Use Of Continuous Monitoring Research Articles

Some aspects of the statistical assessment of the indicators of efficient management of the enterprise labor resources

The article is devoted to the actual problem of effective management of the enterprise human resources; to the research of theoretical approaches to the definition of key indicators to the state assessment of productive labor use. It is proved that the basis for improving the efficiency and development of the economy is productive labor. The method of measuring and evaluating of the dynamics of the labor productivity definition in enterprises using statistical methods is proposed. The effects of productivity changes on the enterprise indicators such as the production capacity use, the reduction of the production costs, profitability rise, etc are examined. Also in the article the reasons and factors determining the indicator level, the basic criterion of of the enterprise labor resources optimality are revealed and proved. The main stages of the development of statistical evaluation methods of the general indicators state of the economic entity labor productivity are observed. For the more complete and effective performance analysis at the enterprise assessment is proposed by such methods as: calculation of gross output (sales revenue) per employee and per one spent man-hour. Investigation of the labor productivity dynamics and assessment of the impact of factors is generally performed using index analysis. The labor productivity dynamics, the use of working time and the average number of employees are analyzed. It is proposed to exclude the impact of volatility indices of effective use of labor resources in the deterioration of other economic activity indicators of the enterprise to improve the conditions for the high productivity achievements; active use of continuous monitoring of the factors of influence, as well as the creation and implementation of the set of measures to ensure the solution. It is found that the successfully organized personnel management system creates the basic settings for the operational management of human resources, solves the problems of the company survival, contributes to its stability and development.

Monitoring the coastal zone using earth observation: application of linear spectral unmixing to coastal dune systems in Wales

AbstractCoastal sand dune systems across temperate Europe are presently characterized by a high level of ecological stabilization and a subsequent loss of biological diversity. The use of continuous monitoring within these systems is vital to the preservation of species richness, particularly with regard to the persistence of early stage pioneer species dependent on a strong sediment supply. Linear spectral unmixing was applied to archived Landsat data (1975–2014) and historical aerial photography (1941–1962) for monitoring bare sand (BS) cover dynamics as a proxy for ecological dune stabilization. Using this approach, a time series of change was calculated for Kenfig Burrows, a 6‐km2 stabilized dune system in South Wales, during 1941–2014. The time series indicated that a rapid level of stabilization had occurred within the study area over a period of 75 years. Accuracy assessment of the data indicated the suitability of medium‐resolution imagery with an RMSE of <10% across all images and a difference of <3% between observed and predicted BS area. Temporal resolution was found to be a significant factor in the representation of BS cover with fluctuations occurring on a sub‐decadal scale, outside of the margin of error introduced through the use of medium‐resolution Landsat imagery. This study demonstrates a tractable approach for mapping and monitoring ecologically sensitive regions at a sub‐Landsat pixel level.

Spatial and temporal seismic velocity changes on Kyushu Island during the 2016 Kumamoto earthquake.

Monitoring of earthquake faults and volcanoes contributes to our understanding of their dynamic mechanisms and to our ability to predict future earthquakes and volcanic activity. We report here on spatial and temporal variations of seismic velocity around the seismogenic fault of the 2016 Kumamoto earthquake [moment magnitude (Mw) 7.0] based on ambient seismic noise. Seismic velocity near the rupture faults and Aso volcano decreased during the earthquake. The velocity reduction near the faults may have been due to formation damage, a change in stress state, and an increase in pore pressure. Further, we mapped the post-earthquake fault-healing process. The largest seismic velocity reduction observed at Aso volcano during the earthquake was likely caused by pressurized volcanic fluids, and the large increase in seismic velocity at the volcano's magma body observed ~3 months after the earthquake may have been a response to depressurization caused by the eruption. This study demonstrates the usefulness of continuous monitoring of faults and volcanoes.

Use of continuous monitoring to assess stream nitrate flux and transformation patterns.

Delivery of nitrogen from farmed fields to the stream network is an ongoing water quality issue in central North America and other parts of the world. Although fertilization and other farming practices have been refined to produce environmental improvements, stemming loss of nitrogen, especially in the soluble nitrate form, is a problem that has seemingly defied solution. The Iowa Nutrient Reduction Strategy is a policy initiative designed to implement conservation and other farm management practices to produce reductions in nitrate loading. The strategy does not focus on how the streams themselves may or may not be processing nitrogen and reducing downstream loading. We used continuous high-frequency nitrate and discharge monitoring over 3years at two sites separated by 18km in a low-order, agricultural stream in eastern Iowa to estimate how nitrogen is processed, and whether or not these processes are reducing downstream loading. We conclude that the upstream to downstream nitrate concentration decline between the two sites was not driven by denitrification. These data also show that nitrate concentrations are closely coupled to discharge during periods of adequate moisture, but decoupling of concentration from discharge occurs during dry periods. This decoupling is a possible indicator of in-stream nitrate processing. Finally, nitrate concentrations are likely diluted by water sourced from non-row crop land covers in the lower reaches of the watershed.

Cerebral microembolic load in open heart surgery with different extracorporeal circulation systems

Somanetics 5100C was used to assess regional tissue oxygen saturation. DO2 and VO2 values to assess the oxygen delivery and consumption were also calculated. The association between cerebral and somatic rSO2 trends and mean arterial pressure, pump flow and blood gases were also studied. Results. it was found that prolonged episodes of decrease of somatic rSO2 during cardiopulmonary bypass with lower haemoglobin levels and DO2 values were strongly associated with occurrence of post-op organ disorders especially acute kidney injury. As the results of the correspondence analysis it was shown that for positive outcome without organ disorders greater importance have absolute values of DO2, VO2 and rSO2 (both cerebral and somatic), but for the poor outcome with complications the length of episodes of rSO2 decrease has the greater influence. It was also found that somatic rSO2 values are not strongly associated with pump flow or mean arterial pressure or arterial pO2. Discussion. the use of continuous monitoring of cerebral and even somatic rSO2 during cardiopulmonary bypass in adults may help the prefusionist to assess the adequacy of tissue oxygenation. To improve the somatic and cerebral rSO2 complex strategy is needed to be worked out because the routine increase of pump or gas flow was shown to be not enough and sometimes controversial [2].

Perceived Usefulness and Ease of Use of Wearable Sensor-Based Systems in Emergency Departments

OCCUPATIONAL APPLICATIONS Patients and nurses had positive reactions with respect to perceived usefulness and ease of use of a wireless wearable sensor-based system in two emergency departments. Results showed that patients' perceptions on the ease of use of the technology were more favorable and less variable than nurses' perception. The results are encouraging for the implementation of such technology in emergency department settings as they seem to promote the use of the technology for continuous monitoring of vital signs.TECHNICAL ABSTRACT Background: The use of wearable sensor-based systems in healthcare settings has been proposed and implemented in previous studies. While their application seems promising, the perceived usefulness and ease of use of such systems have not been assessed in detail in emergency departments. User feedback is critical as it can determine the attitude toward using the technology and ultimately predict its success. Purpose: This article presents an empirical pilot study in which the perceived usefulness and ease of use of a wireless wearable sensor-based system was assessed from the perspective of patients and nurses in emergency departments. The wireless wearable sensors were used to monitor patients' heart rate, respiration rate, temperature, oxygen level, and blood pressure. Methods: The study was conducted in two clinical settings; a total of 40 patients and 20 nurses participated in the study. After a 30-minute use and testing period, patients provided feedback through a survey. Similarly, nurses were asked to provide their feedback after their experience with four patients. Results: Participants reported that the wearable sensor-based technology was very useful and easy to use. Results also showed that mean scores for perceived usefulness and ease of use were higher for patients. Conclusions: Overall, patients and nurses had positive reactions with respect to perceived usefulness and ease of use, which is encouraging for the implementation of such technology in emergency department settings. Although it is not possible to directly predict or infer the degree of acceptability, the results of this study provide a sense of how the prospective users would feel about the usefulness of continuous monitoring as well as the ease of use of the monitoring devices.

Mm-Wave SAR demonstrator as a test bed for advanced solutions in microwave imaging

The capability of imaging and surveying ground areas with airborne and spaceborne sensors has a very high priority in many applications, both in the civilian and military sectors. One of the most essential uses of this capability is in disaster monitoring, where up-to-date, reliable images and data are vital for the undertaking and coordinating of rescue actions. Sensors in space are very accurate but typically have a long revisit time, and thus their use for continuous monitoring is limited. Manned aircrafts equipped with optical, infrared, and synthetic aperture radar (SAR) are costly, and their operation in poor weather conditions (like heavy storms) are limited due to concerns over pilot safety. Unmanned aerial vehicles (UAV) are ideal candidates for the safe and cheap surveillance and imaging of such areas. They can provide continuous monitoring at very low cost, be deployed very quickly, and pose no risk of the loss of life in the case of a platform malfunction caused by heavy weather conditions, technical problems, or human error. The disadvantage of small, unmanned platforms is that they only offer limited space for payloads and have a low electrical power supply. This lays down the conditions for the design of an airborne sensor for small- and medium-sized UAVs. The cheapest solution for UAV surveillance is the use of visual light cameras. Optical cameras are cheap, light, and require a low supply of power, but their usage is limited to the daytime and good weather conditions. The presence of heavy rain, clouds, fog, or smoke can significantly reduce their imaging distance, sometimes down to just a few meters. Far better results can be obtained using much longer electromagnetic waves. The use of far infrared (e.g. in the 10 μm region) can provide thermal information and can be used for the detection of people in both day and night conditions, but it does not provide satisfactory images of land and infrastructures. The use of millimeter and centimeter microwaves with active illumination, combined with SAR technology, can provide high resolution images in all weather conditions, day and night, at a distance of several kilometers.

Intelligent-Well-Monitoring Systems: Review and Comparison

This article, written by Senior Technology Editor Dennis Denney, contains highlights of paper SPE 150195, ’Review, Analysis, and Comparison of Intelligent-Well- Monitoring Systems,’ by M.F. Silva Junior, Petrobras, and K.M. Muradov, SPE, and D.R. Davies, SPE, Heriot-Watt University, prepared for the 2012 SPE Intelligent Energy International, Utrecht, The Netherlands, 27-29 March. The paper has not been peer reviewed. Despite the maturity of intelligent-well (IW) equipment, the concept of an integrated IW as a key element in the “digital oil field” is still not developed fully. Current practice is to evaluate the IW value chain in a fit-for-purpose manner rather than by an integrated-modeling workflow. An increasing variety of real-time downhole monitoring and measurement systems is available for deployment or is in development. A well-founded understanding of data that are actually needed, the most suitable sensor types and interfaces, and availability of data-reconciliation and -validation methodology are key factors for the success of an integrated IW project. Introduction A subsea integrated production frame-work treats the reservoir, wells, flowlines, risers, and topside facilities as a single system. IWs can provide reservoir control by use of continuous monitoring and valve actuation in real-time. Integrated modeling and optimization, in this context, aims to capture the physics of the complex interactions across the processes for true operations support. Actual data are fed into the optimizer after data analysis and assimilation for model calibration and uncertainty minimization. The complete paper details how established concepts from control engineering and metrology can be used for reservoir management. Research and development efforts in permanent well monitoring are divided into two classes: deep-reservoir and near-wellbore. Additional value can be derived from these technologies because they also can identify and classify failures in downhole equipment. Deep-reservoir sensing is related to 4D seismic, dynamic 3D resistivity, and streaming potential (electrokinetic) monitoring techniques that capture the dynamics of the entire reservoir. Near-wellbore sensing includes classical downhole measurements, such as pressure and temperature. Also, monitoring systems have become a distributed sensing network instead of an autonomous system, which requires an understanding of all errors and limitations in the signal path aside from the sensor itself. IW-Monitoring Systems The physical quantities measured by equipment from different manufacturers of sensors for downhole, near- wellbore permanent monitoring of an IW are very similar: pressure, temperature, flow, acceleration (seismic and acoustic), and strain. The differences between them and their limitations are related mostly to the equipment and its installation requirements. The measurement of new physical quantities for deep-reservoir monitoring, such as seismic, electromagnetics, and streaming potential, is in the early stages of development.

Detection of Previously Undiagnosed Atrial Fibrillation in Patients With Stroke Risk Factors and Usefulness of Continuous Monitoring in Primary Stroke Prevention

The detection of undiagnosed atrial tachycardia/atrial fibrillation (AT/AF) among patients with stroke risk factors could be useful for primary stroke prevention. We analyzed newly detected AT/AF (NDAF) using continuous monitoring in patients with stroke risk factors but without previous stroke or evidence of AT/AF. NDAF (AT/AF >5 minutes on any day) was determined in patients with implantable cardiac rhythm devices and ≥1 stroke risk factors (congestive heart failure, hypertension, age ≥75 years, or diabetes). All devices were capable of continuously monitoring the daily cumulative time in AT/AF. Of 1,368 eligible patients, NDAF was identified in 416 (30%) during a follow-up of 1.1 ± 0.7 years and was unrelated to the CHADS(2) score (congestive heart failure, hypertension [blood pressure consistently >140/90 mm Hg or hypertension treated with medication], age ≥75 years, diabetes mellitus, previous stroke or transient ischemic attack). The presence of AT/AF >6 hours on ≥1 day increased significantly with increased CHADS(2) scores and was present in 158 (54%) of 294 patients with NDAF and a CHADS(2) score of ≥2. NDAF was sporadic, and 78% of patients with a CHADS(2) score of ≥2 with NDAF experienced AT/AF on <10% of the follow-up days. The median interval to NDAF detection in these higher risk patients was 72 days (interquartile range 13 to 177). In conclusion, continuous monitoring identified NDAF in 30% of patients with stroke risk factors. In patients with NDAF, AT/AF occurred sporadically, highlighting the difficulty in detecting paroxysmal AT/AF using traditional monitoring methods. However, AT/AF also persisted for >6 hours on ≥1 days in most patients with NDAF and multiple stroke risk factors. Whether patients with CHADS(2) risk factors but without a history of AF might benefit from implantable monitors for the selection and administration of anticoagulation for primary stroke prevention merits additional investigation.

Early detection of deteriorating ventilation by monitoring bilateral chest wall dynamics in the rabbit

Mechanical complications during assisted ventilation can evolve due to worsening lung disease or problems in airway management. These complications affect lung compliance or airway resistance, which in turn affect the chest wall dynamics. The objective of this study was to explore the utility of continuous monitoring of the symmetry and dynamics of chest wall motion in the early detection of complications during mechanical ventilation. The local tidal displacement (TDi) values of each side of the chest and epigastrium were measured by three miniature motion sensors in 18 rabbits. The TDi responses to changes in peak inspiratory pressure (n = 7), induction of one-lung intubation (n = 7), and slowly progressing pneumothorax (PTX) (n = 6) were monitored in parallel with conventional respiratory (SpO(2), EtCO(2), pressure and flow) and hemodynamic (HR and BP) indices. PTX was induced by injecting air into the pleural space at a rate of 1 mL/min. A strong correlation (R(2) = 0.99) with a slope close to unity (0.94) was observed between percent change in tidal volume and in TDi. One-lung ventilation was identified by conspicuous asymmetry development between left and right TDis. These indices provided significantly early detection of uneven ventilation during slowly developing PTX (within 12.9 ± 6.6 min of onset, p = 0.02) almost 1 h before the SpO(2) dropped (77.3 ± 27.4 min, p = 0.02). Decreases in TDi of the affected side paralleled the progression of PTX. Monitoring the local TDi is a sensitive method for detecting changes in tidal volume and enables early detection of developing asymmetric ventilation.

Clinical usefulness of continuous central venous oxygen saturation measurement for postoperative management of patients following transthoracic esophagectomy for carcinoma

Monitoring of central venous blood oxygen saturation (ScvO2) has recently become easier and safer to perform, but its clinical usefulness following esophagectomy has yet to be established. This study evaluated the use of continuous monitoring of ScvO2 in this setting, focusing on its relationship with hemoglobin (Hb) concentrations, and reconsideration about an appropriate indication of red blood cell transfusion from the aspect of tissue oxygen balance. A total of 40 patients were assessed following transthoracic esophagectomy for carcinoma. ScvO2 was measured via a fiberoptic central venous oximetry catheter, postoperatively until discharge from the ICU. Hb was also measured preoperatively and every 8 h postoperatively. In correlation between ScvO2 and Hb values, ScvO2 could still be greater than 70% in patients with a Hb around 7 g/dl who did not have a bleeding event and maintained a stable circulation. Even when Hb dilution ratio (sampling Hb/preoperative Hb) decreased to around 60% of the preoperative value, ScvO2 could remain above 65%. Patients who had severe bleeding exhibited a marked decrease of the ScvO2 value before blood transfusion, but the trend was clearly seen to be a gradual increase of ScvO2 during transfusions. Hb supply is essentially unnecessary if the balance of oxygen supply/demand in tissues is well maintained. ScvO2 may be a better indicator of a physiological need for blood than Hb in postesophagectomy patients. ScvO2 is not influenced by hemodilution and lowering of Hb to around 60% of the preoperative value. As well as being a useful start indicator for blood transfusions, ScvO2 could also become a stop indicator.

Internal Audit's Role in Continuous Monitoring

Continuous Monitoring (CM) is an evolving use of technology to improve operations integrity and information and transaction quality. This article pleads for internal auditors to promote the expanded use of continuous monitoring by operations, as well as, internal audit.

Assessment of quality of midwifery care in labour and delivery wards of selected Kordestan Medical Science University hospitals

Quality improvement of reproductive health care has been announced as one of five global strategies to accelerate progress toward reproductive health goals. The World Health Organization emphasises the evaluation of structure, procedure and outcome of health services to improve quality of care. This study aims to assess the quality of provided care in labour and delivery units in two selected Kordestan Medical Science University hospitals. A descriptive study methodology was utilised to assess the quality of care provided to 96 women with normal pregnancies. Two checklists were used to observe procedures of care and structure together with a questionnaire utilised to assess satisfaction ratings of patients. Data were analysed by SPSS 11.5. Midwifery care was provided in different stages of labour, with the following mean percentages of compatibility with desirable situation: first stage of labour (71.4 per cent), second stage of labour (63.03 per cent), third stage of labour (80.63 per cent) and first 2 hours after labour (70.50 per cent). The lowest scores were related to the domains of "emotional support", "hand wash" and "assessment of vital signs". The paper develops instructions for care provision or promotion of partograph use for continuous monitoring and evaluation of quality of care by managers. Increasing midwifery personnel and providing facilities for accompanied people to improve quality of emotional care can lead to quality improvement, and finally the women's health and satisfaction.

What is the role of airway pressure release ventilation in the management of acute lung injury

The lack of published evidence supporting the use of APRV in the pediatric critical care patient population may diminish its effective application in respiratory failure. The effect of APRV on the number of ventilator days, ICU stay, and mortality still remains to be studied. Further application of APRV in the role of rest settings for ECMO especially in the pediatric cardiac patient population needs to be investigated. Will the use of APRV decrease the time for adequate lung recruitment, decrease sheer trauma, and/or promote earlier decannulation upon the restoration of tolerable cardiac function? Can APRV be utilized as a re-recruitment maneuver? A comparison of APRV over sustained in a randomized-controlled fashion, will there be a significant difference in ventilator days, length of ICU stay, and/or mortality? Does re-recruitment at plateau pressures during suctioning, patient position changes, or in the face of increased airway resistance decrease the number of ventilator days, length of ICU stay, and/or mortality? Does the use of continuous monitoring of carbon dioxide production aid in optimizing P(high)? The list of questions, both speculative and scientific are too numerous to list. Speculation leads to inquiry which over time drives science. More focus is needed on randomized, controlled trials. Initially the comparison of APRV to HFOV needs to be the primary focus for a proactive approach for ALI. Once a comfort level is established with this modality, further scientific inquires will follow. In the meantime, its use is likely to remain controversial.

Novel planar glucose biosensors for continuous monitoring use

Novel planar glucose biosensors to be used for continuous monitoring have been developed. The electrodes are produced with the "screen printing" technique, and present a high degree of reproducibility together with a low cost and the possibility of mass production. Prior to enzyme immobilisation, electrodes are chemically modified with ferric hexacyanoferrate (Prussian Blue). This allows the detection of the hydrogen peroxide produced by the enzymatic reaction catalysed by GOD, at low applied potential (ca. 0.0 V versus Ag/AgCl), highly limiting any electrochemical interferences. The layer of Prussian Blue (PB) showed a high stability at the working conditions (pH 7.4) and also after 1 year of storage dry at RT, no loss of activity was observed. The assembled glucose biosensors, showed high sensitivity towards glucose together with a long-term operational and storage stability. In a continuous flow system, with all the analytical parameters optimised, the glucose biosensors detected glucose concentration as low as 0.025 mM with a linear range up to 1.0mM. These probes were also tested over 50-60 h in a continuous flow mode to evaluate their operational stability. A 0.5 mM concentration of glucose was continuously fluxed into a biosensor wall-jet cell and the current due to the hydrogen peroxide reduction was continuously monitored. After 50-60 h, the drift of the signal observed was around 30%. Because of their high stability, these sensors suggest the possibility of using such biosensors, in conjunction with a microdialysis probe, for a continuous monitoring of glucose for clinical purposes.

A randomised controlled trial of admission electronic fetal monitoring in normal labour

Aim: to test the hypothesis that the use of admission Electronic Fetal Monitoring (EFM) for healthy pregnant women in spontaneous labour would result in an increase in continuous EFM when compared to women who have had no admission EFM. Design: a randomised controlled trial. Setting: the Midwives Birth Unit in Glasgow Royal Maternity Hospital, a major urban teaching hospital with approximately 5000 births per year. Participants: healthy pregnant women admitted in normal labour, deemed low risk based on the midwives’ birth unit admission criteria. Intervention: women were randomly allocated either to receive a routine 20-minute period of EFM at the time of admission (control group), or to receive no routine admission EFM (study group). Outcome measures: primary study outcomes, use of continuous EFM; and use of EFM additional to the admission test. Secondary outcomes: artificial rupture of membranes, use of fetal scalp electrode, fetal blood sample, syntocinon, epidural analgesia, number of vaginal examinations, rate of transfer to labour ward, and reason for transfer. Key findings: there was no statistically significant difference between the groups for use of continuous monitoring, but significantly more women in the control group did receive additional EFM. There was no statistically significant difference between groups for any of the interventions studied. Conclusion: the use of admission EFM did not in itself lead to a cascade of intervention. Other factors including setting of care and philosophy of caregivers may have an effect on the rate of intervention in labour.

Usefulness of continuous monitoring of airway resistance and flow-volume curve in the perioperative management of infants with central airway obstruction: A case of vascular ring

Usefulness of continuous monitoring of airway resistance and flow-volume curve in the perioperative management of infants with central airway obstruction: A case of vascular ring

Clinical outcome of continuous facial nerve monitoring during primary parotidectomy.

To assess whether continuous facial nerve monitoring during parotidectomy is associated with a lower incidence of facial nerve paresis or paralysis compared with parotidectomy without monitoring and to assess the cost of such monitoring. A retrospective analysis of outcomes for patients who underwent parotidectomy with or without continuous facial nerve monitoring. University medical center. Fifty-six patients undergoing parotidectomy in whom continuous electromyographic monitoring was used and 61 patients in whom it was not used. (1) The incidence of early and persistent facial nerve paresis or paralysis and (2) the cost associated with facial nerve monitoring. Early, unintentional facial weakness was significantly lower in the group monitored by electromyograpy (43.6%) than in the unmonitored group (62.3%) (P=.04). In the subgroup of patients without comorbid conditions or surgeries, early weakness in the monitored group (33.3%) remained statistically lower than the rate of early weakness in the unmonitored group (57.5%) (P=.03). There was no statistical difference in the final facial nerve function or incidence of permanent nerve injury between the groups or subgroups. After multivariate analysis, nonmonitored status (odds ratio [OR], 3.22), advancing age (OR, 1.47 per 10 years), and longer operative times (OR, 1.3 per hour) were the only significant independent predictive variables significantly associated with early postoperative facial weakness. The incremental cost of facial nerve monitoring was $379. The results suggest that continuous electromyographic monitoring of facial muscle during primary parotidectomy reduces the incidence of short-term postoperative facial paresis. Advantages and disadvantages of this technique need to be considered together with the additional costs in deciding whether routine use of continuous monitoring is a useful, cost-effective adjunct to parotid surgery.

Changes in viscoelasticity of the myocardium during cardioplegic arrest.

To evaluate the efficacy of myocardial preservation during open heart surgery, we measured the viscoelasticity of the canine myocardium during cardioplegic arrest. A transfer function method was used for the measurement with a monitoring system consisting of a vibrator, a function generator, accerometers and a signal processor. Six mongrel dogs were put on cardiopulmonary bypass and after measurement of control hemodynamics, they were subjected to cardioplegic arrest at myocardial temperatures ranging from 4 to 32 degrees C. Viscoelasticity was measured at every 15 min and the cardioplegic solution was added every 30 min. After two hr of cardioplegic arrest, the myocardium was reperfused and postischemic hemodynamics were measured after 30 min of non-working beating. Satisfactory myocardial function returned in 3 hearts with the myocardial temperatures below 24 degrees C with myocardial viscoelasticity within the control range. Moderately decreased myocardial contractility was noted in a heart kept at temperature of 27 degrees C and its viscoelasticity remained in the control range of 90 min of ischemia and then began to decrease. In 2 hearts kept at temperatures higher than 29 degrees C, severely depressed myocardial contractility was noted, and viscoelasticity decreased transiently at 45 to 60 min and then returned to control levels. These results suggested usefulness of continuous monitoring of the viscoelasticity in early detection of its degenerative alterations due to impaired myocardial preservation during open heart surgery.

Preoperative cardiorespiratory trends in infants with congenital diaphragmatic hernia

The objective of this study was to determine the cardiovascular and pulmonary adaptations of infants with congenital diaphragmatic hernia (CDH) from birth until delayed surgery through the use of continuous monitoring. Continuous cardiovascular (HR, heart rate variability [HR-SD], BP, blood pressure variability [BP-SD], and oxygen saturation) and ventilatory (minute volume, airway pressure, and effective compliance) measurements were made on-line, using a computerized whole-body plethysmograph-incubator (Vital-trends, VT1000), in nine ventilated infants with CDH. Data collection commenced at birth and continued until surgery. Minute mean values for each variable were recorded. Hourly means were computed from the minute means, averaged across infants each hour over the first 50 hours of life, and regressed against postnatal age. Results showed a significant increase in BP ( P < .01), BP-SD ( P < .05), HR-SD ( P < .04), and pH ( P < .02) versus postnatal age, and a decrease in PaCO 2 ( P < .04), FiO 2 ( P < .001), Alveolar-arterial oxygen gradient ( P < .003), and oxygenation index ( P < .002). Infants with CDH show cardiopulmonary trends over the first 2 days of life that are qualitatively similar to those of normal newborn infants. Deviation from these idealized patterns may identify an infant who is not responding satisfactorily to the given therapy and who may require alternative treatment modalities.