Journal of clinical monitoring and computing
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J Clin Monit Comput · Aug 2020
Comparative StudyComparison of multiple cardiac signal acquisition technologies for heart rate variability analysis.
Heart rate variability analysis is a recognized non-invasive tool that is used to assess autonomic nervous system regulation in various clinical settings and medical conditions. A wide variety of HRV analysis methods have been proposed, but they all require a certain number of cardiac beats intervals. There are many ways to record cardiac activity: electrocardiography, phonocardiography, plethysmocardiography, seismocardiography. ⋯ We therefore tested the evolution of several HRV parameters computed from several sensors before, during and after a postural change. The main findings of our study is that even if most sensors were suitable for mean HR computation, some of them demonstrated limited agreement for several HRV analyses methods. We also demonstrated that piezoplethysmocardiography showed better agreement with ECG than other sensors for most HRV indexes.
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J Clin Monit Comput · Aug 2020
Changes in cerebral and renal oxygenation during laparoscopic pyloromyotomy.
Although a laparoscopic approach may be preferred over open procedures for abdominal surgery, there are limited data on the effect of laparoscopic procedures on cerebral and renal oxygenation in neonates and young infants. Here, we evaluated the effect in neonates and infants. In this two-center prospective observational study, we evaluated changes in cerebral and renal regional oxygen saturation (rSO2) in infants during laparoscopic pyloromyotomy. ⋯ Similarly, the increase in fractional tissue oxygen extraction (FTOE) was only statistically significant for cerebral FTOE (0.18 ± 0.12 to 0.23 ± 0.16, p = 0.037). No change in hemodynamic or respiratory parameters was found. Although there was a decrease in cerebral rSO2 and increase in cerebral FTOE during pneumoperitoneum, the values did not decrease below those noted before anesthetic induction.
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J Clin Monit Comput · Aug 2020
SAVIOR ICU: sonification and vibrotactile interface for the operating room and intensive care unit.
Alarm fatigue is an issue for healthcare providers in the intensive care unit, and may result from desensitization of overbearing and under-informing alarms. To directly increase the overall identification of medical alarms and potentially contribute to a downstream decrease in the prevalence of alarm fatigue, we propose advancing alarm sonification by combining auditory and tactile stimuli to create a multisensory alarm. Participants completed four trials-two multisensory (auditory and tactile) and two unisensory (auditory). ⋯ Specifically, the multisensory group had better performance in correctly identifying parameter (p < 0.05) and point of change (p < 0.05) compared to the unisensory group. Participants demonstrated a higher accuracy of identification with the use of multisensory alarms. Therefore, multisensory alarms may relieve the auditory burden of the medical environment and increase the overall quality of care and patient safety.
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Given the number of clinical studies and meta-analyses investigating the impact of cardiac output-guided hemodynamic management on the postoperative outcome of patients undergoing high-risk surgery, clinicians should already have a fair idea of the clinical and economic benefits. However, this is still a matter of debate, there are still large outcome studies going on, and surveys and audits have shown that clinical adoption remains low. Rational patient selection, more affordable monitoring solutions, and the personalization of therapeutic strategies are desirable to ensure that cardiac output monitoring adds value and becomes part of the routine anesthesia management of high-risk surgical patients.
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J Clin Monit Comput · Aug 2020
Letter Case ReportsCapnography-sample line leak and incremental positive end expiratory pressure (PEEP); an interesting interplay.
The capnography is an important monitor to assess the patient's respiratory status. Importance of education for clinicians in interpretation of alarms and various capnography waveforms in different clinical scenarios and equipment malfunction is an understatement. Capnography waveforms due to sample line tube leak is described well in literature. This report describes an interesting effect of incremental positive end expiratory pressure (PEEP) on capnography waveforms linked to sample line leak.