Journal of clinical monitoring and computing
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J Clin Monit Comput · Dec 2016
Prediction of hemodynamic reactivity using dynamic variations of Analgesia/Nociception Index (∆ANI).
The Analgesia/Nociception Index (ANI), a 0-100 non-invasive index calculated from heart rate variability, reflects the analgesia/nociception balance during general anesthesia. We hypothesized that dynamic variations of ANI (∆ANI) would provide better performance than static values to predict hemodynamic reactivity during desflurane/remifentanil general anesthesia. One hundred and twenty-eight patients undergoing ear-nose-throat or lower limb orthopedic surgery were analyzed in this prospective observational study. ⋯ A ∆ANI threshold of -19 % predicts hemodynamic reactivity with 85 % [95 % CI 77-91] sensitivity and 85 % [95 % CI 81-89] specificity. Dynamic variations of ANI provide better performance than static values to predict hemodynamic reactivity during desflurane/remifentanil general anesthesia. These findings may be of interest for the individual adaptation of remifentanil doses guided by ∆ANI during general anesthesia, although this remains to be demonstrated.
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J Clin Monit Comput · Dec 2016
Comparative Study Observational StudyComparison of the accuracy of hemoglobin point of care testing using HemoCue and GEM Premier 3000 with automated hematology analyzer in emergency room.
The laboratory analysis provides accurate, but time consuming hemoglobin level estimation especially in the emergency setting. The reliability of time-sparing point of care devices (POCT) remains uncertain. We tested two POCT devices accuracy (HemoCue(®)201(+) and Gem(®)Premier™3000) in routine emergency department workflow. ⋯ Using the error grid methodology: 94 or 91 % of values (HbHC and HbGEM) fell in the zone of acceptable difference (A), whereas 0 and 1 % (HbHC and HbGEM) were unacceptable (zone C). The absolute accuracy of tested POCT devices was low though reaching a high level of correlation with laboratory measurement. The results of the Morey´s error grid were unfavorable for both POCT devices.
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J Clin Monit Comput · Dec 2016
Wireless non-invasive continuous respiratory monitoring with FMCW radar: a clinical validation study.
Altered respiratory rate is one of the first symptoms of medical conditions that require timely intervention, e.g., sepsis or opioid-induced respiratory depression. To facilitate continuous respiratory rate monitoring on general hospital wards a contactless, non-invasive, prototype monitor was developed using frequency modulated continuous wave radar. We aimed to study whether radar can reliably measure respiratory rate in postoperative patients. ⋯ Eight patients were included; yielding 796 min of observation time during mechanical ventilation and 521 min during spontaneous breathing. After elimination of movement artifacts the bias and 95 % limits of agreement for mechanical ventilation and spontaneous breathing were -0.12 (-1.76 to 1.51) and -0.59 (-5.82 to 4.63) breaths per minute respectively. The radar was able to accurately measure respiratory rate in mechanically ventilated patients, but the accuracy decreased during spontaneous breathing.
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J Clin Monit Comput · Dec 2016
A combination of experimental and finite element analyses of needle-tissue interaction to compute the stresses and deformations during injection at different angles.
One of the main clinical applications of the needles is its practical usage in the femoral vein catheterization. Annually more than two million peoples in the United States are exposed to femoral vein catheterization. How to use the input needles into the femoral vein has a key role in the sense of pain in post-injection and possible injuries, such as tissue damage and bleeding. ⋯ Experimental results were also well confirmed the numerical observations since the lowest pain score was seen at the angle of 90°. The results suggest that the most effective angle of injection would be 90° due to a lower amount of stresses and deformations compared to the other angles of injection. These findings may have implications not only for understating the stresses and deformations induced during injection around the needle-tissue interaction, but also to give an outlook to the doctors to implement the most suitable angle of injection in order to reduce the pain as well as post injury of the patients.
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J Clin Monit Comput · Dec 2016
Prediction of fluid responsiveness in the beach chair position using dynamic preload indices.
Hemodynamic instability in the beach chair position (BCP) may lead to adverse outcomes. Cardiac preload optimization is a prerequisite to improve hemodynamics. We evaluated the clinical usefulness of dynamic indices for the prediction of fluid responsiveness in BCP patients under general anesthesia. ⋯ Patients were considered responders to volume expansion if the stroke volume index increased by ≥15 %. The areas under receiver operating characteristic curves for SVV, PPV and PVI were 0.83, 0.81 and 0.74, respectively (p < 0.05), with the corresponding optimal cut-off values of 12, 15 and 10 %. SVV, PPV and PVI can be used to predict fluid responsiveness in the BCP under mechanical ventilation.