Journal of clinical monitoring and computing
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J Clin Monit Comput · Jun 2023
Associations of an eye-tracking task and pupillary metrics with age and ASA physical status score in a preoperative cohort.
Advanced age, American Society of Anesthesiologists physical status (ASA) classification and the presence of cognitive impairment are associated with an elevated risk of postoperative morbidity and mortality. The visual paired comparison (VPC) task, which relies on recognition of novel images, examines declarative memory. VPC scores have demonstrated the ability to detect mild cognitive impairment and track progression of neurodegenerative disease. ⋯ Our data also revealed an association between VPC score and age (Spearman Rank Correlation, p = 0.0016, r = - 0.21) but not ASA score (Kruskal-Wallis Test, p = 0.14). When compared to a nonsurgical cohort with no history of memory impairment, our population scored worse on the VPC task (Mann-Whitney U Test, p = 0.0002). A preoperative 5 min VPC task and pupillometry are feasible tests in the preoperative setting and may provide a valuable window into an individual's cognition prior to elective surgery.
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J Clin Monit Comput · Jun 2023
Relationship between lung ultrasound and electrical impedance tomography as regional assessment tools during PEEP titration in acute respiratory distress syndrome caused by multi-lobar pneumonia: a pilot study.
Acute respiratory distress syndrome (ARDS) caused by multilobar pneumonia (MLP) is markedly different from typical ARDS in pathology, imaging characteristics, and lung mechanics. Regional lung assessment is required. We aimed to analyze the relationship between two regional assessment tools, lung ultrasound (LUS) and electrical impedance tomography (EIT) during positive end-expiratory pressure (PEEP) titration, and determine an appropriate PEEP level. ⋯ The relationship between the LUS score and Cpix remained the same at every PEEP level but did not reach statistical significance. The individual's mean expected PEEP by LUS was similar to the EIT [10.33(± 1.67) vs. 10.33(± 1.44) cm H2O, P = 0.15]. Regarding the MLP, the LUS scores were associated with EIT parameters, and LUS scores might proof helpful for finding individual PEEP settings in MLP.
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J Clin Monit Comput · Jun 2023
Intradural extramedullary tumor location in the axial view affects the alert timing of intraoperative neurophysiologic monitoring.
Intraoperative neurophysiologic monitoring (IONM) reportedly helps prevent postoperative neurological complications following high-risk spinal cord surgeries. There are negative and positive reports about using IONM for intradural extramedullary (IDEM) tumors. We investigated factors affecting alerts of IONM in IDEM tumor surgery. ⋯ Alert is probably triggered during tumor resection for anterolaterally located tumors. Alerts during tumor resection procedures were more likely to be rescued than other procedures in IDEM tumor surgery.
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J Clin Monit Comput · Jun 2023
Letter Case ReportsStimulation artefact on EEG trace with BIS monitoring during D-wave recording.
The D-wave reflects the corticospinal fibre potentials and is frequently recorded intraoperatively for intramedullary spinal tumours to ensure maximum safe resection. A 38-year-old male had an intramedullary spinal cord tumour surgically removed while being monitored with D-wave from a single distal electrode technique. ⋯ Regular spike artefacts were observed in the EEG signal recorded by the BIS® monitor during the application of the single-pulse transcranial electrical stimulus and were used as a visual indicator of stimulus delivery. Finally, we propose a novel method of confirming stimulus delivery during D-wave recording based on stimulation artefacts in the EEG signal recorded by the BIS® monitor.
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J Clin Monit Comput · Jun 2023
Increasing the reflection efficiency of the Sedaconda ACD-S by heating and cooling the anaesthetic reflector: a bench study using a test lung.
As volatile anaesthetic gases contribute to global warming, improving the efficiency of their delivery can reduce their environmental impact. This can be achieved by rebreathing from a circle system, but also by anaesthetic reflection with an open intensive care ventilator. We investigated whether the efficiency of such a reflection system could be increased by warming the reflector during inspiration and cooling it during expiration (thermocycling). ⋯ Thermocycling of the anaesthetic gas considerably increases the efficiency of the anaesthetic reflector and reduces anaesthetic consumption by almost half in a test lung model. Given that cooling can be miniaturized, this method carries a potential for further saving anaesthetics in clinical practice in the operating theatre as well as for inhaled sedation in the ICU.