Telemedicine/Virtual ICU: Where Are We and Where Are We Going?

Udeh, Chiedozie; Udeh, Belinda; Rahman, Nadeem; Canfield, Christina; Campbell, Jeffrey W.; Hata, J. Steven

doi:10.14797/mdcj-14-2-126

Cited by 83 publications

(34 citation statements)

References 41 publications

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“…Most of the patients transferred to the intensive care unit (ICU) are in critical condition, and these patients are usually accompanied by organ failure of different degrees, among which the most common manifestation is decreased and disordered respiratory function [ 1 ]. In order to ensure the life safety of patients, most patients in the ICU need to implement mechanical ventilation (MV) intervention, i.e., endotracheal intubation through the nose and mouth, to change the patient's spontaneous breathing movement through a ventilator to maintain airway patency [ 2 ]. The use of MV can effectively ensure the normal breathing of patients and prevent serious respiratory diseases caused by hypoxia injury and carbon dioxide accumulation [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Influence of Dexmedetomidine on Diaphragm Function and Postoperative Outcomes in ICU Patients with Mechanical Ventilation

Zhao

Huang

Wang

et al. 2021

Evidence-Based Complementary and Alternative Medicine

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Objective. To probe into the influence of dexmedetomidine (DEX) on diaphragm function and postoperative outcomes of mechanically ventilated patients in the intensive care unit (ICU). Methods. 84 patients with mechanical ventilation (MV) in the ICU of our hospital were selected as the research participants, including 38 patients in the control group (CG) sedated with midazolam (MZ) and 46 patients in the research group (RG) with DEX sedation. Ramsay sedation score, visual analogue scale (VAS), and restlessness score (RS) were used to evaluate their state before sedation (T0), as well as 2 h (T1), 6 h (T2), and 24 h (T3) after sedation, and the alterations of mean arterial pressure (MAP) and heart rate (HR) were recorded. Serum cortisol (Cor), adrenocorticotropic hormone (ACTH), superoxide dismutase (SOD), malondialdehyde (MDA), interleukin- (IL-) 1β, IL-6, and tumor necrosis factor-α (TNF-α) were measured before and 24 h after sedation. The end-inspiratory diaphragm thickness (DTei) and end-expiratory diaphragm thickness (DTee) were measured within 2 h after the initiation of MV and 5 min after the spontaneous breathing test (SBT), and the diaphragm thickening fraction (DTF) was calculated. Finally, the ventilator weaning, MV time, and the incidence of adverse reactions (ADs) of the two groups were counted. Results. T0 and T3 witnessed no distinct difference in Ramsay, VAS, and RS scores between the two arms ( P > 0.05 ), but at T1 and T2, RG had better sedation state and lower VAS and RS scores than CG ( P < 0.05 ), with more stable vital signs ( P < 0.05 ). After sedation, the contents of oxidative stress and inflammatory factors in RG were lower, while DTee, DTei, and DTF were higher, versus CG ( P < 0.05 ). Moreover, RG presented higher success rate of first ventilator weaning, less MV time, and lower incidence of ADs than CG ( P < 0.05 ). Conclusions. DEX is effective in mechanically ventilated patients in the ICU, which can protect patients against diaphragm function damage, improve the success rate of ventilator weaning, and benefit the postoperative outcome, with excellent and rapid sedation effect and less stress damage to patients.

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Section: Introductionmentioning

confidence: 99%

Influence of Dexmedetomidine on Diaphragm Function and Postoperative Outcomes in ICU Patients with Mechanical Ventilation

Zhao

Huang

Wang

et al. 2021

Evidence-Based Complementary and Alternative Medicine

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“…Telemedicine may also be helpful in case discussions for decision making which is useful to promote interaction between physicians, nurses, and patients. Udeh et al exemplified some benefits of telemedicine including [ 84 ]: a) promote evidence-based best practices through checklists and prompting; b) enhance monitoring, early identification, and treatment of critical illness; c) improve coordination of care; and d) increase night-time vigilance. The use of telemedicine in ICUs is associated with decreased mortality and length of stay [ 84 , 85 ].…”

Section: Discussionmentioning

confidence: 99%

“…Udeh et al exemplified some benefits of telemedicine including [ 84 ]: a) promote evidence-based best practices through checklists and prompting; b) enhance monitoring, early identification, and treatment of critical illness; c) improve coordination of care; and d) increase night-time vigilance. The use of telemedicine in ICUs is associated with decreased mortality and length of stay [ 84 , 85 ]. Surprisingly, telemedicine has not been used on a significant scale worldwide, although this methodology is low-cost, feasible, clinically useful, and sustainable.…”

Section: Discussionmentioning

confidence: 99%

Protecting brains and saving futures guidelines: A prospective, multicenter, and observational study on the use of telemedicine for neonatal neurocritical care in Brazil

et al. 2022

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Background Management of high-risk newborns should involve the use of standardized protocols and training, continuous and specialized brain monitoring with electroencephalography (EEG), amplitude integrated EEG, Near Infrared Spectroscopy, and neuroimaging. Brazil is a large country with disparities in health care assessment and some neonatal intensive care units (NICUs) are not well structured with trained personnel able to provide adequate neurocritical care. To reduce this existing gap, an advanced telemedicine model of neurocritical care called Protecting Brains and Saving Futures (PBSF) Guidelines was developed and implemented in a group of Brazilian NICUs. Methods A prospective, multicenter, and observational study will be conducted in all 20 Brazilian NICUs using the PBSF Guidelines as standard-of-care. All infants treated accordingly to the guidelines during Dec 2021 to Nov 2024 will be eligible. Ethical approval was obtained from participating centers. The primary objective is to describe adherence to the PBSF Guidelines and clinical outcomes, by center and over a 3-year period. Adherence will be measured by quantification of neuromonitoring, neuroimaging exams, sub-specialties consultation, and clinical case discussions and videoconference meetings. Clinical outcomes of interest are detection of seizures during hospitalization, use of anticonvulsants, inotropes, and fluid resuscitation, death before hospital discharge, length of hospital stay, and referral of patients to specialized follow-up. Discussion The study will provide evaluation of PBSF Guidelines adherence and its impact on clinical outcomes. Thus, data from this large prospective, multicenter, and observational study will help determine whether neonatal neurocritical care via telemedicine can be effective. Ultimately, it may offer the necessary framework for larger scale implementation and development of research projects using remote neuromonitoring. Trial registration NCT03786497, Registered 26 December 2018, https://www.clinicaltrials.gov/ct2/show/NCT03786497?term=protecting+brains+and+saving+futures&draw=2&rank=1.

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“…Additionally, tele-ICU systems have been shown to reduce alarm fatigue through triage and curation of automatic alerts by remote care teams [ 51 , 59 ]. In recent literature, the potential of population management systems allowing targeted interventions on patients with high risk factors has been highlighted [ 63 ]. Significant amount of data generated by tele-ICU systems can be leveraged for the development of advanced applications [ 64 ].…”

Section: Discussionmentioning

confidence: 99%

Telemedicine in Intensive Care Units: Scoping Review

Guinemer¹,

Boeker²,

Fürstenau³

et al. 2021

J Med Internet Res

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Background The role of telemedicine in intensive care has been increasing steadily. Tele–intensive care unit (ICU) interventions are varied and can be used in different levels of treatment, often with direct implications for the intensive care processes. Although a substantial body of primary and secondary literature has been published on the topic, there is a need for broadening the understanding of the organizational factors influencing the effectiveness of telemedical interventions in the ICU. Objective This scoping review aims to provide a map of existing evidence on tele-ICU interventions, focusing on the analysis of the implementation context and identifying areas for further technological research. Methods A research protocol outlining the method has been published in JMIR Research Protocols. This review follows the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews). A core research team was assembled to provide feedback and discuss findings. Results A total of 3019 results were retrieved. After screening, 25 studies were included in the final analysis. We were able to characterize the context of tele-ICU studies and identify three use cases for tele-ICU interventions. The first use case is extending coverage, which describes interventions aimed at extending the availability of intensive care capabilities. The second use case is improving compliance, which includes interventions targeted at improving patient safety, intensive care best practices, and quality of care. The third use case, facilitating transfer, describes telemedicine interventions targeted toward the management of patient transfers to or from the ICU. Conclusions The benefits of tele-ICU interventions have been well documented for centralized systems aimed at extending critical care capabilities in a community setting and improving care compliance in tertiary hospitals. No strong evidence has been found on the reduction of patient transfers following tele-ICU intervention. International Registered Report Identifier (IRRID) RR2-10.2196/19695

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Telemedicine/Virtual ICU: Where Are We and Where Are We Going?

Cited by 83 publications

References 41 publications

Influence of Dexmedetomidine on Diaphragm Function and Postoperative Outcomes in ICU Patients with Mechanical Ventilation

Influence of Dexmedetomidine on Diaphragm Function and Postoperative Outcomes in ICU Patients with Mechanical Ventilation

Protecting brains and saving futures guidelines: A prospective, multicenter, and observational study on the use of telemedicine for neonatal neurocritical care in Brazil

Telemedicine in Intensive Care Units: Scoping Review

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