Journal of clinical monitoring and computing
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J Clin Monit Comput · Aug 2019
Observational StudyMuscular tissue oxygen saturation during robotic hysterectomy and postoperative nausea and vomiting: exploring the potential therapeutic thresholds.
The relationship between muscular tissue oxygen saturation (SmtO2) during surgery and postoperative nausea and vomiting (PONV) remains to be determined. Patients undergoing robotic hysterectomy participated in this prospective cohort study. SmtO2 of the brachioradialis muscle in the forearm was continuously monitored during surgery. ⋯ PONV occurred in 35 of 106 patients (33%). Based on the multivariable analysis, the SmtO2 threshold of 20% above baseline correlated with less PONV (OR 0.39; 95% CI 0.16-0.93; p = 0.034), and the following values correlated with more PONV: 5% below baseline (OR 2.37; 95% CI 1.26-4.45; p = 0.007), 20% below baseline (OR 16.08; 95% CI 3.05-84.73; p = 0.001), < 70% (OR 2.86; 95% CI 1.17-6.99; p = 0.021) and < 60% (OR 6.55; 95% CI 1.11-38.53; p = 0.038). Our study suggests that a potential therapeutic goal for PONV prophylaxis may be to maintain SmtO2 at > 70% and above baseline.
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J Clin Monit Comput · Aug 2019
Respiratory measurement using infrared thermography and respiratory volume monitor during sedation in patients undergoing endoscopic urologic procedures under spinal anesthesia.
We aimed to evaluate changes in respiratory pattern after sedation by simultaneously applying a respiratory volume monitor (ExSpiron1Xi, RVM) and infrared thermography (IRT) to patients undergoing spinal anesthesia during endoscopic urologic surgeries. After spinal anesthesia was performed, the patient was placed in a lithotomy position for surgery. Then, we established the baseline of the RVM, and started monitoring the mouth and nose with the infrared camera. ⋯ Hypopnea was detected in all subjects within the first 5 min by RVM: the median time required to detect hypopnea was 142.5 (IQR 115-185.2) s. The median time required for SpO2 to decrease > 4% from baseline was 160 (IQR 125-205) s. Our results suggest that IRT can be useful for rapid detection of respiratory changes in patients undergoing sedation following spinal anesthesia for endoscopic urologic procedures.
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J Clin Monit Comput · Aug 2019
Post-extrasystolic characteristics in the arterial blood pressure waveform are associated with right ventricular dysfunction in intensive care patients.
Right ventricular dysfunction (RVD) is associated with end-organ dysfunction and mortality, but has been an overlooked condition in the ICU. We hypothesized that analysis of the arterial waveform in the presence of ventricular extrasystoles could differentiate patients with RVD from patients with a normally functioning right ventricle, because the 2nd and 3rd post-ectopic beat could reflect right ventricular state (pulmonary transit time) during the preceding ectopy. We retrospectively identified patients with echocardiographic evidence of moderate-to-severe RVD and patients with a normal functioning right ventricle (control) from the MIMIC database. ⋯ We identified 34 patients in the control group and 24 patients in the RVD group with ventricular extrasystoles. The mean SBP reduction at the 2nd and 3rd beat was lower in the RVD group compared with the control group [- 1.7 (SD: 1.9) % vs. - 3.6 (SD: 1.9) %, p < 0.001], and this characteristic differentiated RVD subjects from control subjects with an AUC of 0.76 (CI [0.64; 0.89]), with a specificity of 91% and sensitivity of 50%. In this proof-of-concept study, we found that post-extrasystolic ABP characteristics were associated with RVD.