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to assist in the early warning of deterioration in hospitalised children we studied the feasibility of collecting continuous wireless physiological data using Lifetouch (ecG-derived heart and respiratory rate) and WristOx2 (pulse-oximetry and derived pulse rate) sensors. We compared our bedside paediatric early warning (peW) score and a machine learning automated approach: a Real-time Adaptive Predictive Indicator of Deterioration (RAPID) to identify children experiencing significant clinical deterioration. 982 patients contributed 7,073,486 min during 1,263 monitoring sessions. The proportion of intended monitoring time was 93% for Lifetouch and 55% for WristOx2. Valid clinical data was 63% of intended monitoring time for Lifetouch and 50% WristOx2. 29 patients experienced 36 clinically significant deteriorations. The RAPID Index detected significant deterioration more frequently (77% to 97%) and earlier than the PEW score ≥ 9/26. High sensitivity and negative predictive value for the RAPID Index was associated with low specificity and low positive predictive value. We conclude that it is feasible to collect clinically valid physiological data wirelessly for 50% of intended monitoring time. The RAPID Index identified more deterioration, before the PEW score, but has a low specificity. By using the RAPID Index with a PEW system some life-threatening events may be averted. Paediatric Early Warning (PEW) systems have reduced the late or undetected clinical deterioration experienced by some hospitalised children 1-3. Following the introduction of the bedside PEW score in Birmingham Children's Hospital, a multidisciplinary team identified missed opportunities and recommended more continuous monitoring for visualisation of trends and a smart alarm for earlier detection of deterioration. Continuous and intermittent monitoring has led to early identification of patient deterioration, increased rapid response activations and improvements in completeness of vital signs documentation 4,5. Standard monitors require sensors to be hard-wired to patients and require additional software to extract data for advanced analytics 6. Wireless monitoring offers a potentially more comfortable and economical solution although accuracy, continuity, patient tolerability and power management are challenging 7,8. A number of sensors and monitoring systems have been developed and shown to be feasible but few have been sufficiently developed and tested in large clinical trials 7-15. The advantage of more continuous monitoring for ward patients is that trends and Big Data analytics can be used to improve detection of deterioration 16-18. The intent is not that smart alarms replace clinical surveillance but that they are used in addition to current systems to support and augment decision making 19-21. Neither continuous wireless monitoring nor integrated smart alarms have been reported in the context of paediatric wards. This study tests the feasibility of collecting sufficiently useful continuous wireless monitoring and the feasibility of a re...

No abstract

After the detailed evaluation resection can be limited to an extent which is oncologically radical enough (1% remnant liver tissue/kg) and spares parenchyma which can ensure survival yet. With careful preoperative examination mortality can be reduced even to reach zero.

The living related donor mortality after liver donation could occur as a result of postoperative cardiovascular and thromboembolic complication; which could be minimized by detailed preoperative assessment of the living donor. The preoperative functional tests evaluate the physiological reserve or identify the living donors with limited response to the surgical stress. Based on the results of CT volumetry, MRI and liver functional reserve capacity test (indocyanine green retention ratio) the liver resection can be done safely. The preoperative cytochrome P enzymes tests of donors identify the drugs with abnormal metabolism. Balanced anesthesia combined with thoracic epidural anesthesia is done with liver safe, renal safe and ischemic preconditioning drugs. Normovolemic state is maintained with physiologic extrahepatic perfusion and oxygenation conditions. The central venous and hepatic artery pressure is reduced with the guarantee of optimal hepatic perfusion-oxygenation and better liver resection condition. Intraoperative thrombosis prophylaxis is performed with sequential compression device. After liver resection the donor morbidity can be reduced, effective analgesia, thrombosis prophylaxis, liver safe drug therapy and a tight monitoring. Before the first postoperative mobilization a deep vein Doppler ultrasound control is proposed.