Journal of clinical monitoring and computing
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J Clin Monit Comput · Aug 2010
The effect of skin incision on the electroencephalogram during general anesthesia maintained with propofol or desflurane.
A variety of effects of surgical incision on the electroencephalogram (EEG) during modern general anesthesia have been previously described; including both increases and decreases in both high and low frequencies in the EEG. What are the patterns commonly seen during routine clinical anesthesia? ⋯ During anesthesia maintained with desflurane or propofol, surgical incision has modest effects on the EEG patterns. It does not cause an increase in high frequency power; the most consistent changes are a loss of EFA amplitude and burst suppression patterns. This effect is not strongly modified by the depth of anesthesia--as estimated by the BIS.
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J Clin Monit Comput · Aug 2010
Parallel particle filters for online identification of mechanistic mathematical models of physiology from monitoring data: performance and real-time scalability in simulation scenarios.
Combining mechanistic mathematical models of physiology with quantitative observations using probabilistic inference may offer advantages over established approaches to computerized decision support in acute care medicine. Particle filters (PF) can perform such inference successively as data becomes available. The potential of PF for real-time state estimation (SE) for a model of cardiovascular physiology is explored using parallel computers and the ability to achieve joint state and parameter estimation (JSPE) given minimal prior knowledge tested. ⋯ Parallelized PF's performance makes their application to complex mathematical models of physiology for the purpose of clinical data interpretation, prediction, and therapy optimization appear promising. JSPE in the described extremely underdetermined scenario nevertheless extracted information of potential clinical relevance from the data in this simulation setting. However, fully satisfactory resolution of this problem when minimal prior knowledge about parameter values is available will require further methodological improvements, which are discussed.
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J Clin Monit Comput · Jun 2010
Cardiac index measurements by transcutaneous Doppler ultrasound and transthoracic echocardiography in adult and pediatric emergency patients.
Non-invasive hemodynamic monitoring may facilitate resuscitation in critically ill patients. Validation studies examining a transcutaneous Doppler ultrasound technology, USCOM-1A, using pulmonary artery catheter as the reference standard showed varying results. In this study, we compared non-invasive cardiac index (CI) measurements by USCOM-1A with transthoracic echocardiography (TTE). ⋯ The USCOM-1A hemodynamic monitoring technology showed poor correlation and agreement to standard transthoracic echocardiography measures of cardiac function. The utility of USCOM-1A in the management of critically ill patients remains to be determined.
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Here we comment on the paper entitled "A novel laparoscopic pulse oximeter device. An easy, efficient and cost-effective way of detecting arterial structures." authored by Theodosopoulos et al., and recently published in the April issue of the Journal of Clinical Monitoring and Computing.
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J Clin Monit Comput · Jun 2010
Comparative StudyThe mean prehospital machine; accurate prehospital non-invasive blood pressure measurement in the critically ill patient.
Non-invasive blood pressure recordings may be inaccurate in the critically ill patient and measurement difficulties are intensified in the prehospital setting. This may adversely impact upon outcomes for many critically ill patients, particularly those with traumatic brain injury and/or lengthy prehospital times. This study aimed to validate a non-invasive, oscillometric, ambulatory blood pressure measuring device, the Oscar 2, Model 222 (SunTech Medical, Morrisville, USA) during the ambulance transport of critically ill patients. ⋯ When the Oscar 2 does not indicate a fault has occurred, clinicians may be confident the mean pressure, within acceptable limits, is accurate, even during ambulance motion, administration of high doses of vasopressors and mechanical ventilation. The Oscar 2 appears to be an accurate and rugged out-of-hospital device.