Use Of Advanced Monitoring Research Articles

American Heart Association Cardiogenic Shock Registry: Design and Implementation.

Cardiogenic shock is a morbid complication of heart disease that claims the lives of more than 1 in 3 patients presenting with this syndrome. Supporting a unique collaboration across clinical specialties, federal regulators, payors, and industry, the American Heart Association volunteers and staff have launched a quality improvement registry to better understand the clinical manifestations of shock phenotypes, and to benchmark the management patterns, and outcomes of patients presenting with cardiogenic shock to hospitals across the United States. Participating hospitals will enroll consecutive hospitalized patients with cardiogenic shock, regardless of etiology or severity. Data are collected through individual reviews of medical records of sequential adult patients with cardiogenic shock. The electronic case record form was collaboratively designed with a core minimum data structure and aligned with Shock Academic Research Consortium definitions. This registry will allow participating health systems to evaluate patient-level data including diagnostic approaches, therapeutics, use of advanced monitoring and circulatory support, processes of care, complications, and in-hospital survival. Participating sites can leverage these data for onsite monitoring of outcomes and benchmarking versus other institutions. The registry was concomitantly designed to provide a high-quality longitudinal research infrastructure for pragmatic randomized trials as well as translational, clinical, and implementation research. An aggregate deidentified data set will be made available to the research community on the American Heart Association's Precision Medicine Platform. On March 31, 2022, the American Heart Association Cardiogenic Shock Registry received its first clinical records. At the time of this submission, 100 centers are participating. The American Heart Association Cardiogenic Shock Registry will serve as a resource using consistent data structure and definitions for the medical and research community to accelerate scientific advancement through shared learning and research resulting in improved quality of care and outcomes of shock patients.

Anesthesia management for pericardiectomy- a case series study

BackgroundConstrictive pericarditis (CP) is an uncommon disease that limits both cardiac relaxation and contraction. Patients often present with right-sided heart failure as the pericardium thickens and impedes cardiac filling. Pericardiectomy is the treatment of choice for improving hemodynamics in CP patients; however, the procedure carries a high morbidity and mortality, and the anesthetic management can be challenging. Acute heart failure, bleeding and arrhythmias are all concerns postoperatively.MethodsAfter IRB approval, we performed the retrospective analysis of 66 consecutive patients with CP who underwent pericardiectomy from July 2018 to May 2022.ResultsMost patients had significant preoperative comorbidities, including congestive hepatopathy (75.76%), New York Heart Association Type III/IV heart failure (59.09%) and atrial fibrillation (51.52%). Despite this, 75.76% of patients were extubated within the first 24 h and all but 2 of the patients survived to discharge (96.97%).ConclusionsAnesthetic management, including a thorough understanding of the pathophysiology of CP, the use of advanced monitoring and transesophageal echocardiography (TEE) guidance, all played an important role in patient outcomes.

IoT. К вопросу об Интернете вещей

Modern dynamic life makes changes both in the lives of individual households and industrial entities. Households striving for comfort and safety are ready to purchase and use gadgets that trigger the processes of providing climate control, motion sensors and data transmission of consumption meters. In-dustrial enterprises are also seeking to use the Internet of Things, looking for growth drivers by optimizing the costs of monitoring production processes. The use of advanced monitoring and process management tools is the guarantor of the rapid response of individuals and industrial and commercial enterprises to the challenges of competition. This is due to the use of technologies and tools of the Internet of Things.

Regional anaesthesia in pregnant women with cardiovascular diseases

Background. Currently in developed countries, up to 4 % of pregnant women have cardiovascular diseases, which are one of the leading causes of maternal mortality. Anesthesia method have an important role in the abdominal delivery in this category of patients. Objective. To summarize the experience of different anesthesia approaches to abdominal delivery in pregnant women with cardiovascular diseases.Materials and methods. A retrospective analysis of the use of various methods of anesthesia during abdominal delivery of pregnant women with cardiovascular diseases was performed.Results. In “Maternity Hospital № 13” and the Almazov National Medical Research Centre for the period from 2014 to 2018 2140 abdominal deliveries were carried out in pregnant women with heart diseases (1450 and 690, respectively). In the Maternity Hospital №13 1374 (94.8 %) of abdominal deliveries were performed under regional anesthesia, 76 (5.2 %) under general anesthesia. In Almazov National Medical Research Centre 513 (74.3 %) of abdominal deliveries were performed under regional anesthesia, 177 (25.7 %) under general anesthesia. The features of the hemodynamic profile of general and regional anesthesia in pregnant women with various heart disease are presented.Conclusion. In pregnant women with heart disease, up to 88 % of cesarean section are performed under regional anesthesia. General anesthesia is used for contraindications to regional anesthesia, as well as for obstetric indications. The use of advanced monitoring, methods of slow titration of local anesthetic dose and the use of vasopressors allow to avoid hemodynamic disorders in patients with concomitant heart disease.

Acute life-threatening hypoxemia during mechanical ventilation.

To describe current evidence-based practice in the management of acute life-threatening hypoxemia in mechanically ventilated patients and some of the methods used to individualize the care of the patient. Patients with acute life-threatening hypoxemia will often meet criteria for severe ARDS, for which there are only a few treatment strategies that have been shown to improve survival outcomes. Recent findings have increased our knowledge of the physiological effects of spontaneous breathing and the application of PEEP. Additionally, the use of advanced bedside monitoring has a promising future in the management of hypoxemic patients to fine-tune the ventilator and to evaluate the individual patient response to therapy. Treating the patient with acute life-threatening hypoxemia during mechanical ventilation should begin with an evidence-based approach, with the goal of improving oxygenation and minimizing the harmful effects of mechanical ventilation. The use of advanced monitoring and the application of simple maneuvers at the bedside may assist clinicians to better individualize treatment and improve clinical outcomes.

Utilization of emergency crash cart system in the hospital among nursing students

Knowledge regarding utilization of emergency crash cart system in the hospital is very important as the emergency nurses should develop the skills regarding organization, uses and care of crash carts in the hospitals. In this situation, the nurse must be skilled at rapid, accurate physical examination, early recognition of life-threatening illness or injury, the use of advanced monitoring and treatment equipment. Quasi experimental one group pre-test and post-test design with evaluative approach was used. Study was carried out in selected Nursing Colleges in Mysore, using simple random sampling. 100 4th year B. Sc. Nursing students were selected. Data was collected by a self-administered questionnaire which includes demographic data, and 30 items. Self-instructional module was administered after assessing the pre-test. A post test was conducted after 7 days with same tool. Findings reveal that the among 100 students majority 47(47%) of them were in the age group between 22–25 yrs. 52(52%) were females, and 37(37%) of them were got information from Class Teachers. Pre test revealed that 4th year B. Sc. Nursing students were having low level of knowledge with a mean score of 18.35. After giving Self-instructional module post test score increased to 23.69, which shows the effectiveness of Self-instructional module. It has been found that variables like age, sex and source of information shows there is a significant association with post-test knowledge level.

Use of sophisticated intra-operative monitoring in resuscitation of unexpected cardiovascular collapse during general anaesthesia

INTRODUCTIONThe diagnosis of intraoperative anaphylaxis is important but can be difficult as the symptoms can be varying and dependent on patient factors. PRESENTATION OF CASEWe describe an acute, unexpected and life threatening cardiovascular (CV) collapse, presumed to be due to an acute anaphylactic reaction secondary to gelatin administration, following induction of general anaesthesia (GA), in an ASA 3 patient scheduled for axillo-bifemoral bypass. DISCUSSIONThe management of the profound cardiovascular (CV) collapse was greatly assisted by sophisticated haemodynamic, depth of anaesthesia and cerebral oximetry monitoring.1 As far as we are aware this is the first such case where the full haemodynamic, depth of anaesthesia and cerebral oxygenation changes during CV collapse, presumed due to an acute anaphylactic reaction under GA have been fully documented. CONCLUSIONThe use of advanced monitoring intraoperatively proved extremely useful in guiding the resuscitation of a life threatening allergic reaction under general anaesthesia.

Anesthesia for awake craniotomy: A retrospective study

Awake craniotomy is increasingly performed the world over. We share our experience of performing craniotomy awake with our anesthetic protocol. To evaluate and analyze the anesthesia records of the patients who underwent awake craniotomy at our institution. University teaching hospital, Retrospective study. We reviewed records of the 42 consecutive patients who underwent awake craniotomy under conscious sedation using Fentanyl and Propofol infusion until December 2005. The drugs were titrated (Bispectral monitoring was used in 16 patients) to facilitate intermittent intraoperative neurological testing. All patients received scalp blocks with a mixture of bupivacaine and lignocaine with adrenaline. Haloperidol and ondansetron were administered in all patients at induction of anesthesia. All patients completed the procedure. One patient each needed endotracheal intubation and LMA for airway control during closure, while another required CPAP perioperatively because of desaturation to <80%. There was significantly decreased use of anesthetics (P<0.001) and a trend towards reduction in complications (e.g. respiratory depression and deep sedation) (P>0.05) with the use of BIS as compared to without BIS. Intraoperative complications were hypertension (19%), tight brain (14.2%), focal seizure (9.5%) respiratory depression (7.1%), deep sedation (7.1%), tachycardia (7.1%) and bradycardia. Two patients desaturated to <95%. 23.8% patients developed transient neurological deficits. The most frequent postoperative complications were PONV (19%) and seizures (16.6%). With the use of advanced monitoring and newer anesthetics, awake craniotomy is a relatively safe procedure with an accepted rate of complications.

MOLAR

MOLAR is a multi-institutional research effort that concentrates on adaptive, reliable, and efficient operating and runtime system (OS/R) solutions for ultra-scale high-end scientific computing on the next generation of supercomputers. This research addresses the challenges outlined in FAST-OS (forum to address scalable technology for runtime and operating systems) and HECRTF (high-end computing revitalization task force) activities by exploring the use of advanced monitoring and adaptation to improve application performance and predictability of system interruptions, and by advancing computer reliability, availability and serviceability (RAS) management systems to work cooperatively with the OS/R to identify and preemptively resolve system issues. This paper describes recent research of the MOLAR team in advancing RAS for high-end computing OS/Rs.

Shipboard systems deploy automated protection

The electric power systems in today's US Navy ships supply energy to sophisticated systems for weapons, communications, navigation and operation. To maintain the availability of energy to the connected loads that keep all systems and equipment operational, the electric systems utilize fuses, circuit breakers and protective relays to interrupt the smallest portion of the system under any abnormal condition. New techniques are being developed that make use of advanced monitoring and control, automated failure location and automated intelligent system reconfiguration and restoration. The goal is to increase survivability, eliminate human mistakes, make intelligent reconfiguration decisions more quickly, reduce the manpower required to perform the functions and provide optimal electric power service through the surviving system. With fewer personnel being available on ships in the future, the presence of such a system will become essential for maintaining optimal electric power service.