RT 02-03 JJ07 main web - Respiratory Therapy Website

More documents

Recommendations

Info

What is the most exciting technology advancement that you foresee in the future (near and long term)? Among the short term advancements are expanded test menus, further automation, and reduced labor requirements. Long term we foresee the advent of continuous and less invasive technology. Opti Medical Systems Gerri Priest Gerri Priest is VP, Global Marketing, OPTI Medical Systems (formerly AVL). Blood gas analyzers have evolved over the past years to incorporate easier to use graphic user interfaces, reagent packs, maintenance-free sensors and on-board automatic quality control in response to the market’s needs that resulted from reduced technical staffing and the increased movement of critical care testing to the point of care. Recently, the automatic quality control feature has evolved a step further to incorporate sophisticated analyzer monitoring with automated corrective action and subsequent quality control material analyzed as needed. OPTI Medical Systems (formerly AVL) has implemented such an innovative monitoring system called OQM (OPTI Quality Monitor) in their latest OPTI product, the OPTI R Blood Gas Analyzer. OQM is an arrangement of sensors and software that continuously monitor the performance of the OPTI R. This is performed through data analysis and corrective actions. As the OPTI R is performing calibrations and automatic quality control the OQM software is observing the recovered values and sensor behavior by comparing the run to the previous results and then by looking at the sensor response. If the system detects an error it will perform corrective actions to correct the error detected. If the error is severe and the system cannot repair it, the sensor effected will be disabled. Measurements can still be performed but the disabled parameter cannot be reported. When errors occur that result in a disabled sensor the root cause of the failure is detailed in the error report. The OPTI R fluid pack contains three levels of QC solution that are independent from calibration solutions. All OPTI R fluid packs contain quality control solutions for use in the OQM system. This allows all users to take advantage of automatic QC without additional costs. The automatic QC program can be tailored to meet the needs of any user, with the possibility to program up to 15 QC measurements per day; even the most stringent guidelines can be met. The system can also be configured to skip automated QC measurements on Saturdays and Sundays if the facility is only in operation 5 days a week. When configuring the system to perform multiple levels at a single time, the OPTI R will schedule the samples to be run consecutively with a 1 minute pause between samples. This pause time allows for a STAT sample to be run during the automatic QC program. The OPTI R performs 50 patient samples in a single sensor cartridge in addition to the automatic quality control measurements programmed by the user and initiated by the OQM system. Advances in blood gas systems, such as OQM, have further facilitated the movement of blood gas analysis out of the main lab to the point of care for improved turn-around times and thus more efficient patient care while still maintaining high standards of measurement and manager control. 24 Respiratory Therapy Vol. 2 No. 3 � June-July 2007
Articles Challenges in Critical Care: The Brooklyn Hospital Center – Capnography, A Valuable Asset Founded in 1845, The Brooklyn Hospital Center (TBHC) has become a major healthcare resource for the residents of New York City’s largest borough. Equipped with the most sophisticated diagnostic and therapeutic modalities and state-of-the-art technology, TBHC is committed to excellence in patient care. To provide the best possible respiratory care to the 200,000 patients it sees annually, the hospital has a fleet of MAQUET SERVO-i ventilators equipped with advanced functionality. Among the SERVO-i’s advanced features is an optional analyzer/monitor capable of measuring expiratory carbon dioxide (CO 2) concentrations during a respiratory cycle. Results of the measurement of CO 2, referred to as capnography, are graphically displayed on the ventilator screen in a breath-bybreath waveform, or capnogram. The multi-disciplinary respiratory care team at TBHC finds that capnography is very useful as a noninvasive monitor for assessing ventilated patients. While not a replacement or substitute for arterial blood gas sampling, the CO 2 analyzer allows for assessment of a placement of an endotracheal tube in the patient’s airway, ventilator settings and similar measurements, says M. Shahjahan, RRT-NPS, RPFT, Director of Respiratory Care Services. The trend information that the analyzer provides is valuable for reviewing the effectiveness of changes in the ventilator, he says. Waveform Waveform can provide assurances and suggest when changes may be needed. To use the CO 2 analyzer, an airway adaptor is placed at the Y-piece and a sensor snapped onto the airway adapter. The CO 2 analyzer module receives signals from the infrared sensor that reflect the variations of CO 2 in the expiratory gas. The monitoring, which is continuous, is shown both in a waveform and numeric value indicating the CO 2 The views, opinions, and assertions stated by The Brooklyn Hospital Center staff members in this article are strictly those of the clinicals and administrators, and do not necessarily reflect the views of MAQUET. This article was provided by Maquet, Inc, Bridgewater, NJ, maquet.com/us. Members of Respiratory Care Services discussing the role of CO 2 monitoring in patient care. concentration of the end tidal carbon dioxide concentration (ETCO 2) and the rate of elimination of CO 2 or VCO 2. Shahjahan explains that the shape of the waveform can indicate changes in the patient’s condition. “If you look at the waveform, and if it is square, you know you are dealing with very good lungs and a relatively normal lung function. As the patient’s lung fuction is improving, a squarer waveform is a very good sign.” However, he says, if the waveform is non-constant (not square), it can suggest that adjustments need to be made in settings. “If the waveform is slowly rising, it tells you that you don’t have uniform ventilation, and you may have to do something to aid in the resoution of the disease or clinical condition that is emerging,” Shahjahan says. CO 2 monitoring also gives the staff assurance that the ET tube is in the trachea, says Rana Ali, MD, Medical Director of the Respiratory Care Unit. Farhad Arjomond, MD, Medical Director, Respiratory Care Services, adds that the monitoring device is also very useful during recruitment maneuvers where high transpulmonary pressures may cause a fall in preload and cardiac output. “A sudden drop in ETCO 2 may mean low pulmonary perfusion; therefore, higher PaCO 2 to ETCO 2 difference.” Benefits in the OR and Pediatric ICU The CO 2 analyzer has benefits in the OR and in the pediatric ICU. Shahjahan says the CO 2 monitoring device is of most value in the operating theater to confirm the placement and continued secure presence of the endotracheal tube in the trachea. He says Respiratory Therapy Vol. 2 No. 3 � June-July 2007 25
Page 7 and 8: Guest Commentary Are You Ready? How
Page 9: Ethical values to guide decision-ma
Page 14 and 15: treating asthma resulting from this
Page 16 and 17: market leaders in their respective
Page 18 and 19: On the basis of the existing data a
Page 20 and 21: Another practice that may increase
Page 22 and 23: conferences attendance and printed
Page 26 and 27: Capnograms reflective of various co
Page 28 and 29: How do you judge the quality and re
Page 30 and 31: the dust cloud that immediately fol
Page 32 and 33: abnormally thick, tenacious mucus.
Page 34 and 35: 2001 May; 43(5):467-473. 43 Betchle
Page 36 and 37: Figure B - Manifold is connected to
Page 38: Utilization of Infrared Trans-illum
Page 41 and 42: Researchers measured leg fluid volu
Page 43 and 44: Viasys Healthcare, Inc. Steve Birch
Page 45: opportunities bring the training cl
Page 49: How can your product improve patien
Page 52 and 53: labs with their educational needs.
Page 54 and 55: testing outside of the sleep lab, s
Page 56 and 57: Depression and Obstructive Sleep Ap
Page 58 and 59: of CPAP treatment in 32 patients wi
Page 60 and 61: intermittent pauses in respiration,
Page 62 and 63: alertness. Sleep Med 2002, 3:139-14
Page 64 and 65: Figure 1 Supine tidal flow-volume c
Page 66 and 67: Figure 3 The receiver-operating cha
Page 68 and 69: seldom occur in subjects with norma
Page 70 and 71: Contribution of body habitus and cr
Page 72 and 73: Table 1 Reported features that may
Page 74 and 75:
which lead to excessive daytime sle
show all

RT 02-03 JJ07 main web - Respiratory Therapy Website

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?