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一种用于改善心脏手术中协调与沟通的新型可互操作安全系统。

A Novel Interoperable Safety System for Improved Coordination and Communication in Cardiac Surgery.

作者信息

Arney David, Rance Geoffrey, Rithy Srey, Goldman Julian M, Zenati Marco A

机构信息

Massachusetts General Hospital, Boston, MA USA.

Harvard Medical School, Boston, MA USA.

出版信息

OR 2.0 Context Aware Oper Theaters Comput Assist Robot Endosc Clin Image Based Proced Skin Image Anal (2018). 2018 Sep;11041:39-45. doi: 10.1007/978-3-030-01201-4_5. Epub 2018 Oct 2.

Abstract

During cardiac surgery there is an unmet need for safe transfer of responsibility for patient oxygenation back and forth from the anesthesia to the perfusion teams. Prior to cardiopulmonary bypass (CPB), lung ventilation is performed by the anesthesia machine ventilator and is the responsibility of the anesthesia team. During CPB, lung ventilation is halted and oxygenation is performed by the CPB oxygenator and perfusion team This recurrent transfer throughout the procedure introduces the rare but serious possibility of a "never event", resulting in the patient's lungs not being ventilated upon stopping the CPB and potentially leading to catastrophic hypoxemia. Monitors and alarms on the anesthesia and bypass machines would not be useful when the other device is operating so they are routinely put into a standby mode until needed. Consequently, in the event that the handoff is missed, there are no alarms to catch the situation. To solve this unmet need, we propose a novel interoperable, context-aware system capable of detecting and acting if this rare situation occurs. Our system is built on the open-source OpenICE framework, allowing it to seamlessly work with a variety of ventilator and bypass machines.

摘要

在心脏手术期间,对于将患者氧合责任在麻醉团队和灌注团队之间安全地来回转移,存在未被满足的需求。在体外循环(CPB)之前,肺通气由麻醉机呼吸机进行,由麻醉团队负责。在CPB期间,肺通气停止,氧合由CPB氧合器和灌注团队进行。在整个手术过程中这种反复的转移引入了罕见但严重的“绝不发生事件”的可能性,导致在CPB停止时患者的肺未得到通气,并可能导致灾难性的低氧血症。当另一台设备运行时,麻醉机和体外循环机上的监测器和警报将不起作用,因此它们通常被置于备用模式,直到需要时使用。因此,如果交接被遗漏,没有警报来发现这种情况。为了解决这一未被满足的需求,我们提出了一种新颖的可互操作、情境感知系统,如果这种罕见情况发生,该系统能够进行检测并采取行动。我们的系统基于开源的OpenICE框架构建,使其能够与各种呼吸机和体外循环机无缝协作。

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本文引用的文献

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Cognitive Support During High-Consequence Episodes of Care in Cardiovascular Surgery.心血管手术高风险护理阶段的认知支持
IEEE Int Interdiscip Conf Cogn Methods Situat Aware Decis Support. 2017 Mar;2017. doi: 10.1109/COGSIMA.2017.7929610. Epub 2017 May 18.
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