Best practice & research. Clinical anaesthesiology
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Best Pract Res Clin Anaesthesiol · Mar 2009
ReviewSmart alarms from medical devices in the OR and ICU.
Alarms in medical devices are a matter of concern in critical and perioperative care. The high rate of false alarms is not only a nuisance for patients and caregivers, but can also compromise patient safety and effectiveness of care. ⋯ This review gives an overview of the current clinical situation and the underlying problems, and discusses different methods from statistics and computational science and their potential for clinical application. Some examples of the application of new alarm algorithms to clinical data are presented.
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Telemedicine has been studied in the intensive care unit for several decades, but many questions remain unanswered regarding the costs and the benefits of its application. Telemedicine ICU (Tele-ICU) is an electronic means to link physical ICUs to another location which assists in medical decision making. ⋯ While we believe that the future of Tele-ICU is promising, there are multiple issues that must be addressed to increase the benefit of Tele-ICU. Tele-ICU is expensive to deploy and use, it may add burdens to existing intensivists, and it requires organizational and culture changes that can be difficult to accomplish.
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Best Pract Res Clin Anaesthesiol · Mar 2009
ReviewAdvanced closed loops during mechanical ventilation (PAV, NAVA, ASV, SmartCare).
New modes of mechanical ventilation with advanced closed loops are now available, and in the future these could assume a greater role in supporting critically ill patients in intensive care units (ICUs) for several reasons. Two modes of ventilation--proportional assist ventilation and neurally adjusted ventilatory assist--deliver assisted ventilation proportional to the patient's effort, improving patient-ventilator synchrony. ⋯ Preliminary studies are promising, and initial systems are currently being refined with increasing clinical experience. A new era of mechanical ventilation should emerge with these systems.
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Best Pract Res Clin Anaesthesiol · Mar 2009
ReviewImpact of computerized information systems on workload in operating room and intensive care unit.
The number of operating rooms and intensive care departments equipped with a clinical information system (CIS) is rapidly expanding. Amongst the putative advantages of such an installation, reduction in workload for the clinician is one of the most appealing. ⋯ The hypothesis that a third generation CIS can reduce documentation time for ICU nurses and increase time they spend on patient care, is supported by recent literature. Though it seems obvious to extrapolate these advantages of a CIS to the anesthesiology department or physicians in the intensive care, studies examining this assumption are scarce.