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PubMed2005

Development of a multiple objective planning theory and system for sustainable air quality monitoring networks.

Air quality monitoring data are important bases for air quality management strategies planning and performance assessment. Therefore, the environmental protection authorities need to plan the air quality monitoring network effectively. However, in Taiwan, the national Environmental Protection Administration (EPA) and some county environmental protection bureaus (EPB) separately installed their own monitoring stations. This study developed an integrated methodology and computer system for planning air quality monitoring networks. The environmental, social, and economic objectives and sub-objectives, and their weights were identified using system analysis and multiple objective planning, based on the principles of sustainable development. A multiple objective optimization model and procedure for sustainable air quality monitoring networks planning are developed in this study. According to the procedure, a multiple objective planning system for sustainable air quality monitoring networks (MOPSSAQMN) is developed using computer software based on the modified bounded implicit enumeration algorithm with the constraint arrangement method. The air quality monitoring network of Taoyuan County, in northern Taiwan, was used as a case study to demonstrate the proposed method. Two satisfactory alternatives based on different conditions were generated using MOPSSAQMN. The compared results show that this study generated better alternatives than the current monitoring network. An installation schedule for the alternative was proposed, and its first step is now being implemented by the EPB of Taoyuan County Government. The procedure and computer system developed in this study can be used to assist the competent authorities to devise good and different alternatives for air quality monitoring networks planning.

Air Pollutants↗
PubMed2006

Point-of-care antithrombotic monitoring in children.

INTRODUCTION: The use of oral anticoagulant therapy is increasing in children. Managing anticoagulant therapy in children presents unique challenges, including poor venous access. The advent of point-of-care (POC) monitoring of anticoagulant therapy offers a potential solution to this challenge. This paper reviews the published literature relating to POC monitoring of oral anticoagulant therapy in children. MATERIALS AND METHODS: A Medline search was conducted and identified key publications. Papers were reviewed with respect to their objectives, populations and POC device investigated. Study limitations were identified. RESULTS: Five publications and one abstract were identified, reporting studies using five different POC monitors. Three studies had a strong clinical management focus. Outcome measures assessed included target therapeutic range achievement and frequency of adverse events. Correlation between POC and laboratory-based results ranged from 0.83 to 0.96. Home monitoring and self-management using POC monitors were both reported to be preferred compared to standard laboratory testing. CONCLUSIONS: POC monitoring of oral anticoagulant therapy in children offers considerable advantages. The reviewed literature would suggest such monitoring can be performed accurately and reliably. The impact of quality control issues, such as calibration of thromboplastin ISI in POC devices, has not been explored in a paediatric population. Further studies are needed to clarify such issues and confirm the safety, reliability and efficacy of POC monitoring of oral anticoagulant therapy in children, including its home monitoring and self-management programs.

Adolescent↗
PubMed2000

Monitoring, modelling and environmental exposure assessment of industrial chemicals in the aquatic environment.

Monitoring and laboratory data play integral roles alongside fate and exposure models in comprehensive risk assessments. The principle in the European Union Technical Guidance Documents for risk assessment is that measured data may take precedence over model results but only after they are judged to be of adequate reliability and to be representative of the particular environmental compartments to which they are applied. In practice, laboratory and field data are used to provide parameters for the models, while monitoring data are used to validate the models' predictions. Thus, comprehensive risk assessments require the integration of laboratory and monitoring data with the model predictions. However, this interplay is often overlooked. Discrepancies between the results of models and monitoring should be investigated in terms of the representativeness of both. Certainly, in the context of the EU risk assessment of existing chemicals, the specific requirements for monitoring data have not been adequately addressed. The resources required for environmental monitoring, both in terms of manpower and equipment, can be very significant. The design of monitoring programmes to optimise the use of resources and the use of models as a cost-effective alternative are increasing in importance. Generic considerations and criteria for the design of new monitoring programmes to generate representative quality data for the aquatic compartment are outlined and the criteria for the use of existing data are discussed. In particular, there is a need to improve the accessibility to data sets, to standardise the data sets, to promote communication and harmonisation of programmes and to incorporate the flexibility to change monitoring protocols to amend the chemicals under investigation in line with changing needs and priorities.

Environmental Exposure↗
PubMed1993

The safety and value of extradural intracranial pressure monitors in fulminant hepatic failure.

Thirty-six of 68 consecutive patients with fulminant hepatic failure (FHF) progressing to grade 4 encephalopathy who had extradural ICP monitors inserted were reviewed to determine the safety and the value of ICP monitoring. Only minor complications were encountered. These included local wound bleeding at the burrhole site in four patients and a small cerebral hemorrhage in relation to the monitor in one other patient. No significant long-term sequelae were related to the operative procedure. ICP monitoring identified rises in ICP unaccompanied by clinical signs and as a consequence treatment was given to the monitored patients more often than the non-monitored group (median 6 vs. 2 treatments, P < 0.01). The duration of survival from the onset of grade 4 encephalopathy was significantly greater in the ICP monitored group (median 60 vs. 10 h, P < 0.01) although overall survival was unchanged. Monitoring also provided important prognostic information since the peak ICP was higher in non-survivors than in survivors (median 45 vs. 35 mmHg, P = 0.051). The pattern of clinical signs accompanying episodes of intracranial hypertension differed between survivors and non-survivors. Pupillary abnormalities were detected more often in non-survivors while systolic hypertension occurred more frequently amongst survivors with the peak systolic blood pressure being significantly higher. ICP monitoring proved safe and effective, provided valuable information regarding subclinical intracranial hypertension and prognosis and should be regarded as part of the routine management of intracranial hypertension complicating FHF.

Cerebral Hemorrhage↗
PubMed2003

Monitoring freshwater sediments.

The objectives of the SENSPOL Expert Meeting on 'Monitoring Freshwater Sediments' held in Antwerp, Belgium, 12-13 September, 2001, were firstly to identify and define problems and secondly to develop a realistic strategy to solve these problems. Both of the stakeholder groups (governmental authorities and the dredging industry) present at the workshop participated in detailed discussions to elucidate the role of sensors in the field of sediments and sediment/water interfaces. The 19 invited experts were agreed that in situ monitoring systems are needed to monitor freshwater sediments. New recognised tools for sediment monitoring would help industry to meet the governmental sediment quality criteria and to handle the data concerning historic river contamination and geological background data. The need to monitor by effect-related studies together with chemical monitoring was stressed. The main focus for development of new sensor tools should be for on site determination of certain priority pollutants where there would be advantage over existing methods or where no suitable method exists, and to monitor biological effects (alarm systems and effect-related on site tests). Sensing technologies would also be useful to monitor bioavailability in sediments in situ to provide information for risk assessment. In addition, they could be of use to monitor bioremediation in situ. A useful role was forseen in dredging sediments, for in situ sediment screening and to guide treatment of dredged material. The new sensing tools presented, included determination of metal concentrations in sediments using the diffuse gradients in thin films (DGT) technique (Lancaster University, UK), an analytical protocol for determination of metal speciation in sediments (Universitat Autonoma de Barcelona, Spain), microbiotests for determination of sediment toxicity (University of Ghent, Belgium), a portable whole cell sensors device for heavy metal bioavailability (VITO, Belgium) and a microfabricated sensor array system for Pb concentration profile measurement in the microM range at the liquid-solid interface (University of Geneva, Switzerland).

Biosensing Techniques↗
PubMedDate not supplied

Evaluation of a semi-quantitative CO2 monitor with pulse oximetry for prehospital endotracheal tube placement and management.

OBJECTIVE: To evaluate three prototype versions of semi-quantitative end-tidal CO2 monitors with different alarm features during prehospital or interfacility use. METHODS: Subjects were 43 adult, non-pregnant patients requiring intubation, or who already were intubated and required transport. Teams at one AirEvac and seven Advanced Life Support (ALS) paramedic stations were trained in the use of the monitors. Team members at each station evaluated each model for eight days. Participants completed questionnaires following each use. RESULTS: The monitors performed properly in all cases, but in one case, vomit in the airway adapter tube prevented obtaining a readout. The monitors aided management in 40 of 43 cases (93%); in one, the monitor reading was reported as variable (between 20 and 30 mmHg) although the teams knew the monitors were semi-quantitative; in another, the monitor was not required, but performed properly; and the third was the one in which vomit in the tube prevented a reading. In 26 of 43 cases (60.4%), the monitor was used to confirm endotracheal tube placement (there were no instances of incorrect placement). In all cases, the devices were used to monitor respiration and oxygen saturation. Alarms were audible in the environment, but only preferred in the AirEvac situation. The "breath beep" feature was useful, particularly in patients in whom chest movements during respiration were difficult to observe. CONCLUSIONS: "Breath beeps" were clearly audible and were a useful feature in all prehospital and transport environments, while audible alarms were desired only in the AirEvac situation. Semi-quantitative CO2 detection is valuable in the ALS/AirEvac environment, even for teams with high intubation success rates.

Adult↗
PubMedDate not supplied

Weekly telephone contact does not enhance the compliance of home apnea monitoring.

OBJECTIVE: To evaluate the effect of weekly telephone contact with families in enhancing the use of home apnea monitors. STUDY DESIGN: This was a prospective, randomized, single-blinded study of 65 infants who were prescribed home apnea monitoring at the time of initial discharge from the hospital. Exclusion criteria included participation in any other study involving home monitoring or nonavailability of home telephone. Infants were randomized either to the "standard" or "telephone" group by a stratified balanced block technique. All families were instructed to use the monitor during the first 4-week period at all times except during bathing and during the second 4-week period at all unattended times and at night. The families in the telephone group were contacted weekly for 8 weeks. The telephone interview reviewed the events of the previous week but did not include specific encouragement to use the monitor. Both groups received routine pediatric care and follow-up at our high-risk premature clinic. The primary outcome measure was compliance measured as the percentage of time as well as the hours per day that the infant spent on the monitor as recorded by the documented monitor. RESULTS: The telephone (n = 30) and standard (n = 32) groups were similar (p > 0.10) with respect to birth weight (1567 +/- 778 versus 1710 +/- 777 gm), gestational age (30.9 +/- 4.2 versus 31.1 +/- 4.6 weeks), maternal age (24.9 +/- 6.0 versus 25.3 +/- 5.4 years), and commercial insurance (46.7% versus 46.9%), a marker of higher socioeconomic status. Compliance of the telephone versus the standard group was similar during the first 4-week period (74.7 +/- 24.9 versus 75 +/- 27.8%, p = 0.85) (17.9 +/- 5.9 versus 18.2 +/- 6.6 hours/day), the second 4 week period (63.4 +/- 29.1 versus 58.9 +/- 30.9%, p = 0.59) (15.2 +/- 7.0 versus 14.1 +/- 7.4 hours/day) and the entire 8-week period (69.3 +/- 24.7 versus 67.7 +/- 26.2%, p = 0.82, Mann-Whitney U-test) (16.7 +/- 6.0 versus 16.1 +/- 6.5 hours/day), respectively. An abnormal pneumocardiogram at the time of discharge was the only identified factor that improved the compliance for the entire 8-week period (73.1 +/- 22 versus 52.1 +/- 28.5%, p = 0.02) (17.5 +/- 5.2 versus 12.5 +/- 6.8 hours/day) and the first 4-week period of monitoring (81.7 +/- 22.9 versus 59.5 +/- 31.3%, p = 0.01) (19.6 +/- 5.5 versus 14.2 +/- 7.5 hours/day). CONCLUSION: Weekly telephone contact, without specific encouragement to use the monitor, did not improve compliance. Compliance was greater in subjects who had abnormal pneumocardiogram results at the time of discharge from hospital regardless of their telephone/standard group assignment. We speculate that in this already compliant population, more targeted advice is necessary to increase compliance.

Apnea↗
PubMed1985

Effects of monitoring vocal intensity on oral air flow in children and adults.

The purposes of the present investigation were (a) to determine whether child and adult oral air flow data were parallel across two monitoring methods, (b) to determine whether an instruction to speak at a "comfortable effort level" resulted in greater variability of peak oral air flow (Vo) than visual monitoring of vocal intensity level, and (c) to expose possible sources of variation introduced by visual monitoring. Peak Vo from children and adults was measured for stops and fricatives in connected speech during a "comfortable-effort-level" task and during a visually monitored vocal intensity task. The lack of an age-by-monitoring effect in the analysis of variance (ANOVA) showed that child and adult data were parallel. The nonsignificance of F-Max scores for testing across-subject variability showed that the natural maintenance of a comfortable intensity level did not produce greater Vo variance than visual monitoring. This result was extended by a within-subjects comparison: visual monitoring induced subjects to alter their Vo production for some phonemes. Although the Vo of voiced consonants increased only slightly from comfort-level to visual monitoring, the Vo of voiceless consonants increased more sharply. Thus, visual monitoring does not decrease Vo variability, and does introduce spurious Vo values for some consonants.

Adult↗
PubMed2006

Current sedation and monitoring practice for colonoscopy: an International Observational Study (EPAGE).

BACKGROUND AND STUDY AIMS: Sedation and monitoring practice during colonoscopy varies between centers and over time. Knowledge of current practice is needed to ensure quality of care and help focus future research. The objective of this study was to examine sedation and monitoring practice in endoscopy centers internationally. PATIENTS AND METHODS: This observational study included consecutive patients referred for colonoscopy at 21 centers in 11 countries. Endoscopists reported sedation and monitoring practice, using a standard questionnaire for each patient. RESULTS: 6004 patients were included in this study, of whom 53 % received conscious/moderate sedation during colonoscopy, 30 % received deep sedation, and 17 % received no sedation. Sedation agents most commonly used were midazolam (47 %) and opioids (33 %). Pulse oximetry was done during colonoscopy in 77 % of patients, blood pressure monitoring in 34 %, and electrocardiography in 24 %. Pulse oximetry was most commonly used for moderately sedated patients, while blood pressure monitoring and electrocardiography were used predominantly for deeply sedated patients. Sedation and monitoring use ranged from 0 % to 100 % between centers. Oxygen desaturation (</= 85 %) occurred in 5 % of patients, of whom 80 % were moderately sedated. On average, three staff members were involved in procedures. An anesthesiologist was present during 27 % of colonoscopies, and during 85 % of colonoscopies using deep sedation. CONCLUSIONS: Internationally, sedation and monitoring practice during colonoscopy varied widely. Moderate sedation was the most common sedation method used and electronic monitoring was used in three-quarters of patients. Deep sedation tended to be more resource-intensive, implying a greater use of staff and monitoring.

Blood Pressure Determination↗
PubMed1987

[Interval CTG monitoring in labor; a contribution to family-oriented labor in the clinic or a danger to the child?].

Instead of continuous CTG monitoring lasting from the onset of labor to delivery, various obstetricians recommend interval monitoring in cases designated "likely to be free of complications". This enables the mother to move freely from time to time without being permanently confronted by technological apparatus. In the study reported here the authors therefore investigated whether-and if so what-risks interval monitoring involves. In order to answer this question 436 cardiotokograms recorded during labor with externally and internally attached leads were analyzed, evaluated 30 CTG minutes after the Hammacher Score in each case, and the number of points thus obtained was assigned to the corresponding cervical widths. As labor progressed from 3 to 10 cm cervix dilatation, there was a fourfold increase (p less than 0.0001) in particular in tentatively pathologic and prepathologic CTG patterns. No statistically significant difference was found between no-risk and risk patients. A check was also made as to whether the results of interval monitoring are as good as those of continuous monitoring. On the basis of two patient populations with different interval monitoring frequencies (17% versus 6.4%) it was established that with high interval monitoring frequencies the perinatal results were poorer: early morbidity of the newborns was twice as high when interval monitoring was used more often (21.4% versus 10.8%) (p less than 0.0001). From this the authors conclude that for the sake of the child, continuous monitoring during labor ought not to be dispensed with.

Adult↗
PubMed2000

A comparison of hemodynamic data derived by pulmonary artery flotation catheter and the esophageal Doppler monitor in preeclampsia.

OBJECTIVE: This study was undertaken to compare hemodynamic data derived with the esophageal Doppler monitor against those obtained with a pulmonary artery flotation catheter in women with complicated preeclampsia. STUDY DESIGN: Seventeen women with severe preeclampsia who had a pulmonary artery flotation catheter placed for clinical indications also had an esophageal Doppler monitor inserted. Hemodynamic data were recorded on 2 occasions separated by several hours with both the pulmonary artery flotation catheter and the esophageal Doppler monitor simultaneously. RESULTS: The esophageal Doppler monitor underestimated cardiac output by 36% +/- 14% (mean +/- SD). The esophageal Doppler monitor accurately estimated cardiac output in 3 women >40 years old, whereas in the remaining women (all <35 years old) the esophageal Doppler monitor underestimated cardiac output by 38% +/- 11%. The esophageal Doppler monitor accurately reflected changes in cardiac output with time when compared with the pulmonary artery flotation catheter. CONCLUSION: In women with preeclampsia the esophageal Doppler monitor consistently underestimated cardiac output by approximately 40%. It is not known whether the apparent increase in accuracy among the women >40 years old arose by chance or reflected a real improvement in performance. The esophageal Doppler monitor accurately reflected the direction and magnitude of the changes in cardiac output with time.

Adult↗
PubMed1998

Intra-operative monitoring in acoustic neuroma surgery.

Intra-operative neurophysiologic monitoring (IOM) is rapidly evolving as an important adjunct during acoustic neuroma surgery to reduce the incidence of neurologic deficits. Monitoring alerts the surgeon to ongoing changes in neural function. The benefit of facial nerve monitoring in reducing the incidence of facial palsy during acoustic tumor resection appears clear and is now recommended by the National Institutes of Health (Consensus Development Conference on Acoustic Neuroma, 1991). Auditory monitoring is not as effective as facial monitoring but hearing preservation can be enhanced particularly if used with facial monitoring because the latter alerts the surgeon to traumatic manipulations that may affect both facial and cochlear nerves. Monitoring is not a replacement for surgical experience. 'Poor monitoring is worse than no monitoring'.

Action Potentials↗
PubMed2003

Oesophageal pH monitoring in children: how is it perceived by the parents and does the technique change feeding and daily activity?

AIM: To determine whether oesophageal pH monitoring in infants induces changes in daily activity and feeding, and with the help of a questionnaire to evaluate how parents perceive pH monitoring. METHODS: The parents of 100 children, consecutively referred for oesophageal pH monitoring, were asked by one of the authors (A.A.) to respond to a standardized questionnaire immediately after the end of the procedure. Twenty questions were asked, concerning five topics: feeding (4 questions), activity (6 questions), perception of the parents (6 questions), accuracy of the provided information (3 questions), and previous experience with oesophageal pH-metry (1 question). For statistical analysis, every variable was qualified as "no change" and "change" for feeding and activity, as "positive" or "negative" regarding the perception of the test, and as "sufficient" or "insufficient" regarding the information provided. The answers to the questions were also analysed according to the result of the oesophageal pH monitoring (normal vs abnormal), and according to whether or not there was previous experience of oesophageal pH-metry in a first degree relative. RESULTS: Changes in feeding occurred in 28% of cases and changes in activity in 30%, but did not differ according to the oesophageal pH-metry result. Equally, the perception of the parents regarding the test (37% negative), the acceptability of a second pH-metry test (refusal in 52%) and previous experience with oesophageal pH-metry (positive in 25%) were not influenced by the result of the pH monitoring. Parents of infants with abnormal oesophageal pH monitoring were more frequently dissatisfied with the information about the nature of the test provided before the test and also the results than parents of infants with normal results (52% vs 19%, respectively; p < 0.05). CONCLUSION: According to the perception of the parents, pH monitoring induces changes in feeding and activity in 28% and 30%%, respectively; 63% of the parents considered pH monitoring to be well tolerated. Parents of infants with abnormal pH monitoring results need more attention.

Attitude↗
PubMed2004

Patient satisfaction with the SpaceLabs 90207 ambulatory blood pressure monitor in pregnancy.

OBJECTIVE: The objective of this study was to evaluate the acceptability of the SpaceLabs 90207 ambulatory blood pressure monitor among pregnant women. METHODS: Patients participating in research projects involving ambulatory blood pressure monitoring (ABPM) in pregnancy (N = 110) were asked to complete a questionnaire relating to patient satisfaction on completion of the monitoring period. The first part of the questionnaire involved rating on a visual Likert scale (0-10) whether they found the monitor heavy, noisy, cumbersome, disturbing, or embarrassing to wear. The second part of the questionnaire addressed whether cuff inflation caused significant sleep disturbance or physical discomfort. OUTCOME MEASURES: The mean (SD) and range of the Likert scores are reported. The number of patients reporting sleep disturbance or physical discomfort was calculated. Logistic regression was used to examine which factors were significant predictors of discontinuing monitoring. RESULTS: The mean (SD) responses measured by the Liken scores were: finding the monitor heavy 3.2 (2.3); comfortable 4.8 (2.3); straightforward to use 8.8 (1.8); cumbersome 3.8 (2.3); disturbing 4.5 (2.7); noisy 1.6 (2.2); and embarrassing to wear 1.7 (2.1). Difficulty initiating sleep was reported by 28.8% of patients, and a further 56.3% reported difficulty maintaining sleep due to the monitor. Sleep disturbance was found to be the strongest predictor [r = 0.52; OR 1.68 (1.23, 2.27), p = 0.0009] for the 15% of patients discontinuing the monitoring. CONCLUSIONS: While pregnant women tolerate the noise, weight, inconvenience, and disturbance associated with ambulatory blood pressure monitoring (ABPM) well, sleep disturbance is a major cause of dissatisfaction and noncompliance. Future studies should evaluate critically the number of nocturnal blood pressure assessments required, and should allow for a withdrawal rate of approximately 15% when performing sample size calculations for ABPM studies in pregnancy.

Blood Pressure Monitoring, Ambulatory↗
PubMed1992

Age and blood pressure measurement: experience with the TM2420 ambulatory blood pressure monitor and elderly people.

The accuracy of the TM-2420 ambulatory blood pressure monitor was assessed in elderly people. Ninety-four subjects (44 men and 50 women), aged 60-94 with systolic blood pressure (SBP) of 97-208 mmHg and diastolic blood pressure (DBP) of 45-109 mmHg, including 23 with isolated systolic hypertension, were studied in three centres. The monitor was compared simultaneously with pairs of observers using the Hawksley random zero sphygmomanometer. The standard deviation of the difference (SDD) between observers was 4.2 mmHg (SBP), 2.9 mmHg (DBP). The mean difference was 0.49 mmHg (SBP) and 0.27 mmHg (DBP). The SDD between the monitor and the average of the observers' readings was 6.7 mmHg (SBP), 5.5 mmHg (DBP); the mean differences were 4.4 mmHg (SBP) and 4.8 mmHg (DBP). There were no significant differences between the two versions of the monitor used (5 and 7) or between the three pairs of observers. The monitor was equally accurate in isolated systolic hypertension (SDD observers and monitor 6.2 mmHg for SBP, 3.9 mmHg for DBP, mean differences 4.3 mmHg for SBP, 4.5 mmHg for DBP). Twenty-four-hour ambulatory blood pressure monitoring was carried out in 129 subjects aged 60-79; 89% of the monitoring attempted were successful with error rates of < 10%. The mean error rate was 3.8%. The device was well tolerated with only 4.7% of the subjects not completing a monitoring.

Aged↗
PubMed2005

Haemodialysis with on-line monitoring equipment: tools or toys?

BACKGROUND: On-line monitoring of chemical/physical signals during haemodialysis (HD) and bio-feedback represents the first step towards a 'physiological' HD system incorporating adaptive and logic controls in order to achieve pre-set treatment targets. METHODS: Discussions took place to achieve a consensus on key points relating to on-line monitoring and bio-feedback, focusing on the clinical applications. RESULTS: The relative blood volume (BV) reduction during HD can be monitored by optic devices detecting the variations in concentration of haemoglobin/haematocrit. BV changes result from an equilibrium between ultrafiltration and the refilling capacity. However, BV reduction has little power in predicting intra-HD hypotensive episodes, while the combination of the patient-dialysate sodium gradient, the relative BV reduction between the 20th and 40th minute of HD, the irregularity of the profile of BV reduction over time and the heart rate decrease from the start to the 20th minute of HD predict intra-HD hypotension with a sensitivity of 82%, a specificity of 73% and an accuracy of 80%. A bio-feedback system drives the relative BV reduction according to desired values by instantaneously changing the ultrafiltration rate and the dialysate conductivity. This system has proved to reduce the incidence of intra-HD hypotension episodes significantly. Ionic dialysance and the patient's plasma conductivity can be calculated easily from on-line inlet and outlet dialysate conductivity measurements at two different steps of dialysate conductivity. Ionic dialysance is equivalent to urea clearance corrected for recirculation and is a tool for continuously monitoring the dialysis efficiency and detecting early problems with the delivery of the prescribed dose of dialysis. Given the strict and linear relationship between conductivity and sodium content, the conductivity values replace the sodium concentration values and this permits the development of a conductivity kinetic model, by means of which sodium balance can be achieved at each dialysis session. The conductivity kinetic model has been demonstrated to improve intra-HD cardiovascular stability in hypotension-prone patients significantly. Ionic dialysance is also a useful tool to monitor vascular access function, as it can be used to obtain serial measurements of vascular access blood flow. On-line urea monitors provide detailed information on intra-HD urea kinetics and delivered dialysis dose, but they are not in widespread use because of the costs related to the disposable materials (e.g. urease cartridge). The body temperature monitor measures the blood temperature at the arterial and venous lines of the extra-corporeal circuit and, thanks to a bio-feedback system, is able to modulate the dialysate temperature in order to influence the patient's core body temperature, which can be kept at constant values. This is associated with improved intra-HD cardiovascular stability. The module can also be used to quantify total recirculation. CONCLUSIONS: On-line monitoring devices and bio-feedback systems have evolved from toys for research use to tools for routine clinical application, particularly in patients with clinical complications. Conductivity monitoring appears the most versatile tool, as it permits quantification of delivered dialysis dose, achievement of sodium balance and surveillance of vascular access function, potentially at each dialysis session and without extra cost.

Biofeedback, Psychology↗
PubMed1976

ICP monitoring: complications and associated factors.

1. Patients with complications when compared with those not developing a complication: a. Were older, 44.4 vs. 34.5 years; b. Were monitored longer, 14.0 vs. 6.5 days; c. Were treated with steroids longer, 18.3 vs. 10.3 days; d. Were hospitalized longer, 35.7 vs. 27.7 days; e. Are twice as likely to die; f. Average age of those dying is older, 46 vs. 30 years; g. Have no clear relationship to antibiotics; h. Do not have a preponderance of single diagnostic category to account for these differences; i. Complications were always controlled with standard therapy; j. An ICP complication was almost never responsible, per se, for death. 2. Over all complication rate was 18%; due to monitoring was 4.5 to 11.5%. 3. Monitoring was responsible for, or contributed to, 25 to 60% of the complications. 4. No complications occurred when monitoring was discontinued within 3 days. 5. Long periods of treatment with steroids increased the risk of a complication developing. 6. Long periods of monitoring were associated with an increased risk of complication. 7. "Individual" factors are partly responsible for the development of a complication, and death. 8. There are two groups of complications: "early" and "late." A. Those most likely to be monitor related occur "late" and account for 35% of the complications. B. Those developing "early" infection account for 65% of the complications and are most likely caused by factors other than monitoring. While there are complications directly attributable to monitoring, the rate is low and they are readily controlled by standard neurosurgical management. While monitoring may increase the morbidity, it does not increase the mortality. We feel that the over-all risk is small and that the returns are great--both in terms of knowledge and patient benefit.

Adult↗
PubMed2000

The accuracy and precision of body temperature monitoring methods during regional and general anesthesia.

UNLABELLED: We tested the hypotheses that accuracy and precision of available temperature monitoring methods are different between spinal anesthesia (SA) and general anesthesia (GA), and that patients receiving SA are at equal risk for hypothermia as those receiving GA. Patients scheduled for radical retropubic prostatectomy were enrolled. Either GA (n = 16) or SA (n = 16) was given according to patient and clinician preference. Temperatures were monitored with thermocouple probes at the tympanic membrane, axilla, rectum, and forehead skin surface. Tympanic temperatures were also measured with an infrared device, and forehead skin temperatures were monitored with two brands of liquid crystal thermometer strips. Accuracy and precision of these monitoring methods were determined by using tympanic membrane temperature, measured by thermocouple, as the reference core temperature (T(c)). At the end of surgery, T(c) was similar between SA (35.0 +/- 0.1 degrees C) and GA (35.2 +/- 0.1 degrees C) (P = 0.44). Accuracy and precision of each temperature monitoring method were similar between SA and GA. Rectal temperature monitoring offered the greatest combination of accuracy and precision. All other methods underestimated T(c). These findings suggest that patients receiving SA or GA are at equal and significant risk for hypothermia, and should have their temperatures carefully monitored, recognizing that most monitoring methods underestimate T(c). IMPLICATIONS: Body temperature should be monitored during spinal anesthesia because patients are at significant risk for hypothermia. Rectal temperature is a valid method of measuring core temperature, whereas other methods tend to underestimate true core temperature.

Anesthesia, General↗