about the project
Medical news
For authors
Licensed books on medicine
<< Previous Next >>

Methodology for the development of a functional computer monitoring system

In the period from 1988 to 1992, 207 patients with severe mechanical trauma who were admitted to the clinic by ambulance were examined at the clinic of field surgery.

As a result of a thorough verification of the data, the observations with obvious technical errors were deleted, as well as the data of three victims who died shortly after the injury (during the first day). The cause of death was massive irreversible blood loss. Thus, 511 blocks of observations were selected for further analysis.

All of them contained a basic block, which included 14 direct indicators: systolic blood pressure (mmHg), diastolic blood pressure (mmHg), heart rate (bpm) - heart rate, respiratory rate per minute - BH. heart stroke volume (l) - UO, partial pressure of oxygen in arterial and venous blood (mm Hg) - Pao2 and P2O2 - respectively, partial pressure of carbon dioxide in arterial and venous blood (mm Hg) - Pao2 and P2O2, respectively, the acidity of arterial and venous blood - pH and pHv, respectively, the level of hemoglobin (Hb) in the blood (g / l), the saturation of hemoglobin with oxygen in arterial and venous blood (in percent) - НbО2а and Hb02v, respectively.

The use of these indicators allows us to evaluate almost all parts of the oxygen budget and, which is especially important, to study the relationship between oxygen delivery to tissues and its consumption, which changes significantly with the development of endotoxemia [5. 8. 20]. After calculations using the appropriate formulas to create a functional computer monitoring system, the following direct and calculated indicators were selected: stroke index (SI), cardiac index (SI), heart rate (HR), systolic index of the left ventricle of the heart (SRI_I), index minute work of the left ventricle of the heart (MRL_I), the index of total peripheral resistance (OPS_I), mean arterial pressure (ADsr), oxygen gradient between arterial and venous blood (A-VO ^), oxygen consumption a (PO2), indicators of the acid-base state of arterial and venous blood - pH and pHv. partial pressure indicators of oxygen and carbon dioxide in the arterial and venous blood of Pao2, Pvo2, Raso2, and Pvco2.

From the above indicators, it was necessary, using a special mathematical apparatus, to select the optimal number of features that reliably describe this array. To this end, the data array with the above indicators was investigated using the method of “principal components”. As a result of the analysis, eight indicators were selected that have the maximum specific gravity in the selected “main components”.
They are given in table. 4.1.

After identifying the indicators, the data array was processed using one of the varieties of cluster analysis - cluster analysis of observations.

Table 4.1

The proportion of indicators selected by the method of principal components

The essence of the method consists in isolating by an initial method a predetermined number of clusters based on certain attributes by identifying their most stable combinations [21]. The n-dimensional cluster space formed in accordance with this (in accordance with the specified number of clusters) is examined by checking the Fisher criterion whether the selection is reliable or not. During the cluster analysis with the variables selected by us as a result of the preliminary analysis by the method of “principal components”, the following results were obtained (Table 4.2.).

The table shows the formed stable clusters identified during the analysis. Data on the reliability of the separation of these signs into these clusters are given in table. 4.3. The data obtained show a reliable (p = 0.000) allocation of these cluster formations in this array, which is confirmed by the one shown in Fig. 4.1 graph of the reliability of the differences obtained during the cluster analysis in the output of the program.

Table 4.2

The results of cluster analysis on the selected eight variables in an array of 511 observations

Table 4.3

Reliability of differences of indicators divided into clusters




Fig. 4. l.

Graphical reflection of the significance of differences by grouped characteristics in the formed clusters


The presented data show a high reliability of differences in the features that form the cluster image. To verify the significance of differences, the results were processed in pairs by a multiple t-test. Their study fully indicates a highly reliable separation of characters and data blocks included in the array (corresponding to individual clinical observations) into typical pathophysiological clusters.
<< Previous Next >>
= Skip to textbook content =

Methodology for the development of a functional computer monitoring system

  1. Justification of the chosen approach to the development of functional computer monitoring
    Proposed by JHSiegel et al. | 33. 35], the system of functional computer monitoring is based on the assumption that the application of the mathematical methodology of cluster analysis allows us to distinguish typical clinical images (as the author himself calls them, patterns [31. 32 |). The pathogenetic basis for determining such clinical images in certain critical conditions (trauma, sepsis)
  2. Functional computer monitoring system in the diagnosis of sepsis
    An analysis of the dynamics of the criteria of a functional computer monitoring system for the systemic inflammatory response syndrome and sepsis, performed by us. showed that for sepsis, as one form of SSVR. all the characteristic features of this syndrome are inherent. First of all, this is a significant increase in the C / B ratio, corresponding to an increased role of anaerobic metabolic mechanisms against the background, as a rule,
  3. Functional computer monitoring system for uncomplicated early post-shock period
    A functional computer monitoring system was developed with the aim of early recognition and prevention of complications arising in patients with mechanical damage, especially the systemic inflammatory response syndrome. In this regard, a comparison was made of clinical and laboratory parameters with the parameters of the FCM system in patients who suffered severe mechanical trauma with
  4. The principles of the functional computer monitoring system
    The analysis of the obtained four clusters not only showed a mathematically significant difference between them, but also revealed the clinical, biochemical and pathophysiological characteristics of each of the analyzed patterns that are fundamentally different from each other. In this study, we intentionally did not compare the studied clinical and pathophysiological aspects of the course of traumatic disease with
    “The physiological response to severe sepsis is the result of a complex interaction between sympathetically determined cardiac, vascular and pulmonary compensatory mechanisms in response to fundamental disturbances in the intermediate metabolism caused by the septic process.” JHSiegel “Physiological and metabolic correlations in human sepsis” Essentially in this chapter
  6. Functional computer monitoring system in the diagnosis of conditions that "threaten" the development of a systemic inflammatory response syndrome
    Successful treatment of the systemic inflammatory response syndrome and sepsis as one of its forms should be based, first of all, on early diagnosis. As a rule, the treatment of advanced conditions that manifested themselves in the full clinical picture, unfortunately, is ineffective and leads mainly to adverse results. This position has long been well known to practitioners, but early
  7. Functional computer monitoring for systemic inflammatory response syndrome
    The conducted studies have demonstrated the existence of rather close clinical and pathogenetic parallels in the dynamics of the post-traumatic period between the general condition of the wounded, the data of his laboratory analyzes and dynamic assessments in the system of functional computer monitoring in uncomplicated course, as well as in transitional states that “threaten” the development of CVD. Together with
    Registration of blood pressure. The most common way to control hemodynamics is the Riva-Rocci auscultation method using Korotkov sounds, however, it requires a number of conditions to be fulfilled to eliminate errors. So, to measure blood pressure in pregnant women should be in the position on the left side with the location of the cuff on the left hand. In addition, the cuff size matters: if the cuff
  9. Dynamic monitoring of the functional state of the central nervous system, respiratory system, hemodynamics, homeostasis (2nd principle)
    ICP monitoring is leading in patients with severe OCD and swelling symptoms. Most often, invasive monitoring of ICP is used for severe traumatic brain injury, after operations to remove intracerebral hemorrhages, brain tumors. However, with ischemic strokes, hypoxic and ischemic injuries of the central nervous system, an invasive ICP measurement is practically not used. therefore
    During pregnancy and childbirth, significant physiological changes occur in the mother's body, aimed at ensuring increased metabolic processes, taking into account the needs of the mother-placenta-fetus system, to prepare a woman for the stress load during childbirth and for the subsequent closure of placental circulation. The main manifestations of adaptive mechanisms are changes in
  11. Functional diagnostic techniques in cardiology
    • ???? ECG test with physical activity. • ???? ECG monitoring (allows to detect rhythm and conduction disturbances). • ???? Echocardiography (allows you to determine the motility of the ventricular wall, the size of their chambers, the function of the valve apparatus, the ejection fraction, cardiac output (if an esophageal sensor is available, intraoperative monitoring is possible). Violation of local contractility and EF correlate with
  12. Functional tests
    1. Stange test. The time is determined during which the child, after 3 deep breaths and exhalations at the height of the 4th breath, is able to hold his breath. Average age indicators: {foto28} In the presence of cardiovascular pathology, the duration of breath holding is reduced by 50% or more due to the latent state of low blood oxygen saturation. 2. Orthostatic test. Baby in
    Surovtsev I.Yu., Korolev V.N., Kulaev K.I. Chelyabinsk Regional Clinical Oncology Center; Ural Clinical Base Federal State Institution Russian Scientific Center for X-ray Radiology of Roszdrav; South Ural Scientific Center of the Russian Academy of Medical Sciences, Chelyabinsk With the introduction of modern video endoscopic equipment using multiple zoom and inspection modes in a narrow spectrum
Medical portal "MedguideBook" © 2014-2019