Journal of clinical monitoring and computing
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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
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.
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J Clin Monit Comput · Jun 2023
Sevoflurane consumption pattern by individual anaesthesiologists varies widely despite using the same high-end workstations in the same hospital.
Volatile anaesthetics are potent greenhouse gasses but contemporary workstations enable considerable savings while improving patient safety. Institutions may provide this technology to reduce the ecological footprint but proper training and motivation is required to maximize their ecologic and financial benefit. This study aims to compare the sevoflurane consumption of 22 anaesthesiologists in a medium sized hospital 4 years after flow-i workstations (Getinge, Sweden) entered into service, in three airway approaches: intubated patients, laryngeal mask ventilation, and mask anaesthesia. ⋯ The typical CO2 equivalent emissions (GWP20) per anaesthesiologist varied between 8.0 and 19.6 kg/45 min in intubated airways, between 7.9 and 16.3 kg/45 min in LMA, and between 3.6 and 22.3 kg/8 min in mask ventilation. Despite using the same workstations in the same hospital, the typical sevoflurane consumption differed dramatically between 22 anaesthesiologists. In addition to providing advanced workstations, proper education is required to achieve the behavior change needed to reduce the pollution and financial waste associated with volatile anaesthetics.
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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
Feasibility and optimal choice of stimulation parameters for supramaximal stimulation of motor evoked potentials.
The aim was to investigate the feasibility and optimal stimulation parameters for supramaximal stimulation of muscle recorded transcranial electrical stimulation motor evoked potentials (mTc-MEP). ⋯ We recommend using setting 1 when monitoring mTc-MEPs with supramaximal stimulation, after which an individualized ISI optimization can be performed. Moreover, when using supramaximal stimulation, short ISI's (i.e. 1ms or 1.5ms) can be the optimal ISI for obtaining the highest mTc-MEP amplitude.