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ARTICLE |

Experience With a Digital Computer for Study and Improved Management of the Critically Ill FREE

Max H. Weil, MD; Herbert Shubin, MD; Will Rand, MA
[+] Author Affiliations

Reprint requests to 2025 Zonal Ave, Los Angeles 90033 (Dr. Weil).


From the Shock Research Unit, Department of Medicine, University of Southern California School of Medicine, and the Los Angeles County General Hospital, Los Angeles.


JAMA. 1966;198(9):1011-1016. doi:10.1001/jama.1966.03110220095032
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Automated techniques, now bolstered by the availability of a computer, have become increasingly important in recent years as medicine seeks to fulfill the need for ever more comprehensive and technically complex services.

Detailed analysis of physiological data by manual methods is inefficient, both for clinical research and for practical use at the bedside. A combination of sensors, with analysis of their output by an on-line computer, offers a means of achieving a comprehensive inventory of patient condition for immediate use by the physician and the clinical investigator.

Automated measurement and collection of biological data in a clinical setting has been used in a number of areas.1,2 Automated analog devices have been developed for measuring blood pressure by the use of indirect auscultatory techniques.3-6 These devices are not entirely satisfactory for patients in shock, however, since the indirectly obtained blood pressure loses accuracy under conditions of markedly reduced blood

REFERENCES

Wilber, S.A., and Derrick, W.S.:  Patient Monitoring and Anesthetic Management: A Physiological Communications Network , JAMA 191:893-898 ( (March 15) ) 1965;.
Spencer, W.A., and Vallbona, C.:  Application of Computers in Clinical Practice , JAMA 191:917-921 ( (March 15) ) 1965;.
Geddes, L.A., et al:  Numerical Indication of Indirect Systolic and Diastolic Blood Pressures, Heart and Respiratory Rate , Anesthesiology 25:861-866 ( (Nov) -Dec) 1964;.
Ware, R.W., and Kahn, A.R.:  Automatic Indirect Blood Pressure Determinations in Flight , J Appl Physiol 18:210-214 ( (Jan) ) 1963;.
Kahn, A.; Ware, R.W.; and Siahaya, O.:  A Digital Readout Technic for Aerospace Biomedical Monitoring , Amer J Med Electronics 2:152-157 ( (April) -June) 1963;.
Smith, C.R., and Bickley, W.H.: The Measurement of Blood Pressure in the Human Body , SP-5006, Technology Survey, National Aeronautics and Space Administration, Washington, DC, 1964;.
Moody, N.F., et al: " A Cardiac Output Computer for the Rapid Analysis of Indicator Dilution Curves ," in Digest of the 1961 International Conference on Medical Electronics , New York City, (July) , 1961;, p 179.
Hara, H.H., and Belville, J.W.:  On-Line Computation of Cardiac Output From Dye Dilution Curves , Circ Res 12:379-385 ( (April) ) 1963;.
Boyett, J.D., et al:  Rapid Method for Determination of Cardiac Output by Indicator Dilution Techniques , J Lab Clin Med 64:160-167 ( (July) ) 1964;.
Wessel, H.U., et al:  Performance of a New On-Line Computer for Indicator-Dilution Curves , J Appl Physiol 19:1024-1027 ( (Sept) ) 1964;.
Benchimol, A.; Akre, P.R.; and Dimond, E.G.:  Clinical Experience With the Use of Computers for Calculation of Cardiac Output , Amer J Cardiol 15:213-219 ( (Feb) ) 1965;.
Warner, H.R., et al:  Quantitation of Beat-to-Beat Changes in Stroke Volume From the Aortic Pulse Contour in Man , J Appl Physiol 5:495-507 ( (March) ) 1953;.
Guyton, A.C.:  A Continuous Cardiac Output Recorder Employing the Fick Principle , Circ Res 7:661-665 ( (July) ) 1959;.
Peters, R.M., and Stacy, R.W.:  Automatized Clinical Measurement of Respiratory Parameters , Surgery 56:44-52 ( (July) ) 1964;.
Caceres, C.A., et al:  Computer Extraction of Electrocardiographic Parameters , Circulation 25:356-362 ( (Feb) ) 1962;.
Pipberger, H.V., and Stallmann, F.W.:  Computation of Differential Diagnosis in Electrocardiography , Ann NY Acad Sci 115:1115-1128 ( (July 31) ) 1964;.
Shapiro, H.; Simonson, E.; and Cady, L.D., Jr.:  Electrocardiographic Correlations in Normal Patients , Amer J Med Electronics 3:41-46 ( (Jan) -March) 1964;.
Holter, N.J.:  Radioelectrocardiography: A New Technique for Cardiovascular Studies , Ann NY Acad Sci 65:913-923 ( (Aug 9) ) 1957;.
Udhoji, V.N., et al:  Hemodynamic Studies on Clinical Shock Associated With Infection , Amer J Med 34:461-469 ( (April) ) 1963;.
Weil, M.H.; Shubin, H.; and Biddle, M.:  Shock Caused by Gram-Negative Microorganisms: Analysis of 169 Cases , Ann Intern Med 60:384-400 ( (March) ) 1964;.
Udhoji, V.N., and Weil, M.H.:  Circulatory Effects of Angiotensin, Levarterenol and Metaraminol in the Treatment of Shock , New Eng J Med 270:501-505 ( (March 5) ) 1964;.
Broder, G., and Weil, M.H.:  Excess Lactate: An Index of Reversibility of Shock in Human Patients , Science 143:1457-1459 ( (March 27) ) 1964;.
Sambhi, M.P., Weil, M.H.; and Udhoji, V.N.:  Acute Pharmacodynamic Effects of Glucocorticoids: Cardiac Output and Related Hemodynamic Changes in Normal Subjects and Patients in Shock , Circulation 31:523-530 ( (April) ) 1965;.
Weil, M.H.; Shubin, H.; and Rosoff, L.:  Fluid Repletion in Circulatory Shock: Central Venous Pressure and Other Practical Guides , JAMA 192:668-674 ( (May 24) ) 1965;.
Shubin, H., and Weil, M.H.:  The Mechanism of Shock Following Suicidal Doses of Barbiturates, Narcotics and Tranquilizer Drugs, With Observations on the Effects of Treatment , Amer J Med 38:853-863 ( (June) ) 1965;.
Weil, M.H., et al:  On-Line Computer Monitoring of the Seriously Ill Patient , Med Electron Biol Engin 4:265-272, 1966;.
Rockwell, M.A., Jr., et al:  Shock: III. A Computer System as an Aid in the Management of the Critically Ill Patient , Communications ACM 9:355-357 ( (May) ) 1966;.
Meagher, P.F., et al:  Measurement of Respiration Rate From Central Venous Pressure in the Critically Ill Patient , IEEE Trans Biomed Engin 13:54-57 ( (April) ) 1966;.
Meagher, P.F., et al:  Automatic Urinometer for On-Line Monitoring of Patients With Circulatory Shock , Med Electron Biol Engin , to be published.
Shubin, H., and Weil, M.H.:  Efficient Monitoring With a Digital Computer of Cardiovascular Function in Seriously Ill Patients , Ann Intern Med 65:453-460 ( (Sept) ) 1966;.
Rand, W.M.; Weil, M.H.; and Shubin, H.:  Automated Measurement of Cardiac Output by Use of a Digital Computer , Physiologist 9:316 ( (Aug) ) 1966;.

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Wilber, S.A., and Derrick, W.S.:  Patient Monitoring and Anesthetic Management: A Physiological Communications Network , JAMA 191:893-898 ( (March 15) ) 1965;.
Spencer, W.A., and Vallbona, C.:  Application of Computers in Clinical Practice , JAMA 191:917-921 ( (March 15) ) 1965;.
Geddes, L.A., et al:  Numerical Indication of Indirect Systolic and Diastolic Blood Pressures, Heart and Respiratory Rate , Anesthesiology 25:861-866 ( (Nov) -Dec) 1964;.
Ware, R.W., and Kahn, A.R.:  Automatic Indirect Blood Pressure Determinations in Flight , J Appl Physiol 18:210-214 ( (Jan) ) 1963;.
Kahn, A.; Ware, R.W.; and Siahaya, O.:  A Digital Readout Technic for Aerospace Biomedical Monitoring , Amer J Med Electronics 2:152-157 ( (April) -June) 1963;.
Smith, C.R., and Bickley, W.H.: The Measurement of Blood Pressure in the Human Body , SP-5006, Technology Survey, National Aeronautics and Space Administration, Washington, DC, 1964;.
Moody, N.F., et al: " A Cardiac Output Computer for the Rapid Analysis of Indicator Dilution Curves ," in Digest of the 1961 International Conference on Medical Electronics , New York City, (July) , 1961;, p 179.
Hara, H.H., and Belville, J.W.:  On-Line Computation of Cardiac Output From Dye Dilution Curves , Circ Res 12:379-385 ( (April) ) 1963;.
Boyett, J.D., et al:  Rapid Method for Determination of Cardiac Output by Indicator Dilution Techniques , J Lab Clin Med 64:160-167 ( (July) ) 1964;.
Wessel, H.U., et al:  Performance of a New On-Line Computer for Indicator-Dilution Curves , J Appl Physiol 19:1024-1027 ( (Sept) ) 1964;.
Benchimol, A.; Akre, P.R.; and Dimond, E.G.:  Clinical Experience With the Use of Computers for Calculation of Cardiac Output , Amer J Cardiol 15:213-219 ( (Feb) ) 1965;.
Warner, H.R., et al:  Quantitation of Beat-to-Beat Changes in Stroke Volume From the Aortic Pulse Contour in Man , J Appl Physiol 5:495-507 ( (March) ) 1953;.
Guyton, A.C.:  A Continuous Cardiac Output Recorder Employing the Fick Principle , Circ Res 7:661-665 ( (July) ) 1959;.
Peters, R.M., and Stacy, R.W.:  Automatized Clinical Measurement of Respiratory Parameters , Surgery 56:44-52 ( (July) ) 1964;.
Caceres, C.A., et al:  Computer Extraction of Electrocardiographic Parameters , Circulation 25:356-362 ( (Feb) ) 1962;.
Pipberger, H.V., and Stallmann, F.W.:  Computation of Differential Diagnosis in Electrocardiography , Ann NY Acad Sci 115:1115-1128 ( (July 31) ) 1964;.
Shapiro, H.; Simonson, E.; and Cady, L.D., Jr.:  Electrocardiographic Correlations in Normal Patients , Amer J Med Electronics 3:41-46 ( (Jan) -March) 1964;.
Holter, N.J.:  Radioelectrocardiography: A New Technique for Cardiovascular Studies , Ann NY Acad Sci 65:913-923 ( (Aug 9) ) 1957;.
Udhoji, V.N., et al:  Hemodynamic Studies on Clinical Shock Associated With Infection , Amer J Med 34:461-469 ( (April) ) 1963;.
Weil, M.H.; Shubin, H.; and Biddle, M.:  Shock Caused by Gram-Negative Microorganisms: Analysis of 169 Cases , Ann Intern Med 60:384-400 ( (March) ) 1964;.
Udhoji, V.N., and Weil, M.H.:  Circulatory Effects of Angiotensin, Levarterenol and Metaraminol in the Treatment of Shock , New Eng J Med 270:501-505 ( (March 5) ) 1964;.
Broder, G., and Weil, M.H.:  Excess Lactate: An Index of Reversibility of Shock in Human Patients , Science 143:1457-1459 ( (March 27) ) 1964;.
Sambhi, M.P., Weil, M.H.; and Udhoji, V.N.:  Acute Pharmacodynamic Effects of Glucocorticoids: Cardiac Output and Related Hemodynamic Changes in Normal Subjects and Patients in Shock , Circulation 31:523-530 ( (April) ) 1965;.
Weil, M.H.; Shubin, H.; and Rosoff, L.:  Fluid Repletion in Circulatory Shock: Central Venous Pressure and Other Practical Guides , JAMA 192:668-674 ( (May 24) ) 1965;.
Shubin, H., and Weil, M.H.:  The Mechanism of Shock Following Suicidal Doses of Barbiturates, Narcotics and Tranquilizer Drugs, With Observations on the Effects of Treatment , Amer J Med 38:853-863 ( (June) ) 1965;.
Weil, M.H., et al:  On-Line Computer Monitoring of the Seriously Ill Patient , Med Electron Biol Engin 4:265-272, 1966;.
Rockwell, M.A., Jr., et al:  Shock: III. A Computer System as an Aid in the Management of the Critically Ill Patient , Communications ACM 9:355-357 ( (May) ) 1966;.
Meagher, P.F., et al:  Measurement of Respiration Rate From Central Venous Pressure in the Critically Ill Patient , IEEE Trans Biomed Engin 13:54-57 ( (April) ) 1966;.
Meagher, P.F., et al:  Automatic Urinometer for On-Line Monitoring of Patients With Circulatory Shock , Med Electron Biol Engin , to be published.
Shubin, H., and Weil, M.H.:  Efficient Monitoring With a Digital Computer of Cardiovascular Function in Seriously Ill Patients , Ann Intern Med 65:453-460 ( (Sept) ) 1966;.
Rand, W.M.; Weil, M.H.; and Shubin, H.:  Automated Measurement of Cardiac Output by Use of a Digital Computer , Physiologist 9:316 ( (Aug) ) 1966;.
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