Journal of clinical monitoring and computing
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Mechanical ventilation is a sophisticated technique with very narrow therapeutic ranges i.e. highly efficient and able to keep alive the most severe patients, but with considerable side effects and unwanted complications if not properly and timely used. Computerized protocols, closed loop systems, decision support, all terms which need to be defined, may help making mechanical ventilation safer and more efficient. The present paper will provide a short overview on technical and engineering considerations regarding closed loop controlled ventilation as well as tangible clinical evidences supporting the previous statement.
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J Clin Monit Comput · Feb 2014
Observational StudyCardiac output assessed by non-invasive monitoring is associated with ECG changes in children with critical asthma.
The primary aim of this study was to determine changes in CI and SI, if any, in children hospitalized with status asthmatics during the course of treatment as measured by non-invasive EC monitoring. The secondary aim was to determine if there is an association between Abnormal CI (defined as <5 or >95 % tile adjusted for age) and Abnormal ECG (defined as ST waves changes) Non-invasive cardiac output (CO) recordings were obtained daily from admission (Initial) to discharge (Final). Changes in CI and SI measurements were compared using paired t tests or 1-way ANOVA. ⋯ In children that required a prolonged course of treatment, there was also a significant decrease in SI. Abnormal CI at Initial CO recording was associated with ST waves changes on ECG during hospitalization. Future studies are required to determine whether non-invasive CO monitoring can predict which patients are at risk for developing abnormal ECG.
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J Clin Monit Comput · Feb 2014
Bench test assessment of mainstream capnography during high frequency oscillatory ventilation.
To assess the feasibility, stability and predictability of pCO2 measurement (PETCO2) using a main stream capnograph in a high frequency oscillatory ventilation circuit. A commercially available capnograph was mounted into a high frequency oscillatory ventilator patient circuit, adjustable CO2 flow was introduced into an artificial lung and the output of the CO2 sensor assessed under varying ventilator settings. Influence of oxygen content, pressures, heat and moisture were recorded. ⋯ From this bench test, we conclude it is feasible to measure PETCO2 using a main stream capnograph during high frequency oscillatory conditions, these measurements were stable during the experiment. Changes in CO2 production or output can be detected. The system may prove to be of clinical value, but further in vivo measurements are warranted.
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J Clin Monit Comput · Feb 2014
An enriched simulation environment for evaluation of closed-loop anesthesia.
To simulate and evaluate the administration of anesthetic agents in the clinical setting, many pharmacology models have been proposed and validated, which play important roles for in silico testing of closed-loop control methods. However, to the authors' best knowledge, there is no anesthesia simulator incorporating closed-loop feedback control of anesthetic agent administration freely available and accessible to the public. Consequently, many necessary but time consuming procedures, such as selecting models from the available literatures and establishing new simulator algorithms, will be repeated by different researchers who intend to explore a novel control algorithm for closed-loop anesthesia. ⋯ This simulator could be a benchmark-testing platform for closed-loop control of anesthesia, which is of great value and has significant development potential. For convenience, this simulator is termed as Wang's Simulator, which can be downloaded from http://www. AutomMed.org .
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J Clin Monit Comput · Feb 2014
Evaluation of the estimated continuous cardiac output monitoring system in adults and children undergoing kidney transplant surgery: a pilot study.
Evaluation of the estimated continuous cardiac output (esCCO) allows non-invasive and continuous assessment of cardiac output. However, the applicability of this approach in children has not been assessed thus far. We compared the correlation coefficient, bias, standard deviation (SD), and the lower and upper 95 % limits of agreement for esCCO and dye densitography-cardiac output (DDG-CO) measurements by pulse dye densitometry (PDD) in adults and children. ⋯ However, the agreement between esCCO and DDG-CO seems to be higher in children than in adults. These results suggest that esCCO can also be used in children. Future studies with bigger study populations will be required to further investigate these conclusions.