Journal of clinical monitoring and computing
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J Clin Monit Comput · Sep 2024
Pump-driven clinical infusions: laboratory comparison of pump types, fluid composition and flow rates on model drug delivery applying a new quantitative tool, the pharmacokinetic coefficient of short-term variation (PK-CV).
Critically ill or anesthetized patients commonly receive pump-driven intravenous infusions of potent, fast-acting, short half-life medications for managing hemodynamics. Stepwise dosing, e.g. over 3-5 min, adjusts physiologic responses. Flow rates range from < 0.1 to > 30 ml/h, depending on pump type (large volume, syringe) and drug concentration. ⋯ At low flow rates we observed large flow rate variability differences between pump types showing they may not be interchangeable. PK-CV analysis provides a quantitative tool to assess infusion pump performance. Drug plasma concentrations may lag behind intent of pump dose titration.
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J Clin Monit Comput · Sep 2024
Agreement between manual and automatic ultrasound measurement of the velocity-time integral in the left ventricular outflow tract in intensive care patients: evaluation of the AUTO-VTI® tool.
Transthoracic echocardiography is widely used in intensive care unit (ICU) to manage patients with acute circulatory failure. Recently, automated ultrasound (US) measurement applications have been developed but their clinical performance has not been evaluated yet. The aim of this study was to assess the agreement between automated and manual measurements of the velocity-time integral in the left ventricular outflow tract (VTI-LVOT) using the auto-VTI® tool. ⋯ The precision and least significant change measured for the manual measurement of VTI were 7.4 and 10.5%, respectively, and by inference for the automated method 28% and 40%. The new auto-VTI® tool, despite interesting feasibility, demonstrated an insufficient agreement with a systematic bias and an insufficient precision limiting its implementation in critically ill patients. Clinical trial registration: ClinicalTrials.gov identifier: NCT04360304.
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J Clin Monit Comput · Sep 2024
Preoperative biomarkers associated with delayed neurocognitive recovery.
To identify baseline biomarkers of delayed neurocognitive recovery (dNCR) using monitors commonly used in anesthesia. In this sub-study of observational prospective cohorts, we evaluated adult patients submitted to general anesthesia in a tertiary academic center in the United States. Electroencephalographic (EEG) features and cerebral oximetry were assessed in the perioperative period. ⋯ Thirty-one patients developed dNCR (67%). Baseline higher EEG power in the lower alpha band (AUC = 0.73 (95% CI 0.48-0.93)) and lower alpha peak frequency (AUC = 0.83 (95% CI 0.48-1)), as well as lower cerebral oximetry (68 [5] vs 72 [3], p = 0.011) were associated with dNCR. Higher EEG power in the lower alpha band, lower alpha peak frequency, and lower cerebral oximetry values can be surrogates of baseline brain vulnerability.
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J Clin Monit Comput · Sep 2024
Reduction of the acquisition time needed to obtain somatosensory evoked potentials by estimation of the required averaging sweep count by an algorithm.
Somatosensory evoked potentials are frequently acquired by stimulation of the median or tibial nerves (mSEPs and tSEPs) for intraoperative monitoring of sensory pathways. Due to their low amplitudes it is common practice to average 200 or more sweeps to discern the evoked potentials from the background EEG. The aim of this study was to investigate if an algorithm designed to determine the lowest sweep count needed to obtain reproducible evoked potentials in each patient significantly reduces the median necessary sweep count to under 200. 30 patients undergoing spinal surgery at the Department of Neurosurgery were included in the study. ⋯ For tSEPs the sweep count was below 200 in 11 of 15 patients (73.3%) with a mean sweep count of 106 ± 70 (mean ± SD). The calculated mean time to average the potentials could thereby be reduced from 48.8s to 13.7s for mSEPs and from 48.8s to 25.9s for tSEPs. The proposed algorithm allowed sweep count and acquisition time reduction in roughly 90% of all patients for mSEPs and in 70% of all patients for tSEPs.