Journal of clinical monitoring and computing
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J Clin Monit Comput · Apr 2011
Case ReportsTranspulmonary thermodilution in a pediatric patient with an intracardiac left-to-right shunt.
Monitoring of cardiac output (CO) in the perioperative period and in seriously ill pediatric patients is of major importance for medical management. Hemodynamic monitoring, using transpulmonary thermodilution (TPTD) via a single thermal indicator injection, allows for measurements of CO, volumetric variables and extravascular lung water (EVLW). We describe and explain the influence of a left-to-right shunt on TPTD curve characteristics and EVLW measurements in a young child undergoing a surgical atrial septal defect repair. We suggest that these specific changes in the TPTD curve and the overestimation of EVLW detected by current device, in absence of gas exchange abnormalities, could be indicators of existing circulatory shunts in pediatric patients.
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J Clin Monit Comput · Apr 2011
Case ReportsECG myogenic artifacts during clonic seizures: a disturbing (and interesting) finding.
During motor seizures myogenic artifacts may appear on ECG. We report a patient with recurring convulsive seizures involving left side of his body in whom ECG served as a surrogate of electromyography (EMG), showing myogenic artifacts strongly correlated with clonic jerks. ⋯ However, using standard ECG acquisition parameters, muscular activity may be recorded without excessive attenuation of high-frequency myogenic potentials, permitting to indicate the frequency of clonic movements. On the other hand, whenever possible, positioning of ECG surface electrodes on limbs not (or less) involved in clonic epileptic movements may permit to obtain a sufficiently informative ECG recording with less amount of myogenic artifacts, thus providing essential information on heart rate and rhythm.
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J Clin Monit Comput · Feb 2011
ReviewAnesthesia information management systems: a review of functionality and installation considerations.
The functionality and rate of implementation of Anesthesia Information Management Systems (AIMS) has markedly risen over the past decade. These systems have now become much more than the generic automated record keepers, originally proposed and developed in the 1980s. AIMS have now become complex integrated systems, which have been shown to improve patient care and, in some cases, the financial performance of a department. Although the underlying technology has improved greatly over the past 5 years, the process of selecting and completing an AIMS installation still presents a number of challenges, and must be approached carefully in order to maximize the benefits provided by these systems.