Non-parametric classification of esophagus motility by means of neural networks.

Automatic long-term recording of esophageal pressures by means of intraluminal transducers is used increasingly for evaluation of esophageal function. Most automatic analysis techniques are based on detection of derived parameters from the time series by means of arbitrary rule-based criterions. The aim of the present work has been to test the ability of neural networks to identify abnormal contraction patterns in patients with non-obstructive dysphagia (NOBD). Nineteen volunteers and 22 patients with NOBD underwent simultaneous recordings of four pressures in the esophagus for at least 23 hours. Data from 21 subjects were selected for training. The performances of two trained networks were subsequently verified on reference data from 20 subjects. The results show that non-parametric classification by means of neural networks has good potentials. Back propagation shows good performance with a sensitivity of 1.0 and a specificity of 0.8.

[Monitoring of right ventricular ejection fraction with a modified pulmonary artery catheter]. / Monitorering af højre ventrikels uddrivningsfraktion med et modificeret arteria pulmonalis kateter.

The thermodilution method for measuring right ventricular ejection fraction (RVEFTD) is described. The reproducibility of RVEFTD measurements was determined in 48 critically ill patients who all needed pharmacological inotropic support and mechanical ventilation. A coefficient of variance of 12.6% on RVEFTD determinations was found. In 46 of 48 patients (96%), the catheter did not need repositioning.

[Screening for prehypoxemia with oximetry--a study of two methods]. / Screening for praehypoksaemi med oximetri--en undersøgelse af to metoder.

The aim of the present study was to evaluate the validity of pulse oximetry screening for prehypoxaemia, to assess the agreement between pulse- and haem-oximetry and to elucidate any influence of peripheral temperature on pulse oximeter measurements. A consecutive prospective study was undertaken in 91 cardiac surgery patients still in treatment with controlled mechanical ventilation in the early postoperative period. We examined arterial oxygen tension (paO2), arterial oxygen saturation (SaO2) and pulse oximeter saturation (SpO2) from 657 arterial blood samples. The sensitivity of the pulse oximeter was 0.83, the specificity 0.73, and the diagnostic specificity was 0.10, at the chosen level of screening. The pulse oximeter showed a tendency to underestimate the oxygen saturation by 0.85%. The agreement between pulse- and haem-oxymetry was found to be good. The authors conclude that the pulse oximeter is acceptable for respiratory screening in postoperative cardiac surgery. The low specificity and the low diagnostic specificity results in frequent false alarms. Low peripheral temperature (down to 25%) do not influence the validity of either methods.

The reproducibility of measurement of right ventricular ejection fraction and cardiac output by the thermodilution technique in patients on mechanical ventilation.

Thermodilution determined right ventricular ejection fraction (RVEF) and cardiac output (CO) were measured in 48 critically ill patients requiring mechanical ventilation and inotropic and/or vasoactive drugs. The coefficient of variation on CO and RVEF were calculated from triple determinations. The average coefficient of variation based on 551 triple determinations was 12.6% for RVEF (range 2-51%) and 4.9% for CO (range 0-24%). If a 10% coefficient of variation was chosen as acceptable, 95% of the CO measurements were acceptable. The coefficient of variation on RVEF only fulfilled the 10% criteria in 46% of the measurements, but if the accepted level was raised to a 20% coefficient of variation, 90% of the measurements were acceptable. The measurement of RVEF and CO are used for calculation of e.g. right ventricular end diastolic volume (RVEDV). By applying the average coefficient of variation of RVEF and CO, the accumulated error on calculation of RVEDV was found to be divided by 15%- +20% at worst. Before derived parameters such as RVEDV are interpreted or compared with previously obtained values, the accumulated error should be calculated. To ensure the quality of the measurements, our recommendation is always to calculate the coefficient of variation for each triple determination of RVEF and CO.

Evaluation of dynamic performance in liquid-filled catheter systems for measuring invasive blood pressure.

Invasive blood pressure measurement is used in patients with unstable haemodynamics. The demand of the accuracy of these measurements is high. The reliability of the reproduced signal strongly depends on the measurement system's dynamic characteristic-its resonance frequency and damping factor. These characteristics were examined with the frequency response method, which is valuable for second and higher order systems. Most of the pressure measuring systems in use in clinical practice have low damping factor (0.1-0.2), which causes high overshoot in systolic pressure values (up to 13%), since putting all the measuring components in a chain reduces the dynamic properties of a single component and the resonance frequency drops drastically from over 100 Hz to even below 10 Hz. One of the solutions to increase the damping ratio is to insert a damping device R.O.S.E. parallel to the tubing. The resonance frequency remains the same, the damping factor increases to around 0.5. Systems with higher damping factors (0.5-0.7) have lower overshoot (1-2%), therefore the blood pressure measurements are more accurate.