Journal of clinical monitoring and computing
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J Clin Monit Comput · Dec 2023
Arterial blood pressure waveform in liver transplant surgery possesses variability of morphology reflecting recipients' acuity and predicting short term outcomes.
We investigated clinical information underneath the beat-to-beat fluctuation of the arterial blood pressure (ABP) waveform morphology. We proposed the Dynamical Diffusion Map algorithm (DDMap) to quantify the variability of morphology. The underlying physiology could be the compensatory mechanisms involving complex interactions between various physiological mechanisms to regulate the cardiovascular system. As a liver transplant surgery contains distinct periods, we investigated its clinical behavior in different surgical steps. ⋯ The neohepatic phase variability of morphology was associated with EAF scores as well as postoperative bilirubin levels, international normalized ratio, aspartate aminotransferase levels, and platelet count. Furthermore, variability of morphology presents more associations with the above clinical conditions than the common BP measures and their BP variability indices. The variability of morphology obtained during the presurgical phase is indicative of patient acuity, whereas those during the neohepatic phase are indicative of short-term surgical outcomes.
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J Clin Monit Comput · Dec 2023
Quantifying physiological stability in the general ward using continuous vital signs monitoring: the circadian kernel density estimator.
Technological advances seen in recent years have introduced the possibility of changing the way hospitalized patients are monitored by abolishing the traditional track-and-trigger systems and implementing continuous monitoring using wearable biosensors. However, this new monitoring paradigm raise demand for novel ways of analyzing the data streams in real time. The aim of this study was to design a stability index using kernel density estimation (KDE) fitted to observations of physiological stability incorporating the patients' circadian rhythm. ⋯ The time of early warning for the EWS events were 2.8-5.5 h and 2.5 h for the SAEs. The results showed that for severe deviations in the vital signs, the circadian KDE model can alert multiple hours prior to deviations being noticed by the staff. Furthermore, the model shows good generalizability to another cohort and could be a simple way of continuously assessing patient deterioration in the general ward.
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J Clin Monit Comput · Dec 2023
Quantifying pulse oximeter accuracy during hypoxemia and severe anemia using an in vitro circulation system.
Anemia and hypoxemia are common clinical conditions that are difficult to study and may impact pulse oximeter performance. Utilizing an in vitro circulation system, we studied performance of three pulse oximeters during hypoxemia and severe anemia. Three oximeters including one benchtop, one handheld, and one fingertip device were selected to reflect a range of cost and device types. ⋯ The fingertip device was the least accurate of the three oximeters. Pulse oximeter performance is impacted by severe anemia in vitro. The use of in vitro calibration systems may play an important role in augmenting in vivo performance studies evaluating pulse oximeter performance in challenging conditions.
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J Clin Monit Comput · Dec 2023
Evaluation of the effectiveness of analgesia nociception index (ANI) predictability for surgical stimuli under personal analgesic sufficiency status (PASS) measured by pre-tetanus-induced ANI: a pilot study.
The Analgesia Nociception Index (ANI) is a promising monitor to evaluate the balance of nociception and anti-nociception based on heart rate variability. This prospective, interventional, monocentric pilot study aimed to verify the effectiveness of the personal analgesic sufficiency status (PASS) measured by pre-tetanus-induced ANI variation for surgical stimuli. After Ethics approval and informed consent, participants were anesthetized with sevoflurane and increased effect-site concentrations of remifentanil step by step (2, 4, 6 ng ml-1). ⋯ The PASS under pre-tetanus-induced ANI identification didn't meet the analgesic needs under surgical stimuli. Further investigations are required to provide a reliable prediction of individualized analgesia by objective nociception monitors. Trial registration NCT05063461.
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J Clin Monit Comput · Dec 2023
LetterTechnical note: pre-positioning lower limb SSEP during semi-sitting positioning in posterior fossa surgery- does it matter?
Intra-operative monitoring has been a crucial tool in modern neurosurgery as it allows to optimize surgical outcome whilst reducing neurological deficits. Somatosensory evoked potentials are routinely monitored in most spinal and brain surgeries due to providing invaluable information regarding the functional integrity of sensory pathways. ⋯ Nonetheless, we report a case study of a patient in whom lower limb SSEPs were independently affected from upper limb SSEPs during positioning. In this respect, we suggest that both upper and lower limb SSEPs monitoring should be considered during semi-sitting positioning in patients undergoing posterior fossa surgery.