Journal of clinical monitoring and computing
-
J Clin Monit Comput · Sep 2024
Left ventricular end-diastolic pressure response to spinal anaesthesia in euvolaemic vascular surgery patients.
Regional anaesthesia techniques provide highly effective alternative to general anaesthesia. Existing evidence on the effect of spinal anaesthesia (SA) on cardiac diastolic function is scarce. This study aimed to evaluate the effects of a single-injection, low-dose SA on left ventricular end-diastolic pressures (LVEDP) using echocardiography in euvolaemic patients undergoing elective vascular surgery. ⋯ This study in euvolaemic patients undergoing elective vascular surgery provides evidence that SA improved LVEDP.
-
J Clin Monit Comput · Sep 2024
Practical prognostic tools to predict the risk of postoperative delirium in older patients undergoing cardiac surgery: visual and dynamic nomograms.
Postoperative Delirium (POD) has an incidence of up to 65% in older patients undergoing cardiac surgery. We aimed to develop two dynamic nomograms to predict the risk of POD in older patients undergoing cardiac surgery. ⋯ We established two nomogram models based on the preoperative and postoperative time points to predict POD risk and guide the flexible implementation of possible interventions at different time points.
-
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.
-
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.
-
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.