Journal of Clinical Monitoring and Computing最新文献

Ultrasound Elastography (UE) tends to improve the ultrasound diagnosis accuracy. The Strain Elastography (SE) depicts the pathological tissue loss of elasticity in response to an external pressure applied by the operator. It is now recommended for benign/malignant parenchymal process differentiation and for muscle and nervous rigidness assessment and follow-up. The SE was able to differentiate the normal nerves from their muscular-vascular environment based on their own elasticity using a colorimetric scale (CS)0.30 healthy adult patients were included into this prospective observational study. The femoral nerve (FN) and the popliteal sciatic nerve (PSN) were studied using 2D black and white sonography (S) and SE. About the SE, firstly, CS goes from red (stiffer) to blue (softer) differentiating 6 main colors at the visual assessment. Secondly, the CS was transformed into a 3 points tissues classification related to FN and PSN elasticity for easier reading. Results are presented as percentages.FN and PSN in sonography were normal in all patients confirming the different morphology of each kind of nerve with a high level of patient-to-patient reproducibility. SE detected as "stiff" the FN and PSN in respectively 87 and 83% of the patients. Finally, a superposition between sonogram and elastogram greater than 50% was observed in 54 and 70% of the patients.SE represents a promising technique that may complement S to try to improve the quality of nerve localization. Further and larger studies are needed for a better understanding the subject in real clinical conditions.

We evaluated the accuracy and precision of zero-heat flux (ZHF) and dual sensor (DS) non-invasive temperature probes in intensive care unit (ICU) patients undergoing hypothermic temperature control, hypothesizing that both devices would accurately estimate core temperature. In a single-center prospective cohort study, we enrolled 35 ICU patients and applied continuous, non-invasive ZHF and/or DS probes to the lateral forehead or anterior chest to collect 358 observations. Conditions potentially influencing temperature estimation were recorded. Using Bland-Altman analysis with multiple paired observations per individual, we compared the bias between non-invasive probes and direct core temperature measurements. Lin's concordance coefficient (LCC) was computed to quantify precision. The mean bias between the ZHF probe and invasive temperature was + 0.98 °C; for the DS probe, it was - 2.19 °C. In hypothermic patients, the ZHF probe's accuracy improved (bias + 0.28 °C, LCC 0.86), while the DS probe remained inaccurate (bias - 2.52 °C, LCC 0.07). Clinical confounders like vasoactive agents or temperature control devices did not consistently affect bias, accuracy, or precision. Neither the ZHF nor DS non-invasive probes provided sufficient accuracy or precision to guide clinical decisions in the ICU. These results contrast with previous studies reporting biases within ± 0.5 °C. However, the ZHF probe showed promising limited deviation, especially in hypothermic patients.

Background: Assessing fluid responsiveness is crucial in managing critically ill patients. Echocardiography, particularly passive leg raising (PLR)-induced changes in the velocity-time integral of the left ventricular outflow tract (VTI_LVOT), is widely used for this purpose. We hypothesized that PLR-induced changes in the mitral valve velocity-time integral (VTI_Mi) could serve as a reliable alternative.

Methods: This prospective single-center study included septic ICU patients requiring fluid responsiveness assessment. VTI_LVOT and VTI_Mi were measured at baseline and after PLR. Fluid responsiveness was defined as a PLR-induced increase in VTI_LVOT ≥10%. The ability of PLR-induced VTI_Mi changes to predict fluid responsiveness was assessed via ROC curve and gray zone analyses.

Results: Fifty consecutive patients were included (median age 65 years [IQR: 57-73], APACHE II score 22 [IQR: 18-27]). Septic shock was present in 27 (54%), 21 (42%) were mechanically ventilated, and 23 (46%) were classified as responders. PLR-induced changes in VTI_Mi and VTI_LVOT were significantly correlated (ρ = 0.656, p < 0.001). The area under the ROC curve for VTI_Mi was 0.927 (95% CI: 0.849-1, p < 0.001). A 10% increase in VTI_Mi predicted fluid responsiveness with a sensitivity of 83% (95% CI: 61-95) and specificity of 96% (95% CI: 83-99). The gray zone ranged between 5% and 8%, encompassing 16% of the cohort.

Conclusion: PLR-induced changes in VTI_Mi reliably predict fluid responsiveness in critically ill patients. VTI_Mi represents a viable alternative to VTI_LVOT for fluid responsiveness assessment, contributing to individualized hemodynamic management.

Trial registration: NCT05538637.

Purpose: Acute kidney injury (AKI) is a common complication and a strong risk factor for adverse outcomes after transcatheter aortic valve implantation (TAVI). Renal regional tissue oxygen saturation (rSO₂) reflects tissue perfusion and can be measured using near-infrared spectroscopy. We hypothesized that decrease in renal rSO₂ during TAVI would predict post-procedural AKI.

Methods: Patients with severe aortic stenosis who scheduled for transfemoral TAVI were enrolled. Patients undergoing emergent procedures, those with severe renal impairment, those with a distance from skin to renal capsule > 4 cm, those on mechanical ventilation, or those who refused to participate were excluded. The primary outcome was the relationship between changes in renal rSO₂ during TAVI and post-procedural AKI. AKI was determined according to the Valve Academic Research Consortium-2 criteria.

Results: Sixty-four patients were included and analyzed. The mean (standard deviation [SD]) age of patients was 82 (4) years, and the median [interquartile range] procedure time was 75 [65-90] min. The incidence of post-procedural AKI was 33% (21/64). There was no difference in the mean (SD) time-weighted renal rSO₂ (70% [13%] and 73% [11%]), changes in renal rSO₂ (-14% [10%] and - 15% [13%]), or nadir rSO₂ (55% [17%] and 60% [17%]) during TAVI between patients who developed post-TAVI AKI and those who did not (p = 0.227, 0.157, and 0.333, respectively). In multivariable regression analysis, renal rSO₂ variables were not predictors of post-TAVI AKI.

Conclusion: Procedural changes in renal rSO₂ measured using near-infrared spectroscopy did not predict the development of post-TAVI AKI. Further studies are needed to investigate more effective strategies to predict and prevent AKI following TAVI.

Trial registration: This study was registered on cinicaltrials.gov (identifier, NCT04921475, registered on June 10, 2021).

The aim of the present study was to investigate the utility of the intraoperative high frequency variability index (HFVI) / Analgesia Nociception Index (ANI) for predicting postoperative pain in patients undergoing open liver or pancreatic surgery under combined general and epidural anesthesia, with a particular focus on HFVI/ANI measured immediately before extubation. We investigated whether maximum postoperative pain at rest and postoperative morphine consumption were associated with intraoperative HFVI/ANI values, including those measured immediately before extubation, the mean intraoperative values, the difference between values immediately before and 5 min after the first administration of local anesthetics via epidural catheter, and the difference between values immediately before and 5 min after the start of surgery. We analyzed the data obtained from 52 patients and found that HFVI/ANI measured immediately before extubation showed a limited but statistically significant association with postoperative pain at rest. However, receiver operating characteristic curve analysis failed to demonstrate clinically useful predictive performance of HFVI/ANI for postoperative pain defined as Numerical Rating Scale > 3 or > 7. In addition, no association was observed between intraoperative HFVI/ANI measured at any time point and postoperative morphine consumption. The present study demonstrated that intraoperative HFVI/ANI may reflect postoperative pain levels to a limited extent, particularly when measured immediately before extubation, but lacks sufficient accuracy to be used as a standalone predictor of postoperative pain.

Purpose To evaluate the effect of reducing tidal volume from 8 mL/kg predicted body weight (PBW) to 6 mL/kg PBW on dynamic arterial elastance (Eadyn) in patients scheduled for laparoscopic surgery.

Method: After the start of intra-abdominal insufflation, if MAP became < 65 mmHg and SVV > 10%, then the tidal volume was reduced from 8 mL/kg PBW to 6 mL/kg PBW. One min later, 250 mL of lactate Ringer's solution was administered over 10 min. MAP responsiveness was defined as a > 10% increase in MAP following a fluid challenge.

Results: This study included 46 patients, 11 MAP non-responders and 35 MAP responders. Both PPV and SVV decreased significantly (- 19.4 ± 11% and - 19.7 ± 9.9%, respectively) following tidal volume reduction. However, the magnitude of the decrease differed. As a result, the change in Eadyn was minimal on average, although inter-individual variability was observed. Bland-Altman analysis revealed a mean difference of - 0.004, with 95% limits of agreement ranging from - 0.285 to + 0.278. Eadyn values before and after tidal volume reduction failed to predict MAP responsiveness (at 8 mL/kg PBW: area under the ROC curve [AUC] 0.514, at 6 mL/kg PBW: AUC 0.508).

Conclusion: The reduction in tidal volume had a clinically negligible effect on Eadyn. Neither Eadyn values at tidal volume of 8 mL/kg PBW and 6 mL/kg PBW could not predict MAP increase after a fluid challenge during laparoscopic surgery.

Trial registration: This study was registered in the UMIN-CTR Clinical Database (ID: UMIN000054061) on April 4th, 2024. https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi? recptno=R000061722.