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Faldaas BO, Nielsen EW, Storm BS, Lappegård KT, Nilsen BA, Kiss G, Skogvoll E, Torp H, Ingul CB. Real-time feedback on chest compression efficacy by hands-free carotid Doppler in a porcine model. Resusc Plus 2024; 18:100583. [PMID: 38404755 PMCID: PMC10885784 DOI: 10.1016/j.resplu.2024.100583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/30/2024] [Accepted: 02/08/2024] [Indexed: 02/27/2024] Open
Abstract
Aim Current guidelines for cardiopulmonary resuscitation (CPR) recommend a one-size-fits-all approach in relation to the positioning of chest compressions. We recently developed RescueDoppler, a hands-free Doppler ultrasound device for continuous monitoring of carotid blood flow velocity during CPR. The aim of the present study is to investigate whether RescueDoppler via real-time hemodynamic feedback, could identify both optimal and suboptimal compression positions. Methods In this model of animal cardiac arrest, we induced ventricular fibrillation in five domestic pigs. Manual chest compressions were performed for ten seconds at three different positions on the sternum in random order and repeated six times. We analysed Time Average Velocity (TAV) with chest compression position as a fixed effect and animal, position, and sequential time within animals as random effects. Furthermore, we compared TAV to invasive blood pressure from the contralateral carotid artery. Results We were able to detect changes in TAV when altering positions. The positions with the highest (range 19 to 48 cm/s) and lowest (6-25 cm/s) TAV were identified in all animals, with corresponding peak pressure 50-81 mmHg, and 46-64 mmHg, respectively. Blood flow velocity was, on average, highest at the middle position (TAV 33 cm/s), but with significant variability between animals (SD 2.8) and positions within the same animal (SD 9.3). Conclusion RescueDoppler detected TAV changes during CPR with alternating chest compression positions, identifying the position yielding maximal TAV. Future clinical studies should investigate if RescueDoppler can be used as a real-time hemodynamical feedback device to guide compression position.
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Affiliation(s)
- Bjørn Ove Faldaas
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Erik Waage Nielsen
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
- Department of Clinical Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
- Department of Surgery, Nordland Hospital Trust, Bodø, Norway
- Department of Pain Management and Research, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Benjamin Stage Storm
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
- Department of Clinical Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
- Department of Surgery, Nordland Hospital Trust, Bodø, Norway
| | - Knut Tore Lappegård
- Department of Clinical Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
- Department of Medicine, Nordland Hospital Trust, Bodø, Norway
| | - Bent Aksel Nilsen
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
- Department of Surgery, Nordland Hospital Trust, Bodø, Norway
| | - Gabriel Kiss
- Department of Computer Science (IDI), Faculty of Information Technology and Electrical Engineering, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Eirik Skogvoll
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Clinic of Anesthesia and Intensive Care Medicine, St Olav University Hospital, Trondheim, Norway
| | - Hans Torp
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Charlotte Björk Ingul
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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Li B, Yue L, Nie H, Cao Z, Chai X, Peng B, Zhang T, Huang W. The effect of intelligent management interventions in intensive care units to reduce false alarms: An integrative review. Int J Nurs Sci 2024; 11:133-142. [PMID: 38352290 PMCID: PMC10859571 DOI: 10.1016/j.ijnss.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 12/03/2023] [Accepted: 12/11/2023] [Indexed: 02/16/2024] Open
Abstract
Objective In intensive care units (ICU), frequent false alarms from medical equipment can cause alarm fatigue among nurses, which might lead to delayed or missed responses and increased risk of adverse patient events. This review was conducted to evaluate the effectiveness of intelligent management interventions to reduce false alarms in ICU. Method Following the framework of Whitmore and Knafl, the reviewers systematically searched six databases: PubMed, EMBASE, CINAHL, OVID, Cochrane Library, and Scopus, and studies included intelligent management of clinical alarms published in the English or Chinese language from the inception of each database to December 2022 were retrieved. The researchers used the PICOS framework to formulate the search strategy, developed keywords, screened literature, and assessed the studies' quality using the Joanna Briggs Institute-Meta-Analysis of Statistics, Assessment, and Review Instrument (JBI-MAStARI). The review was preregistered on PROSPERO (CRD42023411552). Results Seven studies met the inclusion criteria. The results showed that different interventions for intelligent management of alarms were beneficial in reducing the number of false alarms, the duration of alarms, the response time to important alarms for nurses, and the alarm fatigue levels among nurses. Positive results were found in practice after the application of the novel alarm management approaches. Conclusion Intelligent management intervention may be an effective way to reduce false alarms. The application of systems or tools for the intelligent management of clinical alarms is urgent in hospitals. To ensure more effective patient monitoring and less distress for nurses, more alarm management approaches combined with artificial intelligence will be needed in the future to enable accurate identification of critical alarms, ensure nurses are responding accurately to alarms, and make a real difference to alarm-ridden healthcare environments.
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Affiliation(s)
- Bingyu Li
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Liqing Yue
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Huiyu Nie
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Ziwei Cao
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Xiaoya Chai
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Bin Peng
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Tiange Zhang
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Weihong Huang
- “Mobile Health” Ministry of Education - China Mobile Joint Laboratory, Xiangya Hospital of Central South University, Changsha, Hunan, China
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Thekkan KR, Genna C, Ferro F, Cecchetti C, Dall'Oglio I, Tiozzo E, Raponi M, Gawronski O. Pediatric vital signs monitoring in hospital wards: Recognition systems and factors influencing nurses' attitudes and practices. J Pediatr Nurs 2023; 73:e602-e611. [PMID: 37977971 DOI: 10.1016/j.pedn.2023.10.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/31/2023] [Accepted: 10/31/2023] [Indexed: 11/19/2023]
Abstract
AIMS To describe: 1) systems in place for recognition and response to deteriorating children in Italy, 2) attitudes and practices of registered nurses (RN) towards vital signs (VS) monitoring in pediatric wards, 3) the associations of nurses attitudes and pratices with nurses' and organizational characteristics. DESIGN AND METHODS A multicentre cross-sectional correlational study. Data were collected between January-May 2020 using: an adapted version of the 'Survey on Recognition and Response Systems in Australia', and the 'Ped-V Scale'. Descriptive and adjusted linear regression analysis was performed, accounting for clustering. RESULTS Ten Italian hospitals participated, 432 RNs responded to the Ped-V scale (response rate = 52%). Five (50%) hospitals had a VS policy in place, three hospitals (30%) had a Pediatric Early Warning System (PEWS), almost all hospitals had a system in place to respond to deteriorating children. Following multivariate regression analysis, having a PEWS was significantly associated with Ped-V scale 'Workload', 'Clinical competence', 'Standardization' dimensions; gender was associated with 'key indicators' and pediatric surgical ward with 'Clinical competence'. CONCLUSIONS The use of VS policies and PEWS was not consistent across hospitals caring for children in Italy. Nurses' attitudes and practices (i.e., perception of workload, and clinical competence) were significantly lower in hospitals with increased complexity of care/PEWS. Gender was significantly associated with knowledge scores. PRACTICE IMPLICATIONS System strategies to improve nurses' attitudes and practices towards VS monitoring and education are warranted to support effective behaviors towards VS monitoring, their interpretation, and appropriate communication to activate the efferent limb of the rapid response system.
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Affiliation(s)
- Kiara Ros Thekkan
- Professional Development, Continuing Education and Research Unit, Medical Directorate, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Catia Genna
- Professional Development, Continuing Education and Research Unit, Medical Directorate, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Federico Ferro
- Professional Development, Continuing Education and Research Unit, Medical Directorate, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Corrado Cecchetti
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Immacolata Dall'Oglio
- Professional Development, Continuing Education and Research Unit, Medical Directorate, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Emanuela Tiozzo
- Professional Development, Continuing Education and Research Unit, Medical Directorate, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | | | - Orsola Gawronski
- Professional Development, Continuing Education and Research Unit, Medical Directorate, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
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Erklauer JC, Lai YC. The State of the Field of Pediatric Multimodality Neuromonitoring. Neurocrit Care 2023:10.1007/s12028-023-01858-3. [PMID: 37864125 DOI: 10.1007/s12028-023-01858-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 09/08/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND The use of multimodal neuromonitoring in pediatrics is in its infancy relative to adult neurocritical care. Multimodal neuromonitoring encompasses the amalgamation of information from multiple individual neuromonitoring devices to gain a more comprehensive understanding of the condition of the brain. It allows for adaptation to the changing state of the brain throughout various stages of injury with potential to individualize and optimize therapies. METHODS Here we provide an overview of multimodal neuromonitoring in pediatric neurocritical care and its potential application in the future. RESULTS Multimodal neuromonitoring devices are key to the process of multimodal neuromonitoring, allowing for visualization of data trends over time and ideally improving the ability of clinicians to identify patterns and find meaning in the immense volume of data now encountered in the care of critically ill patients at the bedside. Clinical use in pediatrics requires more study to determine best practices and impact on patient outcomes. Potential uses include guidance for targets of physiological parameters in the setting of acute brain injury, neuroprotection for patients at high risk for brain injury, and neuroprognostication. Implementing multimodal neuromonitoring in pediatric patients involves interprofessional collaboration with the development of a simultaneous comprehensive program to support the use of multimodal neuromonitoring while maintaining the fundamental principles of the delivery of neurocritical care at the bedside. CONCLUSIONS The possible benefits of multimodal neuromonitoring are immense and have great potential to advance the field of pediatric neurocritical care and the health of critically ill children.
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Affiliation(s)
- Jennifer C Erklauer
- Divisions of Critical Care Medicine and Pediatric Neurology and Developmental Neurosciences, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA.
| | - Yi-Chen Lai
- Division of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
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Lee BH, Quillet E, Rigaudeau D, Dechamp N, Duchaud E, Bernardet JF, Boudinot P, Rochat T. Interplay between a bacterial pathogen and its host in rainbow trout isogenic lines with contrasted susceptibility to cold water disease. Microbes Infect 2023; 25:105140. [PMID: 37062327 DOI: 10.1016/j.micinf.2023.105140] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/04/2023] [Accepted: 04/12/2023] [Indexed: 04/18/2023]
Abstract
Infectious diseases are a major constraint on aquaculture. Genetic lines with different susceptibilities to diseases are useful models to identify resistance mechanisms to pathogens and to improve prophylaxis. Bacterial cold-water disease (BCWD) caused by Flavobacterium psychrophilum represents a major threat for freshwater salmonid farming worldwide. A collection of rainbow trout (Oncorhynchus mykiss) isogenic lines was previously produced from a French domestic population. Here, we compared BCWD resistance phenotypes using a subset of isogenic lines chosen for their contrasted susceptibilities to F. psychrophilum. We applied individual monitoring to document the infection process, including time-course quantification of bacteremia and innate immune response. Strikingly, BCWD resistance was correlated with a lower bacterial growth rate in blood. Several immune genes were expressed at higher levels in resistant fish regardless of infection: the Type II arginase (arg2), a marker for M2 macrophages involved in anti-inflammatory responses and tissue repair, and two Toll-like receptors (tlr2/tlr7), responsible for pathogen detection and inflammatory responses. This study highlights the importance of innate and intrinsic defense mechanisms in determining the outcome of F. psychrophilum infections, and illustrates that non-lethal time-course blood sampling for individual monitoring of bacteremia is a powerful tool to resolve within-host pathogen behavior in bacterial fish diseases.
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Affiliation(s)
- Bo-Hyung Lee
- Université Paris-Saclay, INRAE, UVSQ, VIM, Jouy-en-Josas, France
| | - Edwige Quillet
- Université Paris-Saclay, INRAE, GABI, Jouy-en-Josas, France
| | | | | | - Eric Duchaud
- Université Paris-Saclay, INRAE, UVSQ, VIM, Jouy-en-Josas, France
| | | | - Pierre Boudinot
- Université Paris-Saclay, INRAE, UVSQ, VIM, Jouy-en-Josas, France.
| | - Tatiana Rochat
- Université Paris-Saclay, INRAE, UVSQ, VIM, Jouy-en-Josas, France.
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Kienzle MF, Morgan RW, Alvey JS, Reeder R, Berg RA, Nadkarni V, Topjian AA, Lasa JJ, Raymond TT, Sutton RM. Clinician-reported physiologic monitoring of cardiopulmonary resuscitation quality during pediatric in-hospital cardiac arrest: A propensity-weighted cohort study. Resuscitation 2023; 188:109807. [PMID: 37088272 PMCID: PMC10773163 DOI: 10.1016/j.resuscitation.2023.109807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/31/2023] [Accepted: 04/17/2023] [Indexed: 04/25/2023]
Abstract
AIMS The primary objective was to determine the association between clinician-reported use of end-tidal CO2 (ETCO2) or diastolic blood pressure (DBP) to monitor cardiopulmonary resuscitation (CPR) quality during pediatric in-hospital cardiac arrest (pIHCA) and survival outcomes. DESIGN A retrospective cohort study was performed in two cohorts: (1) Patients with an invasive airway in place at the time of arrest to evaluate ETCO2 use, and (2) patients with an arterial line in place at the time of arrest to evaluate DBP use. The primary exposure was clinician-reported use of ETCO2 or DBP. The primary outcome was return of spontaneous circulation (ROSC). Propensity-weighted logistic regression evaluated the association between monitoring and outcomes. SETTING Hospitals reporting to the American Heart Association's Get With The Guidelines®- Resuscitation registry (2007-2021). PATIENTS Children with index IHCA with an invasive airway or arterial line at the time of arrest. RESULTS Between January 2007 and May 2021, there were 15,280 pediatric CPR events with an invasive airway or arterial line in place at the time of arrest. Of 7159 events with an invasive airway, 6829 were eligible for analysis. Of 2978 events with an arterial line, 2886 were eligible. Clinicians reported using ETCO2 in 1335/6829 (20%) arrests and DBP in 1041/2886 (36%). Neither exposure was associated with ROSC. ETCO2 monitoring was associated with higher odds of 24-hour survival (aOR 1.17 [1.02, 1.35], p = 0.03). CONCLUSIONS Neither clinician-reported ETCO2 monitoring nor DBP monitoring during pIHCA were associated with ROSC. Monitoring of ETCO2 was associated with 24-hour survival.
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Affiliation(s)
- Martha F Kienzle
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States.
| | - Ryan W Morgan
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Jessica S Alvey
- Department of Pediatrics, University of Utah, Salt Lake City, UT, United States
| | - Ron Reeder
- Department of Pediatrics, University of Utah, Salt Lake City, UT, United States
| | - Robert A Berg
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Vinay Nadkarni
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Alexis A Topjian
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Javier J Lasa
- Department of Pediatrics, Children's Medical Center, University of Texas - Southwestern, Dallas, TX, United States
| | - Tia T Raymond
- Department of Pediatrics, Medical City Children's Hospital, Dallas, TX, United States
| | - Robert M Sutton
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
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Gomez LA, Shen Q, Doyle K, Vrosgou A, Velazquez A, Megjhani M, Ghoshal S, Roh D, Agarwal S, Park S, Claassen J, Kleinberg S. Classification of Level of Consciousness in a Neurological ICU Using Physiological Data. Neurocrit Care 2023; 38:118-128. [PMID: 36109448 PMCID: PMC9935697 DOI: 10.1007/s12028-022-01586-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 08/08/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Impaired consciousness is common in intensive care unit (ICU) patients, and an individual's degree of consciousness is crucial to determining their care and prognosis. However, there are no methods that continuously monitor consciousness and alert clinicians to changes. We investigated the use of physiological signals collected in the ICU to classify levels of consciousness in critically ill patients. METHODS We studied 61 patients with subarachnoid hemorrhage (SAH) and 178 patients with intracerebral hemorrhage (ICH) from the neurological ICU at Columbia University Medical Center in a retrospective observational study of prospectively collected data. The level of consciousness was determined on the basis of neurological examination and mapped to comatose, vegetative state or unresponsive wakefulness syndrome (VS/UWS), minimally conscious minus state (MCS-), and command following. For each physiological signal, we extracted time-series features and performed classification using extreme gradient boosting on multiple clinically relevant tasks across subsets of physiological signals. We applied this approach independently on both SAH and ICH patient groups for three sets of variables: (1) a minimal set common to most hospital patients (e.g., heart rate), (2) variables available in most ICUs (e.g., body temperature), and (3) an extended set recorded mainly in neurological ICUs (absent for the ICH patient group; e.g., brain temperature). RESULTS On the commonly performed classification task of VS/UWS versus MCS-, we achieved an area under the receiver operating characteristic curve (AUROC) in the SAH patient group of 0.72 (sensitivity 82%, specificity 57%; 95% confidence interval [CI] 0.63-0.81) using the extended set, 0.69 (sensitivity 83%, specificity 51%; 95% CI 0.59-0.78) on the variable set available in most ICUs, and 0.69 (sensitivity 56%, specificity 78%; 95% CI 0.60-0.78) on the minimal set. In the ICH patient group, AUROC was 0.64 (sensitivity 56%, specificity 65%; 95% CI 0.55-0.74) using the minimal set and 0.61 (sensitivity 50%, specificity 80%; 95% CI 0.51-0.71) using the variables available in most ICUs. CONCLUSIONS We find that physiological signals can be used to classify states of consciousness for patients in the ICU. Building on this with intraday assessments and increasing sensitivity and specificity may enable alarm systems that alert physicians to changes in consciousness and frequent monitoring of consciousness throughout the day, both of which may improve patient care and outcomes.
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Affiliation(s)
- Louis A Gomez
- Stevens Institute of Technology, 1 Castle Point on Hudson, Hoboken, NJ, 07030, USA
| | - Qi Shen
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Kevin Doyle
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Athina Vrosgou
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Angela Velazquez
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Murad Megjhani
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Shivani Ghoshal
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
- New York Presbyterian Hospital, New York, NY, USA
| | - David Roh
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
- New York Presbyterian Hospital, New York, NY, USA
| | - Sachin Agarwal
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
- New York Presbyterian Hospital, New York, NY, USA
| | - Soojin Park
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
- New York Presbyterian Hospital, New York, NY, USA
| | - Jan Claassen
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
- New York Presbyterian Hospital, New York, NY, USA
| | - Samantha Kleinberg
- Stevens Institute of Technology, 1 Castle Point on Hudson, Hoboken, NJ, 07030, USA.
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Lee JKW, Tan B, Kingma BRM, Haman F, Epstein Y. Biomarkers for warfighter safety and performance in hot and cold environments. J Sci Med Sport 2022:S1440-2440(22)00503-5. [PMID: 36623995 DOI: 10.1016/j.jsams.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 12/06/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022]
Abstract
Exposure to extreme environmental heat or cold during military activities can impose severe thermal strain, leading to impairments in task performance and increasing the risk of exertional heat (including heat stroke) and cold injuries that can be life-threatening. Substantial individual variability in physiological tolerance to thermal stress necessitates an individualized approach to mitigate the deleterious effects of thermal stress, such as physiological monitoring of individual thermal strain. During heat exposure, measurements of deep-body (Tc) and skin temperatures and heart rate can provide some indication of thermal strain. Combining these physiological variables with biomechanical markers of gait (in)stability may provide further insight on central nervous system dysfunction - the key criterion of exertional heat stroke (EHS). Thermal strain in cold environments can be monitored with skin temperature (peripheral and proximal), shivering thermogenesis and Tc. Non-invasive methods for real-time estimation of Tc have been developed and some appear to be promising but require further validation. Decision-support tools provide useful information for planning activities and biomarkers can be used to improve their predictions, thus maximizing safety and performance during hot- and cold-weather operations. With better understanding on the etiology and pathophysiology of EHS, the microbiome and markers of the inflammatory responses have been identified as novel biomarkers of heat intolerance. This review aims to (i) discuss selected physiological and biomechanical markers of heat or cold strain, (ii) how biomarkers may be used to ensure operational readiness in hot and cold environments, and (iii) present novel molecular biomarkers (e.g., microbiome, inflammatory cytokines) for preventing EHS.
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Rigot SK, Boninger ML, Ding D, Collinger JL, Dicianno BE, Worobey LA. Limb accelerations during sleep are related to measures of strength, sensation, and spasticity among individuals with spinal cord injury. J Neuroeng Rehabil 2022; 19:118. [PMID: 36329467 DOI: 10.1186/s12984-022-01090-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 09/08/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND To evaluate the relationship between measures of neuromuscular impairment and limb accelerations (LA) collected during sleep among individuals with chronic spinal cord injury (SCI) to provide evidence of construct and concurrent validity for LA as a clinically meaningful measure. METHODS The strength (lower extremity motor score), sensation (summed lower limb light touch scores), and spasticity (categorized lower limb Modified Ashworth Scale) were measured from 40 adults with chronic (≥ 1 year) SCI. Demographics, pain, sleep quality, and other covariate or confounding factors were measured using self-report questionnaires. Each participant then wore ActiGraph GT9X Link accelerometers on their ankles and wrist continuously for 1-5 days to measure LA from movements during sleep. Regression models with built-in feature selection were used to determine the most relevant LA features and the association to each measure of impairment. RESULTS LA features were related to measures of impairment with models explaining 69% and 73% of the variance (R²) in strength and sensation, respectively, and correctly classifying 81.6% (F1-score = 0.814) of the participants into spasticity categories. The most commonly selected LA features included measures of power and frequency (frequency domain), movement direction (correlation between axes), consistency between movements (relation to recent movements), and wavelet energy (signal characteristics). Rolling speed (change in angle of inclination) and movement smoothness (median crossings) were uniquely associated with strength. When LA features were included, an increase of 72% and 222% of the variance was explained for strength and sensation scores, respectively, and there was a 34% increase in spasticity classification accuracy compared to models containing only covariate features such as demographics, sleep quality, and pain. CONCLUSION LA features have shown evidence of having construct and concurrent validity, thus demonstrating that LA are a clinically-relevant measure related to lower limb strength, sensation, and spasticity after SCI. LA may be useful as a more detailed measure of impairment for applications such as clinical prediction models for ambulation.
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Gawronski O, Biagioli V, Dall'oglio I, Cecchetti C, Ferro F, Tiozzo E, Raponi M. Attitudes and practices towards vital signs monitoring on paediatric wards: Cross-validation of the Ped-V scale. J Pediatr Nurs 2022; 65:98-107. [PMID: 35410733 DOI: 10.1016/j.pedn.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/15/2022] [Accepted: 03/21/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE To develop and psychometrically test an instrument measuring the attitudes and practices towards vital signs (VS) monitoring in nurses caring for children on paediatric wards (Ped-V scale). DESIGN AND METHODS This is a multicentre cross-validation study with a cross-sectional design. The Ped-V scale was developed by adapting the V-scale to the paediatric context and administered to a convenience sample of clinical nurses working in paediatric wards from January to May 2020. The content validity of the Ped-V scale was evaluated by a group of 10 experts. The psychometric properties of the scale were tested through Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA). RESULTS Overall, 10 Italian hospitals participated in the study, and 640 questionnaires were completed (87% female). At EFA a 30-item version of the scale and four factors emerged. This solution was confirmed at CFA: F1) 'Inaccuracy of VS monitoring and workload'; F2) 'Clinical competence and communication'; F3) 'Standardization and protocol adherence'; F4) 'Misconceptions about key indicators'. Cronbach's alpha ranged between 0.63 and 0.85. CONCLUSIONS The Ped-V scale is valid and reliable for use in the paediatric context to identify barriers concerning nurses' self-efficacy, competences, and knowledge of clinical indicators of paediatric critical deterioration, attitudes towards accuracy, standardization, communication to senior team members and the appropriate use of technology in paediatric VS monitoring. PRACTICE IMPLICATIONS The Ped-V scale may assist in identifying gaps in nurses' attitudes and devising strategies to change nurses' beliefs, knowledge, skills and decreasing individual, local cultural or organizational barriers towards VS monitoring.
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Affiliation(s)
- Orsola Gawronski
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Valentina Biagioli
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Immacolata Dall'oglio
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Corrado Cecchetti
- Pediatric Intensive Care Unit, Department of Critical Care, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Federico Ferro
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy
| | - Emanuela Tiozzo
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Massimiliano Raponi
- Medical Directorate, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
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Moberg R, Moyer EJ, Olson D, Rosenthal E, Foreman B. Harmonization of Physiological Data in Neurocritical Care: Challenges and a Path Forward. Neurocrit Care 2022. [PMID: 35641807 DOI: 10.1007/s12028-022-01524-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 04/20/2022] [Indexed: 10/18/2022]
Abstract
Continuous multimodal monitoring in neurocritical care provides valuable insights into the dynamics of the injured brain. Unfortunately, the "readiness" of this data for robust artificial intelligence (AI) and machine learning (ML) applications is low and presents a significant barrier for advancement. Harmonization standards and tools to implement those standards are key to overcoming existing barriers. Consensus in our professional community is essential for success.
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12
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Giannì G, Minini A, Fratino S, Peluso L, Annoni F, Oddo M, Schuind S, Creteur J, Taccone FS, Bogossian EG. The Impact of Short-Term Hyperoxia on Cerebral Metabolism: A Systematic Review and Meta-Analysis. Neurocrit Care 2022. [PMID: 35641804 DOI: 10.1007/s12028-022-01529-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 04/26/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Cerebral ischemia due to hypoxia is a major cause of secondary brain injury and is associated with higher morbidity and mortality in patients with acute brain injury. Hyperoxia could improve energetic dysfunction in the brain in this setting. Our objectives were to perform a systematic review and meta-analysis of the current literature and to assess the impact of normobaric hyperoxia on brain metabolism by using cerebral microdialysis. METHODS We searched Medline and Scopus, following the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement; we searched for retrospective and prospective observational studies, interventional studies, and randomized clinical trials that performed a hyperoxia challenge in patients with acute brain injury who were concomitantly monitored with cerebral microdialysis. This study was registered in PROSPERO (CRD420211295223). RESULTS We included a total of 17 studies, with a total of 311 patients. A statistically significant reduction in cerebral lactate values (pooled standardized mean difference [SMD] - 0.38 [- 0.53 to - 0.23]) and lactate to pyruvate ratio values (pooled SMD - 0.20 [- 0.35 to - 0.05]) was observed after hyperoxia. However, glucose levels (pooled SMD - 0.08 [- 0.23 to 0.08]) remained unchanged after hyperoxia. CONCLUSIONS Normobaric hyperoxia may improve cerebral metabolic disturbances in patients with acute brain injury. The clinical impact of such effects needs to be further elucidated.
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Bawua LK, Miaskowski C, Suba S, Badilini F, Mortara D, Hu X, Rodway GW, Hoffmann TJ, Pelter MM. Agreement between respiratory rate measurement using a combined electrocardiographic derived method versus impedance from pneumography. J Electrocardiol 2021; 71:16-24. [PMID: 35007832 DOI: 10.1016/j.jelectrocard.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 12/15/2021] [Accepted: 12/20/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Impedance pneumography (IP) is the current device-driven method used to measure respiratory rate (RR) in hospitalized patients. However, RR alarms are common and contribute to alarm fatigue. While RR derived from electrocardiographic (ECG) waveforms hold promise, they have not been compared to the IP method. PURPOSE Study examined the agreement between the IP and combined-ECG derived (EDR) for normal RR (≥12 or ≤20 breaths/minute [bpm]); low RR (≤5 bpm); and high RR (≥30 bpm). METHODOLOGY One-hundred intensive care unit patients were included by RR group: (1) normal RR (n = 50; 25 low RR and 25 high RR); (2) low RR (n = 50); and (3) high RR (n = 50). Bland-Altman analysis was used to evaluate agreement. RESULTS For normal RR, a significant bias difference of -1.00 + 2.11 (95% CI -1.60 to -0.40) and 95% limit of agreement (LOA) of -5.13 to 3.13 was found. For low RR, a significant bias difference of -16.54 + 6.02 (95% CI: -18.25 to -14.83) and a 95% LOA of -28.33 to - 4.75 was found. For high RR, a significant bias difference of 17.94 + 12.01 (95% CI: 14.53 to 21.35) and 95% LOA of -5.60 to 41.48 was found. CONCLUSION Combined-EDR method had good agreement with the IP method for normal RR. However, for the low RR, combined-EDR was consistently higher than the IP method and almost always lower for the high RR, which could reduce the number of RR alarms. However, replication in a larger sample including confirmation with visual assessment is warranted.
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Affiliation(s)
- Linda K Bawua
- School of Nursing, University of California, San Francisco, CA, USA.
| | | | - Sukardi Suba
- School of Nursing, University of Rochester, NY, USA.
| | - Fabio Badilini
- School of Nursing, University of California, San Francisco, CA, USA.
| | - David Mortara
- School of Nursing, University of California, San Francisco, CA, USA.
| | - Xiao Hu
- School of Nursing, Duke University Durham, NC, USA.
| | | | - Thomas J Hoffmann
- School of Nursing, University of California, San Francisco, CA, USA.
| | - Michele M Pelter
- School of Nursing, University of California, San Francisco, CA, USA.
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Na SJ, Ko RE, Ko MG, Jeon K. Automated alert and activation of medical emergency team using early warning score. J Intensive Care 2021; 9:73. [PMID: 34876209 PMCID: PMC8650341 DOI: 10.1186/s40560-021-00588-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 11/24/2021] [Indexed: 01/03/2023] Open
Abstract
Background Timely recognition of warning signs from deteriorating patients and proper treatment are important in improving patient safety. In comparison to the traditional medical emergency team (MET) activation triggered by phone calls, automated activation of MET may minimize activation delays. However, limited data are available on the effects of automated activation systems on the time from derangement to MET activation and on clinical outcomes. The objective of this study was to determine the impact of an automated alert and activation system for MET on clinical outcomes in unselected hospitalized patients. Methods This is an observational study using prospectively collected data from consecutive patients managed by the MET at a university-affiliated, tertiary hospital from March 2013 to December 2019. The automated alert system automatically calculates the Modified Early Warning Score (MEWS) and subsequently activates MET when the MEWS score is 7 or higher, which was implemented since August 2016. The outcome measures of interest including hospital mortality in patients with MEWS of 7 or higher were compared between pre-implementation and post-implementation groups of the automated alert and activation system in the primary analysis. The association between the implementation of the system and hospital mortality was evaluated with logistic regression analysis. Results Of the 7678 patients who were managed by MET during the study period, 639 patients during the pre-implementation period and 957 patients during the post-implementation period were included in the primary analysis. MET calls due to abnormal physiological variables were more common during the pre-implementation period, while MET calls due to medical staff’s worries or concern about the patient’s condition were more common during the post-implementation period. The median time from deterioration to MET activation was significantly shortened in the post-implementation period compared to the pre-implementation period (34 min vs. 60 min, P < 0.001). In addition, unplanned ICU admission rates (41.2% vs. 71.8%, P < 0.001) was reduced during the post-implementation period. Hospital mortality was decreased after implementation of the automated alert system (27.2% vs. 38.5%, P < 0.001). The implementation of the automated alert and activation system was associated with decreased risk of death in the multivariable analysis (adjusted OR 0.73, 95% CI 0.56–0.90). Conclusions After implementing an automated alert and activation system, the time from deterioration to MET activation was shortened and clinical outcomes were improved in hospitalized patients. Supplementary Information The online version contains supplementary material available at 10.1186/s40560-021-00588-y.
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Affiliation(s)
- Soo Jin Na
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ryoung-Eun Ko
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Myeong Gyun Ko
- Intensive Care Unit Nursing Department, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyeongman Jeon
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. .,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
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van der Stam JA, Mestrom EHJ, Scheerhoorn J, Jacobs F, de Hingh IHJT, van Riel NAW, Boer AK, Scharnhorst V, Nienhuijs SW, Bouwman RA. Accuracy of vital parameters measured by a wearable patch following major abdominal cancer surgery. Eur J Surg Oncol 2021:S0748-7983(21)00784-8. [PMID: 34753618 DOI: 10.1016/j.ejso.2021.10.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/13/2021] [Accepted: 10/30/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Recent advances in wearable technology allow for the development of wirelessly connected sensors to continuously measure vital parameters in the general ward or even at home. The present study assesses the accuracy of a wearable patch (Healthdot) for continuous monitoring of heartrate (HR) and respiration rate (RR). MATERIALS AND METHODS The Healthdot measures HR and RR by means of chest accelerometry. The study population consisted of patients following major abdominal oncological surgery. The analysis focused on the agreement between HR and RR measured by the Healthdot and the gold standard patient monitor in the intensive and post-anesthesia care unit. RESULTS For HR, a total of 112 h of measurements was collected in 26 patients. For RR, a total of 102 h of measurements was collected in 21 patients. On second to second analysis, 97% of the HR and 87% of the RR measurements were within 5 bpm and 3 rpm of the reference monitor. Assessment of 5-min averaged data resulted in 96% of the HR and 95% of the RR measurements within 5 bpm and 3 rpm of the reference monitor. A Clarke error grid analysis showed that 100% of the HR and 99.4% of the 5-min averaged data was clinically acceptable. CONCLUSION The Healthdot accurately measured HR and RR in a cohort of patients recovering from major abdominal surgery, provided that good quality data was obtained. These results push the Healthdot forward as a clinically acceptable tool in low acuity settings for unobtrusive, automatic, wireless and continuous monitoring.
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Clemente FM, Silva R, Ramirez-Campillo R, Afonso J, Mendes B, Chen YS. Accelerometry-based variables in professional soccer players: comparisons between periods of the season and playing positions. Biol Sport 2020; 37:389-403. [PMID: 33343073 DOI: 10.5114/biolsport.2020.96852] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/17/2020] [Accepted: 06/19/2020] [Indexed: 12/30/2022] Open
Abstract
The aim of this study was to provide reference data of variation in external training loads for weekly periods within the annual season. Specifically, we aimed to compare the weekly acute load, monotony, and training strain of accelerometry-based measures across a professional soccer season (pre-season, first and second halves of the season) according to players’ positions. Nineteen professional players were monitored daily for 45 weeks using an 18-Hz global positioning system to obtain measures of high metabolic load distance (HMLD), impacts, and high intensity accelerations and decelerations. Workload indices of acute load, training monotony, and training strain were calculated weekly for each of the measures. The HMLD had greater training strain values in the pre-season than in the first (p ≤ 0.001; d = 0.793) and second halves of the season (p ≤ 0.001; d = 0.858). Comparisons between playing positions showed that midfielders had the highest weekly acute load of HMLD (6901 arbitrary units [AU]), while central defenders had the lowest (4986 AU). The pre-season period was associated with the highest acute and strain load of HMLD and number of impacts, with a progressive decrease seen during the season. In conclusion, coaches should consider paying greater attention to variations in HMLD and impacts between periods of the season and between players to individualize training accordingly.
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Thomsen LP, Faaborg TH, Rees SE, Weinreich UM. Arterial and transcutaneous variability and agreement between multiple successive measurements of carbon dioxide in patients with chronic obstructive lung disease. Respir Physiol Neurobiol 2020; 280:103486. [PMID: 32615271 DOI: 10.1016/j.resp.2020.103486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 06/06/2020] [Accepted: 06/26/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE This study evaluates agreement between carbon dioxide measured arterial (PaCO2) and transcutaneous (PtcCO2) over time, by repeated successive measures, taking into consideration the inherent variability of arterial measurements. METHODS AND RESULTS 11 patients receiving LTOT, with severe to very severe COPD in a stable phase were studied. Repeated arterial blood samples were drawn and PtcCO2 measured simultaneously at the ear lobe. Bland-Altman analysis was used to evaluate 95 % limits of agreement (LoA). 194 paired samples were analysed. Following correction for bias, the difference between PaCO2 and PtCO2 during dynamic conditions was 0.02 kPa and LoA 0.94 to -0.90 kPa while 29 % of PtCO2 measurements were outside the range of variability for arterial measurements. CONCLUSION PtcCO2 corrected for intra-patient bias provide reasonable description of PaCO2 values within but not outside steady state conditions. Our results suggest that PtcCO2 is a valuable method for monitoring in chronic rather than acute conditions when bias can be removed.
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Affiliation(s)
- Lars Pilegaard Thomsen
- Respiratory and Critical Care Group, Department of Medicine and Health Science, Aalborg University, Denmark.
| | - Thea Heide Faaborg
- Department of Respiratory Diseases, Aalborg University Hospital, Denmark
| | - Stephen Edward Rees
- Respiratory and Critical Care Group, Department of Medicine and Health Science, Aalborg University, Denmark
| | - Ulla Møller Weinreich
- Department of Respiratory Diseases, Aalborg University Hospital, Denmark; The Pulmonary Research Centre, Aalborg University Hospital, Denmark; The Clinical Institute, Aalborg University Hospital, Denmark
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Omidbeigi M, Mousavi MS, Meknatkhah S, Edalatfar M, Bari A, Sharif-Alhoseini M. Telemetric Intracranial Pressure Monitoring: A Systematic Review. Neurocrit Care 2021; 34:291-300. [PMID: 32430803 DOI: 10.1007/s12028-020-00992-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Telemetric intracranial pressure (ICP) monitoring is a new method of measuring ICP which eliminates some of the shortcomings of previous methods. However, there are limited data on specific characteristics, including the advantages and disadvantages of this method. The main aim of this study was to demonstrate the indications, benefits, and complications of telemetric ICP monitoring. PubMed, MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched for relevant studies without language or date restriction in May 2019. Human studies in which telemetric ICP monitoring was the main subject of the study were included. Our initial search resulted in 1650 articles from which 50 studies were included. There were no randomized controlled trials. The majority of the studies were case reports or case series (68%). The most common aim of studies was testing of the device (52%), and monitoring the disease progression or recovery (46%). The most common indications for telemetric ICP monitoring in these studies were testing cerebrospinal fluid shunt function (46%), ICP control after the procedure (36%), and diagnosing intracranial hypertension (22%) and hydrocephalus (12%). In total, 1423 brain disease patients had been monitored in studies. The possibility of long-term ICP monitoring as the main benefit was reported in 38 (76%) studies. The associated complication rate was 7.1%. Despite the increasing application of telemetric monitoring devices, studies to evaluate specific characteristics of this method have been infrequent and inadequate. Future research using a higher level of scientific methods is needed to evaluate advantage and disadvantages.
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Dursun Ergezen F, Kol E. Nurses' responses to monitor alarms in an intensive care unit: An observational study. Intensive Crit Care Nurs 2020; 59:102845. [PMID: 32238311 DOI: 10.1016/j.iccn.2020.102845] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 02/11/2020] [Accepted: 03/01/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The present study aimed to determine the types of monitor alarms and nurses' responses to them in an adult intensive care unit. DESIGN AND METHODS This was an observational descriptive research study conducted in the adult intensive care unit of a university hospital in the Mediterranean region of Turkey. The nonparticipant observation method was used. Data were collected by two observers using a semi-structured observation form developed according to literature. RESULTS Between August 2016 and January 2017, 13 registered nurses were observed for 328 hours. There were 1781 alarms, which included alarms for blood pressure (37.6%), respiration and oxygen saturation (35.3%) and heart rate and arrhythmia (27.1%). Nurses responded to approximately half (46.9%) of the alarms that required a response. Responses to alarms included silencing them, responding to the patient's clinical condition and solving contact and transmission problems. CONCLUSION In the present study, according to response requirement, the division of the alarms was different. The number of alarms that do not reflect the clinical status of the patient was high. It was found that as the false alarm rate increased, the response rate of nurses to these alarms decreased.
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Affiliation(s)
| | - Emine Kol
- Nursing Faculty, Akdeniz University, Antalya, Turkey
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Cole TS, Jahnke H, Godzik J, Morgan CD, Nakaji P, Little AS. Use of a wrist-mounted device for continuous outpatient physiologic monitoring after transsphenoidal surgery: a pilot study. Pituitary 2019; 22:156-162. [PMID: 30806859 DOI: 10.1007/s11102-019-00946-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE Patients who undergo transsphenoidal surgery can experience hormonal, electrolyte, and fluid disturbances in the postoperative period leading to outpatient readmissions for medical management. Our goal was to determine whether use of a wrist-mounted physiologic tracking device is feasible in this setting and whether changes or trends in these parameters after discharge can help predict aberrant physiology in these patients. METHODS Wrist-mounted physiologic tracking devices that transmit data via Bluetooth to a mobile device were used to monitor patients. Preoperative baseline data and postoperative data were aggregated daily to compare within-patient and between-patient trends. RESULTS Of 11 patients enrolled in the study, 1 was readmitted for symptomatic hyponatremia. Device data completeness ranged from 78 to 93% with the exception of oxygen saturation (25% completeness). The patient with hyponatremia had a significantly lower baseline level of activity compared with other patients. Nonreadmitted patient activity variables (steps, calories, and distance) decreased by 48-52% after the operation (P < 0.001). The activity variables for the patient with hyponatremia were statistically unchanged after the operation; however, the patient did experience a significant decrease in heart rate compared with baseline. CONCLUSION Deployment of a wrist-based physiologic tracking device is feasible for surgical patients in elective clinical practice. Overall, the device was associated with good patient adherence and high patient satisfaction. Patient activity significantly decreased after surgery. A significant decrease in heart rate was detected in a patient with hyponatremia who required readmission, which reflects the known intravascular volume expansion in this state.
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Affiliation(s)
- Tyler S Cole
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Heidi Jahnke
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Jakub Godzik
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Clinton D Morgan
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Peter Nakaji
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Andrew S Little
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA.
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Scorcella C, Damiani E, Domizi R, Pierantozzi S, Tondi S, Carsetti A, Ciucani S, Monaldi V, Rogani M, Marini B, Adrario E, Romano R, Ince C, Boerma EC, Donati A. MicroDAIMON study: Microcirculatory DAIly MONitoring in critically ill patients: a prospective observational study. Ann Intensive Care 2018; 8:64. [PMID: 29766322 PMCID: PMC5953911 DOI: 10.1186/s13613-018-0411-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 05/07/2018] [Indexed: 12/20/2022] Open
Abstract
Background Until now, the prognostic value of microcirculatory alterations in critically ill patients has been mainly evaluated in highly selected subgroups. Aim of this study is to monitor the microcirculation daily in mixed group of Intensive Care Unit (ICU)-patients and to establish the association between (the evolution of) microcirculatory alterations and outcome. Methods This is a prospective longitudinal observational single-centre study in adult patients admitted to a 12-bed ICU in an Italian teaching hospital. Sublingual microcirculation was evaluated daily, from admission to discharge/death, using Sidestream Dark Field imaging. Videos were analysed offline to assess flow and density variables. Laboratory and clinical data were recorded simultaneously. A priori, a Microvascular Flow Index (MFI) < 2.6 was defined as abnormal. A binary logistic regression analysis was performed to evaluate the association between microcirculatory variables and outcomes; a Kaplan–Meier survival curve was built. Outcomes were ICU and 90-day mortality. Results A total of 97 patients were included. An abnormal MFI was present on day 1 in 20.6%, and in 55.7% of cases during ICU admission. Patients with a baseline MFI < 2.6 had higher ICU, in-hospital and 90-day mortality (45 vs. 15.6%, p = 0.012; 55 vs. 28.6%, p = 0.035; 55 vs. 26%, p = 0.017, respectively). An independent association between baseline MFI < 2.6 and outcome was confirmed in a binary logistic analysis (odds ratio 4.594 [1.340–15.754], p = 0.015). A heart rate (HR) ≥ 90 bpm was an adjunctive predictor of mortality. However, a model with stepwise inclusion of mean arterial pressure < 65 mmHg, HR ≥ 90 bpm, lactate > 2 mmol/L and MFI < 2.6 did not detect significant differences in ICU mortality. In case an abnormal MFI was present on day 1, ICU mortality was significantly higher in comparison with patients with an abnormal MFI after day 1 (38 vs. 6%, p = 0.001), indicating a time-dependent significant difference in prognostic value. Conclusions In a general ICU population, an abnormal microcirculation at baseline is an independent predictor for mortality. In this setting, additional routine daily microcirculatory monitoring did not reveal extra prognostic information. Further research is needed to integrate microcirculatory monitoring in a set of commonly available hemodynamic variables. Trial registration NCT 02649088, www.clinicaltrials.gov. Date of registration: 23 December 2015, retrospectively registered Electronic supplementary material The online version of this article (10.1186/s13613-018-0411-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Claudia Scorcella
- Anaesthesia and Intensive Care, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, via Tronto 10/a, 60126, Ancona, Italy
| | - Elisa Damiani
- Anaesthesia and Intensive Care, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, via Tronto 10/a, 60126, Ancona, Italy
| | - Roberta Domizi
- Anaesthesia and Intensive Care, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, via Tronto 10/a, 60126, Ancona, Italy
| | - Silvia Pierantozzi
- Anaesthesia and Intensive Care, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, via Tronto 10/a, 60126, Ancona, Italy
| | - Stefania Tondi
- Anaesthesia and Intensive Care, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, via Tronto 10/a, 60126, Ancona, Italy
| | - Andrea Carsetti
- Anaesthesia and Intensive Care, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, via Tronto 10/a, 60126, Ancona, Italy
| | - Silvia Ciucani
- Anaesthesia and Intensive Care, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, via Tronto 10/a, 60126, Ancona, Italy
| | - Valentina Monaldi
- Anaesthesia and Intensive Care, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, via Tronto 10/a, 60126, Ancona, Italy
| | - Mara Rogani
- Anaesthesia and Intensive Care, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, via Tronto 10/a, 60126, Ancona, Italy
| | - Benedetto Marini
- Anaesthesia and Intensive Care, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, via Tronto 10/a, 60126, Ancona, Italy
| | - Erica Adrario
- Anaesthesia and Intensive Care, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, via Tronto 10/a, 60126, Ancona, Italy
| | - Rocco Romano
- Anaesthesia and Intensive Care, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, via Tronto 10/a, 60126, Ancona, Italy
| | - Can Ince
- Department of Translational Physiology, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - E Christiaan Boerma
- Department of Intensive Care, Medical Centre Leeuwarden, Henri Dunantweg 2, 8934 AD, Leeuwarden, The Netherlands
| | - Abele Donati
- Anaesthesia and Intensive Care, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, via Tronto 10/a, 60126, Ancona, Italy.
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22
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Kruger GH, Shanks A, Kheterpal S, Tremper T, Chiang CJ, Freundlich RE, Blum JM, Shih AJ, Tremper KK. Influence of non-invasive blood pressure measurement intervals on the occurrence of intra-operative hypotension. J Clin Monit Comput 2017; 32:699-705. [PMID: 28965158 DOI: 10.1007/s10877-017-0065-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 09/20/2017] [Indexed: 10/18/2022]
Abstract
The American Society of Anesthesiologists Standards for Basic Monitoring recommends blood pressure (BP) measurement every 5 min. Research has shown distractions or technical factors can cause prolonged measurement intervals exceeding 5 min. We investigated the relationship between prolonged non-invasive BP (NIBP) measurement interval and the incidence of hypotension, detected post-interval. Our secondary outcome was to determine independent predictors of these prolonged NIBP measurement intervals. Retrospective data were analyzed from 139,509 general anesthesia cases from our institution's Anesthesia Information Management System (AIMS). Absolute hypotension (AH) was defined a priori as a systolic BP < 80 mmHg and relative hypotension (RH) was defined as a 40% decrease in systolic BP from the preoperative baseline. Odds ratios (OR) with 95% confidence intervals and Pearson's Chi square Test reported the association of prolonged NIBP measurement intervals on hypotension detected post-NIBP measurement interval. Logistic regression models were developed to determine independent predictors of NIBP measurement intervals. The analysis revealed that NIBP measurement intervals greater than 6 and 10 min are associated with an approximately four times higher incidence of a patient transitioning into hypotension (AH/RH > 6 min OR 4.0 / 3.6; AH/RH > 10 min OR 4.3 / 3.9; p < 0.001). A key finding was that the "> 10-minute AH model" indicated that age 41-80, increased co-morbidity profile, obesity and turning (repositioning) of the operative room table were significant predictors of prolonged NIBP measurement intervals (p < 0.001). While we do not suggest NIBP measurement intervals cause hypotension, intervals greater than 6 and 10 min are associated with a fourfold increase in the propensity of an undetected transition into both RH or AH. These data support current monitoring guidelines.
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Affiliation(s)
- Grant H Kruger
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, USA.
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA.
| | - Amy Shanks
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Sachin Kheterpal
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Tyler Tremper
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | | | - Robert E Freundlich
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - James M Blum
- Critical Care Anesthesiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Albert J Shih
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, USA
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Kevin K Tremper
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
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23
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Nakada H, Horie S, Kawanami S, Inoue J, Iijima Y, Sato K, Abe T. Development of a method for estimating oesophageal temperature by multi-locational temperature measurement inside the external auditory canal. Int J Biometeorol 2017; 61:1545-1554. [PMID: 28391522 DOI: 10.1007/s00484-017-1333-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 01/12/2017] [Accepted: 03/13/2017] [Indexed: 06/07/2023]
Abstract
We aimed to develop a practical method to estimate oesophageal temperature by measuring multi-locational auditory canal temperatures. This method can be applied to prevent heatstroke by simultaneously and continuously monitoring the core temperatures of people working under hot environments. We asked 11 healthy male volunteers to exercise, generating 80 W for 45 min in a climatic chamber set at 24, 32 and 40 °C, at 50% relative humidity. We also exposed the participants to radiation at 32 °C. We continuously measured temperatures at the oesophagus, rectum and three different locations along the external auditory canal. We developed equations for estimating oesophageal temperatures from auditory canal temperatures and compared their fitness and errors. The rectal temperature increased or decreased faster than oesophageal temperature at the start or end of exercise in all conditions. Estimated temperature showed good similarity with oesophageal temperature, and the square of the correlation coefficient of the best fitting model reached 0.904. We observed intermediate values between rectal and oesophageal temperatures during the rest phase. Even under the condition with radiation, estimated oesophageal temperature demonstrated concordant movement with oesophageal temperature at around 0.1 °C overestimation. Our method measured temperatures at three different locations along the external auditory canal. We confirmed that the approach can credibly estimate the oesophageal temperature from 24 to 40 °C for people performing exercise in the same place in a windless environment.
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Affiliation(s)
- Hirofumi Nakada
- Department of Health Policy and Management, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
| | - Seichi Horie
- Department of Health Policy and Management, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan.
| | - Shoko Kawanami
- Department of Health Policy and Management, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
| | - Jinro Inoue
- Department of Health Policy and Management, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
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24
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Ray S, Brick T, Raman S, Birrell PJ, Klein NJ, Peters MJ. Haemodynamic changes with paracetamol in critically-ill children. J Crit Care 2017; 40:108-112. [PMID: 28380408 DOI: 10.1016/j.jcrc.2017.03.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 03/22/2017] [Accepted: 03/29/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE Paracetamol has been associated with a reduction in blood pressure, especially in febrile, critically-ill adults. We hypothesised that blood pressure would fall following administration of paracetamol in critically-ill children and this effect would be greater during fever and among children with a high body surface area to weight ratio. METHODS A 12-month prospective observational study of children (0-16years) admitted to paediatric intensive care, who underwent pulse contour analysis and received paracetamol concurrently. RESULTS Mean arterial blood pressure decreased significantly by 4.7% from baseline (95% CI 1.75-8.07%) in 31 children following 148 doses of paracetamol. The nadir was 2-hour post-dose. The effect was pronounced in children with fever at baseline (6.4%, 95% CI 2.8-10%), although this was not statistically significant. There was no simple relationship between this effect and body surface area to weight ratio. The association between a change in blood pressure and changes in heart rate or measured stroke volume was poor; therefore it was likely that a change in the systemic vascular resistance contributes most to this effect. CONCLUSION There is a significant but modest reduction in blood pressure post-paracetamol in critically-ill children. This is likely related to a change in systemic vascular resistance.
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Affiliation(s)
- Samiran Ray
- Paediatric Intensive Care Unit, Great Ormond Street Hospital, London, WC1N 3JH, UK; Respiratory, Anaesthesia and Critical Care Section, UCL Institute of Child Health, London, WC1N 1EH, UK.
| | - Thomas Brick
- Paediatric Intensive Care Unit, Great Ormond Street Hospital, London, WC1N 3JH, UK
| | - Sainath Raman
- Paediatric Intensive Care Unit, Great Ormond Street Hospital, London, WC1N 3JH, UK; Respiratory, Anaesthesia and Critical Care Section, UCL Institute of Child Health, London, WC1N 1EH, UK
| | - Paul J Birrell
- MRC Biostatistics Unit, Institute of Public Health, Cambridge, CB2 0SR, UK
| | - Nigel J Klein
- Infection, Inflammation and Rheumatology Section, UCL Institute of Child Health, London, WC1N 1EH, UK
| | - Mark J Peters
- Paediatric Intensive Care Unit, Great Ormond Street Hospital, London, WC1N 3JH, UK; Respiratory, Anaesthesia and Critical Care Section, UCL Institute of Child Health, London, WC1N 1EH, UK
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25
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De Jonckheere J, Bonhomme V, Jeanne M, Boselli E, Gruenewald M, Logier R, Richebé P. Physiological Signal Processing for Individualized Anti-nociception Management During General Anesthesia: a Review. Yearb Med Inform 2017; 10:95-101. [PMID: 26293855 DOI: 10.15265/iy-2015-004] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The aim of this paper is to review existing technologies for the nociception / anti-nociception balance evaluation during surgery under general anesthesia. METHODS General anesthesia combines the use of analgesic, hypnotic and muscle-relaxant drugs in order to obtain a correct level of patient non-responsiveness during surgery. During the last decade, great efforts have been deployed in order to find adequate ways to measure how anesthetic drugs affect a patient's response to surgical nociception. Nowadays, though some monitoring devices allow obtaining information about hypnosis and muscle relaxation, no gold standard exists for the nociception / anti-nociception balance evaluation. Articles from the PubMed literature search engine were reviewed. As this paper focused on surgery under general anesthesia, articles about nociception monitoring on conscious patients, in post-anesthesia care unit or in intensive care unit were not considered. RESULTS In this article, we present a review of existing technologies for the nociception / anti-nociception balance evaluation, which is based in all cases on the analysis of the autonomous nervous system activity. Presented systems, based on sensors and physiological signals processing algorithms, allow studying the patients' reaction regarding anesthesia and surgery. CONCLUSION Some technological solutions for nociception / antinociception balance monitoring were described. Though presented devices could constitute efficient solutions for individualized anti-nociception management during general anesthesia, this review of current literature emphasizes the fact that the choice to use one or the other mainly relies on the clinical context and the general purpose of the monitoring.
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Affiliation(s)
- J De Jonckheere
- Julien De jonckheere, INSERM CIC-IT 1403, CHRU de Lille, Maison Régionale de la Recherche Clinique, 6 rue du professeur Laguesse, 59037 Lille Cedex, France, Tel: +33-(0)3-20-44-67-54, E-mail: or,
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26
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Dervishi A. Fuzzy risk stratification and risk assessment model for clinical monitoring in the ICU. Comput Biol Med 2017; 87:169-178. [PMID: 28599216 DOI: 10.1016/j.compbiomed.2017.05.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 05/04/2017] [Accepted: 05/30/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND The decisions that clinicians make in intensive care units (ICUs) based on monitored parameters reflecting physiological deterioration are of major medical and biomedical engineering interest. These parameters have been investigated and assessed for their usefulness in risk assessment. METHODS Totally, 127 ICU adult patients were studied. They were selected from a MIMIC II Waveform Database Matched Subset and had continuous monitoring of heart rate, invasive blood pressure, and oxygen saturation. The monitored data were dimension reduced using deep learning autoencoders and then used to train a support vector machine model (SVM). A combination of methods including fuzzy c-means clustering (FCM), and a random forest (RF) was used to determine the risk levels. RESULTS When classifying patients into stable or deteriorating groups the main performance parameter was the receiver operating characteristics (ROC). The area under the ROC (AUROC) was 93.2 (95% CI (92.9-93.4)) with sensitivity and specificity values of 0.80 and 0.89, respectively. The suggested fuzzy risk levels using the combined method of the FCM clustering and RF achieved an accuracy of 1 (0.9999, 1), with both sensitivity and specificity values equal to 1. CONCLUSIONS The potential for using models in risk assessment to estimate a patient's physiological status, stable or deteriorating, within 4 h has been demonstrated. The study was based on retrospective analysis and further studies are needed to evaluate the impact on clinical outcomes using this model.
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Abstract
Anesthesiologists faced with a patient with sepsis and concurrent cardiac dysfunction must be cognizant of the patient's cardiac status and cause of the cardiac problem to appropriately adapt physiologic and metabolic monitoring and anesthetic management. Anesthesia in such patients is challenging because the interaction of sepsis and cardiac dysfunction greatly complicates management. Intraoperative anesthesia management requires careful induction and maintenance of anesthesia; optimizing intravascular volume status; avoiding lung injury during mechanical ventilation; and close monitoring of arterial blood gases, serum lactate concentrations, and hematology renal and electrolyte parameters. Such patients have increased mortality because of their inability to adequately compensate for the cardiovascular changes caused by sepsis.
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Affiliation(s)
- Abed Abubaih
- Department of Anesthesiology and Critical Care Medicine, Hadassah - Hebrew University Medical Center, Hebrew University - Hadassah School of Medicine, Jerusalem, Israel
| | - Charles Weissman
- Department of Anesthesiology and Critical Care Medicine, Hadassah - Hebrew University Medical Center, Hebrew University - Hadassah School of Medicine, Jerusalem, Israel.
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28
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Fazel Bakhsheshi M, Wang Y, Keenliside L, Lee TY. A new approach to selective brain cooling by a Ranque-Hilsch vortex tube. Intensive Care Med Exp 2016; 4:32. [PMID: 27686339 PMCID: PMC5042908 DOI: 10.1186/s40635-016-0102-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Accepted: 09/08/2016] [Indexed: 11/29/2022] Open
Abstract
Background Target temperature management is the single most effective intervention and the gold standard in post-resuscitation care today. However, cooling the whole body below 33–34 °C can cause severe complications. Therefore, developing a selective brain cooling (SBC) approach which can be initiated early to induce rapid cooling and maintain the target temperature over 12–24 h before slowly rewarming brain temperature by itself alone would be advantageous. Vortex tubes are simple mechanical devices generating cold air from a stream of compressed air without applied chemical or energy. This study investigated whether blowing cooled air from a vortex tube into the nasal cavities is safe and effective to selectively reduce and maintain before slowly rewarming brain temperature back to normal temperature. Methods Experiments were conducted on ten juvenile pigs. Body temperature was measured using an esophageal and a rectal temperature probe while brain temperature with an intraparenchymal thermocouple probe. Cerebral blood flow (CBF) was measured with CT perfusion. Results Brain temperature dropped below 34 °C within 30–40 min while a brain-esophageal temperature difference greater than 3 °C was maintained over 6 h. There was no evidence of nasal or nasopharynx mucosal swelling, necrosis, or hemorrhage on MRI examination. CBF first decreased and then stabilized together with brain temperature before increasing to the baseline level during rewarming. Conclusions SBC was accomplished by blowing cold air from a vortex tube into the nasal cavities. Due to its portability, the method can be used continuously in resuscitated patients in both in- and out-of-hospital situations without interruption.
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Affiliation(s)
- Mohammad Fazel Bakhsheshi
- Imaging Program, Lawson Health Research Institute, London, ON, Canada. .,Imaging Research Laboratories, Robarts Research Institute, 1151 Richmond Street North, London, ON, N6A 5B7, Canada.
| | - Yong Wang
- Imaging Program, Lawson Health Research Institute, London, ON, Canada.,Imaging Research Laboratories, Robarts Research Institute, 1151 Richmond Street North, London, ON, N6A 5B7, Canada
| | - Lynn Keenliside
- Imaging Program, Lawson Health Research Institute, London, ON, Canada.,Imaging Research Laboratories, Robarts Research Institute, 1151 Richmond Street North, London, ON, N6A 5B7, Canada
| | - Ting-Yim Lee
- Imaging Program, Lawson Health Research Institute, London, ON, Canada.,Imaging Research Laboratories, Robarts Research Institute, 1151 Richmond Street North, London, ON, N6A 5B7, Canada.,Department of Medical Imaging and Biophysics, The University of Western Ontario, London, ON, Canada
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29
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Kipnis P, Turk BJ, Wulf DA, LaGuardia JC, Liu V, Churpek MM, Romero-Brufau S, Escobar GJ. Development and validation of an electronic medical record-based alert score for detection of inpatient deterioration outside the ICU. J Biomed Inform 2016; 64:10-19. [PMID: 27658885 DOI: 10.1016/j.jbi.2016.09.013] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 08/23/2016] [Accepted: 09/18/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Patients in general medical-surgical wards who experience unplanned transfer to the intensive care unit (ICU) show evidence of physiologic derangement 6-24h prior to their deterioration. With increasing availability of electronic medical records (EMRs), automated early warning scores (EWSs) are becoming feasible. OBJECTIVE To describe the development and performance of an automated EWS based on EMR data. MATERIALS AND METHODS We used a discrete-time logistic regression model to obtain an hourly risk score to predict unplanned transfer to the ICU within the next 12h. The model was based on hospitalization episodes from all adult patients (18years) admitted to 21 Kaiser Permanente Northern California (KPNC) hospitals from 1/1/2010 to 12/31/2013. Eligible patients met these entry criteria: initial hospitalization occurred at a KPNC hospital; the hospitalization was not for childbirth; and the EMR had been operational at the hospital for at least 3months. We evaluated the performance of this risk score, called Advanced Alert Monitor (AAM) and compared it against two other EWSs (eCART and NEWS) in terms of their sensitivity, specificity, negative predictive value, positive predictive value, and area under the receiver operator characteristic curve (c statistic). RESULTS A total of 649,418 hospitalization episodes involving 374,838 patients met inclusion criteria, with 19,153 of the episodes experiencing at least one outcome. The analysis data set had 48,723,248 hourly observations. Predictors included physiologic data (laboratory tests and vital signs); neurological status; severity of illness and longitudinal comorbidity indices; care directives; and health services indicators (e.g. elapsed length of stay). AAM showed better performance compared to NEWS and eCART in all the metrics and prediction intervals. The AAM AUC was 0.82 compared to 0.79 and 0.76 for eCART and NEWS, respectively. Using a threshold that generated 1 alert per day in a unit with a patient census of 35, the sensitivity of AAM was 49% (95% CI: 47.6-50.3%) compared to the sensitivities of eCART and NEWS scores of 44% (42.3-45.1) and 40% (38.2-40.9), respectively. For all three scores, about half of alerts occurred within 12h of the event, and almost two thirds within 24h of the event. CONCLUSION The AAM score is an example of a score that takes advantage of multiple data streams now available in modern EMRs. It highlights the ability to harness complex algorithms to maximize signal extraction. The main challenge in the future is to develop detection approaches for patients in whom data are sparser because their baseline risk is lower.
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Affiliation(s)
- Patricia Kipnis
- Kaiser Foundation Health Plan, Inc., 1950 Franklin St., 17th Floor, Oakland, CA 94612, United States; Kaiser Permanente Northern California, Division of Research, 2000 Broadway Avenue, 032 R01, Oakland, CA 94612, United States.
| | - Benjamin J Turk
- Kaiser Permanente Northern California, Division of Research, 2000 Broadway Avenue, 032 R01, Oakland, CA 94612, United States
| | - David A Wulf
- Kaiser Permanente Northern California, Division of Research, 2000 Broadway Avenue, 032 R01, Oakland, CA 94612, United States
| | - Juan Carlos LaGuardia
- Kaiser Permanente Northern California, Division of Research, 2000 Broadway Avenue, 032 R01, Oakland, CA 94612, United States
| | - Vincent Liu
- Kaiser Permanente Northern California, Division of Research, 2000 Broadway Avenue, 032 R01, Oakland, CA 94612, United States; Intensive Care Department, Kaiser Permanente Medical Center, 700 Lawrence Expressway, Santa Clara, CA 95051, United States
| | - Matthew M Churpek
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, 5841 South Maryland Avenue, Chicago, IL 60637, United States
| | - Santiago Romero-Brufau
- Mayo Clinic Center for Innovation, 200 1st Street SW, Rochester, MN 55905, United States
| | - Gabriel J Escobar
- Kaiser Permanente Northern California, Division of Research, 2000 Broadway Avenue, 032 R01, Oakland, CA 94612, United States; Department of Inpatient Pediatrics, Kaiser Permanente Medical Center, 1425 S. Main Street Walnut Creek, CA 94596, United States
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30
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Mauri T, Yoshida T, Bellani G, Goligher EC, Carteaux G, Rittayamai N, Mojoli F, Chiumello D, Piquilloud L, Grasso S, Jubran A, Laghi F, Magder S, Pesenti A, Loring S, Gattinoni L, Talmor D, Blanch L, Amato M, Chen L, Brochard L, Mancebo J; PLeUral pressure working Group (PLUG—Acute Respiratory Failure section of the European Society of Intensive Care Medicine). Esophageal and transpulmonary pressure in the clinical setting: meaning, usefulness and perspectives. Intensive Care Med 2016; 42:1360-73. [PMID: 27334266 DOI: 10.1007/s00134-016-4400-x] [Citation(s) in RCA: 267] [Impact Index Per Article: 33.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 05/17/2016] [Indexed: 12/18/2022]
Abstract
PURPOSE Esophageal pressure (Pes) is a minimally invasive advanced respiratory monitoring method with the potential to guide management of ventilation support and enhance specific diagnoses in acute respiratory failure patients. To date, the use of Pes in the clinical setting is limited, and it is often seen as a research tool only. METHODS This is a review of the relevant technical, physiological and clinical details that support the clinical utility of Pes. RESULTS After appropriately positioning of the esophageal balloon, Pes monitoring allows titration of controlled and assisted mechanical ventilation to achieve personalized protective settings and the desired level of patient effort from the acute phase through to weaning. Moreover, Pes monitoring permits accurate measurement of transmural vascular pressure and intrinsic positive end-expiratory pressure and facilitates detection of patient-ventilator asynchrony, thereby supporting specific diagnoses and interventions. Finally, some Pes-derived measures may also be obtained by monitoring electrical activity of the diaphragm. CONCLUSIONS Pes monitoring provides unique bedside measures for a better understanding of the pathophysiology of acute respiratory failure patients. Including Pes monitoring in the intensivist's clinical armamentarium may enhance treatment to improve clinical outcomes.
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Papaioannou V, Chouvarda I, Gaertner E, Benyamina M, Ferry A, Maurel V, Soussi S, Blet A, Chaouat M, Plaud B, Mebazaa A, Legrand M. Heart rate variability and cardiac baroreflex inhibition-derived index predicts pain perception in burn patients. Burns 2016; 42:1445-1454. [PMID: 27170468 DOI: 10.1016/j.burns.2016.04.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 04/18/2016] [Accepted: 04/22/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Dressing changes induce acute pain in burn patients. This pain is difficult to predict and may be therefore undertreated. Two different non-invasive electrophysiological indices from heart rate variability and baroreflex inhibition-derived indices, analgesia/nociception index (ANI) and cardiovascular depth of analgesia (CARDEAN), have been proposed to predict and better assess adequacy of anti-nociception. The aim of this study was to evaluate these techniques as early pain alert tools in conscious burnt patients during dressing changes' procedures. METHODS Twenty adult burnt patients undergoing scheduled wound treatment procedures were included in this prospective observational study. Pain intensity was assessed using a 0-10 numerical rating scale (NRS) and was compared with both ANI and CARDEAN, during the procedures. Non parametric rank sum test and linear discriminant analysis were used for evaluating potential differences of measured variables between periods with different pain intensities. Receiver-operating characteristic (ROC) curves were built to assess their performance to detect pain within following 15s. RESULTS The sensitivity and specificity of ANI to detect pain were 67% and 70% and those of CARDEAN were 77% and 80%, with area under the curve (AUC) values of 0.75 and 0.83, respectively. Their combination increased AUC to 0.87. CONCLUSIONS Both ANI and CARDEAN indices during wound treatment procedures seem to discriminate periods with and without pain within 15s, serving as a potential complementary tool for early optimized pain control.
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Affiliation(s)
- Vasilios Papaioannou
- Department of Anesthesiology and Critical Care and Burn Unit, Hôpitaux Universitaire St-Louis-Lariboisière, Assistance Publique-Hôpitaux de Paris (AP-HP), 75010 Paris, France.
| | - Ioanna Chouvarda
- Aristotle University of Thessaloniki, Lab of Medical Informatics, School of Medicine, Thessaloniki 54124, Greece.
| | - Elizabeth Gaertner
- Department of Anesthesiology and Critical Care and Burn Unit, Hôpitaux Universitaire St-Louis-Lariboisière, Assistance Publique-Hôpitaux de Paris (AP-HP), 75010 Paris, France.
| | - Mourad Benyamina
- Department of Anesthesiology and Critical Care and Burn Unit, Hôpitaux Universitaire St-Louis-Lariboisière, Assistance Publique-Hôpitaux de Paris (AP-HP), 75010 Paris, France.
| | - Axelle Ferry
- Department of Anesthesiology and Critical Care and Burn Unit, Hôpitaux Universitaire St-Louis-Lariboisière, Assistance Publique-Hôpitaux de Paris (AP-HP), 75010 Paris, France.
| | - Veronique Maurel
- Department of Anesthesiology and Critical Care and Burn Unit, Hôpitaux Universitaire St-Louis-Lariboisière, Assistance Publique-Hôpitaux de Paris (AP-HP), 75010 Paris, France.
| | - Sabri Soussi
- Department of Anesthesiology and Critical Care and Burn Unit, Hôpitaux Universitaire St-Louis-Lariboisière, Assistance Publique-Hôpitaux de Paris (AP-HP), 75010 Paris, France.
| | - Alice Blet
- Department of Anesthesiology and Critical Care and Burn Unit, Hôpitaux Universitaire St-Louis-Lariboisière, Assistance Publique-Hôpitaux de Paris (AP-HP), 75010 Paris, France; University of Paris Diderot, Paris, France; U-942 INSERM, 75475 Paris, France.
| | - Marc Chaouat
- Department of Plastic Surgery and Burn Unit, St-Louis Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 75010 Paris, France.
| | - Benoît Plaud
- Department of Anesthesiology and Critical Care and Burn Unit, Hôpitaux Universitaire St-Louis-Lariboisière, Assistance Publique-Hôpitaux de Paris (AP-HP), 75010 Paris, France; University of Paris Diderot, Paris, France; U-942 INSERM, 75475 Paris, France.
| | - Alexandre Mebazaa
- Department of Anesthesiology and Critical Care and Burn Unit, Hôpitaux Universitaire St-Louis-Lariboisière, Assistance Publique-Hôpitaux de Paris (AP-HP), 75010 Paris, France; University of Paris Diderot, Paris, France; U-942 INSERM, 75475 Paris, France.
| | - Matthieu Legrand
- Department of Anesthesiology and Critical Care and Burn Unit, Hôpitaux Universitaire St-Louis-Lariboisière, Assistance Publique-Hôpitaux de Paris (AP-HP), 75010 Paris, France; University of Paris Diderot, Paris, France; U-942 INSERM, 75475 Paris, France.
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Bose E, Hoffman L, Hravnak M. Monitoring cardiorespiratory instability: Current approaches and implications for nursing practice. Intensive Crit Care Nurs 2016; 34:73-80. [PMID: 26927832 DOI: 10.1016/j.iccn.2015.11.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 11/26/2015] [Accepted: 11/27/2015] [Indexed: 12/20/2022]
Abstract
Unrecognised in-hospital cardiorespiratory instability (CRI) risks adverse patient outcomes. Although step down unit (SDU) patients have continuous non-invasive physiologic monitoring of vital signs and a ratio of one nurse to four to six patients, detection of CRI is still suboptimal. Telemedicine provides additional surveillance but, due to high costs and unclear investment returns, is not routinely used in SDUs. Rapid response teams have been tested as possible approaches to support CRI patients outside the intensive care unit with mixed outcomes. Technology-enabled early warning scores, though rigorously studied, may not detect subtle instability. Efforts to utilise nursing intuition as a means to promote early identification of CRI have been explored, but the problem still persists. Monitoring systems hold promise, but nursing surveillance remains the key to reliable early detection and recognition. Research directed towards improving nursing surveillance and facilitating decision-making is needed to ensure safe patient outcomes and prevent CRI.
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Affiliation(s)
- Eliezer Bose
- School of Nursing, University of Pittsburgh, 3500 Victoria St., 336 Victoria Building, Pittsburgh, PA 15261, USA.
| | - Leslie Hoffman
- School of Nursing, University of Pittsburgh, 3500 Victoria St., 336 Victoria Building, Pittsburgh, PA 15261, USA.
| | - Marilyn Hravnak
- School of Nursing, University of Pittsburgh, 3500 Victoria St., 336 Victoria Building, Pittsburgh, PA 15261, USA.
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Churpek MM, Adhikari R, Edelson DP. The value of vital sign trends for detecting clinical deterioration on the wards. Resuscitation 2016; 102:1-5. [PMID: 26898412 DOI: 10.1016/j.resuscitation.2016.02.005] [Citation(s) in RCA: 107] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 01/26/2016] [Accepted: 02/10/2016] [Indexed: 11/16/2022]
Abstract
AIM Early detection of clinical deterioration on the wards may improve outcomes, and most early warning scores only utilize a patient's current vital signs. The added value of vital sign trends over time is poorly characterized. We investigated whether adding trends improves accuracy and which methods are optimal for modelling trends. METHODS Patients admitted to five hospitals over a five-year period were included in this observational cohort study, with 60% of the data used for model derivation and 40% for validation. Vital signs were utilized to predict the combined outcome of cardiac arrest, intensive care unit transfer, and death. The accuracy of models utilizing both the current value and different trend methods were compared using the area under the receiver operating characteristic curve (AUC). RESULTS A total of 269,999 patient admissions were included, which resulted in 16,452 outcomes. Overall, trends increased accuracy compared to a model containing only current vital signs (AUC 0.78 vs. 0.74; p<0.001). The methods that resulted in the greatest average increase in accuracy were the vital sign slope (AUC improvement 0.013) and minimum value (AUC improvement 0.012), while the change from the previous value resulted in an average worsening of the AUC (change in AUC -0.002). The AUC increased most for systolic blood pressure when trends were added (AUC improvement 0.05). CONCLUSION Vital sign trends increased the accuracy of models designed to detect critical illness on the wards. Our findings have important implications for clinicians at the bedside and for the development of early warning scores.
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Affiliation(s)
- Matthew M Churpek
- Department of Medicine, University of Chicago, Chicago, IL, United States.
| | - Richa Adhikari
- Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Dana P Edelson
- Department of Medicine, University of Chicago, Chicago, IL, United States
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Chopra AS, Wong N, Ziegler CP, Morrison LJ. Systematic review and meta-analysis of hemodynamic-directed feedback during cardiopulmonary resuscitation in cardiac arrest. Resuscitation 2016; 101:102-7. [PMID: 26875990 DOI: 10.1016/j.resuscitation.2016.01.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 01/13/2016] [Accepted: 01/21/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND/OBJECTIVE Physiologic monitoring of resuscitative efforts during cardiac arrest is gaining in importance, as it provides a real-time window into the cellular physiology of patients. The aim of this review is to assess the quality of evidence surrounding the use of physiologic monitoring to guide cardiopulmonary resuscitation (CPR), and to examine whether the evidence demonstrates an improvement in patient outcome when comparing hemodynamic-directed CPR versus standard CPR. METHODS Studies were obtained through a search of the PubMed, Embase and Cochrane databases. Peer-reviewed randomized trials, case-control studies, systematic reviews, and cohort studies that titrated CPR to physiologic measures, compared results to standard CPR, and examined patient outcome were included. RESULTS Six studies met inclusion criteria, with all studies conducted in animal populations. Four studies examined the effects of hemodynamic-directed CPR on survival, with 35/37 (94.6%) animals surviving in the hemodynamic-directed CPR groups and 12/35 (34.3%) surviving in the control groups (p<0.001). Two studies examined the effects of hemodynamic-directed CPR on ROSC, with 22/30 (73.3%) achieving ROSC in the hemodynamic-directed CPR group and 19/30 (63.3%) achieving ROSC in the control group (p=0.344). DISCUSSION/CONCLUSION These results suggest a trend in survival from hemodynamic-directed CPR over standard CPR, however the small sample size and lack of human data make these results of limited value. Future human studies examining hemodynamic-directed CPR versus current CPR standards are needed to enhance our understanding of how to effectively use physiologic measures to improve resuscitation efforts and ultimately incorporate concrete targets into international resuscitation guidelines.
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Affiliation(s)
- A S Chopra
- Rescu, Li Ka Shing Knowledge Institute of St. Michael's Hospital, 193 Yonge Street, Toronto, Ontario, Canada M5B1W8.
| | - N Wong
- Rescu, Li Ka Shing Knowledge Institute of St. Michael's Hospital, 193 Yonge Street, Toronto, Ontario, Canada M5B1W8
| | - C P Ziegler
- Health Sciences Library, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario, Canada M5B1W8
| | - L J Morrison
- Rescu, Li Ka Shing Knowledge Institute of St. Michael's Hospital, 193 Yonge Street, Toronto, Ontario, Canada M5B1W8; Division of Emergency Medicine, Department of Medicine, University of Toronto, 1 King's College Circle, Toronto, Ontario, Canada M5S1A8
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Park S, Czosnyka M, Smielewski P. Brain Oxygen Relationship to Cerebral Perfusion Pressure Depends on Tip Location and Time Window: Can Brain O2 Be an Adjunctive Modality for Determining Optimal CPP? Acta Neurochir Suppl 2016; 122:133-135. [PMID: 27165893 DOI: 10.1007/978-3-319-22533-3_27] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Controversy exists regarding the brain tissue oxygen (PbtO2) monitor's optimal tip location and what it actually measures. Recent work [2] identified a "PbtO2 change point" (CPPbt), below which PbtO2 displays pressure-passive behavior, showing significant correlation with optimal cerebral perfusion pressure (CPPopt) as defined by the pressure reactivity index (PRx). This would further support the concept of CPPopt [1] as an individualized target. We endeavored to validate these findings and further explore the relationship between PbtO2 and suboptimal CPP. CPPopt can be determined 55 % of the time [1]. It is undetermined whether PbtO2 can be an adjunctive modality for determining CPPopt.
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Affiliation(s)
- Soojin Park
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
| | - Marek Czosnyka
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Peter Smielewski
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
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Hravnak M, Chen L, Dubrawski A, Bose E, Clermont G, Pinsky MR. Real alerts and artifact classification in archived multi-signal vital sign monitoring data: implications for mining big data. J Clin Monit Comput 2016; 30:875-88. [PMID: 26438655 DOI: 10.1007/s10877-015-9788-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 09/30/2015] [Indexed: 10/23/2022]
Abstract
Huge hospital information system databases can be mined for knowledge discovery and decision support, but artifact in stored non-invasive vital sign (VS) high-frequency data streams limits its use. We used machine-learning (ML) algorithms trained on expert-labeled VS data streams to automatically classify VS alerts as real or artifact, thereby "cleaning" such data for future modeling. 634 admissions to a step-down unit had recorded continuous noninvasive VS monitoring data [heart rate (HR), respiratory rate (RR), peripheral arterial oxygen saturation (SpO2) at 1/20 Hz, and noninvasive oscillometric blood pressure (BP)]. Time data were across stability thresholds defined VS event epochs. Data were divided Block 1 as the ML training/cross-validation set and Block 2 the test set. Expert clinicians annotated Block 1 events as perceived real or artifact. After feature extraction, ML algorithms were trained to create and validate models automatically classifying events as real or artifact. The models were then tested on Block 2. Block 1 yielded 812 VS events, with 214 (26 %) judged by experts as artifact (RR 43 %, SpO2 40 %, BP 15 %, HR 2 %). ML algorithms applied to the Block 1 training/cross-validation set (tenfold cross-validation) gave area under the curve (AUC) scores of 0.97 RR, 0.91 BP and 0.76 SpO2. Performance when applied to Block 2 test data was AUC 0.94 RR, 0.84 BP and 0.72 SpO2. ML-defined algorithms applied to archived multi-signal continuous VS monitoring data allowed accurate automated classification of VS alerts as real or artifact, and could support data mining for future model building.
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Abstract
Occult hemorrhage in surgical/trauma intensive care unit (STICU) patients is common and may lead to circulatory collapse. Continuous electrocardiography (ECG) monitoring may allow for early identification and treatment, and could improve outcomes. We studied 4,259 consecutive admissions to the STICU at the University of Virginia Health System. We collected ECG waveform data captured by bedside monitors and calculated linear and non-linear measures of the RR interbeat intervals. We tested the hypothesis that a transfusion requirement of 3 or more PRBC transfusions in a 24 hour period is preceded by dynamical changes in these heart rate measures and performed logistic regression modeling. We identified 308 hemorrhage events. A multivariate model including heart rate, standard deviation of the RR intervals, detrended fluctuation analysis, and local dynamics density had a C-statistic of 0.62. Earlier detection of hemorrhage might improve outcomes by allowing earlier resuscitation in STICU patients.
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Affiliation(s)
- Travis J Moss
- Division of Cardiovascular Medicine, Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA
| | - Matthew T Clark
- Division of Cardiovascular Medicine, Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA
| | - Douglas E Lake
- Department of Statistics, University of Virginia, Charlottesville, VA
| | - J Randall Moorman
- Division of Cardiovascular Medicine, Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA
| | - J Forrest Calland
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA.
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Do DH, Hayase J, Tiecher RD, Bai Y, Hu X, Boyle NG. ECG changes on continuous telemetry preceding in-hospital cardiac arrests. J Electrocardiol 2015; 48:1062-8. [PMID: 26362882 DOI: 10.1016/j.jelectrocard.2015.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND About 200,000 patients suffer from in-hospital cardiac arrest (IHCA) annually. Identification of at-risk patients is key to improving outcomes. The use of continuous ECG monitoring in identifying patients at risk for developing IHCA has not been studied. OBJECTIVE To describe the profile and timing of ECG changes prior to IHCA. DESIGN Retrospective, observational. SETTING Single 520-bed tertiary care hospital. PATIENTS IHCA in adults between April 2010 and March 2012 with at least 3 hours of continuous telemetry data immediately prior to IHCA. MEASUREMENTS We evaluated up to 24 hours of telemetry data preceding IHCA for changes in PR, QRS, ST segment, arrhythmias, and QTc in ventricular tachycardia cases. We determined mechanism and likely clinical cause of the arrest by chart and telemetry review. RESULTS We studied 81 IHCA patients, in whom the mechanism was ventricular tachycardia/fibrillation in 14 (18%), bradyasystolic in 21 (26%), and pulseless electrical activity (PEA) in 46 (56%). Preceding ECG changes were ST segment changes (31% of cases), atrial tachyarrhythmias (21%), bradyarrhythmias (28%), P wave axis change (21%),QRS prolongation (19%), PR prolongation (17%), isorhythmic dissociation (14%), nonsustained ventricular tachycardia (6%), and PR shortening (5%). At least one of these was present in 77% of all cases, and in 89% of IHCA caused by respiratory or multiorgan failure. Bradyarrhythmias were primarily seen with IHCA in the setting of respiratory or multiorgan failure, and PR and QRS prolongation with IHCA and concomitant multiorgan failure. LIMITATIONS This is a retrospective study with a limited number of cases; each patient serves as their own control, and a separate control population has not yet been studied. CONCLUSIONS ECG changes are commonly seen preceding IHCA, and have a pathophysiologic basis. Automated detection methods for ECG changes could potentially be used to better identify patients at risk for IHCA.
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Affiliation(s)
- Duc H Do
- Cardiac Arrhythmia Center, David Geffen School of Medicine at University of California, Los Angeles, CA
| | - Justin Hayase
- Cardiac Arrhythmia Center, David Geffen School of Medicine at University of California, Los Angeles, CA
| | - Ricardo Dahmer Tiecher
- Cardiac Arrhythmia Center, David Geffen School of Medicine at University of California, Los Angeles, CA
| | - Yong Bai
- Biomedical Engineering Graduate Program, Henry Samueli School of Engineering and Applied Science, University of California, Los Angeles, CA
| | - Xiao Hu
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA; Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Noel G Boyle
- Cardiac Arrhythmia Center, David Geffen School of Medicine at University of California, Los Angeles, CA.
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Rudnick MR, De Marchi L, Plotkin JS. Hemodynamic monitoring during liver transplantation: A state of the art review. World J Hepatol 2015; 7:1302-1311. [PMID: 26052376 PMCID: PMC4450194 DOI: 10.4254/wjh.v7.i10.1302] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Revised: 03/25/2015] [Accepted: 04/09/2015] [Indexed: 02/06/2023] Open
Abstract
Orthotopic liver transplantation can be marked by significant hemodynamic instability requiring the use of a variety of hemodynamic monitors to aide in intraoperative management. Invasive blood pressure monitoring is essential, but the accuracy of peripheral readings in comparison to central measurements has been questioned. When discrepancies exist, central mean arterial pressure, usually measured at the femoral artery, is considered more indicative of adequate perfusion than those measured peripherally. The traditional pulmonary artery catheter is less frequently used due to its invasive nature and known limitations in measuring preload but still plays an important role in measuring cardiac output (CO) when required and in the management of portopulmonary hypertension. Pulse wave analysis is a newer technology that uses computer algorithms to calculate CO, stroke volume variation (SVV) and pulse pressure variation (PPV). Although SVV and PPV have been found to be accurate predicators of fluid responsiveness, CO measurements are not reliable during liver transplantation. Transesophageal echocardiography is finding an increasing role in the real-time monitoring of preload status, cardiac contractility and the diagnosis of a variety of pathologies. It is limited by the expertise required, limited transgastric views during key portions of the operation, the potential for esophageal varix rupture and difficulty in obtaining quantitative measures of CO in the absence of tricuspid regurgitation.
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Mort AJ, Fitzpatrick D, Wilson PM, Mellish C, Schneider A. Lightweight physiologic sensor performance during pre-hospital care delivered by ambulance clinicians. J Clin Monit Comput 2016; 30:23-32. [PMID: 25804608 DOI: 10.1007/s10877-015-9673-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 02/23/2015] [Indexed: 11/01/2022]
Abstract
The aim of this study was to explore the impact of motion generated by ambulance patient management on the performance of two lightweight physiologic sensors. Two physiologic sensors were applied to pre-hospital patients. The first was the Contec Medical Systems CMS50FW finger pulse oximeter, monitoring heart rate (HR) and blood oxygen saturation (SpO2). The second was the RESpeck respiratory rate (RR) sensor, which was wireless-enabled with a Bluetooth(®) Low Energy protocol. Sensor data were recorded from 16 pre-hospital patients, who were monitored for 21.2 ± 9.8 min, on average. Some form of error was identified on almost every HR and SpO2 trace. However, the mean proportion of each trace exhibiting error was <10 % (range <1-50 % for individual patients). There appeared to be no overt impact of the gross motion associated with road ambulance transit on the incidence of HR or SpO2 error. The RESpeck RR sensor delivered an average of 4.2 (±2.2) validated breaths per minute, but did not produce any validated breaths during the gross motion of ambulance transit as its pre-defined motion threshold was exceeded. However, this was many more data points than could be achieved using traditional manual assessment of RR. Error was identified on a majority of pre-hospital physiologic signals, which emphasised the need to ensure consistent sensor attachment in this unstable and unpredictable environment, and in developing intelligent methods of screening out such error.
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Hravnak M, Chen L, Dubrawski A, Bose E, Pinsky MR. Temporal distribution of instability events in continuously monitored step-down unit patients: implications for Rapid Response Systems. Resuscitation 2015; 89:99-105. [PMID: 25637693 DOI: 10.1016/j.resuscitation.2015.01.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 12/10/2014] [Accepted: 01/16/2015] [Indexed: 11/23/2022]
Abstract
AIM Medical Emergency Teams (MET) activations are more frequent during daytime and weekdays, but whether due to greater patient instability, proximity from admission time, or caregiver concentration is unclear. We sought to determine if instability events, when they occurred, varied in their temporal distribution. METHODS Monitoring data were recorded (frequency 1/20Hz) in 634 SDU patients (41,635 monitoring hours). Vital sign excursion beyond our MET trigger thresholds defined alerts. The resultant 1399 alerts from 216 patients were tallied according to clock hour and time elapsed since admission. We fit patient ID (n=216), clock hour, time since SDU admission, and alert present into a null model and three mixed effect logistic regression models: clock hour, hours elapsed since admission, and both clock hour and time elapsed since admission as fixed effect covariates. We performed likelihood ratio tests on these models to assess if, among all alerts, there were proportionally more alerts for any given clock hour, or proximity to admission time. RESULTS Only time elapsed since admission (p<0.001), and not clock hour adjusting for time elapsed since admission (p=0.885), was significant for temporal disproportion. Results were unchanged if the first 24h following admission were excluded from the models. CONCLUSION Although instability alerts are distributed most frequently within 24h after SDU admission in unstable patients, they are otherwise not more likely to distribute proportionally more frequently during certain clock hours. If MET utilization peaks do not coincide with admission time peaks, other variables contributing to unrecognized instability should be explored.
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Phillips MR, Khoury AL, Bortsov AV, Marzinsky A, Short KA, Cairns BA, Charles AG, Joyner BL, McLean SE. A noninvasive hemoglobin monitor in the pediatric intensive care unit. J Surg Res 2015; 195:257-62. [PMID: 25724765 DOI: 10.1016/j.jss.2014.12.051] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 12/08/2014] [Accepted: 12/31/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Critically ill pediatric patients frequently require hemoglobin monitoring. Accurate noninvasive Hb (SpHb) would allow practitioners to decrease anemia from repeated blood draws, traumatic blood draws, and a decreased number of laboratory Hb (LabHb) medical tests. The Food and Drug Administration has approved the Masimo Pronto SpHb and associated Rainbow probes; however, its use in the pediatric intensive care unit (PICU) is controversial. In this study, we define the degree of agreement between LabHb and SpHb using the Masimo Pronto SpHb Monitor and identify clinical and demographic conditions associated with decreased accuracy. MATERIALS AND METHODS We performed a prospective, observational study in a large PICU at an academic medical center. Fifty-three pediatric patients (30-d and 18-y-old), weighing >3 kg, admitted to the PICU from January-April 2013 were examined. SpHb levels measured at the time of LabHb blood draw were compared and analyzed. RESULTS Only 83 SpHb readings were obtained in 118 attempts (70.3%) and 35 readings provided a result of "unable to obtain." The mean LabHb and SpHb were 11.1 g/dL and 11.2 g/dL, respectively. Bland-Altman analysis showed a mean difference of 0.07 g/dL with a standard deviation of ±2.59 g/dL. Pearson correlation is 0.55, with a 95% confidence interval between 0.38 and 0.68. Logistic regression showed that extreme LabHb values, increasing skin pigmentation, and increasing body mass index were predictors of poor agreement between SpHb and LabHb (P < 0.05). Separately, increasing body mass index, hypoxia, and hypothermia were predictors for undetectable readings (P < 0.05). CONCLUSIONS The Masimo Pronto SpHb Monitor provides adequate agreement for the trending of hemoglobin levels in critically ill pediatric patients. However, the degree of agreement is insufficient to be used as the sole indicator for transfusion decisions and should be used in context of other clinical parameters to determine the need for LabHb in critically ill pediatric patients.
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Affiliation(s)
- Michael R Phillips
- Division of Pediatric Surgery, Department of Surgery, North Carolina Children's Hospital, University of North Carolina, Chapel Hill, North Carolina
| | - Amal L Khoury
- Division of Pediatric Surgery, Department of Surgery, North Carolina Children's Hospital, University of North Carolina, Chapel Hill, North Carolina
| | - Andrey V Bortsov
- Department of Anesthesiology, University of North Carolina, School of Medicine, Chapel Hill, North Carolina
| | - Amy Marzinsky
- Division of Pediatric Surgery, Department of Surgery, North Carolina Children's Hospital, University of North Carolina, Chapel Hill, North Carolina
| | - Kathy A Short
- Department of Respiratory Care and Pulmonary Diagnostics, University of North Carolina, Chapel Hill, North Carolina
| | - Bruce A Cairns
- Department of Surgery, University of North Carolina, School of Medicine, Chapel Hill, North Carolina
| | - Anthony G Charles
- Department of Surgery, University of North Carolina, School of Medicine, Chapel Hill, North Carolina
| | - Benny L Joyner
- Department of Pediatrics, Division of Critical Care Medicine, University of North Carolina, School of Medicine, Chapel Hill, North Carolina
| | - Sean E McLean
- Division of Pediatric Surgery, Department of Surgery, North Carolina Children's Hospital, University of North Carolina, Chapel Hill, North Carolina.
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Wilms H, Mittal A, Haydock MD, van den Heever M, Devaud M, Windsor JA. A systematic review of goal directed fluid therapy: rating of evidence for goals and monitoring methods. J Crit Care 2013; 29:204-9. [PMID: 24360819 DOI: 10.1016/j.jcrc.2013.10.019] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 10/13/2013] [Accepted: 10/20/2013] [Indexed: 01/23/2023]
Abstract
PURPOSE To review the literature on goal directed fluid therapy and evaluate the quality of evidence for each combination of goal and monitoring method. MATERIALS AND METHODS A search of major digital databases and hand search of references was conducted. All studies assessing the clinical utility of a specific fluid therapy goal or set of goals using any monitoring method were included. Data was extracted using a pre-determined pro forma and papers were evaluated using GRADE principles to assess evidence quality. RESULTS Eighty-one papers met the inclusion criteria, investigating 31 goals and 22 methods for monitoring fluid therapy in 13052 patients. In total there were 118 different goal/method combinations. Goals with high evidence quality were central venous lactate and stroke volume index. Goals with moderate quality evidence were sublingual microcirculation flow, the oxygen extraction ratio, cardiac index, cardiac output, and SVC collapsibility index. CONCLUSIONS This review has highlighted the plethora of goals and methods for monitoring fluid therapy. Strikingly, there is scant high quality evidence, in particular for non-invasive G/M combinations in non-operative and non-intensive care settings. There is an urgent need to address this research gap, which will be helped by methodologies to compare utility of G/M combinations.
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Affiliation(s)
- Heath Wilms
- The University Of Auckland, Auckland, New Zealand
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Gazarian PK. Nurses' response to frequency and types of electrocardiography alarms in a non-critical care setting: a descriptive study. Int J Nurs Stud 2013; 51:190-7. [PMID: 23810495 DOI: 10.1016/j.ijnurstu.2013.05.014] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2012] [Revised: 05/27/2013] [Accepted: 05/30/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND An important role of the registered nurse is to identify patient deterioration by monitoring the patient condition and vital signs. Increasingly, this is supplemented with continuous electrocardiographic (ECG) monitoring. Continuous monitoring is inefficient in identifying deterioration because of the high number of false and nuisance alarms. Lack of strong evidence or formal guidelines for the care of patients receiving ECG monitoring has led clinicians to rely too heavily on this technology without consideration of its limitations. The nursing workload associated with alarm management remains unexamined. OBJECTIVE To describe nurses' routine practices related to continuous ECG monitoring, frequency and types of alarms, their associated nursing interventions, and the impact on the patient's plan of care. METHODS Design. Prospective, descriptive, observational study. Setting and participants. Between January 2011 and March 2011 we observed nine Registered Nurses providing care for patients receiving continuous ECG monitoring in non-critical care areas. The PI and two research assistants observed each nurse for two 3-h observation periods and recorded data on a researcher designed observation tool. At the end of each observation period, the observers printed the alarm events as recorded by the central monitoring computer. RESULTS Nurses responded to 46.8% of all alarms. During the observation period, there were no dysrhythmia adverse events. One patient had a change in condition requiring transfer to a higher level of care. A range of nursing interventions occurred in response to alarms. CONCLUSION Nurses routine practices related to monitoring continue to reveal gaps in practice related to alarm management. Observations of practice also revealed the difficulties and complexities of managing alarm systems and the range of nursing interventions associated with managing alarms.
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Affiliation(s)
- Priscilla K Gazarian
- School of Nursing and Health Sciences, Simmons College, 300 The Fenway, Boston, MA 02115, United States.
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45
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Ko SB. Multimodality monitoring in the neurointensive care unit: a special perspective for patients with stroke. J Stroke 2013; 15:99-108. [PMID: 24324945 PMCID: PMC3779668 DOI: 10.5853/jos.2013.15.2.99] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2013] [Revised: 05/06/2013] [Accepted: 05/06/2013] [Indexed: 02/06/2023] Open
Abstract
Multimodality monitoring (MMM) is a recently developed method that aids in understanding real-time brain physiology. Early detection of physiological disturbances is possible with the help of MMM, which allows identification of underlying causes of deterioration and minimization of secondary brain injury (SBI). MMM is especially helpful in comatose patients with severe brain injury because neurological examinations are not sensitive enough to detect SBI. The variables frequently examined in MMM are hemodynamic parameters such as intracranial pressure, cerebral perfusion pressure, and mean arterial pressure; brainspecific oxygen tension; markers for brain metabolism including glucose, lactate, and pyruvate levels in brain tissue; and cerebral blood flow. Continuous electroencephalography can be performed, if needed. The majority of SBIs stem from brain tissue hypoxia, brain ischemia, and seizures, which lead to a disturbance in brain oxygen levels, cerebral blood flow, and electrical discharges, all of which are easily detected by MMM. In this review, we discuss the clinical importance of physiological variables as well as the practical applicability of MMM in patients with stroke.
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Affiliation(s)
- Sang-Bae Ko
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
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