Journal of clinical monitoring and computing
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J Clin Monit Comput · Oct 2019
Randomized Controlled Trial Comparative StudyCricoid-mental distance-based versus weight-based criteria for size selection of classic laryngeal mask airway in adults: a randomized controlled study.
The optimal size selection of laryngeal mask airway (LMA) based on body weight is not always applicable. This study was prospectively conducted to evaluate the efficacy of cricoid-mental distance-based method versus weight-based method in optimal size selection of LMA in adults. Seventy-four patients (aged from 18 to 65) undergoing ophthalmic surgery were randomly assigned into cricoid-mental (CM) distance-based group or weight-based group to select appropriate size of LMA. ⋯ The overall success rate of LMA insertion in CM distance-based group was slightly increased in comparison with the weight-based group (100% vs. 91.9%, P = 0.240). There were no significant differences in score of fiber-optic view and postoperative pharyngolaryngeal morbidity between both groups (all P > 0.05). CM distance-based criteria is an alternative choice for optimizing size selection of classic LMA in adults.
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J Clin Monit Comput · Oct 2019
ReviewApplying machine learning to continuously monitored physiological data.
The use of machine learning (ML) in healthcare has enormous potential for improving disease detection, clinical decision support, and workflow efficiencies. In this commentary, we review published and potential applications for the use of ML for monitoring within the hospital environment. We present use cases as well as several questions regarding the application of ML to the analysis of the vast amount of complex data that clinicians must interpret in the realm of continuous physiological monitoring. ⋯ Finally, innovations in monitoring, including those supported by ML, will pose regulatory and medico-legal challenges, as well as questions regarding precisely how to incorporate these features into clinical care and medical education. Rigorous evaluation of ML techniques compared to traditional methods or other AI methods will be required to validate the algorithms developed with consideration of database limitations and potential learning errors. Demonstration of value on processes and outcomes will be necessary to support the use of ML as a feature in monitoring system development: Future research is needed to evaluate all AI based programs before clinical implementation in non-research settings.
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J Clin Monit Comput · Oct 2019
Clinical TrialDevelopment and validation of an android-based application for anaesthesia neuromuscular monitoring.
Quantitative neuromuscular block (NMB) assessment is an internationally recognised necessity in anesthesia care whenever neuromuscular blocking agents are administered. Despite this, the incidence of residual neuromuscular block and its associated major respiratory morbidity and mortality remain unacceptably high considering its preventable nature. Recent surveys show that quantitative NMB assessment is not consistently employed by anesthesiologists. ⋯ This average inter-method difference was not significantly different than the a priori hypothesized difference cut-off of 0.001 (p = 0.78). Lin's concordance correlation coefficient and Pearson's correlation were both of 0.98. The custom developed Android application proved accurate for diagnosis of residual neuromuscular block.
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J Clin Monit Comput · Oct 2019
Comparative StudyHead-to-head comparison of two continuous glucose monitoring systems on a cardio-surgical ICU.
In critical illness hypo-and hyperglycemia have a negative influence on patient outcome. Continuous glucose monitoring (CGM) could help in early detection of hypo-and hyperglycemia. A requirement for these new methods is an acceptable accuracy and precision in clinical practice. ⋯ The Bland Altman Plots revealed an accuracy of 2.5 mg/dl, and a precision of + 43.0 mg/dl to - 38.0 mg/dl (subcutaneous sensor) and an accuracy of - 6.0 mg/dl, and a precision of + 12.4 mg/dl to - 24.4 mg/dl (intravasal sensor). No severe hypoglycemic event, defined as BG level below 40 mg/dl, occurred during treatment. Both sensors showed good accuracy in comparison to the BGA values, however they differ regarding precision, which in case of the subcutaneous sensor is considerable high.
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J Clin Monit Comput · Oct 2019
Observational StudyCerebral oxygen saturation monitoring in preeclamptic pregnant women undergoing cesarean section with spinal anesthesia: a prospective, observational study.
It has been suggested that cerebral oximetry can detect acute and chronic changes in cerebral oxygen saturation due to pregnancy related complications. Furthermore, regional cerebral oxygenation saturation (rcSO2) decreases were obtained during spinal anesthesia for cesarean section. The aim of this prospective observational study is to compare the effects of spinal anesthesia on rcSO2 in preeclamptic and normotensive pregnant women. ⋯ There is decrease in rcSO2 values after spinal anesthesia correlating with hypotension in preeclamptic women. However, the decrease is less than that of normotensive pregnant women, especially the first 5 min after spinal injection when the blood pressure is lowest. The clinical impact of these results and the relationship between cerebral desaturation and neurological complications remain to be determined.