Stories about: ICU

Intelligent ICU monitoring for patients in status epilepticus: BurSIn

The BurSIn system, in development, interprets EEG data along several key parameters and accurately identifies burst and suppression patterns.
The BurSIn system, in development, interprets EEG data along several key parameters and accurately identifies burst and suppression patterns.

Status epilepticus, a life-threatening form of persistent seizure activity in the brain, is challenging to treat. It requires hospitalization in an intensive care unit, constant monitoring and meticulous medication adjustment. An automated, intelligent monitoring system developed by clinicians and engineers at Boston Children’s Hospital could transform ICU care for this neurological emergency.

Typically, children in status epilepticus are first given powerful, short-acting seizure medications. If their seizures continue, they may need to be placed in a medically induced coma, using long-acting sedatives or general anesthetics. “The goal,” explains biomedical engineer Christos Papadelis, PhD, “is to supply enough sedating medication to suppress brain activity and protect the brain from damage, while at the same time avoiding over-sedation.”

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Scrubbing out central line infections

catheter hub cleaning
Sarah Goldberg and Ali Ataollahi pitching their device, which cleans central-line hubs with the push of a button, at Boston Children’s Hospital’s Innovation Tank.

Thousands of hospital patients die every year from infections that start in a central line, a catheter used to inject life-saving medications directly into the bloodstream. One infection can add two to three weeks and a whopping $55,000 to a patient’s hospital stay. Even worse, up to 25 percent of patients who come down with a central line infection die from it—a staggering number considering that 41,000 such infections are recorded in the U.S. each year.

“Central line infections are life-threatening, costly and completely preventable,” says Sarah Goldberg, MD, a fellow in Boston Children’s Hospital’s Cardiac Intensive Care Unit (CICU).

The problem is that the catheter’s hub—the port where it enters the body—is exposed to bacteria in the world around it. If clinicians don’t thoroughly clean the hub before each use, they risk pushing bacteria straight into a patient’s blood. But that brings up a second problem.

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Raising an early warning in the ICU: T3

How can ICU clinicians manage the data from all these monitors?

With the Internet’s meteoric rise in the last 20 years—to the point of being available 24/7 in your pocket—technology pundits, psychologists and sociologists have been sounding ever louder warnings about information overload: the constant onslaught of communication, information and media coming at us all the time, and in ever greater volume.

Now imagine you’re a doctor or nurse in an intensive care unit (ICU). For you, information overload isn’t just a daily reality—it’s a necessary one. To make the right decisions at the right time for each patient, you must keep tabs on numerous bedside monitors—in the ICUs at Boston Children’s Hospital, that’s 10 or more for each child.

Melvin C. Almodovar, MD, medical director of Boston Children’s Cardiac Intensive Care Unit (CICU), and his colleagues wanted a better way to assess the patient’s physiologic state and catch crises before they happen.

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Got vitamin D? Study finds low levels in critically ill children

The sun helps us get some of the vitamin D we need, but not enough of it. A new study finds that critically ill kids are more than twice as likely as kids generally to be vitamin D deficient. (nichole ★/Flickr)

When a child is admitted to a hospital’s intensive care unit (ICU), probably one of the last things on anyone’s mind is, “Are they getting enough vitamin D?”

But this question could be a very important one, according to Kate Madden, MD, and Adrienne Randolph, MD, critical care medicine specialists at Boston Children’s Hospital. In a study of children admitted to Boston Children’s ICU, they found that those with very low vitamin D levels—below what the American Association of Pediatrics (AAP) considers deficient—tended to have more severe illness.

So what’s so important about vitamin D? Turns out, a lot more than most people think.

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Peeking into the black box of lung ventilation

As the lungs expand, the glow blue in this movie made using EIT; areas that are underinflated appear red.
Can we monitor a child's lungs when they're on a ventilator without actually taking a picture? Yes, with a technology called EIT; click the image above to see for yourself. (Courtesy Camille Gómez-Laberge)

Every year, thousands of children in intensive care units across the United States are put on mechanical ventilation to help them breathe. But while this technology has saved countless lives, it can also cause or worsen lung injury.

“A child’s injured lungs don’t often inflate uniformly under ventilation,” says Gerhard Wolf, a critical care doctor in Children’s Hospital Boston’s Department of Anesthesia. “So one part of the lung may be nearly collapsed while another is overinflated. We need to be able to see that so we don’t cause further damage.”

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