Journal of clinical monitoring and computing
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J Clin Monit Comput · Feb 2024
ReviewPredictor role of heart rate variability in subarachnoid hemorrhage: A systematic review.
Background- Subarachnoid hemorrhage (SAH) is one of the most devastating diseases with a high rate of morbidity and mortality. The heart rate variability (HRV) is a non-invasive method of monitoring various components of the autonomic nervous system activity that can be utilized to delineate autonomic dysfunctions associated with various physiological and pathological conditions. The reliability of HRV as a predictor of clinical outcome in aneurysmal subarachnoid hemorrhage (aSAH) is not yet well investigated in literature. ⋯ Results- This systematic review demonstrates a correlation between early changes in HRV indices (time and frequency domain) and the development of neuro-cardiogenic complications and poor neurologic outcome in patients with SAH. Conclusions- A correlation between absolute values or changes of the LF/HF ratio and neurologic and cardiovascular complications was found in multiple studies. Because of significant limitations of included studies, a large prospective study with proper handling of confounders is needed to generate high-quality recommendations regarding HRV as a predictor of post SAH complications and poor neurologic outcome.
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J Clin Monit Comput · Feb 2024
Randomized Controlled TrialEffect of paratracheal pressure on the effectiveness of mask ventilation in obese anesthetized patients: a randomized, cross-over study.
Paratracheal pressure has been recently suggested to compress and occlude the upper esophagus at the lower left paratracheal region to prevent gastric regurgitation alternative to cricoid pressure. It also prevents gastric insufflation. The aim of this randomized cross-over study was to investigate the effectiveness of paratracheal pressure on mask ventilation in obese anesthetized paralyzed patients. ⋯ Hypoxemia did not occur in any of the patients during mask ventilation with or without paratracheal pressure. The application of paratracheal pressure significantly increased both the expiratory tidal volume and peak inspiratory pressure during face-mask ventilation with a volume-controlled mode in obese anesthetized paralyzed patients. Gastric insufflation was not evaluated in this study during mask ventilation with or without paratracheal pressure.
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J Clin Monit Comput · Feb 2024
Randomized Controlled TrialTight control of mean arterial pressure using a closed loop system for norepinephrine infusion after high-risk abdominal surgery: a randomized controlled trial.
Intensive care unit (ICU) nurses frequently manually titrate norepinephrine to maintain a predefined mean arterial pressure (MAP) target after high-risk surgery. However, achieving this task is often suboptimal. We have developed a closed-loop vasopressor (CLV) controller to better maintain MAP within a narrow range. ⋯ Percentage time with MAP under 80 mmHg (1 [0-5]% vs. 26 [16-75]%, p < 0.001) and MAP under 65 mmHg (0 [0-0]% vs. 0 [0-4]%, p = 0.017) were both lower in the CLV group than in the control group. The percentage of time with a MAP > 90 mmHg was not statistically different between groups. In patients admitted to the ICU after high-risk abdominal surgery, closed-loop control of norepinephrine infusion better maintained a MAP target of 80 to 90 mmHg and significantly decreased postoperative hypotensive when compared to manual norepinephrine titration.
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J Clin Monit Comput · Feb 2024
Separation of responsive and unresponsive patients under clinical conditions: comparison of symbolic transfer entropy and permutation entropy.
Electroencephalogram (EEG)-based monitoring during general anesthesia may help prevent harmful effects of high or low doses of general anesthetics. There is currently no convincing evidence in this regard for the proprietary algorithms of commercially available monitors. The purpose of this study was to investigate whether a more mechanism-based parameter of EEG analysis (symbolic transfer entropy, STE) can separate responsive from unresponsive patients better than a strictly probabilistic parameter (permutation entropy, PE) under clinical conditions. In this prospective single-center study, the EEG of 60 surgical ASA I-III patients was recorded perioperatively. ⋯ For the combination of LoR and RoR, values were 0.65 (0.59-0.71) for STE and 0.68 (0.62-0.74) for PE. The ability to differentiate between the clinical status of (un)responsiveness did not significantly differ between STE and PE at any time. Mechanism-based EEG analysis did not improve differentiation of responsive from unresponsive patients compared to the probabilistic PE. Trial registration: German Clinical Trials Register ID: DRKS00030562, November 4, 2022, retrospectively registered.
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J Clin Monit Comput · Feb 2024
Effects of the intermittent intrapulmonary deflation technique on expiratory flow limitation: an in vitro study.
The intermittent intrapulmonary deflation (IID) technique is a recent airway clearance technique that intends to delay the onset of expiratory flow limitation (EFL) during exhalation. We showed in a previous study that IID increased the expiratory volume of COPD patients compared to quiet breathing and positive expiratory pressure (PEP) therapy. We hypothesized that it was due to the attenuation of the EFL. ⋯ The IID and PEP attenuate EFL and increase exhaled volume in the in vitro model.