Journal of clinical monitoring and computing
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J Clin Monit Comput · Feb 2017
Monitoring sleep depth: analysis of bispectral index (BIS) based on polysomnographic recordings and sleep deprivation.
The assessment and management of sleep are increasingly recommended in the clinical practice. Polysomnography (PSG) is considered the gold standard test to monitor sleep objectively, but some practical and technical constraints exist due to environmental and patient considerations. Bispectral index (BIS) monitoring is commonly used in clinical practice for guiding anesthetic administration and provides an index based on relationships between EEG components. ⋯ BIS scores were able to discriminate properly between deep (N3) and light (N1, N2) sleep. BIS values during REM overlapped those of other sleep stages, although EMG activity provided by the BIS monitor could help to identify REM sleep if needed. In conclusion, BIS monitors could provide a useful measure of sleep depth in especially particular situations such as intensive care units, and they could be used as an alternative for sleep monitoring in order to reduce PSG-derived costs and to increase capacity in ambulatory care.
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J Clin Monit Comput · Feb 2017
Accuracy of non-invasive continuous total hemoglobin measurement by Pulse CO-Oximetry in severe traumatized and surgical bleeding patients.
The Masimo Radical-7 Pulse CO-Oximeter (Masimo Corp., USA) non-invasively computes hemoglobin concentration (SpHb). SpHb was compared to Co-Oximeter readings (CoOxHb) of arterial samples in surgery patients of the emergency department. Forty-six patients were enrolled. ⋯ SpHb agreed only moderately with CoOxHb values and predicted decreases of CoOxHb only if changes of SpHb ≤ 1.0 g/dl were excluded. The detection failure rate of SpHb was high. At present, additional refinements of the current technology are necessary to further improve performance of non-invasive hemoglobin measurement in the clinical setting.
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Sedation in locations outside the operating room (OR) is common. Guidelines for safe patient monitoring have been updated by the American Society of Anesthesiology to include monitoring of ventilation and/or carbon dioxide (CO2). Although technologies exist to monitor these variables, the quality and/or availability of these measurements in non-OR settings is not optimal. ⋯ After sedation, the expected decrease in MV after sedation was observed in 18 of 20 patients (average -47.82 %), while an increase in ETCO2 was observed in just 10 of 20 patients (average -5.17 mm Hg). The correlation coefficient between changes in MV and ETCO2 in response to sedation administration was positive and not significant, r = 0.223. Ventilation monitoring may provide an element of safety for earlier and more reliable detection of reduced ventilation compared to a surrogate for hypoventilation, ETCO2, in patients undergoing sedation for GI procedures outside of the OR.
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J Clin Monit Comput · Feb 2017
Effect of wearing an N95 filtering facepiece respirator on superomedial orbital infrared indirect brain temperature measurements.
To determine any effect of wearing a filtering facepiece respirator on brain temperature. Subjects (n = 18) wore a filtering facepiece respirator (FFR) for 1 h at rest while undergoing infrared thermography measurements of the superomedial periobital region of the eye, a non-invasive indirect method of brain temperature measurements we termed the superomedial orbital infrared indirect brain temperature (SOIIBT) measurement. Temperature of the facial skin covered by the FFR, infrared temperature measurements of the tympanic membrane and superficial temporal artery region were concurrently measured, and subjective impressions of thermal comfort obtained simultaneously. ⋯ The SOIIBT values did not change significantly, but subjects who switched from nasal to oronasal breathing during the study (n = 5) experienced a slight increase in the SOIIBT measurements. Wearing a FFR for 1 h at rest does not have a significant effect on brain temperatures, as evaluated by the SOIIBT measurements, but a change in the route of breathing may impact these measurements. These findings suggest that subjective impressions of thermal discomfort from wearing a FFR under the study conditions are more likely the result of local dermal sensations rather than brain warming.