Articles: monitoring.
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Although monitoring of critically ill patients has made giant steps forward in the past 15 years, such monitoring techniques must be viewed as a calculated risk, since a small but finite proportion of patients who are monitored by invasive techniques will suffer untoward and, occasionally, catastrophic consequences. Minimizing the risk involves careful general evaluation of the patient, adherence to strict indications for use of invasive techniques, and care coupled with experience in the actual manipulation. ⋯ The treatment of all critically ill patients must be individualized, and the monitoring techniques employed should be similarly individualized. With such a judicious approach, a great deal of valuable information can be obtained, and an effective and intelligent therapeutic regimen outlines so as to assure a successful outcome in as many patients as possible.
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Four years of clinical experience with a fiberoptic intracranial pressure monitor are presented. One hundred forty patients were monitored, of whom 80 had increased intracranial pressure. Of the patients with nontraumatic intracerebral hematoma and subarachnoid hemorrhage, 100% had increased pressure. ⋯ Despite the evidence, monitoring of intracranial pressure is not routine due to a lack of acceptance and effectiveness. To overcome such problems, a system must meet the criteria of ease of insertion, reliability, and lack of complications. These criteria are fulfilled by the fiberoptic system presented.
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A prospective study was carried out to evaluate accuracy of a real time computer system for arrhythmia monitoring in a coronary care unit. QRS complexes in 57 continuously recorded 30 minute electrocardiographic rhythm strips from 30 patients were classified by the computer. Blinded interpretation of each beat was made by a cardiologist. ⋯ This approach combines major elements of cross correlation of QRS signals as well as grouping of complexes into families. Normal and abnormal templates are stored and newly detected QRS complexes are matched. The program appears to be sufficiently accurate to warrant further applications.
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A prospective study of a computerized arrhythmia alarm system was carried out in the coronary care unit during 200 patient hours of monitoring. The computer system was designed to activate an alarm on the development of rhythm and conduction disorders including asystole, ventricular tachycardia, atrial tachycardia, sinus tachtcardia, bradycardia, frequent premature ventricular beats, atrial fibrillation and bundle branch block. Study patients were simultaneously monitored by the computer system and a conventional analog heart rate alarm system. ⋯ Of 79 computer alarms, 42 (53 percent) were true positive alarms; during the same period there were 167 analog alarms of which only 13 (8 percent) were true positive alarms. In both systems, false positive alarms were primarily due to patient movement, but they occurred only 25 percent as often with the computer system as with the analog system. These results indicate that computerized arrhythmia monitoring systems offer significant advantages over conventional monitoring techniques.