Journal of clinical monitoring and computing
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J Clin Monit Comput · Oct 2024
Time to maximum pupil constriction is variable in neurocritical care patients.
Quantitative pupillometry (QP) use has grown exponentially. Each QP scan captures images of the pupil before, during, and after light exposure to provide component measures of the pupillary light reflex (PLR). This study explores if the time to maximum constriction (tMC) is uniform among neuroscience intensive care unit (NSICU) patients. ⋯ The between-subject mean tMC was 0.97 (0.17) s and ranged from 0.46 s to 1.35 s. The tMC does not occur at a fixed point in time. Clinical applications that seek to characterize pupil health should account for varied tMC and explore relationships to discrete outcomes to determine the clinical usefulness of tMC.
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J Clin Monit Comput · Oct 2024
Wire-in-needle versus conventional syringe-on-needle technique for ultrasound-guided central venous catheter insertion in the internal jugular vein: the WIN randomized trial.
There are different techniques for ultrasound-guided central venous catheter (CVC) insertion. When using the conventional syringe-on-needle technique, the syringe needs to be removed from the needle after venous puncture to pass the guidewire through the needle into the vein. When, alternatively, using the wire-in-needle technique, the needle is preloaded with the guidewire, and the guidewire-after venous puncture-is advanced into the vein under real-time ultrasound guidance. We tested the hypothesis that the wire-in-needle technique reduces the time to successful guidewire insertion in the internal jugular vein compared with the syringe-on-needle technique in adults. ⋯ The wire-in-needle technique-compared with the syringe-on-needle technique-did not reduce the time to successful guidewire insertion in the internal jugular vein. Clinicians can consider either technique for ultrasound-guided CVC insertion in adults.
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J Clin Monit Comput · Oct 2024
Susceptibility of two different PCA pumps to inaccurate delivery associated with pole position at low flow-rates in a pediatric setting - an experimental study.
Vertical displacement of infusion pumps used in patient-controlled analgesia can cause irregularities in drug delivery and is especially crucial at low flow rates, which are commonly used in pediatrics. There is only scarce data available regarding the extent of these inaccuracies. The current in vitro study therefore aimed at a comparison of the performance of two commonly used PCA pumps at different pole positions due to vertical displacement. ⋯ The observed differences between the pumps might be explained by the higher compliance of this syringe pump and the diverse working mechanisms. Overall, the CADD®-Solis pump might be considered a preferable option for patient-controlled analgesia in children. It is nonetheless essential for medical staff to be aware of the effects of vertical displacement of PCA pumps and to minimize these displacements as much as possible.
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J Clin Monit Comput · Oct 2024
Clinical evaluation of a smart wristband for monitoring oxygen saturation, pulse rate, and respiratory rate.
Recently, photoplethysmography-based vital parameter measurements have increased in popularity. However, clinical evaluation of these measurements is lacking. The objective of this study was to rigorously evaluate the clinical accuracy and reliability of a novel photoplethysmography-based wristband for measuring key vital parameters-oxygen saturation (SpO2), respiratory rate (RR), and pulse rate (PR)-during heart catheterisations. ⋯ This study shows that photoplethysmography-based SpO2, RR, and PR measurements can be accurate during heart catheterisations. Future investigations are required to evaluate the wristband's performance under dynamic circumstances as well as over an extended time period. Trial registration: www.clinicaltrials.gov, NCT05566886.
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J Clin Monit Comput · Oct 2024
Small changes in the transducer position cause a systematic change in cardiac output readings: implications for clinical practice.
To systematically evaluate the effect of small changes in transducer position on key hemodynamic variables including CO generated by 4th generation FloTrac software. After cardiac surgery, cardiac output, mean arterial pressure, systemic vascular resistance, and stroke volume variation were measured with 4 generation Flotrac software. The transducer position was randomly placed at the midaxillary plane, 4 cm higher than the midaxillary plane or 4 cm lower than the midaxillary plane. ⋯ Mean arterial pressure and systemic vascular resistance both changed significantly with transducer position (both P < 0.001), whereas no statistically or clinically significant effect was seen on stroke volume variation (P = 0.98). A four-centimeter change in vertical transducer position induced clinically significant changes in cardiac output measurements by 4th generation FloTrac software. Definitions of optimal cardiac output in goal-directed therapy algorithms require meticulous transducer adjustment and can only be used in the reference patient position.