J Clin Monit Comput - Survey of muscle relaxant effects management with a kinemyographic-based data archiving system: a retrospective quantitative and contextual quality control approach.

Tópicos

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Resumo

In a retrospective quality control study of muscle relaxant management, we assessed unbiased files provided by an automatic archiving system using quantitative monitoring generated by a kinemyographic transducer and suggest improvements for a possible future design. 200 randomly selected files were double checked to collect the values of twitch height ratio (THr), train of four ratio (TOFr) and TOF count in four periods: references values acquisition (REF), maximal level of paralysis, paralysis maintenance, pre-tracheal extubation residual paralysis assessment (RPA). The parameter values were selected according to period-specific predefined rules. A quantitative quality control was based upon standardized cut-offs values. A contextual quality control was based upon the detection of "difficult-to-interpret" episodes. Results were expressed on a descriptive basis only. For the REF period, THrs and TOFrs were lacking in, respectively, 47 and 18 of the 200 recordings analysed. A starting TOFr above 0.90 existed in 119 files. Concomitant THrs and TOFrs >0.90 were evidenced 93 times. During RPA period, TOFr >0.90 was recorded on 82 occasions. The optimal combination of THr >0.80 and TOFr >0.90 was detected in 30 files only. Presence of "difficult to interpret" episodes started with 18 files for the REF period and increased to 42, 86 and 52 in the subsequent ones most of them probably related to the absence of initial calibration procedure. In the real life conditions, a near to optimal quality control is not always observable with the quantitative neuromuscular monitoring studied. To improve the NMT monitoring, the calibration of the sensor should be performed vigorously by the anaesthesia provider and the quality of this calibration must be displayed on the screen of the monitor.

Resumo Limpo

retrospect qualiti control studi muscl relax manag assess unbias file provid automat archiv system use quantit monitor generat kinemyograph transduc suggest improv possibl futur design random select file doubl check collect valu twitch height ratio thr train four ratio tofr tof count four period refer valu acquisit ref maxim level paralysi paralysi mainten pretrach extub residu paralysi assess rpa paramet valu select accord periodspecif predefin rule quantit qualiti control base upon standard cutoff valu contextu qualiti control base upon detect difficulttointerpret episod result express descript basi ref period thrs tofr lack respect record analys start tofr exist file concomit thrs tofr evidenc time rpa period tofr record occas optim combin thr tofr detect file presenc difficult interpret episod start file ref period increas subsequ one probabl relat absenc initi calibr procedur real life condit near optim qualiti control alway observ quantit neuromuscular monitor studi improv nmt monitor calibr sensor perform vigor anaesthesia provid qualiti calibr must display screen monitor

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