Journal of clinical monitoring and computing
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J Clin Monit Comput · Aug 2022
Ability of short-time low peep challenge to predict fluid responsiveness in mechanically ventilated patients in the intensive care.
Short-time low PEEP challenge (SLPC, application of additional 5 cmH2O PEEP to patients for 30 s) is a novel functional hemodynamic test presented in the literature. We hypothesized that SLPC could predict fluid responsiveness better than stroke volume variation (SVV) in mechanically ventilated intensive care patients. Heart rate, mean arterial pressure, stroke volume index (SVI) and SVV were recorded before SLPC, during SLPC and before and after 500 mL fluid loading. ⋯ The ROC-AUC of SVIΔ%-SLPC was significantly higher than that of SVV (p = 0.0045). The best cut-off value of SVIΔ%-SLPC was 7.5% with 90% sensitivity and 96% specificity. The percentage change in SVI during SLPC predicts fluid responsiveness in intensive care patients who are ventilated with low tidal volumes; the sensitivity and specificity values are higher than those of SVV.
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J Clin Monit Comput · Aug 2022
Evaluation of a novel mobile phone application for blood pressure monitoring: a proof of concept study.
To provide information about the clinical relevance of blood pressure (BP) measurement differences between a new smartphone application (OptiBP™) and the reference method (automated oscillometric technique) using a noninvasive brachial cuff in patients admitted to the emergency department. We simultaneously recorded three BP measurements using both the reference method and the novel OptiBP™ (test method), except when the inter-arm difference was > 10 mmHg BP. Each OptiBP™ measurement required 1-min and the subsequent reference method values were compared to the values obtained with OptiBP™ using a Bland-Altman analysis and error grid analysis. ⋯ In this pilot study conducted in stable and awake patients admitted to the emergency department, the absolute agreement between the OptiBP™ and the reference method was moderate. However, when BP measurements were made immediately after an initial calibration, error grid analysis showed that 100% of measurement differences between the OptiBP™ and reference method were categorized as no- or low-risk treatment decisions for all patients. Trial Registration: ClinicalTrials.gov Identifier: NCT04121624.
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J Clin Monit Comput · Aug 2022
Processed electroencephalography: impact of patient age and surgical position on intraoperative processed electroencephalogram monitoring of burst-suppression.
We previously reported that processed EEG underestimated the amount of burst suppression compared to off-line visual analysis. We performed a follow-up study to evaluate the reasons for the discordance. Forty-five patients were monitored intraoperatively with processed EEG. ⋯ Machine readings for younger patients (age < 65 years) had higher sensitivity (0.96 vs 0.92; p = 0.021) and specificity (0.99 vs 0.88; p = 0.007) for older patients. The duration of burst suppression estimated by the machine generally had good agreement compared with neurologists' estimation using a more precise off-line measurement. Factors that affected the concordance included patient age and position during surgery, but not EEG artifacts.
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J Clin Monit Comput · Aug 2022
Outcome in patients with open abdomen treatment for peritonitis: a multidomain approach outperforms single domain predictions.
Numerous patient-related clinical parameters and treatment-specific variables have been identified as causing or contributing to the severity of peritonitis. We postulated that a combination of clinical and surgical markers and scoring systems would outperform each of these predictors in isolation. To investigate this hypothesis, we developed a multivariable model to examine whether survival outcome can reliably be predicted in peritonitis patients treated with open abdomen. ⋯ Marginal effects plots highlight the effect of individual outcomes on the prediction of survival outcome in patients undergoing staged laparotomies for treatment of peritonitis. Although most single indices exhibited moderate performance, we observed that the predictive performance was markedly increased when an integrative prediction model was applied. Our proposed MPPM integrative prediction model may outperform the predictive power of current models.
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J Clin Monit Comput · Aug 2022
Clinical TrialThe interest of 100 versus 200 Hz tetanic stimulations to quantify low levels of residual neuromuscular blockade with mechanomyography: a pilot study.
A more sensitive method than the train-of-four ratio seems required to detect low levels of residual neuromuscular blockade before tracheal extubation. The goal of the study was to determine the potential benefit of 5 s of 100 versus 200 Hz tetanic stimulation to quantify the residual block with mechanomyography in anesthetised patients. Twenty informed and consenting 18- to 80-year-old patients undergoing nose surgery were included. ⋯ There were no differences between baseline and post-reversal TFR. The 200 Hz TFR has the potential to better describe low levels of residual neuromuscular blockade than the TOF ratio and 100 Hz TFR and would benefit from further investigations. Retrospectively registered in the Australian and New Zealand Clinical Trials Registry ACTRN12619000273189.