Journal of clinical monitoring and computing
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J Clin Monit Comput · Dec 2020
Comment LetterThe artificial count of artifacts for thoracic ultrasound: what is the clinical usefulness?
Many works in the literature have shown that the increase in the number of B lines is a nonspecific sign of underlying pulmonary disease. Actually these artifacts are the result of a physical effect of ultrasound between the chest wall and the pulmonary air. Nevertheless the intra- and inter-operator variability in B-lines counting does not only reside only in the count itself but depends also on the type and frequency of the probe used, as well as the ultrasound scan machine setting and the patient's chest shape. In our opinion, proposing a software algorithm to count lines B seems like an unproductive effort.
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J Clin Monit Comput · Dec 2020
Right ventricular transverse displacement increases following cardiac surgery: possibly compensating loss in tricuspid annular plane systolic excursion (TAPSE).
Right Ventricular (RV) output mostly derives from longitudinal shortening in normal hearts. However, following even uncomplicated cardiac surgery with preserved RV function a significant and sustained decrease in longitudinal contraction has been observed. How the RV compensates and sustains output in this setting remains unsettled. ⋯ RV speckle tracking strain did not change significantly. Increased transverse displacement likely compensates for reduction in RV longitudinal contraction following cardiac surgery and maintains cardiac output. The sustained output from the right ventricle was not related to an increased contractility.
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J Clin Monit Comput · Dec 2020
A simplified 4-parameter model of volumetric capnograms improves calculations of airway dead space and slope of Phase III.
To evaluate a compact and easily interpretable 4-parameter model describing the shape of the volumetric capnogram, and the resulting estimates of anatomical dead space (VDAW) and Phase III (alveolar plateau) slope (SIII). Data from of 8 mildly-endotoxemic pre-acute respiratory distress syndrome sheep were fitted to the proposed 4-parameter model (4p) and a previously established 7-parameter model (7p). Root mean square error (RMSE) and Akaike information criterion (AIC), as well as VDAW and SIII derived from each model were compared. ⋯ Mean differences between VDAW (2.1 ± 0.04 ml) and SIII (0.047 ± 0.004 mmHg/ml) from 7 and 4p were significant (p < 0.001), but within the observed cycle-by-cycle variability. The proposed 4-parameter model of the volumetric capnogram improves data fitting and estimation of VDAW and SIII as compared to the 7-parameter model of reference. These advantages support the use of the 4-parameter model in future research and clinical applications.
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J Clin Monit Comput · Dec 2020
Prognostic value of a bilateral motor threshold criterion for facial corticobulbar MEP monitoring during cerebellopontine angle tumor resection.
In intraoperative neuromonitoring (IONM), facial nerve motor function (FaNMF) is assessed by facial muscle corticobulbar motor evoked potentials (FMcoMEP). Mostly only amplitude decrease is used as warning criterion. We related a refined criterion for FMcoMEP consisting of a bilateral final-to-baseline motor threshold ratio with standard criteria and postoperative FaNMF. 79 patients (45 females; 48 ± 16 years) undergoing IONM-guided cerebellopontine angle tumor surgery were retrospectively analyzed. ⋯ Diagnostic odds ratios were highest for bfBMT20 compared to iAMT20 and iAR50 for D1 (172.5 vs. 8.7 vs. 0.45) and D7 (51.4 vs. 6.1 vs. 0.8). The refined parameter bFBMT20 provides a valuable contribution to the prognostic assessment of FaNMF. Due to its bihemispheric character, it might thus circumvent false-positive events which affect FMcoMEP bilaterally.
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J Clin Monit Comput · Dec 2020
Observational StudyAccuracy of the non-invasive Tcore™ temperature monitoring system to measure body core temperature in abdominal surgery.
An accurate determination of body core temperature is crucial during surgery in order to avoid and treat hypothermia, which is associated with poor outcome. In a prospective observational study, we evaluated the suitability of the Tcore™ device (Drägerwerk AG & Co. KGaA, Lübeck, Germany)-a non-invasive thermometer-to accurately determine core body temperature. ⋯ In a repeated-measurements version of the Bland and Altman test, a bias of - 0.02 °C and 95% limits of agreement of - 0.48 to 0.44 °C were calculated. In a population analysis, a median absolute error of 0 [- 0.1; + 0.1] °C, a bias of 0 [- 0.276; 0.271] % and an inaccuracy of 0.276 [0.274; 0.354] % was determined. Although the Tcore™ sensor was attached to the frontal skin, it provided an accurate measurement of core body temperature in the investigated intraoperative setting.