Journal of clinical monitoring and computing
-
J Clin Monit Comput · Oct 2023
Modeling the impacts of assumptions and nonpulmonary factors on the performance and reliability of indices of oxygenation.
Assessment of oxygenation is fundamental to the care of patients. Numerous indices of oxygenation have been developed that entail variable degrees of invasiveness, complexity and physiologic underpinning. The clinical reliability of these indices has been questioned. ⋯ These effects manifested as calculated indices either over or under-estimating actual shunt by FShunt, or wide unpredictable variability (scatter) when correlating A-a [Formula: see text] gradient and Pa:Fi ratio to actual shunt. Cardiac output and oxygen extraction have noticeable impacts on all calculated indices. The results support the clinical observations that the performance of indices of oxygenation can vary with fraction of inspired oxygen and various nonpulmonary physiological factors that underly heterogeneity present in the clinical population.
-
J Clin Monit Comput · Oct 2023
Deep learning classification of capnography waveforms: secondary analysis of the PRODIGY study.
Capnography monitors trigger high priority 'no breath' alarms when CO2 measurements do not exceed a given threshold over a specified time-period. False alarms occur when the underlying breathing pattern is stable, but the alarm is triggered when the CO2 value reduces even slightly below the threshold. True 'no breath' events can be falsely classified as breathing if waveform artifact causes an aberrant spike in CO2 values above the threshold. ⋯ The neural network's accuracy was 0.97, precision was 0.97 and recall was 0.96. Performance was consistent across hospitals in internal-external validation. The neural network could reduce false capnography alarms. Further research is needed to compare the frequency of alarms derived from the neural network with the standard approach.
-
J Clin Monit Comput · Oct 2023
Randomized Controlled TrialEffects of preoperative education using virtual reality on preoperative anxiety and information desire: a randomized clinical trial.
This study aimed to investigate the effect of preoperative education using virtual reality (VR) on preoperative anxiety and information desire. The participants were randomly assigned to the VR group and control group. The VR group received preoperative education using VR content describing preoperative and postoperative processes and their management, and the control group received preoperative education with traditional verbal education. ⋯ Preoperative education using VR effectively reduced preoperative anxiety and information desire. Trial registration CRIS, KCT0007489. Registered 30 June 2022. http://cris.nih.go.kr/cris/ .
-
J Clin Monit Comput · Oct 2023
Observational StudyEarly detection of oliguric events in critically ill patients in the ICU with a novel continuous urine flow measurement device: results of an initial validation study.
Urine output is used to evaluate fluid status and is an important marker for acute kidney injury (AKI). Our primary aim was to validate a new automatic urine output monitoring device by comparison to the current practice - the standard urometer. ⋯ The Serenno Medical Automatic urine output measuring device required minimal supervision, little ICU nursing staff attention, and is sufficiently accurate and precise. In addition to providing continuous assessments of urine output, it was considerably more accurate than hourly nursing assessments.
-
J Clin Monit Comput · Oct 2023
Point of care transthoracic echocardiography for the prediction of post - spinal anesthesia hypotension in elderly patients with cardiac diseases and left ventricular dysfunction : Inferior vena cava and post-spinal anesthesia hypotension in elderly patients.
In elderly patients with cardiac diseases, changes in cardiovascular physiology diminish cardiovascular reserve and predispose to hemodynamic instability after spinal anesthesia; hence, such patients could be at risk of postoperative complications. Additionally, transthoracic echocardiography (TTE) is used in clinical practice to evaluate cardiovascular hemodynamics. Therefore, we hypothesized that echocardiographic measurements could display significant diagnostic power in the prediction of post - spinal anesthesia hypotension in elderly patients with cardiac diseases and reduced left ventricular ejection fraction (LV-EF). ⋯ The dIVCmax-to-IVCCI ratio < 48 had significantly higher diagnostic power than IVCCI > 0.28, FAC > 42, E/Em ratio < 9 and SVI < 32 (receiver operator characteristic curve analysis). The gray zone for the dIVCmax-to-IVCCI ratio (40-49) showed the lowest number of inconclusive measurements among echocardiographic variables. The preoperative dIVCmax-to-IVCCI ratio could be a reliable echocardiographic index to predict post - spinal anesthesia hypotension in elderly patients with left ventricular dysfunction.