Abstract:
:To determine the effect of implementing an algorithm of fluid and blood administration based on continuous monitoring of hemoglobin (SpHb) and PVI (plethysmography variability index) on mortality and transfusion on a whole hospital scale. This single-center quality program compared transfusion at 48 h and mortality at 30 days and 90 days after surgery between two 11-month periods in 2013 and 2014 during which all the operating and recovery rooms and intensive care units were equipped with SpHb/PVI monitors. The entire team was trained to use monitors and the algorithm. Team members were free to decide whether or not to use devices. Each device was connected to an electronic wireless acquired database to anonymously acquire parameters on-line and identify patients who received the monitoring. All data were available from electronic files. Patients were divided in three groups; 2013 (G1, n = 9285), 2014 without (G2, n = 5856) and with (G3, n = 3575) goal-directed therapy. The influence of age, ASA class, severity and urgency of surgery and use of algorithm on mortality and blood use were analyzed with cox-proportional hazard models. Because in 2015, SpHb/PVI monitors were no longer available, we assessed post-study mortality observed in 2015 to measure the impact of team training to adjust vascular filling on a patient to patient basis. During non-cardiac surgery, blood was more often transfused during surgery in G3 patients as compared to G2 (66.6% vs. 50.7%, p < 0.001) but with fewer blood units per patient. After adjustment, survival analysis showed a lower risk of transfusion at 48 h in G3 [OR 0.79 (0.68-0.93), p = 0.004] but not in G2 [OR 0.90 (0.78-1.04) p = 0.17] as compared to G1. When adjusting to the severity of surgery as covariable, there was 0.5 and 0.7% differences of mortality at day 30 and 90 whether patients had goal directed therapy (GDT). After high risk surgery, the mortality at day 30 is reduced by 4% when using GDT, and 1% after intermediate risk surgery. There was no difference for low risk surgery. G3 Patients had a lower risk of death at 30 days post-surgery [OR 0.67 (0.49-0.92) p = 0.01] but not G2 patients [OR 1.01, (0.78-1.29), p = 0.96]. In 2015, mortality at 30 days and 90 days increased again to similar levels as those of 2013, respectively 2.18 and 3.09%. Monitoring SpHb and PVI integrated in a vascular filling algorithm is associated with earlier transfusion and reduced 30 and 90-day mortality on a whole hospital scale.
journal_name
J Clin Monit Computjournal_title
Journal of clinical monitoring and computingauthors
Cros J,Dalmay F,Yonnet S,Charpentier M,Tran-Van-Ho J,Renaudeau F,Drouet A,Guilbaut P,Marin B,Nathan Ndoi
10.1007/s10877-019-00367-zsubject
Has Abstractpub_date
2020-08-01 00:00:00pages
683-691issue
4eissn
1387-1307issn
1573-2614pii
10.1007/s10877-019-00367-zjournal_volume
34pub_type
杂志文章abstract::We know that a 10 cm departure from the reference level of pressure transducer position is equal to a 7.5 mmHg change of invasive hemodynamic pressure monitoring in a fluid-filled system. However, the relationship between the site level of a variable arterial pressure transducer and the pulse contour-derived parameter...
journal_title:Journal of clinical monitoring and computing
pub_type: 杂志文章
doi:10.1007/s10877-015-9756-x
更新日期:2016-10-01 00:00:00
abstract:OBJECTIVE:We tested whether a newly installed neuromuscular monitoring device (NMT) with a computerized anesthesia recording system, incorporated in all anesthesia stations, could enhance the commitment to objective neuromuscular monitoring in a teaching hospital anesthesia department. METHODS:After 6 months of famili...
journal_title:Journal of clinical monitoring and computing
pub_type: 杂志文章
doi:10.1007/s10877-008-9135-y
更新日期:2008-08-01 00:00:00
abstract::Prediction of difficult laryngoscopy is still the uncovered secret of anesthetic practice. This pilot study is aimed to assess the efficacy of spirometry measurements in predicting difficult laryngoscopy compared with conventional airway assessment techniques. We enrolled 202 adults, ages 18-40 years, with an American...
journal_title:Journal of clinical monitoring and computing
pub_type: 杂志文章
doi:10.1007/s10877-016-9961-2
更新日期:2017-12-01 00:00:00
abstract::To date, most of the studies on safety and efficacy of supraglottic airway devices were done in Caucasian patients, and the results may not be extrapolated to Asian patients due to the different airway anatomy. We conducted this study to compare Supreme™ LMA (SLMA) and Proseal™ LMA (PLMA) size 1.5 in anaesthetized chi...
journal_title:Journal of clinical monitoring and computing
pub_type: 杂志文章,随机对照试验
doi:10.1007/s10877-018-0109-4
更新日期:2018-12-01 00:00:00
abstract::Recently a novel pain recognition indicator derived from electroencephalogram(EEG) signals, pain threshold index(PTI) has been developed. The aim of this study was to determine whether PTI can be used for prediction of postoperative acute pain while surgical pleth index(SPI) applied as control. Eighty patients undergo...
journal_title:Journal of clinical monitoring and computing
pub_type: 杂志文章
doi:10.1007/s10877-020-00604-w
更新日期:2020-10-12 00:00:00
abstract::The use of processed electroencephalography (EEG) using a simple frontal lead system has been made available for assessing the impact of anesthetic medications during surgery. This review discusses the basic principles behind these devices. The foundations of anesthesia monitoring rest on the observations of Guedel wi...
journal_title:Journal of clinical monitoring and computing
pub_type: 杂志文章,评审
doi:10.1007/s10877-006-9044-x
更新日期:2006-12-01 00:00:00
abstract:INTRODUCTION:Effectively monitoring the level of consciousness during general anesthesia is clinically beneficial to both the patient and the physician. An electroencephalogram (EEG)-based level-of-consciousness monitor can help minimize intraoperative awareness as well as the effects of over-sedation. In this study, w...
journal_title:Journal of clinical monitoring and computing
pub_type: 杂志文章
doi:10.1007/s10877-010-9246-0
更新日期:2010-08-01 00:00:00
abstract:OBJECTIVE:Awareness with recall is a rare but serious complication of general anaesthesia with an incidence ranging from 0.1%-0.7%. In the absence of a reliable depth-of-anaesthesia monitor, attempts have been made to predict awareness from intraoperative haemodynamic monitoring data, with little success. Artificial ne...
journal_title:Journal of clinical monitoring and computing
pub_type: 杂志文章
doi:10.1023/a:1015426015547
更新日期:2002-01-01 00:00:00
abstract::Pulse contour analysis techniques are used for beat-to-beat tracking of cardiac output in critically ill patients. However, an adequate pulse pressure waveform signal and identification of the appropriate (i.e. systolic) part of the waveform by the monitor are crucial for correct calculation of continuous cardiac outp...
journal_title:Journal of clinical monitoring and computing
pub_type: 杂志文章
doi:10.1007/s10877-013-9470-5
更新日期:2013-10-01 00:00:00
abstract::Obstructive sleep apnea (OSA) is a risk factor for perioperative complications, but many OSA patients present undiagnosed. While polysomnography (PSG) is the "gold standard" for diagnosis, its application is technology-intense, time-consuming, expensive, and requires specialists, often delaying surgery. Thus, miniatur...
journal_title:Journal of clinical monitoring and computing
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doi:10.1007/s10877-018-0151-2
更新日期:2019-04-01 00:00:00
abstract::Central venous cannulation is a commonly preformed procedure in many branches of medicine, particularly in anaesthesia and intensive care medicine. The purpose of this study was to compare the landmark-guided technique to the ultrasound-guided technique for internal jugular vein cannulation in cardiovascular surgery p...
journal_title:Journal of clinical monitoring and computing
pub_type: 杂志文章,随机对照试验
doi:10.1007/s10877-014-9585-3
更新日期:2015-02-01 00:00:00
abstract::Cerebrovascular autoregulation (CA) is often impaired following traumatic brain injury. Established technologies and metrics used to assess CA are invasive and conducive for measurement, but not for continuous monitoring. We developed a trans-ocular brain impedance (TOBI) method that may provide non-invasive and conti...
journal_title:Journal of clinical monitoring and computing
pub_type: 杂志文章
doi:10.1007/s10877-020-00556-1
更新日期:2020-07-14 00:00:00
abstract::The composite auditory evoked potentials index (cAAI) uses both cortical electroencephalogram (EEG) and response to auditory stimuli, while the bispectral index (BIS) uses only the cortical EEG and auditory evoked potentials index (AAI) uses only response to auditory stimuli. We expected that the cAAI was more useful ...
journal_title:Journal of clinical monitoring and computing
pub_type: 杂志文章,随机对照试验
doi:10.1007/s10877-013-9441-x
更新日期:2013-06-01 00:00:00
abstract:OBJECTIVE:In mechanical ventilation, the assessment of pulmonary mechanics, mainly of total compliance (Crs), total resistance (Rrs), and intrinsic positive end-expiratory pressure (PEEPint), is clinically important. By using airway pressure (Paw) and flow (V'aw), the least squares fit (LSF) method allows the continuou...
journal_title:Journal of clinical monitoring and computing
pub_type: 杂志文章
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更新日期:1998-02-01 00:00:00
abstract::Jasiukaitis and Lyon (J Clin Monit Comput, https://doi.org/10.1007/s10877-018-0181-9, 2018) described an motor evoked potential (MEP)amplitude trending system to detect MEP amplitude loss against a background of MEP variability. They found that the end of case value of a running R2 triggered by a set MEP amplitude los...
journal_title:Journal of clinical monitoring and computing
pub_type: 杂志文章
doi:10.1007/s10877-019-00272-5
更新日期:2020-02-01 00:00:00
abstract:OBJECTIVES:Optimizing cerebral oxygenation is of paramount importance in certain intraoperative situations. There is, however, a paucity of published data pertaining to changes in cerebral oxygenation seen with increases in the inspired fraction of oxygen (FIO2) or end-tidal carbon dioxide (PETCO2) in anesthetized pati...
journal_title:Journal of clinical monitoring and computing
pub_type: 临床试验,杂志文章
doi:10.1007/s10877-010-9265-x
更新日期:2010-12-01 00:00:00
abstract::Sedation in locations outside the operating room (OR) is common. Guidelines for safe patient monitoring have been updated by the American Society of Anesthesiology to include monitoring of ventilation and/or carbon dioxide (CO2). Although technologies exist to monitor these variables, the quality and/or availability o...
journal_title:Journal of clinical monitoring and computing
pub_type: 杂志文章
doi:10.1007/s10877-015-9809-1
更新日期:2017-02-01 00:00:00
abstract::The American Society of Anesthesiologist recommends peripheral physiological monitoring during general anesthesia, which offers no information regarding the effects of anesthetics on the brain. Since no "gold standard" method exists for this evaluation, such a technique is needed to ensure patient comfort, procedure q...
journal_title:Journal of clinical monitoring and computing
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journal_title:Journal of clinical monitoring and computing
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journal_title:Journal of clinical monitoring and computing
pub_type: 杂志文章,随机对照试验
doi:10.1007/s10877-017-0036-9
更新日期:2018-06-01 00:00:00
abstract::The test of the inner tube integrity is an important checklist prior to the safe use of Bain's breathing system. This is because the major concern with the use of Bain's circuit is the potential malfunctioning of the circuit due to avulsion of the inner fresh gas delivery tube at the machine end which will turn the ou...
journal_title:Journal of clinical monitoring and computing
pub_type: 杂志文章
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journal_title:Journal of clinical monitoring and computing
pub_type: 杂志文章
doi:10.1007/s10877-018-0197-1
更新日期:2019-08-01 00:00:00
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journal_title:Journal of clinical monitoring and computing
pub_type: 杂志文章
doi:10.1007/s10877-018-0152-1
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journal_title:Journal of clinical monitoring and computing
pub_type: 杂志文章
doi:10.1007/s10877-019-00333-9
更新日期:2020-06-01 00:00:00
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journal_title:Journal of clinical monitoring and computing
pub_type: 杂志文章
doi:10.1007/s10877-015-9727-2
更新日期:2016-08-01 00:00:00
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journal_title:Journal of clinical monitoring and computing
pub_type: 杂志文章
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journal_title:Journal of clinical monitoring and computing
pub_type: 杂志文章
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更新日期:2008-10-01 00:00:00
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journal_title:Journal of clinical monitoring and computing
pub_type: 杂志文章
doi:10.1007/s10877-012-9358-9
更新日期:2012-06-01 00:00:00
abstract::Extravascular lung water (EVLW) could increase by permeability pulmonary oedema, cardiogenic oedema, or both. Transthoracic echocardiography examination of a patient allows quantifying B-lines, originating from water-thickened interlobular septa, and the E/Ea ratio, related to pulmonary capillary wedge pressure. The a...
journal_title:Journal of clinical monitoring and computing
pub_type: 杂志文章
doi:10.1007/s10877-014-9582-6
更新日期:2015-02-01 00:00:00
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journal_title:Journal of clinical monitoring and computing
pub_type: 杂志文章
doi:10.1007/s10877-015-9743-2
更新日期:2016-08-01 00:00:00