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Biosensors Data for Systems Analysis During Convalescence

Biomedical Engineering Retreat Ithaca, NY 27 July 2007. Biosensors Data for Systems Analysis During Convalescence. Palmer Q. Bessey, MD Burn Center Weill Medical College. Biomedical Engineering Retreat Ithaca, NY 27 July 2007. Systems Analysis in Surgical Patients.

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Biosensors Data for Systems Analysis During Convalescence

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  1. Biomedical Engineering Retreat Ithaca, NY 27 July 2007 Biosensors Data for Systems Analysis During Convalescence Palmer Q. Bessey, MD Burn Center Weill Medical College

  2. Biomedical Engineering Retreat Ithaca, NY 27 July 2007 Systems Analysis in Surgical Patients Systems Analysis : “.. study of a system ... in an attempt to elucidate its effectiveness or performance ... and the effect of parameter variations on these quantities.” System : Multiple components (subsystems) Large and complex. Complicated inter-relationships Integrity – Common purpose

  3. Biomedical Engineering Retreat Ithaca, NY 27 July 2007 Systems Analysis in Surgical Patients Systems Analysis : “.. study of a system ... in an attempt to elucidate its effectiveness or performance ... and the effect of parameter variations on these quantities.” System : Multiple components (subsystems) Large and complex. Complicated inter-relationships Integrity – Common purpose

  4. Biomedical Engineering Retreat Ithaca, NY 27 July 2007 The Surgical Patient is a System Components (Sub-systems) : Cardiovascular Metabolic Pulmonary Neurologic Renal Hematologic Gastro-intestinal Immunologic Large and complex. Complicated Inter-relationships Integrity. Common purpose: Recovery

  5. Biomedical Engineering Retreat Ithaca, NY 27 July 2007 The Surgical Patient is a System Altered Normal Homeostasis. Threats of Operation (Injury) : Tissue Disruption Hemorrhage Ischemia / Hypoxia Acidosis Bacterial Contamination Transfusion Re-perfusion Hypothermia Complicated Inter-relationships. Integrity. Common purpose: Recovery

  6. Biomedical Engineering Retreat Ithaca, NY 27 July 2007 Systems Analysis in Surgical Patients Task of Convalescent Care : Guide the patient through recovery. Systems Analysis : Gather and assemble performance data Analysis – Efficacy. Risk assessment. Decision making regarding intervention

  7. Biomedical Engineering Retreat Ithaca, NY 27 July 2007 Systems Analysis in Surgical Patients Hypothesis : The care and treatment of ... patients is best done using numerical data in an orderly set of rules.

  8. Biomedical Engineering Retreat Ithaca, NY 27 July 2007 Systems Analysis in Surgical Patients Data Sources : Events Vital signs Nurse observations MD observations Physiologic measures Lab data Special studies Imaging Analysis and Decision Making : Gathering data Multiple individuals Knowledge differences Efficiency

  9. Biomedical Engineering Retreat Ithaca, NY 27 July 2007 Systems Analysis in Surgical Patients Interventions : Risk Assessment Lead time End point – Dose Feed back Issues : Time consuming Multiple steps Communication Incomplete data Error prone Delayed feed back Risks – All interventions / monitoring Opportunites :

  10. Biomedical Engineering Retreat Ithaca, NY 27 July 2007 Systems Analysis – Opportunities More Complete Performance Data : For any / all compents (sub-systems) Cardiac performance (organ perfusion) Respiratory work / efficacy (gas exchange) Blood glucose Hematology / Immunology Wound healing Balance usefulness vs. invasiveness Less invasive is better.

  11. Biomedical Engineering Retreat Ithaca, NY 27 July 2007 Systems Analysis – Opportunities More Timely Data : Point of care testing. Real time data More Efficient Decision Making Standardized patient care protocols.

  12. Biomedical Engineering Retreat Ithaca, NY 27 July 2007 Hyperglycemia Clinical Effects : Impairs PMN / Immunologic defenses Increased incidence of infection Increased vascular tone / hypoperfusion. Increased ventilatory work (CO2 Production) Exaggerate hypermetabolism Impaired wound healing

  13. Biomedical Engineering Retreat Ithaca, NY 27 July 2007 Control of Hyperglycemia Van Den Bergh, 2001

  14. Biomedical Engineering Retreat Ithaca, NY 27 July 2007 Control of Hyperglycemia Van Den Bergh, 2001

  15. Biomedical Engineering Retreat Ithaca, NY 27 July 2007 Control of Hyperglycemia ONGOING INSULIN DOSING

  16. 43 yom, Sepsis, ARDS, Renal Failure 65% BSABPBD # 11 - 12 Tube Feedings

  17. Biomedical Engineering Retreat Ithaca, NY 27 July 2007 Insulin Protocol - Nursing Work

  18. Biomedical Engineering Retreat Ithaca, NY 27 July 2007 Insulin Protocol - Performance

  19. Biomedical Engineering Retreat Ithaca, NY 27 July 2007 Insulin Protocol Summary and Conclusions : N = 17 patients, 99 24-hour periods Nutritional Intake: 1,938 ± 57 kcal/24 hr Total daily insulin dose: 133 ± 12 U/24 hr POC Glucose determinations: 1,849 Hourly POC Glucose: 1,528 (83 %) Under 60 or over 180 mg/dl: 79 (4.3%) Conclusion : Insulin protocol safe and effective. Adds substantially to nursing work load.

  20. Biomedical Engineering Retreat Ithaca, NY 27 July 2007 Systems Analysis in Surgical Patients Hypothesis : The care and treatment of ... patients is best done using numerical data in an orderly set of rules.

  21. Biomedical Engineering Retreat Ithaca, NY 27 July 2007 Systems Analysis – Opportunities Automation : Sheppard et al, Ann Surg, 1968. 154 Cardiac Surgery Patients BP, LAP, Urine output, Chest tube drainage. Automated protocol for blood infusion -- Rules More reliable, consistent More efficient Cost effective Safer

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