Journal of clinical monitoring and computing
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J Clin Monit Comput · Jun 2023
Evaluation of patient state index, bispectral index, and entropy during drug induced sleep endoscopy with dexmedetomidine.
Multiple electroencephalographic (EEG) monitors and their associated EEG markers have been developed to aid in assessing the level of sedation in the operating room. While many studies have assessed the response of these markers to propofol sedation and anesthetic gases, few studies have compared these markers when using dexmedetomidine, an alpha-2 agonist. Fifty-one patients underwent drug induced sleep endoscopy with dexmedetomidine sedation. ⋯ Lightening secondary to RASS score assessment is significantly captured by all three commercial EEG metrics (p < 0.001). Commercial EEG monitors can capture changes in the brain state associated with the RASS score during dexmedetomidine sedation. PSI and Entropy were highly correlated and may be better suited for assessing deeper levels of sedation.
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J Clin Monit Comput · Jun 2023
Clinical TrialNoninvasive intracranial pressure waveforms for estimation of intracranial hypertension and outcome prediction in acute brain-injured patients.
Analysis of intracranial pressure waveforms (ICPW) provides information on intracranial compliance. We aimed to assess the correlation between noninvasive ICPW (NICPW) and invasively measured intracranial pressure (ICP) and to assess the NICPW prognostic value in this population. In this cohort, acute brain-injured (ABI) patients were included within 5 days from admission in six Intensive Care Units. Mean ICP (mICP) values and the P2/P1 ratio derived from NICPW were analyzed and correlated with outcome, which was defined as: (a) early death (ED); survivors on spontaneous breathing (SB) or survivors on mechanical ventilation (MV) at 7 days from inclusion. ⋯ Similar results were observed when decompressive craniectomy patients were excluded. In this study, P2/P1 derived from noninvasive ICPW assessment was well correlated with IHT. This information seems to be as associated with ABI patients outcomes as ICP. Trial registration: NCT03144219, Registered 01 May 2017 Retrospectively registered, https://www.clinicaltrials.gov/ct2/show/NCT03144219 .
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J Clin Monit Comput · Jun 2023
Non-contact respiratory rate monitoring using thermal and visible imaging: a pilot study on neonates.
Respiratory rate (RR) monitoring is essential in neonatal intensive care units. Despite its importance, RR is still monitored intermittently by manual counting instead of continuous monitoring due to the risk of skin damage with prolonged use of contact electrodes in preterm neonates and false signals due to displacement of electrodes. Thermal imaging has recently gained significance as a non-contact method for RR detection because of its many advantages. ⋯ The average absolute error between the proposed and belt-based contact method in healthy adults reached 0.1 bpm and for more challenging conditions was approximately 1.5 bpm and 1.8 bpm, respectively. In the case of neonates, the average error is 1.5 bpm, which are promising results. The Bland-Altman analysis showed a good agreement of estimated RR with the reference method RR and this pilot study provided the evidence of using the proposed approach as a contactless method for the respiratory rate detection of neonates in clinical settings.
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J Clin Monit Comput · Jun 2023
Comparative StudyA comparison of the NeurOs® and the INVOS 5100C® cerebral oximeter during variations of the partial pressure of carbon dioxide and fractional inspiratory concentration of oxygen.
This prospective method comparison study compared cerebral oxygen saturation (ScO2) measurement performance of the new cerebral oximeter (NeurOs®, Mespere LifeSciences, Ontario, Canada) in comparison to the established INVOS 5100C® (Medtronic, Boulder, USA) cerebral oximeter. We performed measurements during different levels of carbon dioxide pressure (PaCO2) during hyper- and hypoventilation and different levels of arterial oxygen saturation (SaO2) induced by variation of the inspiratory fraction of oxygen (FiO2). 59 anesthetized cardiac and vascular surgical patients were studied during hemodynamically stable conditions. Two versions of the NeurOs® oximeter were used in 39 and 20 patients, respectively: an older version with one bi-hemispherical sensor attached to the midline of the forehead and a newer version with two sensors that were attached to the left and right forehead. ⋯ The ScO2 measurement performance of the NeurOs® cerebral oximeter is not interchangeable with the INVOS® cerebral oximeter during variations of ventilation and oxygenation in elective cardiac or vascular surgical patients. The lack of reactivity to changes in ventilation (by variation of PaCO2) and oxygen delivery (by variation of FiO2) question the reliability of NeurOs® measurements to reflect changes in cerebral blood flow and cerebral oxygen balance. This holds true not only for different sensor positions at the forehead but also for different modes of penetration.
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J Clin Monit Comput · Jun 2023
Exploring the relationship between capillary refill time, skin blood flow and microcirculatory reactivity during early resuscitation of patients with septic shock: a pilot study.
Capillary refill time (CRT), a costless and widely available tool, has emerged as a promising target to guide septic shock resuscitation. However, it has yet to gain universal acceptance due to its potential inter-observer variability. Standardization of CRT assessment may minimize this problem, but few studies have compared this approach with techniques that directly assess skin blood flow (SBF). ⋯ An abnormal CRT also was associated with impaired thermal challenge and vascular occlusion tests. Abnormal CRT values observed during early septic shock resuscitation are associated with impaired skin blood flow, and abnormal skin microvascular reactivity. Future studies should confirm these results.