Search PubMed⌕ Search

PubMed · 1399673

Issues in selecting and using apnea documentation systems.

Abstract

The primary purpose of apnea monitoring is to ensure adequate warning of certain life-threatening respiratory and cardiac events, often in infants monitored at home. However, parents often become frustrated by frequent alarms, and other may not use the monitor at all. Unfortunately, ECRI has received a number of incident reports in which infants have died while not connected to their monitors or where a failure to monitor was suspected. We believe that some of these deaths may have been prevented if monitoring had been used properly. The most important step that parents can take to achieve effective monitoring is to faithfully follow the directions of their doctor. In an effort to ensure parental compliance, documentation capability has been added to many of today's monitors. In addition, those involved in providing patient care, especially the prescribing physicians, durable medical equipment (DME) providers, report scorers, interpreting physicians, and other clinicians, should carefully review their monitoring programs and the available documentation monitoring systems to determine how they can best meet their patients' needs. Below, we discuss the factors to consider when contemplating documented apnea monitoring and when selecting a documented monitoring system. The documentation features discussed are those we considered to be distinguishing factors among the systems evaluated in this issue and affected how we rated and ranked these units.

Explore related subjects

Keep this discovery

Explore connections, maps & timelines

BibTeXRIS

1992. Issues in selecting and using apnea documentation systems.. https://pubmed.ncbi.nlm.nih.gov/1399673/

Cite the original work for its findings. Save a collection to share your selection of sources.

KEEP EXPLORING

Related citations

Brainstem respiratory control: substrates of respiratory failure of multiple system atrophy.

Multiple system atrophy may manifest with severe respiratory disorders, including sleep apnea and laryngeal stridor, which reflect a failure of automatic control of respiration. This function depends on a pontomedullary network of interconnected neurons located in the parabrachial/Kölliker Fuse nucleus in the pons, nucleus of the solitary tract, and ventrolateral medulla. Neurons in the preBötzinger complex expressing neurokinin-1 receptors are critically involved in respiratory rhythmogenesis, whereas serotonergic neurons in the medullary raphe and glutamatergic neurons located close to the ventral medullary surface are involved in central chemosensitivity to hypercapnia, hypoxia, or both. Pathological studies using selective neurochemical markers indicate that these neuronal groups are affected in multiple system atrophy. This finding may provide potential anatomical substrates for the respiratory manifestations of the disease.

Apnea↗

Serum caffeine concentrations in preterm neonates.

Caffeine therapy reduces apnea of prematurity, promotes successful extubation from invasive positive-pressure ventilation, and decreases the incidence of bronchopulmonary dysplasia. The recommended dosing for caffeine is a loading dose of 20 mg/kg followed by a 5 mg/kg/d maintenance dose. However, controversy exists about the optimal dosing regimen and data on serum caffeine concentrations in extremely immature infants are scant. We determined serum caffeine concentrations approximately 7 days after starting therapy with a 20 or 25 mg/kg loading dose and a 6 mg/kg/d maintenance dose in 154 infants with a mean gestational age of 29 weeks. The 25th to 75th percentile range for the serum caffeine concentrations with the two dosing regimens was equivalent, approximately 18 to 23 mg/L. Within the first 14 postnatal days, the serum caffeine concentrations were not dependent on postmenstrual age, weight, or postnatal age, and were in a range that is safe and therapeutic. This latter observation remained valid over the ranges of clinical and laboratory assessments of renal and hepatic functions that are usually found in practice. Routine measurement of steady-state serum caffeine concentrations in infants 24 to 35 weeks gestational age is not required in the absence of ongoing apnea/hypopnea or signs compatible with toxicity.

Apnea↗