Journal of clinical monitoring and computing
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J Clin Monit Comput · Jun 2018
Comparative StudyDiscrepancy between in vivo and in vitro comparisons of forced oscillation devices.
The forced oscillation technique (FOT) is an emerging clinical lung function test, with commercial devices becoming increasingly available. However comparability across existing devices has not been established. We evaluated in vivo and in vitro measurements made using three commercial devices against a custom-built device (WIMR): Resmon Pro Diary (Restech srl, Italy), tremoFlo C-100 (Thorasys Medical Systems, Canada), Jaeger Masterscope CT IOS (CareFusion, Hoechberg, Germany). ⋯ No differences were observed using test standards; deviation from theoretical value was <2% for resistance and <5% for reactance. The WIMR, tremoFlo and Resmon Pro but not IOS devices measure similar Rrs, whereas there was more disparity across devices in the estimation of Xrs parameters. The discrepancy between in vivo and in vitro measurements suggest that FOT validation procedures need to take into account the breathing pattern, either using biological controls or a breathing model.
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J Clin Monit Comput · Jun 2018
Comparative StudyComparing volume-clamp method and intra-arterial blood pressure measurements in patients with atrial fibrillation admitted to the intensive or medium care unit.
International guidelines highlight the importance of blood pressure (BP) in patients with atrial fibrillation (AF). However, BP measurement in AF is complicated by beat-to-beat fluctuation. Automated BP measurement devices are not validated for patients with AF and no consensus exists on how to measure BP in AF manually. ⋯ Accuracy of VCM in AF was similar to sinus rhythm. In conclusion, in patients with AF, accurate and precise measurement of non-invasive beat-to-beat BP measurement using the VCM is possible, the one exception being the precision of systolic BP. Beat-to-beat variability can be accurately reproduced.
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J Clin Monit Comput · Jun 2018
ReviewThe oxygen reserve index (ORI): a new tool to monitor oxygen therapy.
Supplemental oxygen is administered in the vast majority of patients in the perioperative setting and in the intensive care unit to prevent the potentially deleterious effects of hypoxia. On the other hand, the administration of high concentrations of oxygen may induce hyperoxia that may also be associated with significant complications. Oxygen therapy should therefore be precisely titrated and accurately monitored. ⋯ The ORI is a dimensionless index that reflects oxygenation in the moderate hyperoxic range (PaO2 100-200 mmHg). The ORI may provide an early alarm when oxygenation deteriorates well before any changes in SpO2 occur, may reflect the response to oxygen administration (e.g., pre-oxygenation), and may facilitate oxygen titration and prevent unintended hyperoxia. In this review we describe this new variable, summarize available data and preliminary experience, and discuss its potential clinical utilities in the perioperative and intensive care settings.
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J Clin Monit Comput · Jun 2018
Randomized Controlled TrialThe effect of intravenous lidocaine infusion on bispectral index during major abdominal surgery.
Intraoperative lidocaine infusion has become widely accepted as an adjunct to general anesthesia where its use has been associated with opioid-sparing and enhanced recovery. The aims of this study were to determine whether or not intravenous (IV) lidocaine infusion (a) has an anesthetic sparing effect during major colorectal procedures and (b) if it also affects level of hypnosis as measured by bispectral index (BIS). Twenty-five patients undergoing laparotomy for resection of colorectal tumours were randomized to receive either IV lidocaine (1.5 mg kg-1 bolus then 1 mg kg-1 per hour) or an equivalent volume of normal saline commenced after intravenous induction of general anesthesia. ⋯ Higher BIS values in the lidocaine versus placebo group may indicate that levels of hypnosis were not equivalent. Alternatively, BIS may not be a sensitive indicator of synergistic interactions between local anesthetic and volatile agent. Our results advocate a cautious approach to titration of general anesthesia when combined with lidocaine infusion.
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J Clin Monit Comput · Jun 2018
ReviewA review of recent advances in data analytics for post-operative patient deterioration detection.
Most deaths occurring due to a surgical intervention happen postoperatively rather than during surgery. The current standard of care in many hospitals cannot fully cope with detecting and addressing post-surgical deterioration in time. For millions of patients, this deterioration is left unnoticed, leading to increased mortality and morbidity. ⋯ This work also aims to highlight the opportunities that lie in personalizing the models developed for patient deterioration for these particular post-surgical patients and make the output more actionable. The integration of pre- and intra-operative data, e.g. comorbidities, vitals, lab data, and information about the procedure performed, in post-operative early warning algorithms would lead to more contextualized, personalized, and adaptive patient modelling. This, combined with careful integration in the clinical workflow, would result in improved clinical decision support and better post-surgical care outcomes.