Computers in Critical Care and Pulmonary Medicine: Volume 3

318 Pages·1983·7.286 MB·English

by  Dwayne R. Westenskow, Thomas D. Wast, Robert J. Bowman, Devin B. Ohlson (auth.), Sreedhar Nair, Omar Prakash, Richard P. Imbruce (eds.)

COMPUTERS IN
CRITICAL CARE AND
PULMONARY MEDICINE
VOLUME 3
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COMPUTERS IN
CRITICAL CARE AND
PULMONARY MEDICINE
VOLUME 3
Edited by
Sreedhar Nair
Yale University School of Medicine
Norwalk, Connecticut
Associate Editors
Omar Prakash
Erasmus University
Rotterdam, The Netherlands
and
Richard P. Imbruce
University of Bridgeport
Bridgeport, Connecticut
PLENUM PRESS • NEW YORK AND LONDON
Library of Congress Cataloging in Publication Data
International Symposium on Computers in Critical Care and Pulmonary Medicine (3rd:
1981: Norwalk Hospital)
Computers in critical care and pulmonary medicine. Volume 3.
"Proceedings of the Third International Symposium on Computers in Critical Care
and Pulmonary Medicine, held June 17-19,1981, at Norwalk Hospital, Norwalk, Con
necticut"-T.p. verso.
Includes bibliographical references and index.
1. Critical care medicine-Data processing-Congresses. 2. Patient monitoring
Data processing-Congresses. 3. Pulmonary function tests-Data process
ing-Congresses. I. Nair, Sreedhar. II. Prakash, Omar. III. Imbruce, Richard P. IV.
Title. [DNLM: W3 IN916XGJ
RC86.2.1565 1981 616'.028'02854 83-4077
ISBN-13: 978-1-4684-4405-6 e-ISBN-13: 978-1-4684-4403-2
DOl: 10.1007/978-1-4684-4403-2
Proceedings of the Third International Symposium on Computers in Critical Care
and Pulmonary Medicine, held June 17-19, 1981, at Norwalk Hospital,
Norwalk, Connecticut
©1983 Plenum'Press, New York
Softcover reprint of the hardcover lst edition 1983
A Division of Plenum Publishing Corporation
233 Spring Street, New York, N.Y. 10013
All rights reserved
No part of this book may be reproduced, stored in a retrieval system, or transmitted
in any form or by any means, electronic, mechanical, photocopying, microfilming,
recording, or otherwise, without written permission from the Publisher
Proceedings of the third international symposium on Computers in
Critical Care and Pulmonary Medicine, held at Norwalk Hospital,
Norwalk, Connecticut, June 17-19, 1981.
Chairman Sreedhar Nair
Norwalk, Connecticut, U.S.A.
Co-Chairman Omar Prakash
Rotterdam, The Netherlands
STEERING COMMITTEE
Jeffrey Augenstein, Miami, U.S.A.
Reed M. Gardner, Salt Lake City, U.S.A.
Richard P. Imbruce, Norwalk, U.S.A.
Bjorn Jonson, Lund, Sweden
John J. Osborn, San Francisco, U.S.A.
Richard M. Peters, San Diego, U.S.A.
Iga1 Staw, Norwalk, U.S.A.
INTERNATIONAL ADVISORY COMMITTEE
Richard M. Peters, Chairman, San Diego, U.S.A.
David Denison, London, U.K.
Robert C. Eberhart, Dallas, U.S.A.
Claude Lenfant, Bethesda, U.S.A.
010f Norlander, Stockholm, Sweden
James Payne, London, U.K.
Alastair A. Spence, Glasgow, U.K.
Dwayne Westenskow, Salt Lake City, U.S.A.
HONORARY CHAIRMAN
Norman A. Brady, Norwalk, U.S.A.
CONFERENCE SECRETARY
Nancy Smith, Connecticut, U.S.A.
1982 Plenum Press, New York
A division of Plenum Publishing Corporation
233 Spring Street, New York, New York 10013
v
PREFACE
The third international symposium on Critical Care and
Pulmonary Medicine was held in Norwalk Hospital, Yale University
School of Medicine in June 1981. This publication contains the
majority of papers that were presented at the three day conference.
The book deals with the use of computers in: (1) monitoring
(2) pulmonary laboratory (3) anesthesia (4) database management.
Extraordinary progress in the use of computers in critical care
medicine and pulmonary function testing is evident in the presen
tations.
I would like to thank the members of the Steering Committee
and the International Advisory Committee for their efforts in bring
ing together many leaders in the field, and enriching the symposium
with their own contributions. My special thanks to Mr. Norman Brady,
President of the Norwalk Hospital, for his generous hospitality and
his untiring assistance during the three days of the symposium. I
would also like to thank Martin H. Floch, M.D., Chairman of the
Department of Medicine, Norwalk Hospital, for his advice and support.
I sincerely appreciate the cooperation and help from the members of
the Section of Pulmonary Medicine and Medical Computer Science of
the Norwalk Hospital. Finally I would like to thank Ms. Nancy Smith
for the excellent work in the preparation of the manuscripts, and
the staff of the Plenum Press for their help in publishing this
volume.
Sreedhar Nair
vii
CONTENTS
SECTION I - MONITORING IN THE ICU
Closing the Loop
Dwayne R. Westenskow, Thomas D. Wast,
Robert J. Bowman, and Kevin B. Ohlson 1
Computerized Multibed Respiratory Monitoring
S.Z. Turney
9
Criteria for Successful Use of Computers in
Critical Care -- A Manufacturer's Perspective
Mark Halloran, Joe Harrington, Tom Rathke,
and Mike Stern 27
ICU Monitoring of Ventilation Distribution
Richard R. Mitchell, Ross M. Wilson,
and Kianne Sierra 33
A Distributed Microprocessor Respiratory Intensive
Care Monitoring System with Mass Spectrometer,
Proximal Flowmeter, and Airway Pressure Transducer
Con Rader, Warren Taylor, and Darrell Hansen
45
On Line Monitoring of Respiratory Values on a
Respiratory Intensive Care Unit
H.J. Bender, P.M. Osswald, H.J. Hartung,
and H. Lutz 59
Use of a Microprocessor Controlled, Mass Spectrometer
Based Monitoring System for Risk Management in a
Community Hospital ICU
Ramon G. Hannah 65
Rapid Non-Invasive Determination of Cardiac Output at
Rest by CO2 Rebreathing using a Computerized System:
Application in Normal Adults with Cardiac Disease
Donald A. Mahler, Richard A. Matthay, Peter E. Snyder
Rene Langou, Barry L. Zaret, and Jacob Loke 73
ix
x CONTENTS
Transcutaneous O2 and CO2 Monitoring in the Adult
William C. Shoemaker, and Kevin K. Tremper 83
SECTION II
THE USE OF COMPUTERS IN THE PULMONARY FUNCTION LABORATORY
Accuracy of Commercially Available Computerized
Spirometers
Walter Arossa, Sergio Spinaci, and Gianni Forconi 95
The Application of the Sequential Moments of the
Forced Expiratory Spirogram to an Exponential
Model of the Spirogram
M.R. Miller, A.C. Pincock, and D. Grove 99
Automated Pulmonary Analysis by an On Line Micro
computer
Lawrence D. Nadel 103
Automatic Correction for the Effects of Changing
Gas Viscosity in Pneumotachographic Measurements
H. Burchardi, T. Stokke, and W. Ohrdorf 115
Clinical Assessment of Spirometric Data
Gary R. Epler 119
Computer Evaluation of Expiratory Gas Parameters
and Alveolar to Arterial Differences in Clinical
and Research Pulmonary Medicine
Antonio Gianne11a Neto, Edo Fornai,
Paoli Paoletti, Paolo Pisani, Carlo Marchesi,
and Carlo Giuntini 125
Computing Circuit for Breath-by-Breath Ventilation
Frederic P. Torres, and Stephen N. Steen 135
History Dependence of Maximal Flow
P.J. Chowienczyk, T.J.H. Clark, andC.B. Wolff 139
Immediate Responses to Lung Irritants Detected by
Automated Measurements of Airway Resistance and
Partial Flow-Volume Curves
P.J. Rees, P.J. Chowienczyk, and T.J.H. Clark 145
Lower Limits of Normal for Spirometric Reference
Values
Robert O. Crapo, Reed M. Gardner, and Michael L. Beus 157
CONTENTS xi
Measurement of Specific Diffusing Capacity (DL/vA)
in Critically III Patients
E. Rosenberg 167
A Microcomputer System for the Analysis of Spirograms
S. Valenti, A. Tiano, V. Brusasco, P. Crimi,
and D. Rocchi 177
On Line Pulmonary Testing Utilizing a Portable
Microcomputer
Richard C. Pugh, Jon A.A. Foure,
and Monroe S. Karetzky 181
Pulmonary Fast Space Measurement from Expired PC02:
A Pulmonary Function Test Designed for Automation 187
John J. Osborn, Ross Wilson, Christopher M. Tsoi,
Eric Sullivan, and Richard R. Mitchell
Signal Processing for Computerized Spirometry
Reed M. Gardner, David V. Ostler, and Robert O. Crapo 195
Spectral Analysis of Pulmonary Artery Pressure
Richard K. Brienzo, John E. Brimm, 205
and Richard M. Peters
A Standard Artificial Lung for System Calibration in
Physiological Gas Exchange Measurement
S.L. Foster, and A.C. Norton 213
The Measurement of Respiratory Impedance by the
Forced Oscillation Method: Clinical Experiments
and Their Interpretation
Ch. Depeursinge, A.K. Boutaleb, E. Mooser, F. Feihl, 221
F. Despeursinge, and C. Perret
SECTION III - DATABASE MANAGEMENT
A Microprocessor Based Data Management System in
Operating Room and Intensive Care Unit
O. Prakash, S.G. Bas V.D. Borden, and Simon Meij 225
Clinical Experience with a Mini Computer Based Data
Management System in Surgical Intensive Care
I.J. Lustig, J.N. Parrish, J.S. Augenstein,
J.M. Civetta, G.H. Rodman, and T.E. Caruthers 233
Clinical Relevant Data -- What and How Often?
Richard M. Peters 239
xii CONTENTS
Effective Anesthesia Record Keeping Utilizing A
Computerized Data Management System
Hugh Forthman, and Kenneth Niejadlik 247
The Data Are Collected. What's Next?
John E. Brimm, Maureen A. Knight,
and Richard M. Peters 253
Utilization and Cost Effectiveness of Computerized
Patient Data Management in the Multispecialty
Intensive Care Unit
G.V.S. Parr, and R.D. Wallen 263
SECTION IV - MISCELLANEOUS SUBJECTS
A Microcomputer Based System for the Screening of
Occupational Health Groups
Raphael H. Warshaw, Alan S. Brooker,
George DeFlorio, Hans E. Einstein,
and Kaye H. Kilburn 273
Gravity Dependence of Crackles
Frank F. Davidson, Jr., and Raymond L. H. Murphy 279
Effect of the Medical Device Legislation on
Automation in Medicine
David S. Shindell 287
Rapid Lung Sound Amplitude Measurement by Automated
Flow Gated Phonopheumography
Steven S. Kraman 293
Implementation of an Integrated Critical Care Computer
Oscar Diaz, and Chris Haudenschild 297
What Can We Measure?
John J. Osborn 313
INDEX 319