Bedside Monitoring

Immunosensors promise to become principal players ia chemical, diagnostic, and environmental analyses by the latter 1990s. Given the practical limits of immunosensors (low ppb or ng/mL to mid-pptr or pg/mL) and their portabiUty, the primary appHcation is expected to be as rapid screening devices ia noncentralized clinical laboratories, ia iatensive care faciUties, and as bedside monitors, ia physicians offices, and ia environmental and iadustrial settings (49—52). Industrial appHcations for immunosensors will also include use as the basis for automated on-line or flow-injection analysis systems to analyze and control pharmaceutical, food, and chemical processing lines (53). Immunosensors are not expected to replace laboratory-based immunoassays, but to open up new appHcations for immunoassay-based technology. 

Nordstrom CH. 2003. Assessment of critical thresholds for cerebral perfusion pressure performing bedside monitoring of cerebral energy metabolism. Neurosurg Focus... 

Nordstrom CH, Reinstrup P, Xu W, Gardenfors A, Ungerstedt U. 2003. Assessment of the lower limit for cerebral perfusion pressure in severe head injuries by bedside monitoring of regional energy metabolism. Anesthesiology 98(4) 809-814. 

Sensing. Crown compounds modified by responsible chromogenic groups (chromoionophores) proved valuable tools for measuring metal ions and even enantiomeric guest concentrations in solution. Ion selective electrodes based on crown compounds and podands as the sensitive component have broad analytical applications from industrial wastewater control to clinical bedside monitoring of blond. 

Collison ME, Meyerhoff ME. Chemical sensors for bedside monitoring of critically ill patients. Analytical Chemistry 1990, 62, 425A 437A. 

A third application for pTAS is in the biomedical field. Gumbrecht et al. [46, 47] developed a monolithically integrated, ISFET-based sensor system for (bedside) monitoring of blood pH, p02 and pC02 in patients. Here the successful introduction on the market mainly depends on the price of the system, for which reason a CMOS-compatible design of the silicon part is needed. Evidently, such a development is only possible in the case of a high volume market. 

FIGURE 6 Bedside monitor recording of systemic artery pressure (SAP) and pulmonary artery pressure (PAP) in a 7-month-old child with postoperative pulmonary hypertension refractory to treatment, including hyperventilation with oxygen, anesthesia, alkalosis, nitroprus-side, prostaglandin E, and acetylcholine. Administration of 80-ppm inhaled nitric oxide produced an immediate reduction in PAP, with little effect on SAP. 

FIGURE 8 Bedside monitor recording of pulmonary artery pressure (PAP) and systemic artery pressure (SAP) in a 1-day-old postoperative patient after repair of obstructed total anomalous pulmonary venous connection. Stable PAP and SAP are achieved with 15-ppm nitric oxide (NO). When the NO was transiently discontinued, there was a prompt increase in PAP and profound systemic hypotension. With reinstitution of NO, recovery occurred. Subsequently, the child was easily weaned from NO. 

Instruments. similar lo the i-S I A T bedside monitor have been available for some lime lor in vitro poien-lionieiric determination of vara)us analytes in biomedical and hiolouical svslcnis. In recent vears. there... 

A large number of enthalpimetric assays based on immobilized enzyme reactors have been proposed with potential interest to biotechnology, clinical chemistry, and food analysis. Several of these have been applied in bioprocess monitoring and recently bedside monitoring of glucose and urea have been... 

Most bedside monitoring systems allow for simultaneous monitoring of two leads, such as lead II with or MCL. Lead II or the lead that clearly shows the P waves and QRS complex may be used for sinus node arrhythmias, PACs, and AV block. The precordial leads V. and Vg or the bipolar leads MCL. and MCLg are the best leads for monitoring rhythms with wide QRS complexes and for differentiating VT from SVT with aberrancy. 

The data is then displayed on the bedside monitor of the patient. The bedside monitor is connected to the main server tbrou the Ethernet WLAN, so the data is also routed to the physician panel for real-time monitoring of tiie patient... 

The best monitoring lead is determined by the patient s medical condition and by the arrhythmias most likely to occur. Most bedside monitoring systems allow for simultaneous monitoring of two leads such as lead II with Vj or MCLj. 

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