Patient Monitoring in Neonatal and Pediatric Critical Care

Patient Monitoring in Neonatal and Pediatric Critical Care Focus Germany Manfred Seidenfaden – NKE, 201202 1

Overview Standard Performance Extended Performance Data Processing & Therapy Support Manfred Seidenfaden – NKE, 201202 Technical Solutions Patient Monitoring General Approach 2

General Approach Patient Monitoring in Neonatal and Pediatric Intensive Care in Germany • Respiratory Monitoring • Hemodynamic Monitoring Standard Monitoring • Temperature Monitoring • Extended Monitoring Focus on Non‐Invasive Procedures Manfred Seidenfaden – NKE, 201202 3

General Approach – Measurement Procedures • Respiratory Monitoring ‐ Impedance‐Plethysmography ‐ Capnography ‐ Pulse Oximetry ‐ arterial Bloodgas Analysis ‐ transcutaneous Bloodgas Analysis • Hemodynamic Monitoring ‐ ECG ‐ Non‐Invasive Blood Pressure (NIBP) • Temperature Monitoring • Extended Monitoring ‐ Central Venous Pressure ‐ Pulmonal Arterial Pressure (very seldomly) ‐ Cardiac Output (mainly, less, or non‐invasive) ‐ amplitude integrated Electroencephalography (a. EEG) ‐ depth anesthesia, sedation monitoring (BIS) Manfred Seidenfaden – NKE, 201202 4

General Approach – Data Processing RS‐ 232 C Data Output (numerical information) Patient Monitoring System Information Transfer Information Management Systems – Documentation, Therapeutic Support etc. HL 7 Gateway (numerical & graphical information) Manfred Seidenfaden – NKE, 201202 5

Standard Monitoring From ECG, Sp. O 2 and Respiration to the Oxygencardiorespirography (OCRG) • ECG – Heart Rate • Pulse Oximetry – Sp. O 2, Pulse Rate • Impedance Plethysmography – Respiration Rate Combining the parameters and providing a trend with 1 cm/min or 3 cm/min of review information creates a high density picture of the patient‘s history – the OCRG. Manfred Seidenfaden – NKE, 201202 6

Standard Monitoring Temperature Monitoring In children, we often find changing temperature conditions in general, and differences between core and skin temperature in neonates. Therefore, we find the demand on a provision of multiple temperature measurements. NIBP Monitoring To determine the blood pressure the non‐invasive method is usually used. (As within other measurements, to reduce the risk for nosocomial infections, often disposable components are being used. ) Additional Pulse Oximetry Monitoring In specific cases the use of a second Sp. O 2‐Value is a standard procedure. For instance, in case of right‐left‐shunt (e. g. Patent Ductus Arteriosus [PDA]), we find different oxygen saturation between right upper (pre‐ductal) and lower limb (post ductal). The provision of saturation information and differences supports therapy process. Manfred Seidenfaden – NKE, 201202 7

Standard Monitoring Capnography The general attempt to monitor the respiration may be sufficient in non critical patients, respectively, the linear connection between imdepance changes and changes in tidal volume (in small tidal volumes) may be accetable. In patients with obstructive diseases the impedance method will be insufficient. The capnography can be a solution in those cases. Depending on the age of the patient, various systems are available providing expiratory, or in‐ and expiratory CO 2 information. Neonates: Focus on side‐stream measurement, with gas sample rates down to 50 ml/min, supporting gas measurement in intubated and non‐intubated patients. Manfred Seidenfaden – NKE, 201202 Patients >2 kg: Mainstream measurement, various solutions (intubated & non‐intubated; inspiratory & expiratory), including the smallest sensor in the market (new cap. ONE) 8

Standard Monitoring Bloodgas Analysis Generally, the discontinous arterial Bloodgas Analysis is a standard procedure, especially, in critical patients and after big surgeries. Yet, we find a standard use of transcutaneous Bloodgas Analysis in difficult patients with instable respiratory conditions, for instance. This method is particularly appreciate because of the continous monitoring and decrease of arterial Bloodgas Analysis‘. Manfred Seidenfaden – NKE, 201202 9

Standard Monitoring Alarm Management General experiences show, a high number of alarms creates inattention to alarms. Considering the fast changing vital conditions in neonates particulary, require a an adaptation of the alarm management to avoid risk for the patient and support the clinician. Manfred Seidenfaden – NKE, 201202 10

Extended Monitoring Invasive Blood Pressure & Cardiac Output Usually, when the determination of an invasive blood pressure, or cardiac output measurement will be indicated, in Germany, the patient is usually transferred to a regional center (NICU/PICU), or university clinic. Mostly central venous pressure and arterial pressure measurements. Manfred Seidenfaden – NKE, 201202 11

Extended Monitoring amplitude integrated Encephalography (a. EEG) The determination of neurological information in neonatal intensive care environments is actually not very common. Recently, we find a parameter, the a. EEG, which is becoming a standard procedure in German NICUs – the a. EEG. The a. EEG provides information mainly within the following indications: · Attack waveform detection in Neonatal seizure attack · Brain wave function evaluation at low oxygen ischemia brain syndrome (HIE), neonatal temporal death · Monitoring on brain low temperature therapy · Other disease which is suspected abnormal brain function such as intracranial bleeding The parameter can be provided in a combination with OCRG over a patient monitor, or over an independent a. EEG system, or as option of an EEG‐Machine. Information provided at an independent a. EEG system Manfred Seidenfaden – NKE, 201202 12

Extended Monitoring Bi-Spectral-Index (BIS) – monitoring depth of anesthesia, sedation As in anesthesia of adult patients, also in pediatrics, the BIS does support the monitoring of depth of anesthesia, respectively, the monitoring of sedation. Principally, it provides information about the level of hypnosis (direct information) and an indirect information about the analgetic status of the patient. Manfred Seidenfaden – NKE, 201202 13

Technical Solutions High-End Modular Performance BSM‐ 9101 Advanced Modular Performance BSM‐ 6000 Advanced Performance BSM‐ 3000 Basic Performance Manfred Seidenfaden – NKE, 201202 BSM‐ 2300 PVM‐ 2700 14

Technical Solutions Simplicity as basis for highest Security PVM-2700 series Manfred Seidenfaden – NKE, 201202 15

Technical Solutions Advanced Performance to Support Enhanced Clinical Demands OCRG CO 2 -Main Dual Sp. O 2 a. EEG CO 2 -Side tcp. O 2/CO 2 Manfred Seidenfaden – NKE, 201202 16

Manfred Seidenfaden Nihon Kohden Europe Gmb. H Regional Sales Manager Russia & CIS Raiffeisenstr. 10 61191 Rosbach v. d. H. Germany Phone +49 175 54 09 609 Mail manfred. seidenfaden@nke. de Skype manfred_seidenfaden (CZ) Manfred Seidenfaden – NKE, 201202 17