Journal of clinical monitoring and computing
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In the present review we will describe and discuss the physiological and technological background necessary in understanding the dynamic parameters of fluid responsiveness and how they relate to recent softwares and algorithms' applications. We will also discuss the potential clinical applications of these parameters in the management of patients under general anesthesia and mechanical ventilation along with the potential improvements in the computational algorithms.
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J Clin Monit Comput · Feb 2011
ReviewAnesthesia information management systems: a review of functionality and installation considerations.
The functionality and rate of implementation of Anesthesia Information Management Systems (AIMS) has markedly risen over the past decade. These systems have now become much more than the generic automated record keepers, originally proposed and developed in the 1980s. AIMS have now become complex integrated systems, which have been shown to improve patient care and, in some cases, the financial performance of a department. Although the underlying technology has improved greatly over the past 5 years, the process of selecting and completing an AIMS installation still presents a number of challenges, and must be approached carefully in order to maximize the benefits provided by these systems.
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J Clin Monit Comput · Feb 2011
ReviewAcid-base chemistry of plasma: consolidation of the traditional and modern approaches from a mathematical and clinical perspective.
Debate still exists as to whether the Stewart (modern) or traditional model of acid-base chemistry is best in assessing the acid-base status of critically ill patients. Recent studies have compared various parameters from the modern and traditional approaches, assessing the clinical usefulness of parameters such as base excess, anion gap, corrected anion gap, strong ion difference and strong ion gap. To compare the clinical usefulness of these parameters, and hence the different approaches, requires a clear understanding of their meaning; a task only possible through understanding the mathematical basis of the approaches. The objective of this paper is to provide this understanding, limiting the mathematics to a necessary minimum. ⋯ Although different in their concepts, the traditional and modern approaches based on mathematical models can be seen as complementary giving, in principle, the same information about the acid-base status of plasma.
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Capnography has become a standard of perioperative monitoring in pediatric anesthesiology. It has also begun to find application in a variety of situations outside the perioperative setting. While the use of capnography has been increasing, the dissemination and acceptability of capnography in all areas of pediatrics has been variable. The purpose of this study was to describe all the applications and interpretations of capnography that have been reported in children. ⋯ Capnography has been proven to be a useful non-invasive perioperative monitor of the physiology and safety of the child. This list of the clinical applications and interpretations of capnography could find use in teaching and simulation in pediatrics.
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J Clin Monit Comput · Apr 2010
Review Meta AnalysisVentilator-associated pneumonia: current status and future recommendations.
Ventilator-associated pneumonia (VAP) is a common hazardous complication in ICU patients. The aim of the current review is to give an update on the current status and future recommendations for VAP prevention. ⋯ EBPG consensus includes: elevation of the head of the bed, use of daily "sedation vacations" and decontamination of the oropharynx. Technological solutions should aim to use the most comprehensive combination of subglottic suction of secretions, optimization of ETT cuff pressure and ultrathin cuffs. VAP is a type of hospital-acquired pneumonia that develops more than 48 h after endotracheal intubation. Its incidence is estimated to be 9-27%, with a mortality of 25-50% [Am J Respir Crit Care Med 171:388-416 (2005), Am J Med 85:499-506 (1988), Chest 122:2115-2121 (2002), Intensive Care Med 35:9-29 (2009)]. The most important target in VAP handling is its prevention. The aim of this article is to review the pathogenesis, epidemiology and the different strategies/technologies for prevention of VAP.