Continuous Auscultation of Heart and Bilateral Breath Sounds

To the Editor.— The frequent determination of vital signs, such as heart rate and bilateral breath sounds, is a mainstay in the care of critically ill infants. Unfortunately, the routine determination of such vital signs involves the manipulation and disturbance of the infant, unnecessary risk of exposure to cold, increased risk of apnea, and infection.1,2 In addition, the frequent disruption of the infant's sleep pattern may take an unaccountable physiologic and psychologic toll. To deal with this common and challenging problem we have devised a simple and inexpensive monitoring device, using readily available supplies, which facilitates the continuous or intermittent evaluation of heart rate and bilateral breath sounds.

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DETECÇÃO EM TEMPO REAL DA FREQUÊNCIA CARDÍACA DE PESSOAS POR MEIO DA ANÁLISE DE VARIAÇÕES TEMPORAIS EM VÍDEOS

e-xacta ◽

10.18674/exacta.v9i1.1666 ◽

2016 ◽

Vol 9 (1) ◽

pp. 49 ◽

Cited By ~ 1

Author(s):

Kessiler Almeida Silveira Rodrigues ◽

Moisés Henrique Ramos Pereira ◽

Flávio Luis Cardeal Pádua

Keyword(s):

Heart Rate ◽

Continuous Monitoring ◽

Vital Signs ◽

Computational Method ◽

Burn Victims ◽

Non Invasive ◽

Statistical Confidence ◽

Common Causes ◽

Supportive Environments

As doenças cardiovasculares são, atualmente, as causas mais comuns de morbimortalidade no mundo. Na perspectiva da prevenção de doenças e agravos, tornam-se fundamentais ações que criem ambientes favoráveis à saúde e favoreçam escolhas saudáveis. Medidas de prevenção e monitoramento contínuo de sinais vitais são necessários, sendo a frequência cardíaca um sinal promissor. No entanto, tal monitoramento pode ser difícil e pouco eficiente, quando não impossível, em determinados casos, como por exemplo, vítimas de queimaduras. Este artigo propõe uma aplicação para monitoramento da frequência cardíaca não invasivo e sem a necessidade de contato, podendo ser manuseado por qualquer pessoa. Para a determinação da frequência cardíaca, a aplicação combina técnicas de processamento de imagens, tratamento de sinais fotopletismográficos e análise de variações temporais em vídeos. Os resultados obtidos demonstram que, considerando 95% de confiança estatística e um erro padrão de 1,08 batimentos por minuto, a aplicação desenvolvida possui a mesma média para aferições de batimentos cardíacos em relação a um dispositivo já consolidado no mercado para essa finalidade, mostrando-se como um método computacional promissor para medições em repouso.Abstract Cardiovascular diseases are currently the most common causes of morbidity and mortality worldwide. From the perspective of prevention of diseases and disorders, become fundamental actions that create supportive environments for health and promote healthy choices. Prevention and continuous monitoring of vital signs are necessary, and the heart rate a promising sign. However, such monitoring can be difficult and inefficient, if not impossible, in certain cases, such as burn victims. This paper proposes an application for monitoring heart rate non-invasive and without the need to touch and can be handled by anyone. For the determination of heart rate the application combines techniques of image processing, processing and analysis of signals photo-plethysmography temporal changes in video. The obtained results show that, considering a 95% statistical confidence and a standard error of 1.08 beats per minute, the developed application has the same average heartbeats' measurements in relation to a consolidated device on the market used for the same purpose, showing itself as a promising computational method for rest measurements.

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New Device for Noninvasive Telemetric Monitoring of Vital Signs in Healthy and Newly Operated Piglets

Journal of the American Association for Laboratory Animal Science ◽

10.30802/aalas-jaalas-19-000052 ◽

2020 ◽

Vol 59 (1) ◽

pp. 90-93

Author(s):

Nikolaj Bøgh ◽

Peter Agger ◽

Camilla Omann ◽

Martin N Skov ◽

Christoffer laustsen ◽

...

Keyword(s):

Heart Rate ◽

Data Quality ◽

Respiration Rate ◽

Medical Practice ◽

Vital Signs ◽

Interquartile Range ◽

Laboratory Animals ◽

New Device ◽

Noninvasive Monitor

Measuring vital signs is central to medical practice, but they are difficult to monitor in awake laboratory animals. We examined the feasibility of a noninvasive device for telemetric assessment of respiration rate, heart rate, temperature and movement in pigs. Awake piglets were monitored continuously for 31 h (interquartile range, 7) before (n = 4) and after (n = 3) surgery. Data quality was sufficient for determination of all parameters. We conclude that continuous, noninvasive monitor- ing of pigs is possible by using the evaluated device.

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Validation Study of a Contactless Monitoring Device for Vital Signs During Sleep and Sleep Architecture in Adults With Sleep-Disordered Breathing

Sleep Medicine Research ◽

10.17241/smr.2021.01144 ◽

2021 ◽

Vol 12 (2) ◽

pp. 118-124

Author(s):

Young Jeong Lee ◽

Hyun Tag Kang ◽

Ji Ho Choi ◽

Ji Eun Moon ◽

Young Jun Lee ◽

...

Keyword(s):

Heart Rate ◽

Body Temperature ◽

Respiratory Rate ◽

Sleep Disordered Breathing ◽

Intraclass Correlation ◽

Vital Signs ◽

Sleep Architecture ◽

University Hospital ◽

Monitoring Device ◽

Disordered Breathing

Background and Objective Few clinical studies have investigated the accuracy of non-contact monitoring devices for vital signs during sleep and sleep architecture in adults with sleep-disordered breathing (SDB). The purpose of this study was to assess the accuracy of a contactless monitoring device for 1) heart rate, respiratory rate, and body temperature during sleep and 2) sleep architecture in adults with SDB.Methods Thirty-five consecutive adults, who visited a tertiary university hospital due to suspected SDB, underwent a complete physical examination and standard (level 1) polysomnography plus body temperature measurement with a contactless monitoring device (HoneyCube System).Results A total of 30 subjects (mean age = 46.43 ± 12.9 years; male: female = 22: 8) were finally included, and five subjects were excluded due to inadequate data in this study. The intraclass correlation coefficient values of heart rate, respiratory rate, and body temperature measured using the contactless monitoring device were 0.91 (95% confidence interval [CI]: 0.892, 0.928), 0.937 (95% CI: 0.919, 0.954), and 0.918 (95% CI: 0.895, 0.941), respectively. The mean kappa value for sleep architecture was 0.562 (95% CI: 0.529, 0.596).Conclusions The contactless monitoring device showed good (almost perfect) agreement in terms of heart rate, respiratory rate, and body temperature and moderate agreement in sleep architecture with contact measurements. These results suggest that the HoneyCube System is a good candidate device for sleep monitoring at home and in multiple accommodations.

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Relationship between CRP Albumin Ratio and the Mortality in Critically Ill Patients with AKI: A Retrospective Observational Study

BioMed Research International ◽

10.1155/2021/9957563 ◽

2021 ◽

Vol 2021 ◽

pp. 1-9

Author(s):

Jiajia Wang ◽

Kai Zhao ◽

Xuehui Mao ◽

Yabin Zhang ◽

Jing Shao ◽

...

Keyword(s):

Nutritional Status ◽

Critically Ill ◽

Subgroup Analysis ◽

Critically Ill Patients ◽

Multivariate Regression ◽

Prognostic Score ◽

Vital Signs ◽

Albumin Ratio ◽

Provincial Hospital ◽

Increased Risk

Background. AKI is known to be associated with inflammation and nutritional status. The novel inflammatory prognostic score CAR (CRP/albumin ratio), which combines inflammation and nutritional status, was hypothesized to be associated with mortality in critically ill AKI patients in this study. Methods. The included cases were patients admitted to the ICU of Shandong Provincial Hospital from January 2016 to November 2018 and diagnosed with AKI within 48 hours of ICU admission. From the electronic case database of Shandong Provincial Hospital, we extracted the baseline demographic information, vital signs, routine laboratory parameters, complications, and other data. The above records are measured within 48 hours of admission to ICU. The clinical endpoint was the total cause mortality rate in hospital and 2 years. We constructed two multivariate regression models to determine the statistically significant correlation between CAR and mortality and conducted subgroup analysis to determine the mortality among different subgroups. Results. A total of 580 patients were included in this study. In multivariate regression analysis, higher CAR was associated with an increase in hospital and two-year all-cause mortality in critically ill patients with AKI after adjusting gender, age, respiratory frequency, temperature, and other confounding factors (tertile 3 versus tertile 1: OR, 95% CI: 2.97, 1.70-5.17; 3.03, 1.68-5.47, respectively; P < 0.001 ). Subgroup analysis showed that the CAR level in each subgroup increases with hospital mortality in critically ill patients with AKI. Conclusion. The increase of CAR in critically ill patients with AKI was associated with an increased risk of all-cause death.

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Proton pump inhibitors versus histamine-2 receptor blockers for stress ulcer prophylaxis in patients with sepsis: a retrospective cohort study

Journal of International Medical Research ◽

10.1177/03000605211025130 ◽

2021 ◽

Vol 49 (6) ◽

pp. 030006052110251

Author(s):

Minqiang Huang ◽

Ming Han ◽

Wei Han ◽

Lei Kuang

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Hospital Mortality ◽

Critically Ill ◽

Proton Pump ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Stress Ulcer ◽

Increased Risk ◽

Ulcer Prophylaxis

Objective We aimed to compare the efficacy and risks of proton pump inhibitor (PPI) versus histamine-2 receptor blocker (H2B) use for stress ulcer prophylaxis (SUP) in critically ill patients with sepsis and risk factors for gastrointestinal bleeding (GIB). Methods In this retrospective cohort study, we used the Medical Information Mart for Intensive Care III Clinical Database to identify critically ill adult patients with sepsis who had at least one risk factor for GIB and received either an H2B or PPI for ≥48 hours. Propensity score matching (PSM) was conducted to balance baseline characteristics. The primary outcome was in-hospital mortality. Results After 1:1 PSM, 1056 patients were included in the H2B and PPI groups. The PPI group had higher in-hospital mortality (23.8% vs. 17.5%), GIB (8.9% vs. 1.6%), and pneumonia (49.6% vs. 41.6%) rates than the H2B group. After adjusting for risk factors of GIB and pneumonia, PPI use was associated with a 1.28-times increased risk of in-hospital mortality, 5.89-times increased risk of GIB, and 1.32-times increased risk of pneumonia. Conclusions Among critically ill adult patients with sepsis at risk for GIB, SUP with PPIs was associated with higher in-hospital mortality and higher risk of GIB and pneumonia than H2Bs.

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Intranasal dexmedetomidine: the ideal drug for sedation in the pediatric echo lab?

Cardiology in the Young ◽

10.1017/s1047951121002493 ◽

2021 ◽

pp. 1-5

Author(s):

David E Saudek ◽

Deborah Walbergh ◽

Peter Bartz ◽

Sara Shreve ◽

Amy Schaal ◽

...

Keyword(s):

Heart Rate ◽

Heart Disease ◽

Chart Review ◽

Chloral Hydrate ◽

Vital Signs ◽

Cyanotic Heart Disease ◽

Historical Cohort ◽

Safety And Efficacy ◽

Attractive Option ◽

The Ideal

Abstract Background: Intranasal dexmedetomidine is an attractive option for procedural sedation in pediatrics due to ease of administration and its relatively short half-life. This study sought to compare the safety and efficacy of intranasal dexmedetomidine to a historical cohort of pediatric patients sedated using chloral hydrate in a pediatric echo lab. Methods: Chart review was performed to compare patients sedated between September, 2017 and October, 2019 using chloral hydrate and intranasal dexmedetomidine. Vital signs, time to sedation, duration of sedation, need for second dose of medication, rate of failed sedation, and impact on vital signs were compared between groups. Subgroup analysis was performed for those with complex and cyanotic heart disease. Results: Chloral hydrate was used in 356 patients and intranasal dexmedetomidine in 376. Patient age, complexity of heart disease, and duration of sedation were similar. Rates of failed sedation were very low and similar. Average heart rate and minimum heart rate were lower for those receiving intranasal dexmedetomidine than chloral hydrate. Impact on vital signs was similar for those with complex and cyanotic heart disease. No adverse events occurred in either group. Conclusions: Sedation with intranasal dexmedetomidine is comparable to chloral hydrate in regards to safety and efficacy for children requiring echocardiography. Consistent with the mechanism of action, patients receiving intranasal dexmedetomidine have a lower heart rate without morbidity.

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Considerations in the provision of teleconsultations for outpatient obstetric anaesthesia care during the Covid-19 pandemic

Proceedings of Singapore Healthcare ◽

10.1177/2010105821991170 ◽

2021 ◽

pp. 201010582199117

Author(s):

Leonard Wei Wen Loh ◽

Yingke He ◽

Hairil Rizal Abdullah ◽

Kai Lee Ng ◽

Un Sam Mok

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Severe Illness ◽

Continuing Care ◽

Short Report ◽

Obstetric Anaesthesia ◽

Increased Risk ◽

Process And Outcome ◽

Risk Of Exposure ◽

Anaesthesia Care

Evidence has emerged that pregnant women who contract coronavirus disease 2019 (Covid-19) are at increased risk of certain forms of severe illness as well as complications requiring intensive care unit admission and resultant mortality. Teleconsultations can facilitate continuing care for obstetric patients during the Covid-19 pandemic while reducing their risk of exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In this short report, we share our experience in the provision of teleconsultations for ambulatory obstetric anaesthesia patients in our high-risk obstetric anaesthesia clinic during the Covid-19 pandemic. Appropriate labour analgesia or anaesthesia plans were able to be formulated and communicated to the patients by teleconsultation, resulting in no delay or compromise in their peripartum care. Both patients and clinicians reported satisfaction with the teleconsultation process and outcome. The considerations and challenges in setting up a teleconsultation service as well as the factors in favour of teleconsultation are also explored.

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Relationship between Sleep and Hypertension: Findings from the NHANES (2007–2014)

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18157867 ◽

2021 ◽

Vol 18 (15) ◽

pp. 7867

Author(s):

Chunnan Li ◽

Shaomei Shang

Keyword(s):

Blood Pressure ◽

Sleep Disorder ◽

Sleep Duration ◽

Sleep Pattern ◽

Poor Sleep ◽

Sleep Patterns ◽

Short Sleep Duration ◽

Logistic Regression Models ◽

Increased Risk ◽

Definition Of

Background: To evaluate the association of sleep factors (sleep duration, self-reported trouble sleeping, diagnosed sleep disorder) and combined sleep behaviors with the risk of hypertension. Methods: We analyzed 12,166 adults aged 30–79 years who participated in the 2007–2014 National Health and Nutrition Examination Survey. Sleep duration, self-reported trouble sleeping and sleep disorders were collected using a standardized questionnaire. We included three sleep factors (sleep duration, self-reported trouble sleeping and sleep disorder) to generate an overall sleep score, ranging from 0 to 3. We then defined the sleep pattern as “healthy sleep pattern” (overall sleep score = 3), “intermediate sleep pattern” (overall sleep score = 2), and “poor sleep pattern” (0 ≤ overall sleep score ≤ 1) based on the overall sleep score. The definition of hypertension was based on self-reported antihypertensive medication use or biological measurement (systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure ≥90 mm Hg). We used weighted logistic regression models to investigate the associations between sleep and hypertension. Results: The overall prevalence of hypertension was 37.8%. A short sleep duration (OR = 1.20, 95% CI: 1.08 to 1.33, p = 0.001), self-reported trouble sleeping (OR = 1.45, 95% CI: 1.28 to 1.65, p < 0.001) and sleep disorder (OR = 1.33, 95% CI: 1.07 to 1.66, p = 0.012) were related to the risk of hypertension. Poor sleep patterns were closely correlated with the risk of hypertension (OR = 1.90, 95% CI: 1.62 to 2.24). Conclusions: Participants with poor sleep patterns were associated with an increased risk for hypertension.

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Associations between left bundle branch block with different PR intervals, QRS durations, heart rates and the risk of heart failure: a register-based cohort study using ECG data from the primary care setting

Open Heart ◽

10.1136/openhrt-2020-001425 ◽

2021 ◽

Vol 8 (1) ◽

pp. e001425

Author(s):

Marc Meller Søndergaard ◽

Johannes Riis ◽

Karoline Willum Bodker ◽

Steen Møller Hansen ◽

Jesper Nielsen ◽

...

Keyword(s):

Heart Failure ◽

Primary Care ◽

Heart Rate ◽

Left Bundle Branch Block ◽

Bundle Branch Block ◽

Increased Risk ◽

Pr Interval ◽

Qrs Duration ◽

The Impact

AimLeft bundle branch block (LBBB) is associated with an increased risk of heart failure (HF). We assessed the impact of common ECG parameters on this association using large-scale data.Methods and resultsUsing ECGs recorded in a large primary care population from 2001 to 2011, we identified HF-naive patients with a first-time LBBB ECG. We obtained information on sex, age, emigration, medication, diseases and death from Danish registries. We investigated the association between the PR interval, QRS duration, and heart rate and the risk of HF over a 2-year follow-up period using Cox regression analysis.Of 2471 included patients with LBBB, 464 (18.8%) developed HF during follow-up. A significant interaction was found between QRS duration and heart rate (p<0.01), and the analyses were stratified on these parameters. Using a QRS duration <150 ms and a heart rate <70 beats per minute (bpm) as the reference, all groups were statistically significantly associated with the development of HF. Patients with a QRS duration ≥150 ms and heart rate ≥70 bpm had the highest risk of developing HF (HR 3.17 (95% CI 2.41 to 4.18, p<0.001). There was no association between the PR interval and HF after adjustment.ConclusionProlonged QRS duration and higher heart rate were associated with increased risk of HF among primary care patients with LBBB, while no association was observed with PR interval. Patients with LBBB with both a prolonged QRS duration (≥150 ms) and higher heart rate (≥70 bpm) have the highest risk of developing HF.

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Lower serum chloride concentrations are associated with increased risk of mortality in critically ill cirrhotic patients: an analysis of the MIMIC-III database

BMC Gastroenterology ◽

10.1186/s12876-021-01797-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yun Ji ◽

Libin Li

Keyword(s):

Critically Ill ◽

Serum Sodium ◽

Kidney Injury ◽

Icu Mortality ◽

Independent Prognostic Marker ◽

Risk Of Mortality ◽

Serum Chloride ◽

Increased Risk ◽

Cirrhotic Patients ◽

End Stage

Abstract Background Cirrhosis can be complicated by electrolyte abnormalities, but the major focus has been concentrated on the clinical significance of serum sodium levels. Emerging studies have identified hypochloremia as an independent prognostic marker in patients with chronic heart failure and chronic kidney disease. The aim of this study was to investigate whether serum chloride levels were associated with mortality of critically ill cirrhotic patients. Methods Critically ill cirrhotic patients were identified from the Multi-parameter Intelligent Monitoring in Intensive Care III Database. The primary outcome was ICU mortality. Logistic regression was used to explore the association between serum chloride levels and ICU mortality. The area under the receiver operating characteristic curves (AUC) was used to assess the performance of serum chloride levels for predicting ICU mortality. Results A total of 1216 critically ill cirrhotic patients were enrolled in this study. The overall ICU mortality rate was 18.8%. Patients with hypochloremia had a higher ICU mortality than those with non-hypochloremia (34.2% vs. 15.8%; p < 0.001). After multivariable risk adjustment for age, gender, ethnicity, chloride, sodium, Model for End-stage Liver Disease score, Sequential Organ Failure Assessment score, Elixhauser comorbidity index, mechanical ventilation, vasopressors, renal replacement therapy, acute kidney injury, hemoglobin, platelet, and white blood cell, serum chloride levels remained independently associated with ICU mortality (OR 0.94; 95% CI 0.91–0.98; p = 0.002) in contrast to serum sodium levels, which were no longer significant (OR 1.03; 95% CI 0.99–1.08; p = 0.119). The AUC of serum chloride levels (AUC, 0.600; 95% CI 0.556–0.643) for ICU mortality was statistically higher than that of serum sodium levels (AUC, 0.544; 95% CI 0.499–0.590) (p < 0.001). Conclusions In critically ill cirrhotic patients, serum chloride levels are independently and inversely associated with ICU mortality, thus highlighting the prognostic role of serum chloride levels which are largely overlooked.

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