Journal of clinical monitoring and computing
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J Clin Monit Comput · Dec 2022
Effect of near real-time feedback tool in the electronic medical record on protocol compliance during laparoscopic cholecystectomy: a single-center retrospective analysis.
Implementation of evidence-based medicine has proved difficult across medical fields. Leveraging the electronic medical record may improve clinician compliance to published best practices. Our hypothesis was that the use of a near real-time feedback tool would improve compliance to the protocol steps. ⋯ Individual protocol component compliance increased from 4994/8418 (59.3%) to 7669/8554 (89.7%) (p < 0.001). The near real-time feedback tool reduced the number of cases with every number of deviations (except zero) at p < 0.001. The near real-time feedback tool significantly improved protocol compliance for patients undergoing laparoscopic cholecystectomy.
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J Clin Monit Comput · Dec 2022
Validity of transcranial Doppler ultrasonography-determined dynamic cerebral autoregulation estimated using transfer function analysis.
Transcranial Doppler ultrasonography (TCD) is used widely to evaluate dynamic cerebral autoregulation (dCA). However, the validity of TCD-determined dCA remains unknown because TCD is only capable of measuring blood velocity and thus only provides an index as opposed to true blood flow. To test the validity of TCD-determined dCA, in nine healthy subjects, dCA was evaluated by transfer function analysis (TFA) using cerebral blood flow (CBF) or TCD-measured cerebral blood velocity during a perturbation that induces reductions in TCD-determined dCA, lower body negative pressure (LBNP) at two different stages: LBNP - 15 mmHg and - 50 mmHg. ⋯ In addition, the ICA Q-determined TFA LF ngain from rest to LBNP50 was significantly correlated with TCD-determined TFA LF ngain (r = 0.460, P = 0.016) despite a low intraclass correlation coefficient. Moreover, in the Bland-Altman analysis, the difference in the TFA LF ngains determined by blood flow and velocity was within the margin of error, indicating that the two measurement methods can be interpreted as equivalent. These findings suggest that TCD-determined dCA can be representative of actual dCA evaluated with CBF.
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J Clin Monit Comput · Dec 2022
Randomized Controlled TrialEvaluation of indigenously developed closed-loop automated blood pressure control system (claps): a preliminary study.
Closed-loop systems have been designed to assist anesthetists in controlling anesthetic drugs and also maintaining the stability of various physiological variables in the normal range. In the present study, we describe and clinically evaluated a novel closed-loop automated blood pressure control system (CLAPS) in patients undergoing cardiac surgery under cardiopulmonary bypass. Forty ASA II-IV adult patients undergoing elective cardiac surgery were randomly allocated to receive adrenaline, noradrenaline, phenylephrine and nitroglycerine (NTG) adjusted either through CLAPS (CLAPS group) or manually (Manual group). ⋯ The cardiac index and left ventricular end-diastolic area were comparable between the groups. Automated infusion of vasoactive drugs using CLAPS is feasible and also better than manual control for controlling hemodynamics during cardiac surgery. Trial registration number and date This trial was registered in the Clinical Trial Registry of India under Registration Number CTRI/2018/01/011487 (Retrospective; registration date; January 23, 2018).
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J Clin Monit Comput · Dec 2022
Observational StudyChanges in regional oxygen saturation of the kidney and brain of infants during hospitalization.
In pre-term infants, the postnatal changes in the regional oxygen saturation (rSO2) of the brain and kidney are unclear. ⋯ Unlike in most infants born after the late pre-term period, the renal rSO2 remained lower than the cerebral rSO2 on the expected date of birth in infants born very pre-term.
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J Clin Monit Comput · Dec 2022
Improvement in vocal-cord visualization with Trachway video intubating stylet using direct oxygen flow and effective analysis of the fraction of inspired oxygen: a bench study.
The Trachway video intubating stylet device facilitates the visualization of the airways of patients from the tip of an endotracheal tube (ETT) during intubation. The major limitations of Trachway are the restricted view due to secretions and the risk of a prolonged apnea during intubation. We conducted a bench study to verify the performance of an alternative, easily applicable airway device that allows better visualization of trackways during Trachway-assisted intubation and prevents the detrimental effects of apnea-related hypoxia. ⋯ The ODD, which can be easily coupled with Trachway stylets, enabled high-quality visualization during oxygen flows of 6-8 L/min, and higher FiO2 fractions were achieved at higher oxygen flow rates. The use of the ODD improved the visualization of the airways during video stylet-assisted intubations using the additional FiO2 supply. The ODD developed in this study improves the visualization of airways with Trachway stylets and enhances the safety of intubation.