Journal of clinical monitoring and computing
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Monitoring of continuous blood pressure and cardiac output is important to prevent hypoperfusion and to guide fluid administration, but only few patients receive such monitoring due to the invasive nature of most of the methods presently available. Noninvasive blood pressure can be determined continuously using finger cuff technology and cardiac output is easily obtained using a pulse contour method. In this way completely noninvasive continuous blood pressure and cardiac output are available for clinical use in all patients that would otherwise not be monitored. Developments and state of art in hemodynamic monitoring are reviewed here, with a focus on noninvasive continuous hemodynamic monitoring form the finger.
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J Clin Monit Comput · Aug 2012
Randomized Controlled TrialDecision support for optimized blood glucose control and nutrition in a neurotrauma intensive care unit: preliminary results of clinical advice and prediction accuracy of the Glucosafe system.
Assessment of glycemic control with model-based decision support ("Glucosafe") in neurotrauma intensive care patients in an ongoing randomized controlled trial with a blood glucose (BG) target of 5-8 mmol/L. Assessment of BG prediction accuracy of the model and assessment of the effect that two potential model extensions would have on prediction accuracy in this trial. In the intervention group insulin infusion rates and nutrition are varied based on Glucosafe's decision support. ⋯ The patient-specific carbohydrate absorption factor improved prediction accuracy significantly (P = 0.001). Glucosafe advice reduces hyperglycemia in neurotrauma intensive care patients. Further parameterization can improve model prediction accuracy.
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J Clin Monit Comput · Aug 2012
ReviewFrom system to organ to cell: oxygenation and perfusion measurement in anesthesia and critical care.
Maintenance or restoration of adequate tissue oxygenation is a main goal of anesthesiologic and intensive care patient management. Pathophysiological disturbances which interfere with aerobic metabolism may occur at any stage in the oxygen cascade from atmospheric gas to the mitochondria, and there is no single monitoring modality that allows comprehensive determination of "the oxygenation". To facilitate early detection of tissue hypoxia (or hyperoxia) and to allow a goal directed therapy targeted at the underlying problem, the anesthesiologist and intensive care physician require a thorough understanding of the numerous determinants that influence cellular oxygenation. This article reviews the basic physiology of oxygen uptake and delivery to tissues as well as the options to monitor determinants of oxygenation at different stages from the alveolus to the cell.
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J Clin Monit Comput · Aug 2012
Implementation of a standards-based anaesthesia record compliant with the health level 7 (HL7) clinical document architecture (CDA).
With the increasing use of anaesthesia information management systems (AIMS) there is the opportunity for different institutions to aggregate and share information both nationally and internationally. Potential uses of such aggregated data include outcomes research, benchmarking and improvement in clinical practice and patient safety. ⋯ This paper describes the development of a standard terminology for anaesthesia and also a Domain Analysis Model and implementation guide to facilitate a standard representation of AIMS records as extensible markup language documents that are compliant with the Health Level 7 Version 3 clinical document architecture. A representation of vital signs that is compliant with the International Standards Organization 11073 standard is also discussed.