J Clin Monit Comput - Oxygenation advisor recommends appropriate positive end expiratory pressure and FIO2 settings: retrospective validation study.

Tópicos

{ blood(1257) pressur(1144) flow(957) }
{ decis(3086) make(1611) patient(1517) }
{ medic(1828) order(1363) alert(1069) }
{ measur(2081) correl(1212) valu(896) }
{ method(1969) cluster(1462) data(1082) }
{ chang(1828) time(1643) increas(1301) }
{ spatial(1525) area(1432) region(1030) }
{ surgeri(1148) surgic(1085) robot(1054) }
{ detect(2391) sensit(1101) algorithm(908) }
{ estim(2440) model(1874) function(577) }
{ imag(1057) registr(996) error(939) }
{ network(2748) neural(1063) input(814) }
{ clinic(1479) use(1117) guidelin(835) }
{ system(1050) medic(1026) inform(1018) }
{ model(2341) predict(2261) use(1141) }
{ ehr(2073) health(1662) electron(1139) }
{ data(2317) use(1299) case(1017) }
{ inform(2794) health(2639) internet(1427) }
{ system(1976) rule(880) can(841) }
{ extract(1171) text(1153) clinic(932) }
{ model(2220) cell(1177) simul(1124) }
{ general(901) number(790) one(736) }
{ method(984) reconstruct(947) comput(926) }
{ data(3963) clinic(1234) research(1004) }
{ perform(999) metric(946) measur(919) }
{ compound(1573) activ(1297) structur(1058) }
{ perform(1367) use(1326) method(1137) }
{ model(3480) simul(1196) paramet(876) }
{ model(2656) set(1616) predict(1553) }
{ age(1611) year(1155) adult(843) }
{ signal(2180) analysi(812) frequenc(800) }
{ group(2977) signific(1463) compar(1072) }
{ gene(2352) biolog(1181) express(1162) }
{ time(1939) patient(1703) rate(768) }
{ use(976) code(926) identifi(902) }
{ implement(1333) system(1263) develop(1122) }
{ survey(1388) particip(1329) question(1065) }
{ process(1125) use(805) approach(778) }
{ method(2212) result(1239) propos(1039) }
{ model(3404) distribut(989) bayesian(671) }
{ can(774) often(719) complex(702) }
{ imag(1947) propos(1133) code(1026) }
{ data(1737) use(1416) pattern(1282) }
{ bind(1733) structur(1185) ligand(1036) }
{ sequenc(1873) structur(1644) protein(1328) }
{ method(1219) similar(1157) match(930) }
{ featur(3375) classif(2383) classifi(1994) }
{ imag(2830) propos(1344) filter(1198) }
{ imag(2675) segment(2577) method(1081) }
{ patient(2315) diseas(1263) diabet(1191) }
{ take(945) account(800) differ(722) }
{ studi(2440) review(1878) systemat(933) }
{ motion(1329) object(1292) video(1091) }
{ assess(1506) score(1403) qualiti(1306) }
{ treatment(1704) effect(941) patient(846) }
{ framework(1458) process(801) describ(734) }
{ problem(2511) optim(1539) algorithm(950) }
{ error(1145) method(1030) estim(1020) }
{ learn(2355) train(1041) set(1003) }
{ concept(1167) ontolog(924) domain(897) }
{ algorithm(1844) comput(1787) effici(935) }
{ method(1557) propos(1049) approach(1037) }
{ data(1714) softwar(1251) tool(1186) }
{ design(1359) user(1324) use(1319) }
{ control(1307) perform(991) simul(935) }
{ care(1570) inform(1187) nurs(1089) }
{ search(2224) databas(1162) retriev(909) }
{ featur(1941) imag(1645) propos(1176) }
{ case(1353) use(1143) diagnosi(1136) }
{ howev(809) still(633) remain(590) }
{ studi(1410) differ(1259) use(1210) }
{ risk(3053) factor(974) diseas(938) }
{ research(1085) discuss(1038) issu(1018) }
{ import(1318) role(1303) understand(862) }
{ visual(1396) interact(850) tool(830) }
{ studi(1119) effect(1106) posit(819) }
{ record(1888) medic(1808) patient(1693) }
{ health(3367) inform(1360) care(1135) }
{ monitor(1329) mobil(1314) devic(1160) }
{ state(1844) use(1261) util(961) }
{ research(1218) medic(880) student(794) }
{ patient(2837) hospit(1953) medic(668) }
{ cost(1906) reduc(1198) effect(832) }
{ sampl(1606) size(1419) use(1276) }
{ data(3008) multipl(1320) sourc(1022) }
{ first(2504) two(1366) second(1323) }
{ intervent(3218) particip(2042) group(1664) }
{ activ(1138) subject(705) human(624) }
{ patient(1821) servic(1111) care(1106) }
{ use(2086) technolog(871) perceiv(783) }
{ can(981) present(881) function(850) }
{ analysi(2126) use(1163) compon(1037) }
{ health(1844) social(1437) communiti(874) }
{ structur(1116) can(940) graph(676) }
{ high(1669) rate(1365) level(1280) }
{ cancer(2502) breast(956) screen(824) }
{ use(1733) differ(960) four(931) }
{ drug(1928) target(777) effect(648) }
{ result(1111) use(1088) new(759) }
{ activ(1452) weight(1219) physic(1104) }

Resumo

A decision support, rule-based oxygenation advisor that provides guidance for setting positive end expiratory pressure (PEEP) and fractional inhaled oxygen concentration (FIO2) for patients with respiratory failure is described. The target oxygenation goal is to achieve and maintain pulse oximeter oxygen saturation (SpO2) = 88 and = 95%, as posited by the Acute Respiratory Distress Syndrome Network, by recommending appropriate combinations of PEEP and FIO2. For patient safety, the oxygenation advisor monitors mean arterial blood pressure (MAP) to ensure it is = 65 mmHg for hemodynamic stability and inspiratory plateau pressure (Pplt) so it is = 30 cm H2O for lung protection. The purpose of this validation study was to compare attending physicians' recommendations to those recommendations of the oxygenation advisor for setting PEEP and FIO2. Adults with respiratory failure (n = 117) receiving ventilatory support were studied. PEEP, FIO2, SpO2, MAP, and Pplt are input variables into the advisor. Recommendations to increase, maintain, or decrease PEEP and FIO2 are the oxygenation advisor's output variables. Physicians' recommendations for setting PEEP and FIO2 were recorded; the oxygenation advisor's recommendations were also recorded for comparison. At all times, ventilator settings were based on recommendations from attending physicians. PEEP ranged from 2 to 22 cm H2O and FIO2 ranged from 0.30 to 0.65. A total of 326 recommendations by the oxygenation advisor and attending physicians were made to increase, maintain, or decrease PEEP and FIO2. There was a very significant relationship (p < 0.0001) between recommendations of the oxygenation advisor and attending physicians for setting PEEP and FIO2. The agreement rate for recommendations by the oxygenation advisor and attending physicians was 92%. The K statistic, a test of the strength of agreement of recommendations between the oxygenation advisor and attending physicians, was 0.82 (p < 0.0001), indicating "almost perfect agreement". Relationships for recommendations made by the oxygenation advisor and attending physicians for setting PEEP and FIO2 were excellent, PEEP: r = 0.98 (p < 0.01), r(2) = 0.96; FIO2: r = 0.91 (p < 0.01), r(2) = 0.83, bias and precision values were negligible. A novel oxygenation advisor provided continuous and automatic recommendations for setting PEEP and FIO2 that were shown to be as good as the clinical judgment of experienced attending physicians. For all patients, the target oxygenation goal was achieved. Concerning patient safety, the oxygenation advisor detected those occasions when MAP and Pplt were in potentially unsafe ranges.

Resumo Limpo

decis support rulebas oxygen advisor provid guidanc set posit end expiratori pressur peep fraction inhal oxygen concentr fio patient respiratori failur describ target oxygen goal achiev maintain puls oximet oxygen satur spo posit acut respiratori distress syndrom network recommend appropri combin peep fio patient safeti oxygen advisor monitor mean arteri blood pressur map ensur mmhg hemodynam stabil inspiratori plateau pressur pplt cm ho lung protect purpos valid studi compar attend physician recommend recommend oxygen advisor set peep fio adult respiratori failur n receiv ventilatori support studi peep fio spo map pplt input variabl advisor recommend increas maintain decreas peep fio oxygen advisor output variabl physician recommend set peep fio record oxygen advisor recommend also record comparison time ventil set base recommend attend physician peep rang cm ho fio rang total recommend oxygen advisor attend physician made increas maintain decreas peep fio signific relationship p recommend oxygen advisor attend physician set peep fio agreement rate recommend oxygen advisor attend physician k statist test strength agreement recommend oxygen advisor attend physician p indic almost perfect agreement relationship recommend made oxygen advisor attend physician set peep fio excel peep r p r fio r p r bias precis valu neglig novel oxygen advisor provid continu automat recommend set peep fio shown good clinic judgment experienc attend physician patient target oxygen goal achiev concern patient safeti oxygen advisor detect occas map pplt potenti unsaf rang

Resumos Similares

BMC Med Inform Decis Mak - A decision support system to determine optimal ventilator settings. ( 0,662664303560307 )
J Clin Monit Comput - Reference values for volumetric capnography-derived non-invasive parameters in healthy individuals. ( 0,659666339204082 )
Comput Methods Programs Biomed - Retinal artery-vein caliber grading using color fundus imaging. ( 0,646238706520897 )
J Clin Monit Comput - Non-invasive cardiac output and oxygen delivery measurement in an infant with critical anemia. ( 0,634673086855745 )
Med Biol Eng Comput - Determinants of vascular and cardiac baroreflex sensitivity values in a random population sample. ( 0,629728906797199 )
Methods Inf Med - Public reporting in Germany: the content of physician rating websites. ( 0,627262739816064 )
Med Biol Eng Comput - Assessment of dynamic cerebral autoregulation and cerebral carbon dioxide reactivity during normothermic cardiopulmonary bypass. ( 0,623109284046998 )
J Am Med Inform Assoc - The influence of computerized decision support on prescribing during ward-rounds: are the decision-makers targeted? ( 0,619590915820181 )
Comput Methods Programs Biomed - Measurements of the left atrium and pulmonary veins for analysis of reverse structural remodeling following cardiac ablation therapy. ( 0,617851344668648 )
J Clin Monit Comput - Cardiac output measured by uncalibrated arterial pressure waveform analysis by recently released software version 3.02 versus thermodilution in septic shock. ( 0,612905690824043 )
J Clin Monit Comput - The relationship between the area of peripherally-derived pressure volume loops and systemic vascular resistance. ( 0,61240789017787 )
J Clin Monit Comput - Continuous measurement of cardiac output with the electrical velocimetry method in patients under spinal anesthesia for cesarean delivery. ( 0,609493138565563 )
Comput Math Methods Med - A new high-resolution spectral approach to noninvasively evaluate wall deformations in arteries. ( 0,60771302383758 )
J Am Med Inform Assoc - A clinical data warehouse-based process for refining medication orders alerts. ( 0,604423230008667 )
J Clin Monit Comput - Noninvasive cardiac output monitoring during exercise testing: Nexfin pulse contour analysis compared to an inert gas rebreathing method and respired gas analysis. ( 0,603377705562769 )
J Clin Monit Comput - Changes in R-Wave amplitude in DII lead is less sensitive than pulse pressure variation to detect changes in stroke volume after fluid challenge in ICU patients postoperatively to cardiac surgery. ( 0,597028668553721 )
J Clin Monit Comput - Noninvasive continuous beat-to-beat radial artery pressure via TL-200 applanation tonometry. ( 0,596397064031798 )
J Clin Monit Comput - The relative trending accuracy of noninvasive continuous hemoglobin monitoring during hemodialysis in critically ill patients. ( 0,595973879741725 )
J Clin Monit Comput - Arterial pressure waveform derived cardiac output FloTrac/Vigileo system (third generation software): comparison of two monitoring sites with the thermodilution cardiac output. ( 0,595441208309231 )
J Clin Monit Comput - A model-based decision support system for critiquing mechanical ventilation treatments. ( 0,594736558542843 )
Med Biol Eng Comput - Coronary-aortic interaction during ventricular isovolumic contraction. ( 0,591084790260865 )
J Clin Monit Comput - The mean prehospital machine; accurate prehospital non-invasive blood pressure measurement in the critically ill patient. ( 0,589252135262438 )
Comput Methods Programs Biomed - Impact of pulmonary vascular stiffness and vasodilator treatment in pediatric pulmonary hypertension: 21 patient-specific fluid-structure interaction studies. ( 0,589033394455819 )
J Clin Monit Comput - Pulse-plethysmographic variables in hemodynamic assessment during mannitol infusion. ( 0,587448982201866 )
Med Biol Eng Comput - Estimation of mean arterial pressure from the oscillometric cuff pressure: comparison of different techniques. ( 0,586647212070746 )
J Clin Monit Comput - Assessment of cerebral oxygenation using near infrared spectroscopy during isovolemic hemodilution in pediatric patients. ( 0,586046902062027 )
Comput Math Methods Med - Influence of distal resistance and proximal stiffness on hemodynamics and RV afterload in progression and treatments of pulmonary hypertension: a computational study with validation using animal models. ( 0,58458944738727 )
J Clin Monit Comput - Relations between respiratory changes in R-wave amplitude and arterial pulse pressure in mechanically ventilated patients. ( 0,579678488716847 )
J Clin Monit Comput - Heart sounds analysis via esophageal stethoscope system in beagles. ( 0,578992722988637 )
J Clin Monit Comput - Melodic algorithms for pulse oximetry to allow audible discrimination of abnormal systolic blood pressures. ( 0,57898703694404 )
J Clin Monit Comput - Developing an algorithm for pulse oximetry derived respiratory rate (RR(oxi)): a healthy volunteer study. ( 0,578417977595545 )
J Clin Monit Comput - The changes of pulmonary blood flow in non-ventilated lung during one lung ventilation. ( 0,57789832461604 )
J Clin Monit Comput - Assessment of the effect of rapid crystalloid infusion on stroke volume variation and pleth variability index after a preoperative fast. ( 0,575440983405672 )
Med Biol Eng Comput - Dynamic cerebral autoregulation: different signal processing methods without influence on results and reproducibility. ( 0,574710133384018 )
Med Biol Eng Comput - A coupled flow-acoustic computational study of bruits from a modeled stenosed artery. ( 0,574249544712813 )
J Clin Monit Comput - Fluid responsiveness is about stroke volume, and not pulse pressure Yogi: the power of Doppler fluid management and cardiovascular monitoring. ( 0,573204930309725 )
Comput. Biol. Med. - Neural network study for standardizing pulse-taking depth by the width of artery. ( 0,572974074422678 )
Comput. Biol. Med. - The hemodynamic alterations induced by the vascular angular deformation in stent-assisted coiling of bifurcation aneurysms. ( 0,572393029326178 )
J Clin Monit Comput - Pulse oximeter plethysmograph variation and its relationship to the arterial waveform in mechanically ventilated children. ( 0,571824358196128 )
J Clin Monit Comput - The evaluation of a non-invasive respiratory volume monitor in surgical patients undergoing elective surgery with general anesthesia. ( 0,569528560732234 )
J Clin Monit Comput - Decrease in pulmonary artery pressure after administration of thoracic epidural anesthesia in a patient with Marfan syndrome awaiting aortic valve replacement procedure. ( 0,569191928769939 )
J Clin Monit Comput - The use of a noninvasive hemoglobin monitor for determining fluid distribution and elimination in pediatric patients undergoing minor surgery. ( 0,568887121567064 )
Comput Math Methods Med - The relationship between the 24h blood pressure variability and carotid intima-media thickness: a compared study. ( 0,568522877997215 )
AMIA Annu Symp Proc - Supporting shared decision making within the MobiGuide project. ( 0,568279147694098 )
Med Biol Eng Comput - Haemodynamic forces on in vitro thrombi: a numerical analysis. ( 0,56751848386122 )
J Clin Monit Comput - Hemodynamic volumetry using transpulmonary ultrasound dilution (TPUD) technology in a neonatal animal model. ( 0,566177827590517 )
J Clin Monit Comput - Cardiopulmonary interactions and volume status assessment. ( 0,56514514259974 )
J Clin Monit Comput - The effects of low-dose ketamine on the analgesia nociception index (ANI) measured with the novel PhysioDoloris? analgesia monitor: a pilot study. ( 0,564881872772062 )
J Clin Monit Comput - Generic and patient-specific models of the arterial tree. ( 0,563971400396809 )
Comput Math Methods Med - Plasma volume expansion resulting from intravenous glucose tolerance test. ( 0,563852553623339 )
J Clin Monit Comput - Continuous non-invasive monitoring improves blood pressure stability in upright position: randomized controlled trial. ( 0,563341347125829 )
J Clin Monit Comput - Continuous minimally invasive peri-operative monitoring of cardiac output by pulmonary capnotracking: comparison with thermodilution and transesophageal echocardiography. ( 0,563119388434301 )
J Clin Monit Comput - Validation of continuous and noninvasive hemoglobin monitoring by pulse CO-oximetry in Japanese surgical patients. ( 0,562424851703066 )
J Clin Monit Comput - Evaluation of mean systemic filling pressure from pulse contour cardiac output and central venous pressure. ( 0,561783345459338 )
Med Biol Eng Comput - Assessment of respiratory flow and efforts using upper-body acceleration. ( 0,559872618062984 )
J Med Syst - VIKOR method with enhanced accuracy for multiple criteria decision making in healthcare management. ( 0,55986654214363 )
Med Biol Eng Comput - Electropermeabilization of endocytotic vesicles in B16 F1 mouse melanoma cells. ( 0,559564335730745 )
Comput Math Methods Med - Follicle structure influences the availability of oxygen to the oocyte in antral follicles. ( 0,556597118960432 )
Med Biol Eng Comput - Characterization of skin dermis microcirculation in flow-mediated dilation using optical sensor with pressurization mechanism. ( 0,555640993334392 )
Comput Math Methods Med - Mathematical analysis of non-Newtonian blood flow in stenosis narrow arteries. ( 0,554769404679614 )
J Clin Monit Comput - Pulmonary artery pulsatility is the main cause of cardiogenic oscillations. ( 0,554571276161816 )
Comput Math Methods Med - Simulation of the Frank-Starling Law of the Heart. ( 0,553808684894082 )
Med Decis Making - Sequential value-of-information assessment for prospective drug safety monitoring using claims databases: the comparative safety of prasugrel v. clopidogrel. ( 0,552328476052565 )
J Clin Monit Comput - Combination of continuous pulse pressure variation monitoring and cardiac filling pressure to predict fluid responsiveness. ( 0,550962473178544 )
Med Biol Eng Comput - The effect of aortic wall and aortic leaflet stiffening on coronary hemodynamic: a fluid-structure interaction study. ( 0,550573656264366 )
J Clin Monit Comput - Variations in the pre-ejection period induced by deep breathing do not predict the hemodynamic response to early haemorrhage in healthy volunteers. ( 0,550573012879901 )
Med Biol Eng Comput - Model-based correction of the influence of body position on continuous segmental and hand-to-foot bioimpedance measurements. ( 0,550312950360878 )
Med Biol Eng Comput - Arterial reservoir-excess pressure and ventricular work. ( 0,550288346218384 )
J Clin Monit Comput - Continuous real time endotracheal tube cuff pressure waveform. ( 0,548399101643747 )
Med Decis Making - Are medical outcomes fungible? A survey of voters, medical administrators, and physicians. ( 0,548199141460182 )
Med Biol Eng Comput - Short and longer term repeatability of ballistocardiography in a sitting position with EMFi sensor. ( 0,547600349336006 )
Med Biol Eng Comput - Monitoring intracellular, interstitial, and intravascular volume changes during fluid management procedures. ( 0,546651298061985 )
J Clin Monit Comput - Arterial line for monitoring SpO2 in patients with ischemic peripheries. ( 0,546539631642812 )
J Clin Monit Comput - Transcranial Doppler monitoring of middle cerebral flow velocity in a patient with a ventriculoperitoneal shunt undergoing laparoscopy. ( 0,545201079124674 )
Comput. Biol. Med. - Evaluation of a novel automated non-invasive pulse pressure variation algorithm. ( 0,544554386417332 )
Comput Methods Programs Biomed - A model of perfusion of the healthy human lung. ( 0,544512084419764 )
J Clin Monit Comput - Capability of a new paediatric oesophageal Doppler monitor to detect changes in cardiac output during testing of external pacemakers after cardiac surgery. ( 0,543641384705381 )
J Clin Monit Comput - Noninvasive continuous hemodynamic monitoring. ( 0,543421394302925 )
Comput Math Methods Med - Evaluation of a model-based hemodynamic monitoring method in a porcine study of septic shock. ( 0,542008734260495 )
J Clin Monit Comput - Bedside assessment of passive leg raising effects on venous return. ( 0,541833402849183 )
J Clin Monit Comput - Pulse oximetry-derived respiratory rate in general care floor patients. ( 0,541330527915804 )
Med Biol Eng Comput - Cardiac oxygen supply is compromised during the night in hypertensive patients. ( 0,541314355227746 )
J Clin Monit Comput - Cardiac output monitoring in septic shock: evaluation of the third-generation Flotrac-Vigileo. ( 0,540406430688867 )
Comput. Biol. Med. - A semi-automated computer tool for the analysis of retinal vessel diameter dynamics. ( 0,539612610229866 )
J Clin Monit Comput - An evaluation of the Integrated Pulmonary Index (IPI) for the detection of respiratory events in sedated patients undergoing colonoscopy. ( 0,539275849702577 )
J Med Syst - Impact of computerized order entry and pre-mixed dialysis solutions for continuous veno-venous hemodiafiltration on selection of therapy for acute renal failure. ( 0,538851808581003 )
Med Biol Eng Comput - Time delay correction of the synchrogram for optimized detection of cardiorespiratory coordination. ( 0,538771458490554 )
Comput Math Methods Med - Numerical study for blood flow in pulmonary arteries after repair of tetralogy of Fallot. ( 0,53851303424106 )
J Clin Monit Comput - Radial-femoral concordance in time and frequency domain-based estimates of systemic arterial respiratory variation. ( 0,538399635893244 )
Comput Math Methods Med - Evaluating the hemodynamical response of a cardiovascular system under support of a continuous flow left ventricular assist device via numerical modeling and simulations. ( 0,538201665013386 )
J Clin Monit Comput - Impact of central hypovolemia on photoplethysmographic waveform parameters in healthy volunteers. Part 1: time domain analysis. ( 0,536873569820279 )
J Clin Monit Comput - Dead space reduction by Kolobow's endotracheal tube does not justify the waiving of volume monitoring in small, ventilated lungs. ( 0,536659287789835 )
Med Biol Eng Comput - Computational model for estimating the short- and long-term cardiac response to arteriovenous fistula creation for hemodialysis. ( 0,536659287789835 )
Comput Math Methods Med - Simulation of exercise-induced syncope in a heart model with severe aortic valve stenosis. ( 0,536527983572362 )
Comput Math Methods Med - Transformation of physical DVHs to radiobiologically equivalent ones in hypofractionated radiotherapy analyzing dosimetric and clinical parameters: a practical approach for routine clinical practice in radiation oncology. ( 0,535574002103828 )
J Clin Monit Comput - A new reusable skin-protective sphygmomanometer cuff. ( 0,53548988317951 )
Int J Med Inform - Design of decision support interventions for medication prescribing. ( 0,535406243269901 )
J Clin Monit Comput - The effect of endotracheal tube cuff pressure change during gynecological laparoscopic surgery on postoperative sore throat: a control study. ( 0,535048520128134 )
J Clin Monit Comput - Respiratory and non-respiratory sinus arrhythmia: implications for heart rate variability. ( 0,534821182383839 )
Med Decis Making - Better medicine by default. ( 0,534732482427946 )