Journal of clinical monitoring and computing
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J Clin Monit Comput · Jun 2013
Comparative Study Observational StudyCardiac output monitoring in septic shock: evaluation of the third-generation Flotrac-Vigileo.
Continuous cardiac index (CI) monitoring is frequently used in critically ill patients. Few studies have compared the pulse contour-based device FloTrac/Vigileo to pulmonary artery thermodilution (PAC) in terms of accuracy for CI monitoring in septic shock. The aim of our study was to compare the third-generation FloTrac/Vigileo to PAC in septic shock. ⋯ The overall correlation coefficient between PAC-CI and FloTrac/Vigileo CI was 0.47 (p < 0.01), with r(2) = 0.22. The area under the curve of the ROC curve for detecting concordant and significant changes in CI was 0.72 (0.53; 0.87). In our study, third-generation Flowtrac-Vigileo appears to be too inaccurate to be recommended for CI monitoring in septic shock.
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J Clin Monit Comput · Jun 2013
Randomized Controlled TrialThe effects of DEX premedication on volatile induction of mask anesthesia (VIMA) and sevoflurane requirements.
We investigated the effect of intravenous premedication with single dose of dexmedetomidine (DEX) on volatile anesthetic induction time and sevoflurane requirements of anesthesia maintenance in adults by monitoring the bispectral index (BIS). Sixty adult patients with status of ASA I-II undergoing general anesthesia with endotracheal intubation were randomly divided into two groups: The first group; a control group (group C, n = 30) and the second group; DEX group (group D, n = 30). Each patient in group D was premedicated with intravenous DEX 0.5 μg/kg or placebo 10 min before the induction of anesthesia. ⋯ Analgesic requirement was noted in postoperative 24 h-period. The time to induction of anesthesia (p < 0.0001) and Etsevoflurane at 1 min (p < 0.05) were significantly lower in group D than in group C. Intravenous premedication with 0.5 μg/kg of DEX decreased the induction time by almost 75 % and provided a significant decrease in Etsevoflurane.
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J Clin Monit Comput · Jun 2013
Randomized Controlled TrialStO₂ guided early resuscitation in subjects with severe sepsis or septic shock: a pilot randomised trial.
The scientific community has agreed upon developing accurate monitoring of tissue perfusion and oxygenation to improve the management of subjects with sepsis. This pilot study aimed to investigate the feasibility of targeting tissue oxygen saturation (StO₂) in addition to the currently recommended resuscitation goals, central venous pressure, mean arterial pressure and central venous oxygen saturation, in patients with severe sepsis or septic shock. A pilot, single-centre, randomised, non-blinded trial recruited 30 subjects with severe sepsis upon intensive care unit admission at an academic medical centre in France. ⋯ At study day 7, there were 5/15 (33.3 %) subjects who died or had a DSOFA > 0 in the experimental arm and 4/15 (26.6 %) who died or had a DSOFA > 0 in the control arm (p = 1.00). This pilot study was the first randomised controlled trial using an algorithm derived from the SSC recommendations, which included StO₂ as a treatment goal. However, the protocol showed no clear trend for or against targeting StO₂.
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A new application of photoplethysmography (PPG) has emerged recently to provide the possibility of heart rate monitoring without a telemetric chest strap. The aim of this study was to determine if a new device could detect pulsation over a broad range of skin types, and what light wavelength would be most suitable for detecting the signals. A light emitting diode-based PPG system was used to detect changes in pulsatile blood flow on 23 apparently healthy individuals (11 male and 12 female, 20-59 years old) of varying skin types classified according to a questionnaire in combination with digital photographs with a skin type chart. Four different light wavelengths (470, 520, 630, and 880 nm) were tested. Normalized modulation level is calculated as the AC/DC component ratio and represents the change in flow over the underlying constant state of flow or perfusion. ⋯ We concluded that a PPG-based device can detect pulsation across all skin types and that a greater resolution was obtained using a green light wavelength at rest and a green or blue light wavelength during exercise.
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J Clin Monit Comput · Jun 2013
A system for portable sleep apnea diagnosis using an embedded data capturing module.
Sleep apnea (SA) is a very common disease with serious health consequences, yet is very under-diagnosed, partially because of the high cost and limited accessibility of in-laboratory polysomnography (PSG). The purpose of this work is to introduce a newly developed portable system for the diagnosis of SA at home that is both reliable and easy to use. The system includes personal devices for recording breath sounds and airflow during sleep and diagnostic algorithms to process the recorded data. The data capturing device consists of a wearable face frame with an embedded electronic module featuring a unidirectional microphone, a differential microphone preamplifier, a microcontroller with an onboard differential analogue to digital converter, and a microSD memory card. The device provides continuous data capturing for 8 h. Upon completion of the recording session, the memory card is returned to a location for acoustic analysis. We recruited 49 subjects who used the device independently at home, after which each subject answered a usability questionnaire. Random data samples were selected to measure the signal-to-noise ratio (SNR) as a gauge of hardware functionality. A subset of 11 subjects used the device on 2 different nights and their results were compared to examine diagnostic reproducibility. Independent of those, system's performance was evaluated against PSG in the lab environment in 32 subject. The overall success rate of applying the device in un-attended settings was 94 % and the overall rating for ease-of-use was 'excellent'. Signal examination showed excellent capturing of breath sounds with an average SNR of 31.7 dB. Nine of the 11 (82 %) subjects had equivalent results on both nights, which is consistent with reported inter-night variability. The system showed 96 % correlation with simultaneously performed in-lab PSG. ⋯ Our results suggest excellent usability and performance of this system and provide a strong rationale to further improve it and test its robustness in a larger study.