Journal of clinical monitoring and computing
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J Clin Monit Comput · Jul 1998
Normothermic cardiopulmonary bypass increases heparin requirements necessary to maintain anticoagulation.
With the practice of warm cardiopulmonary bypass (CPB) at our institution we have observed an apparent increase in heparin requirements. CPB temperature predictability affects pharmacokinetics and differences in drug metabolism can be expected. We hypothesized that heparin requirements would increase with increasing CPB temperature. ⋯ Maintenance of adequate heparin anticoagulation during CPB is clinically important. Warm CPB patients required more heparin per minute than those undergoing cold CPB. More frequent assessment of anticoagulation and administration of additional heparin should be considered in patients undergoing warm CPB.
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J Clin Monit Comput · Jul 1998
Validation of routine incidence reporting of one anaesthesia provider institution within a nation-wide quality of process assessment program.
In 1992, a long-term project was launched by the German Society for Anaesthesiology and Intensive Care Medicine to render quality comparisons between anaesthesia providers. As one of the first volunteer centres, we established the standardised reporting of perioperative anaesthesia related incidents, events, and complications (IEC) in any routine anaesthetic procedure performed. This present study is aimed to explore the longitudinal stability of IEC recordings in one institution, which should be a prerequisite for valid external comparisons. ⋯ Use of the quality control statistics is suitable to distinguish random from systematic influence on quality indicators. IEC recordings that are not specific in pathophysiologic type or are of low grade of clinical severity, are heavily dependent on systematic documentation features. We assume that peak values, such as in times of optimised documentation discipline, better reflect reality than average values because missing reporting is much more likely than false positives.
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J Clin Monit Comput · Jul 1998
Sensitivity of near infrared spectroscopy to cerebral and extra-cerebral oxygenation changes is determined by emitter-detector separation.
To examine the effect of two emitter-detector separations (2.7 and 5.5 cm) on the detection of changes in cerebral and extra-cerebral tissue oxygenation using near infrared spectroscopy (NIRS). ⋯ The differing sensitivity of the proximal and distal channels to changes in cerebral and extracerebral oxygenation is compatible with theoretical models of NIR light transmission in the adult head and may provide a basis for spatially resolving these changes. The optimal emitter-detector separation for adult NIRS requires further investigation and may differ between individuals.
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J Clin Monit Comput · Jul 1998
Sampling intervals to record severe hypotensive and hypoxic episodes in anesthetised patients.
To define the longest sampling interval which will faithfully record the time course of episodes of severe hypotension and hypoxia in anesthetised patients. ⋯ Our current anesthetic record is inadequate to record many of the severe changes that we observed. One minute recording intervals, such as used in many electronic record keeping systems, are too slow to capture the rapid rates of change seen, and may lead to the assumption that an episode was not recognized promptly or that treatment was not administered in a timely manner.
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J Clin Monit Comput · Jul 1998
Randomized Controlled Trial Clinical TrialInfluence of pulse oximetry and capnography on time to diagnosis of critical incidents in anesthesia: a pilot study using a full-scale patient simulator.
Many studies (outcome, epidemiological) have tested the hypothesis that pulse oximetry and capnography affect the outcome of anesthetic care. Uncontrollable variables in clinical studies make it difficult to generate statistically conclusive data. In the present study, we eliminated the variability among patients and operative procedures by using a full-scale patient simulator. We tested the hypothesis that pulse oximetry and capnography shorten the time to diagnosis of critical incidents. ⋯ Simulation may offer new approaches to the study of monitoring technology. However, the limitations of current simulators and the resources required to perform simulator-based research are impediments to wide-spread use of this tool.