Health devices
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Practice Guideline Guideline
Transporting critically ill patients. American College of Critical Care Medicine, Society of Critical Care Medicine, and American Association of Critical-Care Nurses.
Guidelines for transporting critically ill patients were published simultaneously in the June 1993 issue of Critical Care Medicine (21[6]:931-7) and the May 1993 issue of the American Journal of Critical Care (2[3]:189-95). Developed by a task force composed of members from the American College of Critical Care Medicine, the Society of Critical Care Medicine, and the American Association of Critical-Care Nurses (AACN), these guidelines, summarized below, outline the reasons and requirements for transporting patients, including the personnel who should be involved and the equipment (including monitors) that should accompany the patient. The task force's recommendations are consistent with ECRI's previous recommendations, also summarized below, but are more comprehensive and stringent in some respects and provide additional details.
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This report is an Update Evaluation of oxygen concentrators. Since the publication of the original study in Health Devices, 22(1), January 1993, we have become increasingly concerned about the potential for oxygen concentrators to produce less-than-therapeutic levels of oxygen without an indication. Because of this concern, we have revised our oxygen concentration status indicator (OCSI) criteria. ⋯ Our ratings and rankings of oxygen concentrators, in both the current and previous study, are based primarily on the availability of an OCSI that meets our criteria, as well as on electrical safety and maintenance issues. Readers are cautioned not to base purchasing decisions on our ratings alone, but on a thorough understanding of all issues surrounding the use of oxygen concentrators, which can be gained only by reading the original Evaluation and this Update in their entirety. In the original Evaluation issue, clinical and technical issues are discussed in detail in the Clinical and Technical Overview, and important factors to consider, such as required flow, OCSIs, high-temperature performance, electrical safety, noise, maintenance, and cost, are covered in the Discussion section, "Issues in Selecting, Purchasing, and Using Oxygen Concentrators." Also see "Add-on Oxygen Concentration Status Indicators" in this issue.
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Combined defibrillator/monitors enable the operator to assess and monitor the ECG and rapidly deliver a defibrillating countershock to patients suffering from ventricular fibrillation during a cardiac arrest. In addition, these units provide synchronized cardioversion for treating other arrhythmias, such as ventricular tachycardia, and most now offer external noninvasive pacemaker capability for treating patients with ventricular bradycardia or asystole. Defibrillator/monitors are critical resuscitation instruments and must perform effectively to avoid the otherwise preventable death of a cardiac arrest patient. ⋯ They are rated either Acceptable or Acceptable--Not Recommended for these applications, based primarily on technical performance (including battery operation, which is especially important in portable units), characteristics (such as line-powered operation and portability), features (such as automatic documentation), and human factors design (especially ease of use); some are inappropriate for specific uses because of their respective limitations in these applications. The portable physiologic patient monitor is not rated, but is discussed.** All of the pacemakers available as components of the evaluated units are acceptable for use; however, in most cases, purchasing decisions should be made according to defibrillator/monitor needs. The stand-alone pacemaker is rated Unacceptable because of its numerous performance, safety, and human factors disadvantages and because, other than its being a stand-alone unit, it offers no advantages over the other evaluated pacemakers; see "The Zoll NTP-1000 Stand-alone Noninvasive Pacemaker." Readers are cautioned not to base purchasing decisions on our ratings and rankings alone, but on a thorough understanding of the issues surrounding defibrillator/monitors and noninvasive pacemakers, which can be gained only by reading this study in its entirety.(ABSTRACT TRUNCATED AT 400 WORDS)