Journal of clinical monitoring and computing
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J Clin Monit Comput · Jun 2012
An evaluation of the Integrated Pulmonary Index (IPI) for the detection of respiratory events in sedated patients undergoing colonoscopy.
The Integrated Pulmonary Index (IPI™) is a new decision making tool calculated from measured end tidal carbon dioxide (etCO(2)), respiratory rate (RR), oxygen saturation (SpO(2)) and pulse rate (PR) using a fuzzy logic model. The aim of this study was to compare prospectively IPI to respiratory adverse events in patients undergoing moderate sedation for colonoscopy. Following ethics committee approval and personal informed consent 51 adult patients undergoing elective colonoscopy were enrolled. ⋯ Among requires attention events (n = 113) the IPI was high (7-10) in 53.1 %, intermediate (4-6) in 32.7 %, or low (1-3) in 14.2 %. The presented data demonstrate limited agreement between respiratory physiological parameters and the IPI. Further IPI evaluation and validation is indicated mainly for events requiring immediate intervention and in different patient populations including obese patients.
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J Clin Monit Comput · Jun 2012
Comparative StudyAnesthesia recordkeeping: accuracy of recall with computerized and manual entry recordkeeping.
Anesthesia information management systems (AIMS) are rapidly gaining widespread acceptance. Aggressively promoted as an improvement to manual-entry recordkeeping systems (MERS) in the areas of accuracy, quality improvement, billing and vigilance, these systems record all patient vital signs and parameters, providing a legible hard copy and permanent electronic record. Concern exists that the practitioner may be less vigilant unless this data is recorded manually. ⋯ Demographic covariates were analyzed to ensure homogeneity between groups and facilities. No significant statistical differences were identified between the accuracy of recall among the groups. There was no difference in the accuracy of practitioners' recall of patient variables when using computerized or manual entry recordkeeping systems, suggesting little impact on vigilance.
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J Clin Monit Comput · Jun 2012
Case ReportsTransesophageal echocardiography and intraoperative phlebotomy during surgical repair of coarctation of aorta in a patient with atrial septal defect, moderately severe mitral regurgitation and severe pulmonary hypertension.
Acute left ventricular (LV) or right ventricular (RV) dysfunction during repair of coarctation of aorta (CoA) is rare. Well-developed collateral circulation between branches of both the subclavian arteries (SCAs) and upper descending thoracic aorta decompress LV and prevents acute rise in afterload. An adult patient presented for CoA repair. ⋯ Both the SCAs were filling retrograde. A unique anatomy in which aortic-clamping proximal to CoA and both the SCAs would increase flow to spinal-cord as clamping of the SCAs will stop stealing of blood into the CoA but potentially increase LV afterload, MR, left to right shunt across ASD and RV volume and pressure load depending on the magnitude of flow across the CoA. The increases in LV afterload, MR, and RV afterload and volume overload were managed by controlled phlebotomy and fine-tuned by manipulating inhaled isoflurane concentration whereas the Transesophageal echocardiography (TEE) monitored and guided the management.
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J Clin Monit Comput · Jun 2012
A model-based decision support system for critiquing mechanical ventilation treatments.
A computerized system for critiquing mechanical ventilation treatments is presented that can be used as an aide to the intensivist. The presented system is based on the physiological model of the subject's respiratory system. It uses modified versions of previously developed models of adult and neonatal respiratory systems to simulate the effects of different ventilator treatments on the patient's blood gases. ⋯ Evaluation tests were done on adult and neonate patients with different diagnoses. In both groups combined, the differences between the arterial partial pressures of CO(2) predicted by the system and the experimental values were 1.86 ± 1.6 mmHg (mean ± SD), and the differences between the predicted arterial hemoglobin oxygen saturation values, S(aO2), and the experimental values measured by using pulse oximetry, S(pO2), were 0.032 ± 0.02 (mean ± SD). The proposed system has the potential to be used alone or in combination with other decision support systems to set ventilation parameters and optimize treatment for patients on mechanical ventilation.
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J Clin Monit Comput · Jun 2012
Intraoperative MRI electrical noise and monitor ECG filters affect arrhythmia detection and identification.
Most electrical equipment in the modern operating room (OR) radiates electrical noise (EN) that can interfere with patient monitors. We have described the EN that an intraoperative magnetic resonance imaging (iMRI) system emits and have shown that this high-energy EN diminishes the quality of the ECG waveform during iMRI scans in our neurosurgical OR. We have also shown that the ECG signal filters in our iMRI-compatible patient monitor reduce this interference but, in the process, disturb the true morphology of the displayed waveform. ⋯ Depending on the OR design, the patient may be out of the anesthetist's direct view during a scan procedure. The anesthetist must rely on monitored physiologic parameters to assess patient status during this time. He/she should be familiar with his/her monitor's filtering capabilities and routinely adjust the ECG filters to achieve the best compromise between minimized EN effects and maximized displayed ECG signal quality.