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At least 1,333 records · Page 74Linked to original sources
PubMed1978

The cerebral function monitor during open-heart surgery.

Open-heart surgery has entered the third decade of its existence. The period has demonstrated increased patient safety during and after open-heart surgery due to the employment of simple and reliable monitoring techniques. The monitoring of the function of the brain has not kept pace with these advances. Electroencephalographic (EEG) method is impractical for routine use in the operating room and in the intensive care unit. The cerebral function monitor (CFM) offers simplified continuous monitoring and interpretation of cerebral electrical activity (integrated EEG) in the clinical situation. The unit displays a two channel tracing, one representing cerebral activity and a second indicating electrode impedance artefacts. The early changes seen in addition to other conventional monitoring of the electrocardiogram, blood pressures, pulse rate, etc. offers information especially pertinent to open-heart surgery. It would appear that there is a place in anesthetic practice during and after cardiopulmonary bypass for the routine use of the CFM to supplement existing monitoring for the safer conduct of open-heart surgery. This study analyzes the value of a cerebral function monitor in 112 patients undergoing open-heart surgery.

Brain↗
PubMed1989

[Monitoring critically ill patients during transport by helicopter using a patient with abdomen apertum as an example].

Noninvasive continuous monitoring systems are newly emerging as an important means of monitoring during transports in emergency care, e.g. transportation by helicopter. While automatic oscillometric blood pressure monitors have been used in the perioperative area for some time, a similar development can be observed in the field of emergency care and transportation with the availability of light, portable and battery operated systems. For monitoring adequate oxygenation, pulse oximeters have recently been brought into discussion for both the perioperative period and the transport of critically ill patients. In contrast to well-established monitoring techniques during helicopter transports (ECG, inspection, manually measured blood pressure (BP), pulse oximetry reveals an oxygen deficiency due to respiratory and cardiocirculatory problems, enabling precious time to be saved. This concept is illustrated during the helicopter transport of a critically ill patient with abdomen apertum caused by Clostridium perfringens infection. Even with a critical look at the already described mishaps of this method--e.g. overestimation of true O2 saturation (sO2) and additional overestimation caused by Hb-derivatives--pulse oximetry was found to be superior to the established monitoring techniques. Furthermore, oscillometric blood pressure detection was very satisfactory during the 30-min helicopter transport. Based on our results, we believe pulse oximetry and automatic oscillometric BP-measurement to be useful for monitoring during transports in helicopters, thus improving patient safety.

Abdomen↗
PubMed1988

Invasive cardiac monitoring.

Since its introduction in 1970, the application for PA catheter monitoring has dramatically broadened. PA catheters provide the ability to obtain hemodynamic data for the assessment, monitoring, and therapeutic management of critically ill patients. Because of the potential complications associated with PA catheter monitoring, numerous editorials and articles have questioned the procedure's risk to benefit ratio. These articles address the insufficient availability of adequate outcome data or suggest no demonstrated benefit from PA monitoring. Subgroups of patients have been identified in whom the data obtained from PA monitoring altered the clinician's assessment and management. In spite of the study of Rao, which implies that PA catheters can improve mortality in critically ill patients, no scientific study of outcome has been able to confirm this impression. If an adequate understanding of the limitations of PA monitoring does not exist, appropriate selection and implementation of therapy cannot occur. The problem is not as much the technology, as it is the knowledge and expectations of the clinician. "Human" complications from inadequate understanding of the physiologic data are quite common. Reliance on the measured pressure is often misleading. The use of "absolute numbers" rather than trends or relative changes in the values monitored can compromise clinical assessment. Overzealous utilization and acceptance of any quantitative measurement without coordination with clinical judgment is fraught with failure.

Cardiac Catheterization↗
PubMed1986

Invasive cardiorespiratory monitoring.

Several principles should be kept in mind when choosing appropriate monitoring. First, select monitoring devices that provide relevant information on which therapeutic decisions can be made. Second, when alternative, noninvasive monitoring devices are available, use these preferentially because the risk to the patient usually is decreased. Third, when invasive monitoring devices are used, sterile technique and catheter care become extremely important. Fourth, record information that is obtained from monitoring frequently, and titrate therapy continuously based on information generated. Fifth, remove invasive monitoring devices as soon as they are no longer necessary. Finally, when new monitoring approaches are presented, they should be evaluated not only on the basis of their sophistication and cost, but also on the basis of how important will be the new physiologic measurements they provide to improve patient outcome.

Cardiac Output↗
PubMed1985

Biological monitoring of workers exposed to organic solvents--past and present.

The development of biological monitoring for persons exposed to organic solvents is described. The advantages of this supervision strategy, as well as the reservation against it, are discussed. With the target organs of organic solvents, matrices and parameters for biological monitoring taken into consideration, the following recommendations can be given: the determination of solvent level in blood or alveolar air as a substitute is obligatory for the biological monitoring of organic solvents (the toxic stress of the target organ--the brain--is reflected this way); metabolites have to be determined also when they or their predecessors impair other organs. The discussion of chemical analysis, interference and influencing factors, as well as biological limit values, leads to suggestions of how to interpret the results of biological monitoring. Beyond the estimation of the health risk of the individual worker, the results also have to be interpreted on a group basis. Only in this way can all information on biological monitoring be used to the advantage of prevention. In summary, today biological monitoring is possible for most of the organic solvents. Estimation of health risk in the case of simultaneous exposure to several solvents is still not possible. Parameters measuring toxic strain must be established. The various social groups have to be convinced of the advantages of biological monitoring.

Environmental Monitoring↗
PubMed1985

Monitoring at the Instituut voor Epilepsiebestrijding Meer en Bosch.

A requirement for intensive epilepsy monitoring arose from a demand for ictal EEG registration for diagnostic purposes and in the context of pharmacokinetic research. The monitoring facility developed gradually: first conventional EEG equipment was used on the wards, later miniaturized pre-amplifiers were introduced to allow the patient greater freedom, finally a comprehensive specialized monitoring facility was created with its own accommodation. For most clinical and research applications arising in the Institute intensive observation and video monitoring are necessary. The greater reliability, channel capacity and bandwidth of cable telemetry offer considerable advantages over alternative monitoring techniques as radio telemetry. For recording from patients in locations outside the monitoring unit but where restricted mobility is acceptable a combination of telephone telemetry with a local radio link is used. Synchronization of EEG and video images is achieved by various means, depending on the application: split-screen technique, superimposition of EEG on video images or annotating the paper EEG chart with digital time information derived from the video time-date generator. Buffering of EEG signals is also available by means of a computer disk or a shift register. During the development of the system evaluation studies have been performed showing a progressively increasing yield of clinically useful information. At the most recent assessment, 79% of the investigations answered the clinical question addressed, in 65% of instances the findings had consequences for management and in over 25% the decisions resulting from monitoring had long-term therapeutic benefits for the patient.

Automation↗
PubMed1985

Monitoring at the Swiss Epilepsy Center.

Long-term monitoring facilities have proven irreplaceable in the investigation of epileptic patients as well as in the assessment of therapy. We describe an integrated monitoring system which has been in operation in our center for over 5 years. It includes long-term monitoring by means of a 21-channel EEG write-out and video taping, ambulatory monitoring using a 4-channel cassette as well as an intensive monitoring system combining 16-channel radio telemetered EEG with split-screen video technology. Technical equipment, organization, indications, applications and clinical results are presented in detail. The availability of an experienced team of specialists (neurologist, engineer, clinical pharmacologist, neuropsychologist) is a prerequisite for the optimal utilization of these facilities. With out integrated monitoring system we investigate an average of 550 patients/year. In over half the cases, the desired information can be provided, resulting in a direct therapeutic benefit. The additional value of these methods, especially of the intensive monitoring, lies also in the possibility of compiling new knowledge about semiology and electro-clinical correlation of epileptic seizures, possible trigger mechanisms and long-term therapeutic effects. This should help to better understand the underlying pathophysiology and to further reduce the number of epileptic patients not responding to therapy.

Ambulatory Care↗
PubMedDate not supplied

[Holter monitoring in patients with focal cerebral ischaemic attacks (author's transl)].

One hundred patients with focal cerebral ischaemic attacks of suspected embolic origin were investigated by Holter monitoring to determine whether paroxysmal arrhythmia may have been responsible for the episodes. There were 57 men and 43 women aged from 16 to 79 years (mean 50 years). Ninety-seven had residual focal neurological deficits and 3 had transient ischaemic attacks. The neurological lesions were verified by cerebral angiography in 68. Twenty-one had arterial hypertension and 9 had old myocardial infarction or angina. Nine had a history of palpitations. None had cardiac valve disease. All patients were in sinus rhythm, 4 had ventricular extrasystoles on routine ECG, and 4 had supraventricular extrasystoles. None of the patients were receiving anti-arrythmic drugs at the time of investigation. Holter monitoring was performed for 18 hours in 91 cases and for 24-54 hours in the remaining ones. The interval between the cerebral ischaemic attack and the monitoring was less than one month (mean 20 days) for 50 patients and longer for the others. Cardiac arrythmias were found in 36 patients. Sixteen had more than 10 supraventricular extrasystoles per hour, 13 had runs of 3 to 8 beats of supraventricular tachycardia, 1 had an episode of atrial fibrillation. Eighteen subjects had more than 5 ventricular extrasystoles per hour, 1 had accelerated ventricular rhythm, 2 had runs of 4 to 7 beats of ventricular tachycardia. Two patients had second degree A.V. block. None had palpitations during monitoring. Arrythmias were increasingly frequent with age. Our findings are similar to those obtained with monitoring in ambulatory asympatomatic subjects of the same age without apparent heart diseases reported by other authors. On the other hand, the frequency of arrythmia was unrelated to the time elapsed between the ischaemic attack and Holter monitoring. In conclusion, Holter monitoring performed several weeks after suspected cerebral embolism failed to reveal arrythmias likely to be responsible for a focal cerebral ischaemic attack.

Adolescent↗
PubMed1984

The role of prolonged esophageal pH monitoring in the diagnosis of gastroesophageal reflux.

To reassess 24-hour esophageal monitoring and determine if shorter time periods might retain its diagnostic benefits, we studied 16 gastroesophageal reflux (GER) patients and eight controls. Esophageal pH monitoring was performed for 24 hours, with patients in an upright position during the day and supine when retiring. During the 24-hour pH monitoring period, the mean percentage time that pH was less than 4.0 in GER patients, 13.2% +/- 2.9% (SEM), was significantly higher than in normal subjects, 0.7% +/- 0.2% (SEM). Analysis of individual data indicated clear separation of GER patients from normal subjects when in the upright posture, but 25% of GER patients were within the range of the normal subjects when supine (overnight). Three-hour time periods after meals were analyzed. Postprandial pH monitoring, when compared with 24-hour pH monitoring, can identify GER with a 77% sensitivity and a 96% specificity. A 12-hour period (four hours after the dinner meal and eight hours supine) can identify GER with a 94% sensitivity and a 100% specificity. We conclude that (1) 24-hour pH monitoring of the esophagus may have a continuing role in research aspects of GER, (2) 12-hour pH monitoring is a highly accurate test that could be adapted to patients' work schedules or to outpatient telemetry, and (3) postprandial pH testing is a practical, less expensive, and accurate method of diagnosing GER that could be utilized by any gastroenterology diagnostic unit.

Esophagus↗
PubMed1984

A randomized comparative crossover evaluation of glucose monitoring technologies.

Twenty-four diabetic patients receiving insulin were randomized to 3 groups. Group I began self blood glucose monitoring by meter and switched to visually read strips at 3 months. Group II began self blood glucose monitoring by visually read strips and switched to meter readings at 3 months. Group III monitored urine glucoses for the 6 months of the trial. Professional interaction time was the same for all patients and each patient was placed on the same insulin delivery scheme (3 shots NPH and/or regular). Mean C-peptide levels 6 min following intravenous glucagon was comparable in all 3 groups. Patients monitoring blood glucose showed a significant decrease in glycosylated hemoglobin values (p less than 0.01) from patients monitoring urine at 6 months of the trial. Patients subjectively felt meters were more accurate than visual strips but both groups I and II showed lower glycosylated hemoglobin levels (p less than 0.02 at 6 months) and sequence analysis revealed no sequence effect. The trial confirms that blood glucose monitoring technologies have advantages over urine monitoring in helping patients achieve improved glucose levels. Patients perform equally well in terms of blood glucose "control" whether visually read strips or meters are used for initial teaching or maintenance if patients are instructed appropriately in each methodology. These findings have economic implications for large scale treatment programs.

Adolescent↗
PubMed1984

Long-term reactions of women to electronic fetal monitoring during labor.

The long-term reactions of women to electronic fetal monitoring during labor were studied by mailing a questionnaire to a random sample of 110 women two to five months postpartum. Of the 75 women who responded and in whom the fetal monitor had been used, 74 gave an overall positive response to fetal monitoring. Four important factors underlying the responses of the women were identified. The monitor was remembered as an important provider of information, as an agent of reassurance, and not as an invader of privacy. Most women did not remember the monitor as an uncomfortable or distracting agent, though their responses for this factor were not so strong as for the other factors. No significant associations were found between the four factors and marital status, age, education, parity, specialty of physician, length of monitoring, or amount and adequacy of prenatal information obtained about the monitor. Significant associations were found between three of the factors and race.

Adult↗
PubMed1983

[Continuous intracranial pressure monitoring in normal pressure hydrocephalus--with special reference to clinical significance of B wave and prognostic criteria for CSF shunting].

The authors investigated the hydrodynamics in normal pressure hydrocephalus (NPH) and suggested surgical indication for identifying cases suitable for shunt operation. 48 patients with presumed NPH who underwent CT scanning, CT cisternography, and continuous monitoring of intracranial pressure for 24 hours were studied for assessing the correlation of incidence of B wave with clinicopathological features of the normal pressure hydrocephalus syndromes. The causes of NPH consisted of idiopathic of primary origin in 24 patients, subarachnoid hemorrhage in 9, head injury in 8, cerebrovascular occlusion in 3, meningitis in 2, intracerebral hematoma in one and craniotomy in one. The incidence of B waves in term of percentage of time with B waves did not correlate with the age of the patients and presence or absence of CT evidence of brain atrophy. There was a good correlation between incidence of B waves and the degree of ventriculomegaly, the presence of periventricular lucency on CT, and the grade of CSF circulation disturbance as evaluated by CT cisternography. The pathogenesis of B waves may be related to increased malabsorption of CSF in the major pathways and episodic pressure response promoting CSF absorption in the lesser pathways. Those patients who exhibit the type IV or type V on CT cisternography and B waves for more than 20% of the time monitored on continuous monitoring of intracranial pressure (ICP) responded to shunting in more than 90%. Patients showing type III-b on CT cisternography and B waves for more than 5% on ICP monitoring benefited from a shunt in about 70%. On the other hand, patients with type III-a on CTC and B waves for less than 5% of the time monitored could not be expected to respond to shunting. Incidence of B waves on continuous ICP monitoring correlated closely with response to CSF shunting. Therefore continuous ICP monitoring, combined with CT cisternography, provide a reliable indication of the potential of a patient with NPH to recover after shunting.

Adult↗
PubMed1978

The importance of monitoring in anesthesia.

A plea is made for continuous electronic monitoring of every patient undergoing an anesthetic. Such monitoring is far superior to clinical observation by means of the natural sensors. A continuous record of the vital phenomena is indispensable. Routine monitoring of the following is advised: ECG, heart rate, capnogram, plethysmogram, temperature, oxygen percentage and indirect blood pressure. Big operations demand central venous pressure and direct blood pressure monitoring, in addition. In the Institute of Anesthesiology in Utrecht all electronic monitors are built into a single unit which is used during every anesthetic. Capnography it dealt with in some detail and its value as a universal monitor demonstrated. The routine use of electronic monitors improves the quality of anesthesia and increases the safety of the patient.

Adolescent↗
PubMed1980

Puerperal endometritis and intrauterine fetal heart rate monitoring.

The incidence of puerperal endometritis in 5058 patients who were delivered during a one year study period was recorded prospectively. Caesarean section was performed in 774 cases (15.3%) and intrauterine fetal heart rate monitoring was used in 2016 cases (39.9%). After vaginal delivery, the incidence of endometritis was 1.5% in those monitored externally and 2.4% in those monitored internally (P less than 0.05). After Caesarean section, endometritis occurred in 8.0% of those monitored externally and in 16.4% of those monitored internally for varying times (P less than 0.01). The duration of monitoring had no significant effect on these infection rates. The risk of puerperal endometritis after internal fetal monitoring seemed to be the same as after one vaginal examination.

Endometritis↗
PubMed1995

["Home monitoring" does not prevent crib death. Managing possibilities and results of new technology].

Each night, about 300 Norwegian infants are connected to monitors that register respiratory movement. Most of the infants are siblings to cot death victims. It has never been proven that these simple devices have saved lives in such cases. On the contrary it has happened that infants have succumbed to cot death while connected to such monitors. During the last ten years, 1,200 simple monitors for home use have been sold in Norway. In most cases these are owned by departments of pediatrics or by county centres for medical equipment, and are lent to families. The use of monitors varies considerably among the different counties. Thus in the county of Nordland 100 monitors are available, while Buskerud county has only two. Based on undocumented effect and great variation in availability, it seems appropriate to ask: what forces maintain home monitoring, and is it possible to discontinue this service? If no new and better technology is developed, it is necessary to consider the consequences of continuing to use ineffective devices. Conversely, it is also necessary to look at the consequences of discontinuing the service. Based on the present knowledge about risk factors, it would seem better to emphasize a dialogue between parents and doctor, rather than continue to use monitors.

Home Care Services↗
PubMed1995

[Intraoperative facial nerve monitoring in parotid surgery].

Neurophysiological monitoring of cranial motor nerves has proved to be of value in cerebellopontine and skull base surgery. Unfortunately, facial nerve monitoring has been used infrequently for routine parotid gland surgery because suspicion of expense, possible unreliability and the requirement for extra personnel. This study presents clinical experience at the University of Erlangen with facial nerve monitoring during parotid gland surgery done by residents. Advantages are also emphasized for the experienced ENT-surgeon for use during revision parotidectomy. In 35 consecutive patients with benign parotid gland tumors intraoperative monitoring of the facial nerve was done using two different two-channel electromyography units. Bipolar coaxial electrical stimulation was superior to the monopolar stimulation mode. The average operative time and postoperative functional results were compared with those of a control group consisting of 24 patients without monitoring. Findings demonstrated a reduction is operative time and better functional outcome in the patient group with monitoring. Additionally four patients had to undergo total revision parotidectomy because of recurrent benign tumors, while one patient suffered from chronic parotitis due to sialolithiasis and required complete parotidectomy for relief of symptoms. No patient developed permanent facial paresis and nerve monitoring proved to be very helpful for identification and protection of the facial nerve in scar tissue.

Electric Stimulation↗
PubMed1994

Respiratory monitoring in an intermediate intensive unit.

The major goal of monitoring is continuous recording of indices that enhance our understanding of the underlying pathophysiology, in order to improve diagnosis and guide management, and identify trends that assist in assessing the therapeutic response and predicting prognosis. Nowadays, technology has made it possible to automatically sense and display a wide variety of physiological indices. An ideal monitoring system should be pertinent to patient management, propose interpretable data, show high technical accuracy, high sensitivity, good reproducibility, be practical to use. The international literature, our personal experience, and cost considerations have proposed the following monitoring standards as the best for a noninvasive respiratory intermediate intensive care unit (RIICU): 1) mandatory indices: respiratory rate, oxygen saturation, haemogas-analysis, tidal volume, minute ventilation, maximum voluntary ventilation, forced expiratory volume in one second, forced vital capacity, vital capacity, maximal inspiratory pressure, heart rate and blood pressure; 2) second choice indices: capnometry, respiratory inductive plethysmography, transcutaneous monitoring of gases, haemodynamic monitoring, mechanics data by means of an oesophageal balloon, and central drive. Pulmonary monitoring devices shorten the time for patients who remain on mechanical ventilators; a reduction both in the risk of associated complications and the costs involved is a natural consequence. Continuous monitoring of significant physiological indices has the potential for predicting a critical event, and providing an opportunity for the institution of lifesaving measures.(ABSTRACT TRUNCATED AT 250 WORDS)

Critical Care↗
PubMed1993

Are capillary whole blood coagulation monitors suitable for the control of oral anticoagulant treatment by the international normalized ratio?

The 512 Coagulation Monitor is a portable coagulation photometer that uses disposable cartridges containing a lyophilized rabbit brain thromboplastin to measure the PT for capillary whole blood. It has been proposed as a suitable system for patient self monitoring at home, but its performance has never been thoroughly assessed for results expressed as International Normalized Ratio (INR). In particular, there is no available information about the adequacy of the WHO calibration model with the Monitor. The aims of the study were to determine the International Sensitivity Index (ISI) against the secondary International Reference Preparation for rabbit thromboplastin and to assess the precision of the INR. The study demonstrates that the Monitor can be calibrated with the WHO model, because log-transformed PTs for patients stabilized on oral anticoagulants and normal individuals are linearly related and because the same orthogonal regression line describes patient and normal data points adequately. However, the ISI calculated in this study (2.715) is higher than that adopted by the manufacturer (2.036). The between-assay reproducibility of the Monitor is acceptable (CV = 9.7%) with results expressed in seconds, but become unacceptably poor when the results are converted into INR (CV = 18.8%) because of the high ISI value of the thromboplastin used. We think that the Monitor might be suitable for monitoring oral anticoagulant therapy if the manufacturer would provide a more sensitive thromboplastin in the cartridges.

Administration, Oral↗