==================================HSR07================================== 7. Application of computers in the intensive care unit. 1 UI - 87085134 AU - Shotts JF ; Hauf E TI - The Hewlett-Packard 1000--Vitalmetrics VM220 connection: a description of the automated ultrasonic urine output measurement system in the CICU of Genolier Clinic. AB - After over eighteen years experience using an automated weighing technique to monitor the urine output, we have changed our system in favor of the Vitalmetrics VM220 ultrasonic urine/bladder temperature measurement devices. Last year we began with one VM220 interfaced directly to the Hewlett-Packard 1000 computer's standard ASCII circuit card (H-P 12966A ASCII BACI). We found that we could read and interpret the ASCII string transmitted by the VM220; then started a search for a suitable multiplexing device through which we could manage all six of our VM220's with only one interface card. Perhaps there are many more, but we found two which we shall discuss in this report: 1. The Baytech Associates model 528-B 8 channel switching device and 2. the SEA Corporation signal distribution controller (also known as the cluster controller) which has 16 channels. In our post-operative cardiovascular intensive care unit (CICU), we have used the Baytech 528-B multiplexer to monitor the urine output for over 250 open heart surgery patients. Later this year, we acquired a cluster controller from SEA Corporation in Birmingham, Alabama (USA). We have written software for testing and incorporating this application into a Hewlett-Packard Patient Data Management System (PDMS). MH - Bladder ; *Computers ; Coronary Care Units ; Human ; Monitoring, Physiologic/*METHODS ; Software ; Temperature ; *Ultrasonics ; *Urine SO - Int J Clin Monit Comput 1986;3(3):175-82 2 UI - 87038236 AU - Villalobos J ; Manzano JL ; Blazquez M ; Bola:nos J ; Lubillo S TI - Computerized system in intensive care medicine. AB - A complete understanding of the computer's capabilities and an exact identification and definition of the ICU problems/needs are essential for the complete control of patient records and the full utilization of the computer as a clinical tool. MH - Decision Making, Computer-Assisted ; Hospital Information Systems/ *ORGANIZATION & ADMIN. ; Intensive Care Units/*ORGANIZATION & ADMIN. ; Medical Records ; Spain SO - Med Inf (Lond) 1986 Jul-Sep;11(3):269-75 3 UI - 87035265 AU - Brennan J ; Schulze K ; James LS TI - A microcomputer system for monitoring ventilation in neonates. AB - The characteristics of a microcomputer-based system for measuring ventilatory parameters in neonates on mechanical ventilatory assistance are described. The tidal flows of the infant are sensed by a pneumotachometer housed in the wall of a constant pressure plethysmograph. The processed signal from the pneumotachometer is fed to a dedicated analog-to-digital converter and 6502 microcomputer, which, in turn, loads a dual ported RAM buffer with smoothed, digitized, tidal flow data. At the end of each minute the Apple 2+ processes the accumulated data and computes tidal volume, respiratory frequency, minute volume and the difference between inspired and expired volume. Numerical outputs for these variables and a histogram, representing the distribution of tidal volumes for the minute, are printed on a dot matrix printer. This inexpensive system is capable of presenting contemporary, summarized, ventilatory data in a form that is potentially very useful for the clinicians who are managing the care of the infant. MH - *Computers ; Human ; Infant, Newborn ; Intensive Care Units, Neonatal ; *Microcomputers ; Monitoring, Physiologic/*INSTRUMENTATION ; *Respiration ; Respiration, Artificial ; Software ; Support, U.S. Gov't, P.H.S. ; Tidal Volume SO - Int J Clin Monit Comput 1986;3(1):11-6 4 UI - 87029383 AU - Appel PL ; Kram HB ; Mackabee J ; Fleming AW ; Shoemaker WC TI - Comparison of measurements of cardiac output by bioimpedance and thermodilution in severely ill surgical patients. AB - In order to evaluate a new thoracic electrical bioimpedance (TEB) system for measurement of stroke volume based on the Sramek-Bernstein equation, 391 paired values of cardiac output were measured simultaneously with the standard thermodilution method. These values were obtained from 16 patients selected for having the most severe illness during a 6-month period; the intent was to evaluate the bioimpedance method in the worst possible situations. The correlation coefficient (r) was 0.83, slope was 0.87, intercept was 1.53, and the mean difference between the two methods was 16.2 +/- 11.8 (SD)% in the total series. In 285 paired samples where satisfactory conditions were met, r was 0.90, slope was 0.98, intercept was 0.34, and the mean difference was 11.8 +/- 8.9%. The data indicate satisfactory correlations between these two methods. When the TEB waveform is satisfactory, the agreement between TEB and thermodilution is as good as the agreement between serial thermodilution methods. Difficulties may arise with dysrhythmias, tachycardia (heart rate greater than 150 beat/min), metal in the chest or chest wall, sepsis, hypertension, and extremely oily skin. Mechanical ventilation did not appear to be a problem. MH - *Cardiac Output ; Comparative Study ; *Critical Care ; Evaluation Studies ; Human ; Intensive Care Units ; Intraoperative Period ; Microcomputers ; Postoperative Period ; Support, Non-U.S. Gov't ; *Thermodilution ; Wounds and Injuries SO - Crit Care Med 1986 Nov;14(11):933-5 5 UI - 87027772 AU - Hope CE ; Morrison DL TI - Understanding and selecting monitoring equipment in anaesthesia and intensive care. AB - Techniques for sensing, acquiring, processing and displaying physiological variables used to assist the process of monitoring in anaesthesia and intensive care have been reviewed. The role of instrumental monitoring in clinical practice and the comparative effectiveness of Man versus Machine has been outlined. Future developments in monitoring in clinical practice have been identified. It is important that physicians stay abreast of developments in the technology of measurement and monitoring instrumentation so that they not only assist in the development of standards but also have a complete understanding of the precision and real usefulness of any given item of equipment. To this end, guidelines have been tabulated which may permit those who have the responsibility for acquiring updating or using monitoring equipment, to more completely examine the features of any apparatus which is being considered for purchase. MH - Anesthesiology/*INSTRUMENTATION ; Automatic Data Processing ; Data Display ; Electrocardiography/INSTRUMENTATION ; Human ; Information Systems ; *Intensive Care Units ; Monitoring, Physiologic/ *INSTRUMENTATION SO - Can Anaesth Soc J 1986 Sep;33(5):670-9 6 UI - 86306163 AU - Gilkison C ; Ploessl J TI - The impact of computers on patient care and research: the pentobarbital coma experience. AB - Computer applications to patient care in an intensive care unit are examples the potential computers hold for health care, education, and research. The clinical application of a computer system to research and patient care in a selected research population, the pentobarbital coma study group, is described. The computer has been valuable in research for its data collecting and processing capabilities. It has also allowed the nursing staff to devote more time to patient care activities. MH - *Computers ; Head Injuries/*DRUG THERAPY ; Human ; Intensive Care Units ; Intracranial Pressure/DRUG EFFECTS ; Monitoring, Physiologic/*METHODS ; *Nursing ; Pentobarbital/*THERAPEUTIC USE ; Research SO - J Neurosci Nurs 1986 Aug;18(4):196-9 7 UI - 86265320 AU - Rein AJ ; Hsieh KS ; Elixson M ; Colan SD ; Lang P ; Sanders SP ; Castaneda AR TI - Cardiac output estimates in the pediatric intensive care unit using a continuous-wave Doppler computer: validation and limitations of the technique. AB - We compared the cardiac index obtained by means of a continuous-wave Doppler computer with simultaneous thermodilution measurements in 25 children in the pediatric intensive care unit (40 observations). The aortic diameter was measured at various levels to determine which provided the best measure of cardiac index. The Doppler measurements were performed independently by a physician trained in Doppler cardiography and by a nurse with no experience in echocardiography. Both the nurse and physician obtained high-quality flow velocity recordings in all patients in a mean time of 5 minutes or less. Cardiac index and total systemic vascular resistance measured by means of Doppler and thermodilution techniques were highly correlated (r = 0.86 and r = 0.93, respectively). The highest correlation was obtained when Doppler cardiac index was computed by means of the internal diameter measured at the aortic anulus. There was no significant difference between the nurse's and physician's measurements. We conclude that cardiac index can be accurately determined in the pediatric intensive care unit by means of continuous-wave Doppler computer, even when operated by personnel not trained in Doppler cardiography. MH - *Cardiac Output ; Child ; Child, Preschool ; Comparative Study ; Computers ; Echocardiography/INSTRUMENTATION/*METHODS ; Evaluation Studies ; Female ; Human ; *Intensive Care Units ; Male ; Pediatric Nursing ; *Pediatrics ; Thermodilution SO - Am Heart J 1986 Jul;112(1):97-103 8 UI - 86252864 AU - Mitchell RR ; Wilson RM ; Sierra D TI - ICU monitoring of ventilation distribution. AB - The oxygen washin method has been shown to be a practical way to measure functional residual capacity (FRC) in the intensive care unit. The ventilator oxygen concentration is increased and measurements of respiratory flow and oxygen concentration at the mouth are made with the patient monitoring system. No additional personnel, bedside equipment or ventilator attachments are required. A feasibility study was performed to determine if this method could be used to estimate a continuous distribution of ventilation with respect to ventilation to volume ratio VA/V. Due to gas mixing in the ventilator, the inspired oxygen fraction does not increase instantaneously to its new value. An equation was derived which models the lung as 50 discrete compartments and accounts for the transient change in mean inspired oxygen fraction. A digital computer simulation demonstrated good distribution recovery for one and two mode ventilation distributions. Continuous distributions were computed for four post cardiac surgery patients at four levels of positive end expiratory pressure (PEEP). In these patients a linear increase in the amount of ventilation in the normal VA/V range occurred with increasing PEEP, i.e., slow and fast spaces tended to move centrally toward a more normal VA/V range. At zero PEEP 26% of the ventilation occurred in the normal range and this increased to 49% at 15 PEEP. Dead space fraction was poorly estimated and spurious modes occurred in the high VA/V range. MH - Computers ; Functional Residual Capacity ; Heart Surgery ; Human ; *Intensive Care Units ; Models, Biological ; *Monitoring, Physiologic ; Oxygen/ANALYSIS ; *Positive Pressure Respiration ; Postoperative Care ; *Respiration ; Respiratory Airflow ; Support, U.S. Gov't, P.H.S. SO - Int J Clin Monit Comput 1986;2(4):199-206 9 UI - 86226394 AU - Hegyi T TI - Transcutaneous bilirubinometry in the newborn infant: state of the art. AB - Hyperbilirubinemia in the newborn infant continues to challenge physicians. Clinical evaluation and treatment have evolved well-established principles over the past decade. This review examines neonatal bilirubin metabolism and focuses on a recently developed clinical diagnostic tool, the transcutaneous bilirubinometer. In spite of some limitations, the transcutaneous bilirubinometer can be best applied as a screening tool to identify healthy full-term infants who require serum bilirubin determination. With proper application, this device can eliminate most invasive diagnostic testing. Optimal use of the instrument requires the relationship between the serum bilirubin concentration and the transcutaneous bilirubinometer index to be determined for each device, institution, and population. MH - Bilirubin/*BLOOD ; Birth Weight ; Blood Chemical Analysis/ *INSTRUMENTATION ; *Computers ; Gestational Age ; Human ; Infant, Newborn ; Intensive Care Units, Neonatal ; Jaundice, Neonatal/BLOOD/*DIAGNOSIS ; Spectrophotometry/*INSTRUMENTATION SO - J Clin Monit 1986 Jan;2(1):53-9 10 UI - 86226393 AU - Schmitt EA ; Brantigan CO TI - Common artifacts of pulmonary artery and pulmonary artery wedge pressures: recognition and interpretation. AB - Bedside measurement of pulmonary artery pressure and pulmonary artery wedge pressure has an important role in the management of critically ill patients. Unfortunately, waveform abnormalities and artifacts commonly distort numeric values and lead to incorrect therapeutic decisions. The clinical impact of these artifacts is magnified by the digital pressure displays used in most intensive care units. We present here an atlas and an analysis of the artifacts that commonly occur. Use of analog rather than digital pulmonary artery wedge pressure data, when combined with an understanding of the physiological characteristics of patients, can prevent critical errors in patient management. MH - *Computers ; Heart Catheterization/*INSTRUMENTATION ; Human ; Intensive Care Units ; Pneumonia/DIAGNOSIS ; Pulmonary Edema/DIAGNOSIS ; *Pulmonary Wedge Pressure ; Respiration, Artificial SO - J Clin Monit 1986 Jan;2(1):44-52 11 UI - 86191227 AU - Shabot MM ; Carlton PD ; Sadoff S ; Nolan-Avila L TI - Graphical reports and displays for complex ICU data: a new, flexible and configurable method. AB - The use of computers for critical care data management may markedly increase the volume of digital numbers presented to the nurse and clinician. Such digital displays and reports may not be optimum for estimating the graded levels of intervention required for specific physiologic problems. We have devised software subsystems which allow for rapid configuration of medically oriented graphical reports and video images, using an English language syntax rather than specific computer code. These subsystems produce graphical reports which resemble previous hand-written charts, and video displays which are useful for hemodynamic patient management. MH - *Data Display ; Human ; *Intensive Care Units ; Monitoring, Physiologic/ *METHODS/TRENDS ; *Online Systems ; Software SO - Comput Methods Programs Biomed 1986 Mar;22(1):111-6 12 UI - 86187104 AU - Poland RL ; Bollinger RO ; Cummings GE TI - Implementation of a statewide perinatal automated medical network (PAM/NET) for Michigan. AB - PAM/NET is a computerized data base and conferencing system used by nine neonatal intensive care units in Michigan and Illinois. The system depends on the timesharing resource of a large university mainframe computer. The data base functions are managed by a sophisticated inverted file relational data base management system capable of mass storage and rapid and specific retrieval of individual cases or summary data. Data stored in the system are used to generate admission, discharge and developmental assessment clinic summaries that serve as such for the medical record and as letters to primary physicians. We report here the early experience in the design and dissemination of this database network to the participating hospitals. Conflicting goals of sharing and confidentiality of clinical data are addressed in the design of this system. MH - Ambulatory Care Facilities ; Child Development ; Confidentiality ; Female ; Human ; Infant, Newborn ; *Intensive Care Units, Neonatal ; Interinstitutional Relations ; Michigan ; Online Systems/*ORGANIZATION & ADMIN. ; Patient Admission ; Patient Discharge ; *Perinatology ; Pilot Projects ; Pregnancy SO - Am J Perinatol 1986 Apr;3(2):144-6 13 UI - 86139203 AU - Murdock DK ; Moran JF ; Stafford M ; King L ; Loeb HS ; Scanlon PJ TI - Pacemaker malfunction: fact or artifact? AB - In summary, the present examples illustrate how pacemaker malfunction can be simulated by the sources of artifact produced or detected by the monitoring equipment. This form of pseudopacemaker malfunction remains a common cause of mistaken diagnosis of pacemaker malfunction. A thorough understanding of the examples outlined above should help distinguish true pacemaker malfunction from pseudopacemaker malfunction produced by artifact. MH - Amplifiers ; Analog-Digital Conversion ; Diagnostic Errors ; Electrocardiography/INSTRUMENTATION/METHODS ; Equipment Failure ; Human ; Intensive Care Units ; Monitoring, Physiologic/INSTRUMENTATION ; Pacemaker, Artificial/*STANDARDS ; Telemetry/INSTRUMENTATION SO - Heart Lung 1986 Mar;15(2):150-4