Abstract
An intelligent alarm system for the postoperative monitoring of cardiac surgery patients, which did not require any manual data entries, was tested in two phases. A clinician monitored at bedside the patients' recovery and verified clinically abnormal physiological states. After the first test with ten patients, the system's rulebase was upgraded and then tested with an additional 15 patients. The alarm system employed two PC/ATs and was programmed to give notive of four pathological states (hyperdynamic state, hypovolemic state, hypoventilation and left ventricular failure) at two levels of urgency (alarm and alert levels). The monitoring lasted 5.4±1.7 hours per patient (mean ±S.D.), totalling 134.7 hours. The system alarmed 27 times during the first and 73 times during the second phase of the testing. The sensitivity of the alarms was 100% in both phases, and the specificities increased from 20.0% to 73.9% and from 59.1% to 70.0% for the alarms and the alerts, respectively. This computerized decision support system based exclusively on data available in the automatically collected data base had a low false positive rate and gave early warnings about pathological states in the homogeneous group of adult postoperative cardiac patients.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Bradshaw KE, Gardner RM, Clemmer TP, Orme JF, Thomas F, West BJ. Physician decision-making-Evaluation of data used in a computerized ICU. Int J Clin Monit Comp 1984; 1: 81–91.
Kari A, Ruokonen E, Takala J. Comparison of acceptance and performance of automated and manual data management systems in intensive care. Int J Clin Monit Comp 1990; 7: 157–62.
Tuman KJ, McCarthy RJ, Spiess BD, DaValle M, Dabir R, Ivankovich AD. Does choice of anesthetic agent significantly affect outcome after coronary artery surgery? Anesthesiology 1989; 70: 189–98.
Philip JH. Thoughtful alarms. In: Gravenstein JS, Newbower RS, Ream AK et al. (eds) The automated anesthesia record and alarm systems. Butterwoths, Boston 1987; 191–201.
Koski EMJ, Mäkivirta A, Sukuvaara T, Kari A. Frequency and reliability of alarms in the monitoring of cardiac postoperative patients. Int J Clin Mon Comp 1990; 7: 129–33.
Loeb RG, Brunner JX, Westenskow DR, Feldman B, Pace NL. The Utah anesthesia workstation. Anesthesiology 1989; 70: 999–1007.
Brunner JX, Westenskow DR, Zelenkov P. Prototype ventilator and alarm algorithm for NASA space station. Int J Clin Monit Comp 1989; 5: 90–9.
Shepard LC, Kouchoukos LT, Kurtts MA, Kirklin JW. Automated treatment of critically ill patients following operation. Ann Surg 1968; 168: 596.
Henkind S, Teicholz L, Harrison M. Intensive care unit monitoring using a real-time expert system. Proc Computers in Cardiology 1984; 7–13.
Stoodley KDC, Crew AD, Lu R, Naghdy F. A microcomputer implementation of status and alarm algorithms in a cardiac surgical intensive care unit. Int J Clin Mon Comp 1987; 4: 115–22.
Cohn AI, Rosenbaum S, Factor M, Miller PL. DYNASCENE: an approach to computer-based intelligent cardiovascular monitoring using sequential clinical ‘scenes’. Meth Inf Med 1990; 29: 122–31.
Van den Heuvel J, Stemerdink JDB, Bogers AJJC, Bree DS. GUUS an expert system in the intensive care unit. Int J Clin Monit Comp 1990; 7: 171–5.
Wyatt J, Spiegelhalter D. Evaluating medical expert systems: what to test and how? Med Inform 1990; 15(3): 205–17.
Koski EMJ, Mäkivirta A, Sukuvaara T, Kari A. Development of an expert system for haemodynamic monitoring: computerized symbolization of on-line monitoring data. 8: 289–93.
Sukuvaara T, Koski EMJ, Mäkivirta A, Kari A. A knowledgebased alarm system for monitoring cardiac operated patients-Technical construction and evaluation. Int J Clin Monit Comp 1993; 10: 117–26.
Avent RK, Charlton JD. A critical review of trend-detection methodologies for biomedical monitoring systems. Crit rev Biomed Eng 1990; 17: 621–59.
O'Carroll TM. Survey of alarms in an intensive therapy unit. Anesthesia 1986; 41: 742–4.
Mäkivirta A, Koski E, Kari A, Sukuvaara T. The median filter as a preprocessor for a patient monitor limit alarm system in intensive care. Comput Meth Progr Biomed 1991; 34: 139–44.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Koski, E.M.J., Sukuvaara, T., Mäkivirta, A. et al. A knowledge-based alarm system for monitoring cardiac operated patients-assessment of clinical performance. J Clin Monit Comput 11, 79–83 (1994). https://doi.org/10.1007/BF01259556
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01259556