J Clin Monit Comput - Clinical refinement of the automatic lung parameter estimator (ALPE).

Tópicos

{ care(1570) inform(1187) nurs(1089) }
{ design(1359) user(1324) use(1319) }
{ extract(1171) text(1153) clinic(932) }
{ perform(999) metric(946) measur(919) }
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{ framework(1458) process(801) describ(734) }
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{ data(3963) clinic(1234) research(1004) }
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{ can(981) present(881) function(850) }
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{ ehr(2073) health(1662) electron(1139) }
{ state(1844) use(1261) util(961) }
{ research(1218) medic(880) student(794) }
{ patient(2837) hospit(1953) medic(668) }
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{ data(2317) use(1299) case(1017) }
{ age(1611) year(1155) adult(843) }
{ signal(2180) analysi(812) frequenc(800) }
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Resumo

The automatic lung parameter estimator (ALPE) method was developed in 2002 for bedside estimation of pulmonary gas exchange using step changes in inspired oxygen fraction (FIO2). Since then a number of studies have been conducted indicating the potential for clinical application and necessitating systems evolution to match clinical application. This paper describes and evaluates the evolution of the ALPE method from a research implementation (ALPE1) to two commercial implementations (ALPE2 and ALPE3). A need for dedicated implementations of the ALPE method was identified: one for spontaneously breathing (non-mechanically ventilated) patients (ALPE2) and one for mechanically ventilated patients (ALPE3). For these two implementations, design issues relating to usability and automation are described including the mixing of gasses to achieve FIO2 levels, and the automatic selection of FIO2. For ALPE2, these improvements are evaluated against patients studied using the system. The major result is the evolution of the ALPE method into two dedicated implementations, namely ALPE2 and ALPE3. For ALPE2, the usability and automation of FIO2 selection has been evaluated in spontaneously breathing patients showing that variability of gas delivery is 0.3 % (standard deviation) in 1,332 breaths from 20 patients. Also for ALPE2, the automated FIO2 selection method was successfully applied in 287 patient cases, taking 7.2 ? 2.4 min and was shown to be safe with only one patient having SpO2 < 86 % when the clinician disabled the alarms. The ALPE method has evolved into two practical, usable systems targeted at clinical application, namely ALPE2 for spontaneously breathing patients and ALPE3 for mechanically ventilated patients. These systems may promote the exploration of the use of more detailed descriptions of pulmonary gas exchange in clinical practice.

Resumo Limpo

automat lung paramet estim alp method develop bedsid estim pulmonari gas exchang use step chang inspir oxygen fraction fio sinc number studi conduct indic potenti clinic applic necessit system evolut match clinic applic paper describ evalu evolut alp method research implement alp two commerci implement alp alp need dedic implement alp method identifi one spontan breath nonmechan ventil patient alp one mechan ventil patient alp two implement design issu relat usabl autom describ includ mix gass achiev fio level automat select fio alp improv evalu patient studi use system major result evolut alp method two dedic implement name alp alp alp usabl autom fio select evalu spontan breath patient show variabl gas deliveri standard deviat breath patient also alp autom fio select method success appli patient case take min shown safe one patient spo clinician disabl alarm alp method evolv two practic usabl system target clinic applic name alp spontan breath patient alp mechan ventil patient system may promot explor use detail descript pulmonari gas exchang clinic practic

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