Journal of clinical monitoring and computing
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J Clin Monit Comput · Apr 2023
ReviewBioelectrical impedance analysis during deresuscitation: correlation and agreement with cumulative fluid balance in ICU patients.
Bioelectrical impedance analysis (BIA) is a promising tool to evaluate the body composition of critically-ill patients. The present study aimed to assess its value as a fluid management monitoring tool during standardized deresuscitation strategy. A historical cohort of critically-ill adult patients with fluid overload and continuous renal replacement therapy was used to explore both relationship and agreement between changes in cumulative fluid balance and BIA-derived hydration variables within the 5 days following initiation of deresuscitation strategy using net ultrafiltration. ⋯ Total body water (rho = 0.63), extracellular water (rho = 0.68), and intracellular water (rho = 0.67) were significantly correlated with cumulative fluid balance (all P values < 0.001). The limits of agreement did not allow interchangeability for a delta of 2L between cumulative fluid balance and BIA-derived hydration variables (P > 0.05). BIA hydration-derived variables are significantly correlated with cumulative fluid balance but the large limits of agreements exclude interchangeability of the measures.
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Recent publications have suggested that pulse oximeters exhibit reduced accuracy in dark-skinned patients during periods of hypoxemia. Masimo SET® (Signal Extraction Technology®) has been designed, calibrated, and validated using nearly equal numbers of dark and light skinned subjects, with the goal of eliminating differences between pulse oximetry saturation (SpO2) and arterial oxygen saturation (SaO2) values due to skin pigmentation. The accuracy concerns reported in dark-skinned patients led us to perform a retrospective analysis of healthy Black and White volunteers. ⋯ Occult hypoxemia was rare and did not occur in Black subjects. Masimo RD SET® can be used with equal assurance in people with dark or light skin. These laboratory results were obtained in well-controlled experimental conditions in healthy volunteers-not reflecting actual clinical conditions/patients.
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Four recent cases utilizing transabdominal motor-evoked potentials (TaMEPs) are presented as illustrative of the monitoring technique during lumbosacral fusion, sciatic nerve tumor resection, cauda equina tumor resection, and lumbar decompression. Case 1: In a high-grade lumbosacral spondylolisthesis revision fusion, both transcranial motor-evoked potentials (TcMEPs) and TaMEPs detected a transient focal loss of left tibialis anterior response in conjunction with L5 nerve root decompression. ⋯ Case 4: TaMEPs were successfully acquired with little anesthetic fade utilizing an anesthetic regimen of 1.1 MAC Sevoflurane during a lumbar decompression. While the first two cases present TaMEPs and TcMEPs side-by-side, demonstrating TaMEPs correlating to TcMEPs (Case 1) or a more accurate reflection of patient outcome (Case 2), no inference regarding the accuracy of TaMEPs to monitor nerve elements during cauda equina surgery (Cases 3) or the lumbar decompression presented in Case 4 should be made as these are demonstrations of technique, not utility.
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J Clin Monit Comput · Apr 2023
Association between intraoperative plantar regional oxygen saturation and acute kidney injury after cardiac surgery.
Acute kidney injury (AKI) is one of the most common complications after cardiac surgery, associated with increased mortality and morbidity. Near-infrared spectroscopy (NIRS) continuously measures regional oxygen saturation(rSO2) in real-time. This exploratory retrospective study aimed to investigate the association between intraoperative plantar rSO2 and postoperative AKI in cardiac surgery patients. ⋯ Independent of MAP, intraoperative plantar rSO2 was associated with AKI after cardiac surgery. However, intraoperative cerebral rSO2 was not associated with AKI. Intraoperative plantar rSO2 monitoring may be helpful in preventing AKI.
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J Clin Monit Comput · Apr 2023
Device for remote and realtime monitoring of neonatal vital signs in neonatal intensive care unit using internet of things: proof-of-concept study.
Realtime and remote monitoring of neonatal vital signs is a crucial part of providing appropriate care in neonatal intensive care units (NICU) to reduce mortality and morbidity of newborns. In this study, a new approach, a device for remote and real-time monitoring of neonatal vital signs (DRRMNVS) in the neonatal intensive care unit using the internet of things (IoT), was proposed. The system integrates four vital signs: oxygen saturation, pulse rate, body temperature and respiration rate for continuous monitoring using the Blynk app and ThingSpeak IoT platforms. ⋯ The developed DRRMNVS device was cheap and had acceptable measurement accuracy of vital signs in a controlled environment. The system has the potential to advance healthcare service delivery for neonates with further development from this proof-of-concept level.