Journal of clinical monitoring and computing
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J Clin Monit Comput · Apr 2022
Assessment of the 50 % and 95 % effective paratracheal forces for occluding the esophagus in anesthetized patients.
This study aimed to evaluate the 50% and 95% effective paratracheal forces for occluding the esophagus in anesthetized patients. In 46 anesthetized patients, the upper esophagus was examined using ultrasonography, and the lower paratracheal area over the esophagus just above the clavicle was marked. Manual paratracheal force was applied over that area using a novel pressure sensing device set-up. ⋯ According to Dixon and Mood method, the 50% effective paratracheal force (confidence interval) was 18.4 (17.5‒19.3) N with the use of a 12-Fr esophageal stethoscope and 12.8 (11.0‒14.6) N with the use of an 18-Fr esophageal stethoscope. Using probit regression analysis, the 50% and 95% effective paratracheal forces were 18.4 (16.8‒19.6) N and 20.6 (19.4‒27.9) N, respectively, with the use of a 12-Fr esophageal stethoscope, and 12.4 (8.3‒14.4) N and 16.9 (14.7‒37.3) N, respectively, with the use of an 18-Fr esophageal stethoscope. Our findings suggest a guide for applying paratracheal force during rapid sequence induction and tracheal intubation.
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J Clin Monit Comput · Apr 2022
Accuracy of identifying hospital acquired venous thromboembolism by administrative coding: implications for big data and machine learning research.
Big data analytics research using heterogeneous electronic health record (EHR) data requires accurate identification of disease phenotype cases and controls. Overreliance on ground truth determination based on administrative data can lead to biased and inaccurate findings. Hospital-acquired venous thromboembolism (HA-VTE) is challenging to identify due to its temporal evolution and variable EHR documentation. ⋯ Additionally, 45% of diagnostic test confirmed HA-VTE cases lacked corresponding ICD codes. ICD-9-CM coding missed diagnostic test-confirmed HA-VTE cases and inaccurately assigned cases without confirmed VTE, suggesting dependence on administrative coding leads to inaccurate HA-VTE phenotyping. Alternative methods to develop more sensitive and specific VTE phenotype solutions portable across EHR vendor data are needed to support case-finding in big-data analytics.
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J Clin Monit Comput · Apr 2022
Multi-analyte calibration and verification of a multi-parameter laser-based pulse oximeter.
Almost since its introduction pulse oximetry was known to overestimate oxygen saturation in cases of carbon monoxide poisoning or elevated methemoglobin (metHb) levels. To eliminate this dangerous behavior some manufacturers have added additional LED emitters to try to increase the number of measured hemoglobin species and to improve measurement accuracy, but have not been very successful. We hypothesized that the use of narrow-band laser light sources would make accurate and precise measurement of the four primary species of hemoglobin possible, even in cases of elevated levels of carboxyhemoglobin (COHb). ⋯ This laser-based pulse oximeter measured all four species of hemoglobin accurately and precisely (ARMS ≤ 1.8%) for metHb levels in the clinically normal range. At elevated metHb levels the device continued to provide accurate and precise measurements of metHb and RHb (ARMS ≤ 1.7%). The use of monochromatic laser light sources can create a new generation of highly accurate, multi-parameter, pulse oximeters.
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J Clin Monit Comput · Apr 2022
Adaptive threshold-based alarm strategies for continuous vital signs monitoring.
Continuous vital signs monitoring in post-surgical ward patients may support early detection of clinical deterioration, but novel alarm approaches are required to ensure timely notification of abnormalities and prevent alarm-fatigue. The current study explored the performance of classical and various adaptive threshold-based alarm strategies to warn for vital sign abnormalities observed during development of an adverse event. A classical threshold-based alarm strategy used for continuous vital signs monitoring in surgical ward patients was evaluated retrospectively. ⋯ Combining specific strategies improved overall performance most and resulted in earlier presentation of alarms in case of adverse events. Strategies that adapt vital sign alarm thresholds to personal or situational factors may improve early detection of adverse events or reduce alarm rates as compared to classical alarm strategies. Accordingly, further investigation of the potential of adaptive alarms for continuous vital signs monitoring in ward patients is warranted.
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J Clin Monit Comput · Apr 2022
The effect of different inflating volume on the measurement accuracy of the modified cuff pressure measurement method.
To evaluate the effect of different inflation volume on the measurement accuracy of the modified cuff pressure measurement method in different shapes of cuffs, so as to provide reference for the correct monitoring of cuff pressure in clinic. In vitro study: The traditional cuff pressure measurement method (the cuff pressure gauge before measurement shows 0 cm H2O) and the modified cuff pressure measurement method (the cuff pressure before measurement shows 25 cm H2O, 28 cm H2O, 30 cm H2O or 32 cm H2O) were used to measure cylindrical and tapered cuffs, and the effect of different inflation volume on cuff pressure was analyzed statistically. Clinical study: patients with the artificial airway established by orotracheal intubation or tracheotomy in Neuro-ICU were prospectively selected as subjects, and the measurement procedure was the same as in vitro study. ⋯ The traditional cuff pressure measurement method can directly lead to the cuff pressure drop, which is easy to cause the leakage of secretions on the cuffs and the misjudgment of the cuff pressure by medical personnel. However, the modified cuff pressure measurement method can effectively reduce cuff pressure loss, and taking the actual cuff pressure value as the inflation volume is the highest measurement accuracy. The tapered cuff is more susceptible to air volume, so it is necessary to pay attention to its measurement and correction in clinical practice.