Journal of clinical monitoring and computing
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J Clin Monit Comput · Dec 2024
What is the minimum time interval for reporting of intraoperative core body temperature measurements in pediatric anesthesia? A secondary analysis.
Given that perioperative normothermia represents a quality parameter in pediatric anesthesia, numerous studies have been conducted on temperature measurement, albeit with heterogeneous measurement intervals, ranging from 30 s to fifteen minutes. We aimed to determine the minimum time interval for reporting of intraoperative core body temperature across commonly used measurement intervals in children. Data were extracted from the records of 65 children who had participated in another clinical study and analyzed using a quasibinomial mixed linear model. ⋯ Probabilities for the detection of hyperthermia (n = 9) were lower and omitted for hypothermia due to low prevalence (n = 1). In conclusion, the core body temperature should be reported at intervals of no more than five minutes to ensure the detection of any temperature change in normothermic ranges. Further studies should focus on hypothermic and hyperthermic ranges.
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J Clin Monit Comput · Dec 2024
An open source autoregulation-based neuromonitoring algorithm shows PRx and optimal CPP association with pediatric traumatic brain injury.
This study aimed to develop an open-source algorithm for the pressure-reactivity index (PRx) to monitor cerebral autoregulation (CA) in pediatric severe traumatic brain injury (sTBI) and compared derived optimal cerebral perfusion pressure (CPPopt) with real-time CPP in relation to long-term outcome. Retrospective study in children (< 18 years) with sTBI admitted to the pediatric intensive care unit (PICU) for intracranial pressure (ICP) monitoring between 2016 and 2023. ICP was analyzed on an insult basis and correlated with outcome. ⋯ PRx thresholds 0.0, 0.20, 0.25 and 0.30 resulted in OR 1.01 (1.00-1.02) (p < 0.006). CPP in optimal range associated with unfavorable outcome on day one (0.018, p = 0.029) and four (-0.026, p = 0.025). Our algorithm can obtain optimal targets for pediatric neuromonitoring that showed association with long-term outcome, and is now available open source.
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J Clin Monit Comput · Dec 2024
Clot formation risk in the clearing fluid after arterial catheter blood sampling: coagulation factors consumption over time - a prospective pilot study.
After blood sampling from an arterial catheter, the reinjection of the clearing fluid (a mixture of saline solution and blood) is proposed to limit blood loss. However, reinjecting clots may cause embolic complications. The primary objective was to assess fibrinogen consumption in the clearing fluid as an indicator of clot formation over time. ⋯ Unfractionated heparin anti-Xa activity was higher than 0.10 UI/ml in 17 (57%). Although no macroscopic clots were observed in the clearing fluid, its coagulation factors decreased over the 5 min following reservoir filling, indicating potential initiation of clot formation. Our findings stress the need for further studies assessing the safety of reinjecting clearing fluid as part of patient blood management.
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J Clin Monit Comput · Dec 2024
Capnodynamic determination of end-expiratory lung volume in a porcine model of hypoxic pulmonary vasoconstriction.
The capnodynamic method, End Expiratory Lung Volume CO2 (EELV-CO2), utilizes exhaled carbon dioxide analysis to estimate End-Expiratory Lung Volume (EELV) and has been validated in both normal lungs and lung injury models. Its performance under systemic hypoxia and variations in CO2 elimination is not examined. This study aims to validate EELV-CO2 against inert gas wash in/wash out (EELV- SF6, sulfur hexafluoride) in a porcine model of stable hemodynamic conditions followed by hypoxic pulmonary vasoconstriction and inhaled nitric oxide (iNO). ⋯ EELV-CO2 generates absolute values in parallel with EELV -SF6. Stressing EELV-CO2 with hypoxic pulmonary vasoconstriction and iNO, transiently impairs the agreement which stabilizes once normoxemia is reestablished.