Journal of clinical monitoring and computing
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J Clin Monit Comput · Aug 2017
Observational StudyUsing extra systoles to predict fluid responsiveness in cardiothoracic critical care patients.
Fluid responsiveness prediction is an unsettled matter for most critical care patients and new methods relying only on the continuous basic monitoring are desired. It was hypothesized that the post-ectopic beat, which is associated with increased preload, could be analyzed in relation to preceding sinus beats and that the change in cardiac performance (e.g. systolic blood pressure) at the post-ectopic beat could predict fluid responsiveness. Cardiothoracic critical care patients scheduled for a 500 ml volume expansion were observed. ⋯ The change in pre-ejection period predicted fluid responsiveness in 22 patients correctly with 67 % specificity and 83 % sensitivity (optimal threshold: 19 ms pre-ejection period decrease), ROC area: 0.81 (CI [0.66;0.96]). Pulse pressure variation had ROC area of 0.57 (CI [0.39;0.75]). Based on standard critical care monitoring, analysis of the extra systolic post-ectopic beat predicts fluid responsiveness in cardiothoracic critical care patients with good accuracy.
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J Clin Monit Comput · Aug 2017
Case ReportsInsertion of intra-oral electrodes for cranial nerve monitoring using a Crowe-Davis retractor.
Acoustic neuroma resection is an example of a neurosurgical procedure where the brainstem and multiple cranial nerves are at risk for injury. Electrode placement for monitoring of the glossopharyngeal and hypoglossal nerves during acoustic neuroma resection can be challenging. The purpose of this report is to illustrate the use of a device for intra-oral electrode placement for intraoperative monitoring of the glossopharyngeal and hypoglossal nerves. ⋯ The tumor was resected successfully. Monitoring of the cranial nerves (including the glossopharyngeal and hypoglossal nerves) revealed no concerning responses. The Crowe-Davis retractor and the technique described allowed insertion of electrodes for neural monitoring, contributing to neural preservation.
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J Clin Monit Comput · Aug 2017
Design and validation of a questionnaire to evaluate the usability of computerized critical care information systems.
The implementation of computerized critical care information systems (CCIS) can improve the quality of clinical care and staff satisfaction, but also holds risks of disrupting the workflow with consecutive negative impacts. The usability of CCIS is one of the key factors determining their benefits and weaknesses. However, no tailored instrument exists to measure the usability of such systems. ⋯ We tested validity and reliability of the digital version of the questionnaire in a sample population. In the sample population of 535 participants both usability evaluation models showed a strong correlation with the overall rating of the system (multiple correlation coefficients ≥0.80) as well as a very high internal consistency (Cronbach's alpha ≥0.93). The novel questionnaire is a valid and reliable instrument to measure the usability of CCIS and can be used to study the influence of the usability on their implementation benefits and weaknesses.
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J Clin Monit Comput · Aug 2017
Assessment of an alternative calibration technique to record breathing pattern and its variability with respiratory inductive plethysmography.
Recent literature has raised doubts on the existing calibration methods for respiratory inductive plethysmography (RIP) which can lead to erroneous estimation of tidal volume. This study sought to validate an alternative calibration method to record tidal volume and tidal volume variability during rest and exercise by comparing the measurements obtained from a RIP device against a pneumotachograph (PT) for breath-by-breath analysis. 11 healthy individuals were recruited. Tidal volume and variability were simultaneously recorded during 30 min of rest and 20 min of exercises. ⋯ No statistical significant difference was observed in tidal volume variability between devices during rest and exercises. This study provides support for an alternative calibration method, which addresses existing limitations. The simplicity of equipment set up process and no need to perform subject cooperated calibration procedure will improve the respiratory monitoring process.
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This work aims to introduce a new needle insertion simulation to predict the deflection of a bevel-tip needle inside soft tissue. The development of such a model, which predicts the steering behavior of the needle during needle-tissue interactions, could improve the performance of many percutaneous needle-based procedures such as brachytherapy and thermal ablation, by means of the virtual path planning and training systems of the needle toward the target and thus reducing possible incidents of complications in clinical practices. The Arbitrary-Lagrangian-Eulerian (ALE) formulation in LS-DYNA software was used to model the solid-fluid interactions between the needle and tissue. ⋯ The effect of the needle diameter and its bevel tip angle on the final shape of the needle was investigated using this model. To maneuver around the anatomical obstacles of the human body and reach the target location, thin sharp needles are recommended, as they would create a smaller radius of curvature. The insertion model presented in this work is intended to be used as a base structure for path planning and training purposes for future studies.