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Yu-ting Lin - One of the best experts on this subject based on the ideXlab platform.
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differentiation of skin incision and laparoscopic trocar insertion via quantifying transient bradycardia measured by electrocardiogram
Journal of Clinical Monitoring and Computing, 2020Co-Authors: Cheng-hsi Chang, Yue-lin Fang, Yu-jung Wang, Yu-ting LinAbstract:Most surgical procedures involve structures deeper than the skin. However, the difference in surgical noxious stimulation between skin incision and laparoscopic trocar insertion is unknown. By analyzing instantaneous heart rate (IHR) calculated from the electrocardiogram, in particular the transient bradycardia in response to surgical stimuli, this study investigates surgical noxious stimuli arising from skin incision and laparoscopic trocar insertion, and their difference. Thirty-five Patients undergoing laparoscopic cholecystectomy were enrolled in this prospective observational study. Sequential surgical steps including umbilical skin incision (11 mm), umbilical trocar insertion (11 mm), xiphoid skin incision (5 mm), xiphoid trocar insertion (5 mm), subcostal skin incision (3 mm), and subcostal trocar insertion (3 mm) were investigated. IHR was derived from electrocardiography and calculated by the modern time-varying power spectrum. Similar to the classical heart rate variability analysis, the time-varying low frequency power (tvLF), time-varying high frequency power (tvHF), and tvLF-to-tvHF ratio (tvLHR) were calculated. Prediction probability (PK) analysis and global pointwise F-test were used to compare the statistical performance between indices and the heart rate readings from the Patient Monitor. Analysis of IHR showed that surgical stimulus elicits a transient bradycardia, followed by the increase of heart rate. Transient bradycardia is more significant in trocar insertion than skin incision (p < 0.001 for tvHF). The IHR change quantifies differential responses to different surgical intensity. Serial PK analysis demonstrates de-sensitization in skin incision, but not in laparoscopic trocar insertion. Quantitative indices present the transient bradycardia introduced by noxious stimulation. The results indicate different effects between skin incision and trocar insertion.
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unexpected sawtooth artifact in beat to beat pulse transit time measured from Patient Monitor data
PLOS ONE, 2019Co-Authors: Yu-ting Lin, Chenyun Lin, Martin G FraschAbstract:Object It is increasingly popular to collect as much data as possible in the hospital setting from clinical Monitors for research purposes. However, in this setup the data calibration issue is often not discussed and, rather, implicitly assumed, while the clinical Monitors might not be designed for the data analysis purpose. We hypothesize that this calibration issue for a secondary analysis may become an important source of artifacts in Patient Monitor data. We test an off-the-shelf integrated photoplethysmography (PPG) and electrocardiogram (ECG) Monitoring device for its ability to yield a reliable pulse transit time (PTT) signal. Approach This is a retrospective clinical study using two databases: one containing 35 subjects who underwent laparoscopic cholecystectomy, another containing 22 subjects who underwent spontaneous breathing test in the intensive care unit. All data sets include recordings of PPG and ECG using a commonly deployed Patient Monitor. We calculated the PTT signal offline. Main results We report a novel constant oscillatory pattern in the PTT signal and identify this pattern as a sawtooth artifact. We apply an approach based on the de-shape method to visualize, quantify and validate this sawtooth artifact. Significance The PPG and ECG signals not designed for the PTT evaluation may contain unwanted artifacts. The PTT signal should be calibrated before analysis to avoid erroneous interpretation of its physiological meaning.
Cheng-hsi Chang - One of the best experts on this subject based on the ideXlab platform.
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differentiation of skin incision and laparoscopic trocar insertion via quantifying transient bradycardia measured by electrocardiogram
Journal of Clinical Monitoring and Computing, 2020Co-Authors: Cheng-hsi Chang, Yue-lin Fang, Yu-jung Wang, Yu-ting LinAbstract:Most surgical procedures involve structures deeper than the skin. However, the difference in surgical noxious stimulation between skin incision and laparoscopic trocar insertion is unknown. By analyzing instantaneous heart rate (IHR) calculated from the electrocardiogram, in particular the transient bradycardia in response to surgical stimuli, this study investigates surgical noxious stimuli arising from skin incision and laparoscopic trocar insertion, and their difference. Thirty-five Patients undergoing laparoscopic cholecystectomy were enrolled in this prospective observational study. Sequential surgical steps including umbilical skin incision (11 mm), umbilical trocar insertion (11 mm), xiphoid skin incision (5 mm), xiphoid trocar insertion (5 mm), subcostal skin incision (3 mm), and subcostal trocar insertion (3 mm) were investigated. IHR was derived from electrocardiography and calculated by the modern time-varying power spectrum. Similar to the classical heart rate variability analysis, the time-varying low frequency power (tvLF), time-varying high frequency power (tvHF), and tvLF-to-tvHF ratio (tvLHR) were calculated. Prediction probability (PK) analysis and global pointwise F-test were used to compare the statistical performance between indices and the heart rate readings from the Patient Monitor. Analysis of IHR showed that surgical stimulus elicits a transient bradycardia, followed by the increase of heart rate. Transient bradycardia is more significant in trocar insertion than skin incision (p < 0.001 for tvHF). The IHR change quantifies differential responses to different surgical intensity. Serial PK analysis demonstrates de-sensitization in skin incision, but not in laparoscopic trocar insertion. Quantitative indices present the transient bradycardia introduced by noxious stimulation. The results indicate different effects between skin incision and trocar insertion.
Qingzhen Peng - One of the best experts on this subject based on the ideXlab platform.
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Plasminogen improves lung lesions and hypoxemia in Patients with COVID-19.
QJM : monthly journal of the Association of Physicians, 2020Co-Authors: Ting Wang, Chunying Guo, Dongmei Zhang, Zhaoxing Huang, Xianshan Zhou, Qingzhen PengAbstract:Background Lungs from Patients with coronavirus disease 2019 (COVID-19) have shown typical signs of acute respiratory distress syndrome (ARDS), formation of hyaline membrane mainly composed of fibrin and 'ground-glass' opacity. Previously, we showed plasminogen itself is a key regulator in fibrin degradation, wound healing and infection. Aim We aimed to investigate whether plasminogen can improve lung lesions and hypoxemia of COVID-19. Design Thirteen clinically moderate, severe or critical COVID-19 Patients were treated with atomization inhalation of freeze-dried plasminogen. Methods Levels of their lung lesions, oxygen saturation and heart rates were compared before and after treatment by computed tomography scanning images and Patient Monitor. Results After plasminogen inhalation, conditions of lung lesions in five clinically moderate Patients have quickly improved, shown as the decreased range and density of 'ground glass' opacity. Improvements of oxygen saturation were observed in six clinically severe Patients. In the two Patients with critical conditions, the oxygen levels have significantly increased from 79-82% to 91% just about 1 h after the first inhalation. In 8 of 13 Patients, the heart rates had slowed down. For the five clinically moderate Patients, the difference is even statistically significant. Furthermore, a general relief of chest tightness was observed. Conclusion Whereas it is reported that plasminogen is dramatically increased in adults with ARDS, this study suggests that additional plasminogen may be effective and efficient in treating lung lesions and hypoxemia during COVID-19 infections. Although further studies are needed, this study highlights a possible hope of efficiently combating this rapid epidemic emergency.
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Plasminogen Improves Lung Lesions and Hypoxemia in Patients with COVID-19
SSRN Electronic Journal, 2020Co-Authors: Ting Wang, Chunying Guo, Dongmei Zhang, Zhaoxing Huang, Xianshan Zhou, Qingzhen PengAbstract:Background: Lungs from Patients with coronavirus disease 2019 (COVID-19) have shown typical signs of acute respiratory distress syndrome (ARDS), formation of hyaline membrane mainly composed of fibrin, and ‘ground-glass’ opacity. Previously, we showed plasminogen itself is a key regulator in fibrin degradation, wound healing and infection. Thus, here we aimed to investigate whether plasminogen can improve lung lesions and hypoxemia of COVID-19. Methods: Thirteen clinically moderate, severe or critical COVID-19 Patients were treated with atomization inhalation of freeze-dried plasminogen. Levels of their lung lesions, oxygen saturation and heart rates were compared before and after treatment by CT scanning images and Patient Monitor. Findings: After plasminogen inhalation, conditions of lung lesions in 5 clinically moderate Patients have quickly improved, shown as the decreased range and density of ‘ground glass’ opacity. Improvements of the levels of oxygen saturation were observed in 6 clinically severe Patients. In the 2 Patients with critical conditions, the oxygen levels have significantly increased from 79-82% to 91% just about 1 hour after the first inhalation. In 8 of 13 Patients the heart rates had slowed down. For the 5 clinically moderate Patients, the difference is even statistically significant. Furthermore, a general relief of chest tightness was observed. Interpretation: Whereas it is reported that plasminogen is dramatically increased in adults with ARDS, this study suggests that additional plasminogen may be effective and efficient in treating lung lesions and hypoxemia caused by COVID-19 infections. This study highlights a possible hope of efficiently combating this rapid epidemic emergency. Funding: None.
Ting Wang - One of the best experts on this subject based on the ideXlab platform.
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Plasminogen improves lung lesions and hypoxemia in Patients with COVID-19.
QJM : monthly journal of the Association of Physicians, 2020Co-Authors: Ting Wang, Chunying Guo, Dongmei Zhang, Zhaoxing Huang, Xianshan Zhou, Qingzhen PengAbstract:Background Lungs from Patients with coronavirus disease 2019 (COVID-19) have shown typical signs of acute respiratory distress syndrome (ARDS), formation of hyaline membrane mainly composed of fibrin and 'ground-glass' opacity. Previously, we showed plasminogen itself is a key regulator in fibrin degradation, wound healing and infection. Aim We aimed to investigate whether plasminogen can improve lung lesions and hypoxemia of COVID-19. Design Thirteen clinically moderate, severe or critical COVID-19 Patients were treated with atomization inhalation of freeze-dried plasminogen. Methods Levels of their lung lesions, oxygen saturation and heart rates were compared before and after treatment by computed tomography scanning images and Patient Monitor. Results After plasminogen inhalation, conditions of lung lesions in five clinically moderate Patients have quickly improved, shown as the decreased range and density of 'ground glass' opacity. Improvements of oxygen saturation were observed in six clinically severe Patients. In the two Patients with critical conditions, the oxygen levels have significantly increased from 79-82% to 91% just about 1 h after the first inhalation. In 8 of 13 Patients, the heart rates had slowed down. For the five clinically moderate Patients, the difference is even statistically significant. Furthermore, a general relief of chest tightness was observed. Conclusion Whereas it is reported that plasminogen is dramatically increased in adults with ARDS, this study suggests that additional plasminogen may be effective and efficient in treating lung lesions and hypoxemia during COVID-19 infections. Although further studies are needed, this study highlights a possible hope of efficiently combating this rapid epidemic emergency.
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Plasminogen Improves Lung Lesions and Hypoxemia in Patients with COVID-19
SSRN Electronic Journal, 2020Co-Authors: Ting Wang, Chunying Guo, Dongmei Zhang, Zhaoxing Huang, Xianshan Zhou, Qingzhen PengAbstract:Background: Lungs from Patients with coronavirus disease 2019 (COVID-19) have shown typical signs of acute respiratory distress syndrome (ARDS), formation of hyaline membrane mainly composed of fibrin, and ‘ground-glass’ opacity. Previously, we showed plasminogen itself is a key regulator in fibrin degradation, wound healing and infection. Thus, here we aimed to investigate whether plasminogen can improve lung lesions and hypoxemia of COVID-19. Methods: Thirteen clinically moderate, severe or critical COVID-19 Patients were treated with atomization inhalation of freeze-dried plasminogen. Levels of their lung lesions, oxygen saturation and heart rates were compared before and after treatment by CT scanning images and Patient Monitor. Findings: After plasminogen inhalation, conditions of lung lesions in 5 clinically moderate Patients have quickly improved, shown as the decreased range and density of ‘ground glass’ opacity. Improvements of the levels of oxygen saturation were observed in 6 clinically severe Patients. In the 2 Patients with critical conditions, the oxygen levels have significantly increased from 79-82% to 91% just about 1 hour after the first inhalation. In 8 of 13 Patients the heart rates had slowed down. For the 5 clinically moderate Patients, the difference is even statistically significant. Furthermore, a general relief of chest tightness was observed. Interpretation: Whereas it is reported that plasminogen is dramatically increased in adults with ARDS, this study suggests that additional plasminogen may be effective and efficient in treating lung lesions and hypoxemia caused by COVID-19 infections. This study highlights a possible hope of efficiently combating this rapid epidemic emergency. Funding: None.
Carola Van Pul - One of the best experts on this subject based on the ideXlab platform.
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the heuristics of nurse responsiveness to critical Patient Monitor and ventilator alarms in a private room neonatal intensive care unit
PLOS ONE, 2017Co-Authors: Rohan Joshi, Heidi Van De Mortel, Loe Feijs, Peter Andriessen, Carola Van PulAbstract:Aim Alarm fatigue is a well-recognized Patient safety concern in intensive care settings. Decreased nurse responsiveness and slow response times to alarms are the potentially dangerous consequences of alarm fatigue. The aim of this study was to determine the factors that modulate nurse responsiveness to critical Patient Monitor and ventilator alarms in the context of a private room neonatal intensive care setting. Methods The study design comprised of both a questionnaire and video Monitoring of nurse-responsiveness to critical alarms. The Likert scale questionnaire, comprising of 50 questions across thematic clusters (critical alarms, yellow alarms, perception, design, nursing action, and context) was administered to 56 nurses (90% response rate). Nearly 6000 critical alarms were recorded from 10 infants in approximately 2400 hours of video Monitoring. Logistic regression was used to identify Patient and alarm-level factors that modulate nurse-responsiveness to critical alarms, with a response being defined as a nurse entering the Patient’s room within the 90s of the alarm being generated. Results Based on the questionnaire, the majority of nurses found critical alarms to be clinically relevant even though the alarms did not always mandate clinical action. Based on video observations, for a median of 34% (IQR, 20–52) of critical alarms, the nurse was already present in the room. For the remaining alarms, the response rate within 90s was 26%. The median response time was 55s (IQR, 37-70s). Desaturation alarms were the most prevalent and accounted for more than 50% of all alarms. The odds of responding to bradycardia alarms, compared to desaturation alarms, were 1.47 (95% CI = 1.21–1.78; <0.001) while that of responding to a ventilator alarm was lower at 0.35 (95% CI = 0.27–0.46; p <0.001). For every 20s increase in the duration of an alarm, the odds of responding to the alarm (within 90s) increased to 1.15 (95% CI = 1.1–1.2; p <0.001). The random effect per infant improved the fit of the model to the data with the response times being slower for infants suffering from chronic illnesses while being faster for infants who were clinically unstable. Discussion Even though nurses respond to only a fraction of all critical alarms, they consider the vast majority of critical and yellow alarms as useful and relevant. When notified of a critical alarm, they seek waveform information and employ heuristics in determining whether or not to respond to the alarm. Conclusion Amongst other factors, the category and duration of critical alarms along with the clinical status of the Patient determine nurse-responsiveness to alarms.
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The heuristics of nurse responsiveness to critical Patient Monitor and ventilator alarms in a private room neonatal intensive care unit
2017Co-Authors: Rohan Joshi, Heidi Van De Mortel, Loe Feijs, Peter Andriessen, Carola Van PulAbstract:AimAlarm fatigue is a well-recognized Patient safety concern in intensive care settings. Decreased nurse responsiveness and slow response times to alarms are the potentially dangerous consequences of alarm fatigue. The aim of this study was to determine the factors that modulate nurse responsiveness to critical Patient Monitor and ventilator alarms in the context of a private room neonatal intensive care setting.MethodsThe study design comprised of both a questionnaire and video Monitoring of nurse-responsiveness to critical alarms. The Likert scale questionnaire, comprising of 50 questions across thematic clusters (critical alarms, yellow alarms, perception, design, nursing action, and context) was administered to 56 nurses (90% response rate). Nearly 6000 critical alarms were recorded from 10 infants in approximately 2400 hours of video Monitoring. Logistic regression was used to identify Patient and alarm-level factors that modulate nurse-responsiveness to critical alarms, with a response being defined as a nurse entering the Patient’s room within the 90s of the alarm being generated.ResultsBased on the questionnaire, the majority of nurses found critical alarms to be clinically relevant even though the alarms did not always mandate clinical action. Based on video observations, for a median of 34% (IQR, 20–52) of critical alarms, the nurse was already present in the room. For the remaining alarms, the response rate within 90s was 26%. The median response time was 55s (IQR, 37-70s). Desaturation alarms were the most prevalent and accounted for more than 50% of all alarms. The odds of responding to bradycardia alarms, compared to desaturation alarms, were 1.47 (95% CI = 1.21–1.78;