Best practice & research. Clinical anaesthesiology
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Best Pract Res Clin Anaesthesiol · Mar 2009
ReviewComputerized physician order entry in critical care.
Computerized physician order entry means prescribing of medication and ordering laboratory tests or radiology examinations in an electronic way instead of using paper forms. In itself, it offers advantages such as legible orders, faster order completion, inventory management and automatic billing. If combined with clinical decision support, the real benefits of CPOE become apparent in the first place by prevention of medication errors and adverse drug events. ⋯ Therefore, and for reasons of end-user acceptance, implementation is challenging. CPOE has the potential for significant economic saving. However, the initial implementation cost is high.
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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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Blood glucose control performed by intensive care unit (ICU) nurses is becoming standard practice for critically ill patients. New algorithms, ranging from basic protocols to elementary computerized protocols to advanced computerized protocols, have been presented during the last years aiming to reduce the workload of the medical team. ⋯ Particularly advanced computerized protocols can potentially be introduced as fully-automated blood glucose algorithms when accurate and reliable near-continuous glucose sensor devices are available. Furthermore, it is surprising to consider in some of the described protocols that the original blood glucose target ranges (80-110 mg/dl) were increased (due to fear of hypoglycaemia) and/or that glycaemia levels were determined in capillary blood samples.