Journal of clinical monitoring and computing
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J Clin Monit Comput · Dec 2017
ReviewCerebral hemodynamics in sepsis assessed by transcranial Doppler: a systematic review and meta-analysis.
Cerebral microcirculation is gradually compromised during sepsis, with significant reductions in the function of capillaries and blood perfusion in small vessels. Transcranial Doppler ultrasound (TCD) has been used to assess cerebral circulation in a typical clinical setting. This study was to systematically review TCD studies, assess their methodological quality, and identify trends that can be associated with the temporal evolution of sepsis and its clinical outcome. ⋯ Cerebral haemodynamic is impaired in sepsis. Modifications in cerebral blood flow may be consequence to the endothelial dysfunction of the microvasculature induced by the release of inflammatory mediators. A better understanding of cerebral hemodynamics may improve the clinical management of patients with sepsis and, consequently, improve clinical outcomes.
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J Clin Monit Comput · Dec 2017
Prediction of difficult laryngoscopy using spirometry: a pilot study.
Prediction of difficult laryngoscopy is still the uncovered secret of anesthetic practice. This pilot study is aimed to assess the efficacy of spirometry measurements in predicting difficult laryngoscopy compared with conventional airway assessment techniques. We enrolled 202 adults, ages 18-40 years, with an American Society of Anaesthesiologists score of I or II, scheduled for elective surgery and undergoing general anesthesia. ⋯ In a multivariate linear regression model, all spirometry measurements revealed that forced inspiratory vital capacity (β = -2.050, P = 0.022) was the significant predictor for difficult laryngoscopy. The area under the curve for forced inspiratory vital capacity with a cut-off value of 3.1950 L while using thyromental distance as difficult laryngoscopy indicator is 0.754 and forced inspiratory vital capacity showed a sensitivity of 0.718 and specificity of 0.714 with a positive likelihood ratio of 2.5104 and negative likelihood ratio of 0.3949. Forced inspiratory vital capacity showed a close association with the prediction of difficult laryngoscopy.
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J Clin Monit Comput · Dec 2017
Influence of continuously evolving transcatheter aortic valve implantation technology on cerebral oxygenation.
This study assessed the influence of the evolution in Transcatheter Aortic Valve Implantation technology on cerebral oxygenation. Cerebral oxygenation was measured continuously with Near-Infrared Spectroscopy and compared retrospectively between balloon-expandable, self-expandable and differential deployment valves which were implanted in 12 (34%), 17 (49%) and 6 patients (17%), respectively. Left and right SctO2 values were averaged at four time points and used for analysis (i.e. at baseline, balloon-aortic valvuloplasty, valve deployment, and at the end of the procedure). ⋯ Furthermore, both the incidence and duration below a cerebral oxygenation of 55% was significantly different between balloon and self-expandable valves (p = 0.038 and p = 0.018, respectively). This study demonstrated that Transcatheter Aortic Valve Implantation procedures are associated with significant cerebral desaturations, especially during balloon-aortic valvuloplasty and valve deployment. Moreover, our results showed that latest innovations in Transcatheter Aortic Valve Implantation technology beneficially influenced the adequacy of cerebral perfusion.
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J Clin Monit Comput · Dec 2017
Comparative StudyComparison of non-invasive peripheral venous saturations with venous blood co-oximetry.
The estimation of venous oxygen saturations using photoplethysmography (PPG) may be useful as a noninvasive continuous method of detecting changes in regional oxygen supply and demand (e.g. in the splanchnic circulation). The aim of this research was to compare PPG-derived peripheral venous oxygen saturations directly with venous saturation measured from co-oximetry blood samples, to assess the feasibility of non-invasive local venous oxygen saturation. This paper comprises two similar studies: one in healthy spontaneously-breathing volunteers and one in mechanically ventilated anaesthetised patients. ⋯ In the anaesthetised patients SxvO2 values were only 3.81% lower than SpO2 and tended to underestimate venous saturation (mean difference = -2.67 ± 5.89%) while correlating weakly with ScovO2 (r = 0.10). The results suggest that significant refinement of the technique is needed to sufficiently improve accuracy to produce clinically meaningful measurement of peripheral venous oxygen saturation. In anaesthetised patients the use of the technique may be severely limited by cutaneous arteriovenous shunting.
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J Clin Monit Comput · Dec 2017
Comparative StudyComparison of the qCON and qNOX indices for the assessment of unconsciousness level and noxious stimulation response during surgery.
The objective of this work is to compare the performances of two electroencephalogram based indices for detecting loss of consciousness and loss of response to nociceptive stimulation. Specifically, their behaviour after drug induction and during recovery of consciousness was pointed out. Data was recorded from 140 patients scheduled for general anaesthesia with a combination of propofol and remifentanil. ⋯ Furthermore, the qCON showed faster decrease during induction. This behaviour is associated with the hypothesis that the loss of response to stimuli (analgesic effect) might be reached after the loss of consciousness (hypnotic effect). On the contrary, the qNOX showed a faster increase at the end of the surgery, associated with the hypothesis that a higher probability of response to stimuli might be reached before the recovery of consciousness.