Journal of clinical monitoring and computing
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J Clin Monit Comput · Feb 2009
Specificity improvement for network distributed physiologic alarms based on a simple deterministic reactive intelligent agent in the critical care environment.
Automated physiologic alarms are available in most commercial physiologic monitors. However, due to the variability of data coming from the physiologic sensors describing the state of patients, false positive alarms frequently occur. Each alarm requires review and documentation, which consumes clinicians' time, may reduce patient safety through 'alert fatigue' and makes automated physician paging infeasible. ⋯ Alarms generated by patient monitors, the intelligent agent and alerts documented on patient flow sheets were compared. Significant improvements in the specificity of the physiologic alarms based on systolic and mean blood pressure was found on average to be 99% and 88% respectively. Even through significant improvements were noted based on this algorithm much work still needs to be done to ensure the sensitivity of alarms and methods to handle spurious sensor data due to patient or sensor movement and other influences.
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J Clin Monit Comput · Dec 2008
Case ReportsMainstream time-capnography: an aid to select an appropriate uncuffed endotracheal tube in small children.
Uncuffed endotracheal tubes are commonly used in children in an attempt to decrease the potential for pressure induced tracheal injury. However, uncuffed endotracheal tube may increase the risk of aspiration and lead to erratic delivery of preset tidal volume during mechanical ventilation. ⋯ Air-leak following tracheal intubation can be recognized by the presence of audible leak, by auscultation over the trachea, by palpation over the trachea and by observing effects of positive end-expiratory pressure on inspiratory expiratory tidal volume difference during mechanical ventilation. We describe mainstream time-capnograph as an aid to recognize leak around the endotracheal tube and its utility to determine appropriate endotracheal tube size in small children.
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J Clin Monit Comput · Dec 2008
Is the cardiac output obtained from a Swan-Ganz catheter always zero?
By means of a Swan-Ganz catheter cardiac output is calculated using the Stewart-Hamilton thermodilution equation. Assuming the body as a thermally isolated inert system, this equation theoretically always results in zero cardiac output. ⋯ It is at least a necessary condition for the application of the Stewart-Hamilton equation, that core body temperature is kept constant in a thermo- regulatory steady state.
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J Clin Monit Comput · Oct 2008
Reliability of cardiac output calculation by the fick principle and central venous oxygen saturation in emergency conditions.
For many years thermodilution has been the gold standard for determining cardiac output in the critically ill patients. Less invasive methods have recently been introduced. This study aimed at evaluating the agreement between cardiac output (CO) measured by a new Fick method, using central venous saturation (Scvo(2)), and that measured by the classic thermodilution technique, in patients requiring emergent CO evaluation. ⋯ The new method of Fick assessed emergent CO as reliably as the thermodilution, regardless of whether it was low or high. The use of Scvo(2) allows for prompt bedside calculation for most emergency patients.
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J Clin Monit Comput · Oct 2008
Controlled Clinical TrialTransoesophageal Doppler monitoring for fluid and hemodynamic treatment during lung surgery.
Patients undergoing lung resection are vulnerable to fluid overhydration. Recently, goal-directed fluid therapy using transoesophageal Doppler monitoring (TDM) has been shown to improve postoperative clinical outcome. The aim of this study was to assess the feasibility of TDM during open-chest procedures for guiding fluid and hemodynamic treatment. ⋯ In thoracic surgical patients, TDM can be used to detect and correct low flow conditions and to guide hemodynamic support during the intraoperative period.