Journal of clinical monitoring and computing
-
J Clin Monit Comput · Aug 2014
Randomized Controlled TrialComplex signals bioinformatics: evaluation of heart rate characteristics monitoring as a novel risk marker for neonatal sepsis.
Heart rate characteristics monitoring for early detection of late-onset neonatal sepsis was first described in 2003. This technique, which uses mathematical methods to report the fold-increase in the risk of imminent neonatal sepsis, adds independent information to laboratory tests and clinical findings, and, in a large randomized trial, reduced NICU mortality of very low birth weight infants. Through re-analysis and new secondary analyses of published studies, we have systematically evaluated the utility of this new risk marker for screening the growing population of premature infants. ⋯ Heart rate characteristics monitoring is a validated risk marker for sepsis in the NICU.
-
J Clin Monit Comput · Aug 2014
Poincaré plot analysis of autocorrelation function of RR intervals in patients with acute myocardial infarction.
The Poincaré plot of RR intervals (RRI) is obtained by plotting RRIn+1 against RRIn. The Pearson correlation coefficient (ρRRI), slope (SRRI), Y-intercept (YRRI), standard deviation of instantaneous beat-to-beat RRI variability (SD1RR), and standard deviation of continuous long-term RRI variability (SD2RR) can be defined to characterize the plot. Similarly, the Poincaré plot of autocorrelation function (ACF) of RRI can be obtained by plotting ACFk+1 against ACFk. ⋯ The ρACF and SACF correlated significantly and negatively with normalized high-frequency power (nHFP), and significantly and positively with normalized very low-frequency power (nVLFP) of heart rate variability in both groups of patients. On the contrary, the RMSSDACF/SDACF and SD1ACF/SD2ACF correlated significantly and positively with nHFP, and significantly and negatively with nVLFP and low-/high-frequency power ratio (LHR) in both groups of patients. We concluded that the ρACF, SACF, RMSSDACF/SDACF, and SD1ACF/SD2ACF, among many other indices of ACF Poincaré plot, can be used to differentiate between patients with AMI and patients with PCA, and that the increase in ρACF and SACF and the decrease in RMSSDACF/SDACF and SD1ACF/SD2ACF suggest an increased sympathetic and decreased vagal modulations in both groups of patients.
-
J Clin Monit Comput · Aug 2014
Randomized Controlled TrialThe effect of desflurane versus propofol on regional cerebral oxygenation in the sitting position for shoulder arthroscopy.
The sitting position may cause significant hemodynamic instability and cerebral hypoperfusion. We investigated the effects of desflurane and propofol on regional cerebral oxygenation (rSO2) in the sitting position during arthroscopic shoulder surgery. Forty patients undergoing arthroscopic shoulder surgery in the sitting position were randomly allocated to the desflurane group (n = 20) or the propofol group (n = 20). ⋯ The incidence of rSO2 <75% of the baseline values after the sitting position was similar between the groups (0 and 10% in the desflurane and propofol group, respectively, P = 0.487). When anesthetized patients were raised to the sitting position, desflurane preserved cerebral oxygenation better than propofol at equipotent concentrations in terms of BIS. However, both anesthetics were associated with significant decrease in the rSO2 values during the sitting position.
-
J Clin Monit Comput · Aug 2014
LetterContinuous real time endotracheal tube cuff pressure waveform.
Endotracheal tube cuff pressure monitoring is one of the standard degrees of care afforded to anesthetized patients in the operative theater. Traditional pressure transducer when used to monitor cuff pressure provides real time continuous sine wave pressure waveform which has not been described in literature so far. This unique waveform needs to be further processed and evaluated to check its utility in airway pressure monitoring.
-
Intense neuromuscular blockade (NMB) measured by post tetanic count (PTC) was monitored, reversed and verified in this pig model. In a cross-over assessor blinded design six pigs were randomized to either no NMB followed by intense NMB, or intense NMB followed by no NMB. Neuromuscular measurements were performed with acceleromyography [train-of-four (TOF) Watch SX]. ⋯ We established a pig model for monitoring intense NMB with surface stimulation electrodes and acceleromyography. We verified total relaxation of the diaphragm and the abdominal muscles at the PTC 0-1 by suction test and with surface electromyography. This pig model is suitable for studies with experimental abdominal surgery with monitoring of intense NMB, and where relaxation of the diaphragm and the abdominal muscles are required.