Journal of clinical monitoring and computing
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J Clin Monit Comput · Dec 2023
Review Meta AnalysisConfirming identification of the epidural space: a systematic review of electric stimulation, pressure waveform analysis, and ultrasound and a meta-analysis of diagnostic accuracy in acute pain.
To review the use of epidural electric stimulation test, pressure waveform analysis, and ultrasound assessment of injection as bedside methods for confirming identification of the epidural space in adults with acute pain, the PubMed database was searched for relevant reports between May and August 2022. Studies reporting diagnostic accuracy with conventional Touhy needles and epidural catheters were further selected for meta-analysis. Sensitivity and specificity were estimated using univariate logistic regression for electric stimulation and pressure analysis, and pooling of similar studies for ultrasound. ⋯ Risk of bias was significant and accuracy estimates must be interpreted with caution. Electric stimulation and pressure waveform analysis seem clinically useful, although they must be interpreted cautiously. In the future, clinical trials in patients with difficult anatomy will likely be most useful. Ultrasound requires further investigation.
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J Clin Monit Comput · Dec 2023
ReviewOptical crosstalk and other forms of light interference in pulse oximeter comparison studies.
Pulse oximeter accuracy is important for the quality and safety of patient care. Methodological errors occurring during pulse oximeter accuracy studies can confound results. One potential source of error during pulse oximeter comparison studies is optical interference due to sensor-to-sensor crosstalk. Optical crosstalk can occur whenever pulse oximeter sensors are tested in close proximity of one another, as occurs during pulse oximeter comparison studies. ⋯ Crosstalk and other forms of optical interference can corrupt pulse oximeter readings. Proper sensor placement and use of optical shielding of sensors are crucial steps to help protect the integrity of the data. Studies to further characterize crosstalk during pulse oximeter comparison studies are needed.
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J Clin Monit Comput · Dec 2023
Observational StudyInternal jugular vein collapsibility does not predict fluid responsiveness in spontaneously breathing patients after cardiac surgery.
The objective of our study was to evaluate the diagnostic accuracy of internal jugular vein (IJV) collapsibility as a predictor of fluid responsiveness in spontaneously breathing patients after cardiac surgery. ⋯ In spontaneously breathing patients after surgical coronary revascularisation, collapsibility of the internal jugular vein did not predict fluid responsiveness.
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J Clin Monit Comput · Dec 2023
Quantifying pulse oximeter accuracy during hypoxemia and severe anemia using an in vitro circulation system.
Anemia and hypoxemia are common clinical conditions that are difficult to study and may impact pulse oximeter performance. Utilizing an in vitro circulation system, we studied performance of three pulse oximeters during hypoxemia and severe anemia. Three oximeters including one benchtop, one handheld, and one fingertip device were selected to reflect a range of cost and device types. ⋯ The fingertip device was the least accurate of the three oximeters. Pulse oximeter performance is impacted by severe anemia in vitro. The use of in vitro calibration systems may play an important role in augmenting in vivo performance studies evaluating pulse oximeter performance in challenging conditions.
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J Clin Monit Comput · Dec 2023
Quantifying physiological stability in the general ward using continuous vital signs monitoring: the circadian kernel density estimator.
Technological advances seen in recent years have introduced the possibility of changing the way hospitalized patients are monitored by abolishing the traditional track-and-trigger systems and implementing continuous monitoring using wearable biosensors. However, this new monitoring paradigm raise demand for novel ways of analyzing the data streams in real time. The aim of this study was to design a stability index using kernel density estimation (KDE) fitted to observations of physiological stability incorporating the patients' circadian rhythm. ⋯ The time of early warning for the EWS events were 2.8-5.5 h and 2.5 h for the SAEs. The results showed that for severe deviations in the vital signs, the circadian KDE model can alert multiple hours prior to deviations being noticed by the staff. Furthermore, the model shows good generalizability to another cohort and could be a simple way of continuously assessing patient deterioration in the general ward.