Journal of clinical monitoring and computing
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J Clin Monit Comput · Feb 2024
Editorial Comment LetterClosing the loop: automation in anesthesiology is coming.
Anesthesiology and intensive care medicine provide fertile ground for innovation in automation, but to date we have only achieved preliminary studies in closed-loop intravenous drug administration. Anesthesiologists have yet to implement these tools on a large scale despite clear evidence that they outperform manual titration. ⋯ The aim is to decrease the error between the closed-loop controller's input and output. In this editorial we consider the available intravenous anesthesia closed-loop systems, try to clarify why they have not yet been implemented on a large scale, see what they offer, and propose the future steps towards automation in anesthesia.
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J Clin Monit Comput · Feb 2024
Observational StudyEffects of positive end-expiratory pressure on brain oxygenation, systemic oxygen cascade and metabolism in acute brain injured patients: a pilot physiological cross-sectional study.
Patients with acute brain injury (ABI) often require the application of positive end-expiratory pressure (PEEP) to optimize mechanical ventilation and systemic oxygenation. However, the effect of PEEP on cerebral function and metabolism is unclear. The primary aim of this study was to evaluate the effects of PEEP augmentation test (from 5 to 15 cmH2O) on brain oxygenation, systemic oxygen cascade and metabolism in ABI patients. ⋯ PEEP augmentation test did not affect cerebral and systemic oxygenation or metabolism. Changes in cerebral oxygenation significantly correlated with DO2, SaO2, and VCO2. Cerebral oxygen monitoring could be considered for individualization of mechanical ventilation setting in ABI patients without high or instable intracranial pressure.
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J Clin Monit Comput · Feb 2024
Improving case duration accuracy of orthopedic surgery using bidirectional encoder representations from Transformers (BERT) on Radiology Reports.
A major source of inefficiency in the operating room is the mismatch between scheduled versus actual surgical time. The purpose of this study was to demonstrate a proof-of-concept study for predicting case duration by applying natural language processing (NLP) and machine learning that interpret radiology reports for patients undergoing radius fracture repair. ⋯ This proof-of-concept study demonstrated the successful application of NLP and machine leaning to extract features from unstructured clinical data resulting in improved prediction accuracy for surgical case duration.
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J Clin Monit Comput · Feb 2024
Changes in motor evoked potentials after erector spinae block in scoliosis surgery-when to take pre-incision baseline recordings?
Multimodal intraoperative neurophysiological monitoring (IONM) is highly valuable in scoliosis surgeries for monitoring spinal cord function, particularly during instrumentation. Accurate timing of baseline recordings of TcMEP and SSEP is crucial, as any changes observed during surgery and instrumentation are compared to these baseline recordings. ⋯ Remarkably, SSEPs remained unchanged during this period. These findings suggest that USG-ESPB may produce TcMEP changes, highlighting the importance of carefully considering the timing of baseline TcMEP acquisition in scoliosis surgery.
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J Clin Monit Comput · Feb 2024
Randomized Controlled TrialEfficacy and safety of three inflation methods of the laryngeal mask airway Ambu® Auraonce™: a randomized controlled study.
The laryngeal mask airway (LMA) is commonly used for airway management. Cuff hyperinflation has been associated with complications, poor ventilation and increased risk of gastric insufflation. This study was designed to determine the best cuff inflation method of AuraOnce™ LMA during bronchoscopy and EBUS (Endobronquial Ultrasound Bronchoscopy) procedure. ⋯ No difference between groups was found either for OLP (p = 0.53), LV (p = 0.26) and PC (p = 0.16). When a cuff manometer is not available, a partial inflation of AuraOnce™ LMA cuff using MV method allows to control intracuff pressure, with no significant changes of OLP and LV compared to RV and NV insufflation method. Registration clinical trial: NCT04769791.