; and (b) a reusable patient-isolated videoscope and monitoring screen, with the flexible scope located into a specially-designed, blind-end channel terminating in the bowl of the SAD, preventing the videoscope from contacting patient body fluids in the SAD bowl. Third generation placement-under-direct-vision supraglottic airway devices possess several theoretical safety and ease of use advantages which now need to be validated in clinical use.