International journal of clinical monitoring and computing
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Int J Clin Monit Comput · Jan 1997
Comparative StudyThe effect of surgical ICU triage patterns on differing severity adjusted outcomes in France and the United States.
Surgical patients treated in French intensive care units (ICU's) appear to have higher mortality rates than patients in the United States. We hypothesized that this may be due to the French practice of not transferring dying patients from the ICU. We wished to determine if the different mortality rates could be explained by transfer practices for dying patients or other factors such as severity of illness. ⋯ The differences in severity adjusted ICU mortality between French ICU's and our SICU are explained by different triage practices for terminally ill patients following elective ICU admission. These triage differences do not fully explain the mortality differences seen among patients emergently admitted to the ICU. Other factors such as the presence of trauma, ICU staffing practices, patient mix or other unidentified factors may be responsible for the severity adjusted differences in mortality among emergency surgical ICU patients.
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Int J Clin Monit Comput · Nov 1996
Comparative StudyDouble burst monitoring during recovery from atracurium-induced neuromuscular blockade: a comparison with train-of-four.
Double burst stimulation (DBS) was originally introduced for improved manual detection of residual neuromuscular blockade. Previous studies demonstrated a high correlation between mechanomyographical responses to DBS and train-of-four (TOF) stimulation during recovery from neuromuscular blockade. However, repeatability and bias analyses that are recommended when new monitoring devices are introduced into clinical practice [11] have not yet been performed. ⋯ The limits of agreement between DBS and TOF responses were so wide that DBS and TOF can not be used interchangeably.
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Int J Clin Monit Comput · Nov 1996
Comparative StudyPerformance assessment of an adaptive model-based feedback controller: comparison between atracurium, mivacurium, rocuronium and vecuronium.
The performance of an adaptive model-based controller for the administration of atracurium, mivacurium, rocuronium and vecuronium was compared in 159 adult surgical patients. The degree of neuromuscular block was set to 90% for atracurium, rocuronium and vecuronium and to 95% for mivacurium. ⋯ Although the controller appeared to be able to control rocuronium induced block at 90% and mivacurium induced block at 95% better than atracurium and vecuronium block at 90%, the differences in the controller performance between the four studied relaxants were small and have hardly any clinical significance. We conclude that a model-based adaptive controller is useful in the administration of atracurium, mivacurium, rocuronium or vecuronium.
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Int J Clin Monit Comput · Nov 1996
Development of a portable closed-loop atracurium infusion system: systems methodology and safety issues.
Safety of closed-loop drug infusion systems is an issue often raised as a matter of concern. As a result, many closed-loop control systems are reported in the literature merely as computer simulation studies and few ever reach the stage of physical realisation and formal clinical evaluation. ⋯ The benefits of closed-loop muscle relaxation in providing stable surgical operating conditions over a wide range of patient sensitivities while infusing the minimum amount of drug makes this a worthwhile aim and serves to demonstrate safety issues which are generally applicable to other closed-loop drug infusion systems. It is hoped that the described methodology will facilitate and encourage the clinical application of closed-loop drug infusion systems so that clinical staff and patients may receive the benefits of closed-loop drug therapy.
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Int J Clin Monit Comput · Aug 1996
PatSim--simulator for practising anaesthesia and intensive care. Development and observations.
Simulators may be used in training personnel for the situations when consequences of inappropriate action could be dangerous or expensive. Mishaps and accidents in connection with the use of biomedical instrumentation are frequently a result of technical malfunction and improper use of the equipment. In the medical field, however, use of simulators is not very common. ⋯ They include laryngospasm, change of lung compliance or airway resistance, pneumothorax, leakage of the intubation tube cuff, blocking of the breathing sounds from one lung, secretion, gastric regurgitation and diuresis. During a simulation session, the trainee should be exposed to a lifelike situation. Hence, we place the manikin in a room that resembles either intensive care or operating room environment.