Journal of clinical monitoring and computing
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J Clin Monit Comput · Jan 2025
Effect of postoperative peripheral nerve blocks on the analgesia nociception index under propofol anesthesia: an observational study.
The analgesia nociception index (ANI), also referred to as the high frequency variability index (HFVI), is reported to be an objective measure of nociception. This study investigated changes in ANI after peripheral nerve blocks (PNB) under general anesthesia. Understanding these changes could enhance assessment of PNB efficacy before emergence from general anesthesia. ⋯ The increased ANI value after PNB under propofol anesthesia may be a valuable indicator for assessing PNB efficacy.
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J Clin Monit Comput · Jan 2025
Accuracy of remote, video-based supraventricular tachycardia detection in patients undergoing elective electrical cardioversion: a prospective cohort.
Unobtrusive pulse rate monitoring by continuous video recording, based on remote photoplethysmography (rPPG), might enable early detection of perioperative arrhythmias in general ward patients. However, the accuracy of an rPPG-based machine learning model to monitor the pulse rate during sinus rhythm and arrhythmias is unknown. We conducted a prospective, observational diagnostic study in a cohort with a high prevalence of arrhythmias (patients undergoing elective electrical cardioversion). ⋯ For pulse rate measurement, the bias and limits of agreement for sinus rhythm were 1.21 [- 8.60 to 11.02], while for arrhythmia, they were - 7.45 [- 35.75 to 20.86]. The machine learning model accurately identified sinus rhythm and arrhythmias using rPPG in real-world conditions. Heart rate underestimation during arrhythmias highlights the need for optimization.
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J Clin Monit Comput · Jan 2025
Cost-effectiveness of data driven personalised antibiotic dosing in critically ill patients with sepsis or septic shock.
This study provides an economic evaluation of bedside, data-driven, and model-informed precision dosing of antibiotics in comparison with usual care among critically ill patients with sepsis or septic shock. ⋯ Data-driven personalised antibiotic dosing in critically ill patients as implemented in the AutoKinetics trial cannot be recommended for implementation as a cost-effective intervention.
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J Clin Monit Comput · Jan 2025
ReviewAssessing fluid responsiveness by using functional hemodynamic tests in critically ill patients: a narrative review and a profile-based clinical guide.
Fluids are given with the purpose of increasing cardiac output (CO), but approximately only 50% of critically ill patients are fluid responders. Since the effect of a fluid bolus is time-sensitive, it diminuish within few hours, following the initial fluid resuscitation. Several functional hemodynamic tests (FHTs), consisting of maneuvers affecting heart-lung interactions, have been conceived to discriminate fluid responders from non-responders. ⋯ This is due to the random CO fluctuations. Finally, the presence of continuous CO monitoring in ICU patients is not standard and the assessment of fluid responsiveness with surrogate methods is clinically useful, but also challenging. In this review we provide an algorithm for the use of FHTs in different subgroups of ICU patients, according to ventilatory setting, cardiac rhythm and the availability of continuous hemodynamic monitoring.
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J Clin Monit Comput · Jan 2025
The use of the surgical pleth index to guide anaesthesia in gastroenterological surgery: a randomised controlled study.
The measurement of nociception and the optimisation of intraoperative antinociceptive medication could potentially improve the conduct of anaesthesia, especially in the older population. The Surgical Pleth Index (SPI) is one of the monitoring methods presently used for the detection of nociceptive stimulus. Eighty patients aged 50 years and older who were scheduled to undergo major abdominal surgery were randomised and divided into a study group and a control group. ⋯ However, in the subgroup of patients who underwent operation with invasive blood pressure monitoring, there was less severe hypotension (MAP < 55) (0.3% vs. 0.0%, p = 0.02) and intermediate hypotension (MAP < 65) (10.2% vs. 2.6%, p = 0.07) in the treatment group, even though remifentanil consumption was higher (3.5 µg kg- 1h- 1 vs. 5.1 µg kg- 1h- 1p = 0.03). The use of SPI guidance for the administration of remifentanil during surgery did not help to reduce the remifentanil consumption. However, the results from invasively monitored study group suggest more timely administered opioid when SPI was used.