mceleste.dias@gmail.com celeste.dias@med.up.pt ‘Full’ Multimodal Brain Monitoring at NCCU How can I use ICM+ What can be done better Thank you for the kind invitation. It´s a pleasure to be here with all of you as member of the ICM+ club Celeste Dias mceleste.dias@gmail.com celeste.dias@med.up.pt

‘Full’ Multimodal Brain Monitoring at NCCU University Hospital of São João, Porto Trauma Centre 778 beds 3.700.000 inhabitants from the north of Portugal 1959 I’m a portuguese intensivist. I come from Porto, a city in the north of Portugal and I work in the University Hospital of São João. It’s the one the biggest public hospitals in the country and in 2012 it was considered the best hospital. It has 778 beds and covers a population of almost 4million inhabitants. 2013 2012

‘Full’ Multimodal Brain Monitoring at NCCU Intensive Care Department 2 General ICU (38 intensive care beds and 19 intermediate care beds) 1 Neurocritical Care Unit (10 intensive care beds and 6 intermediate care beds) 2012 NCCU: 379 + 1305 patients discharged I belong to the Intensive Care Department which has 38 intensive care beds and 19 intermediate care beds. NCCU exists since 1989 and I’m the Chief Consultant of the unit since 1998. We have 10 ICU beds and 6 intermediate care beds.Last year we discharged 379 patients from the ICU beds and 1305 patients from the intermediate beds.

‘Full’ Multimodal Brain Monitoring at NCCU March 2011, multimodal brain monitoring with ICM+ We start to use ICM+ in March 2011. We prepare it with the help of Peter during a short stay in the hospital with na early morning presentation for all the hospital and university comunity and then worked all day installing the software and configuring the computers as well as customizing some profiles and layouts of ICM+. It was really a very short day!!!

How can I use ICM+ ‘Full’ Multimodal Brain Monitoring at NCCU First barriers and challenges 1. Cables for analogue and digital input signals viewlink network RS232 Being alone with all my clinical doubts added to the engineering problems it was not na easy task. Fortunately I got a good help from our CIS software engineer. usb db25 pin db9 pin

How can I use ICM+ ‘Full’ Multimodal Brain Monitoring at NCCU First barriers and challenges 2. Configuration for analogue and digital input signals COM ports: physical and virtual The problems did not stop with cables and plugs but got more complicated because computers have crazy things such as physical and virtual COM ports. Once again I had the help from the IT team transforming virtual ports into “physical ports” so that COM 3 and 4 were always the same.

How can I use ICM+ ‘Full’ Multimodal Brain Monitoring at NCCU First barriers and challenges 3. Diferent medical monitors »» different sockets and different comunication protocols But different machines have different plugs and different comunication protocols. We had to struggle against all these problems.

How can I use ICM+ ‘Full’ Multimodal Brain Monitoring at NCCU First barriers and challenges How to teach the ICU staff (doctors and nurses)? Which cables and connections should they choose for all the equipments and settings? - lectures for all the staff to present the software and the hardware - label all the cables, plugs and ports with numbers and code colours - photos of the monitors, cables and connections - diagrams anf flowcharts of all the steps - translation of ICM+ manual to protuguese What didi we do?

a tool for clinical decision ‘Full’ Multimodal Brain Monitoring at NCCU How can I use ICM+ ICP and CPP guidelines and optimal CPP at bedside After starting using the ICM+ and the chart for optimal CPP it was impossible to treat patients in the same way as in the past. Nurses wanted to look for the optimal CPP whenever possible. a tool for clinical decision

What can be done better ‘Full’ Multimodal Brain Monitoring at NCCU Plug and play configuration develop a software as an interface / communication tool between ICM+ and equipments and make plug and play a reality We are looking forward a new step in ICM+ that is the era of plug and play. For that we still need to improve and automate the interface and communication between software and equipments

What can be done better ‘Full’ Multimodal Brain Monitoring at NCCU Integration with clinical information systems interface between CIS and ICM+ to share information about patient’s clinical state and evolution during ICU stay We also aim to develop na interface between CIS and ICM+ to share information about patient’s clinical state and evolution during ICU stay, such as nursing events, medications, evaluations, lab results,… And have decision like optimal CPP in the CIS

What can be done better ‘Full’ Multimodal Brain Monitoring at NCCU Offline analysis and reanalysis improve the available information about offline analysis in order to make life easier for self learning users and also for users that are distant from the Lab It would also be fundamental to improve the available information about offline analysis in order to make life easier for self learning users and also for users that are distant from the Lab

‘Full’ Multimodal Brain Monitoring at NCCU ICM+ user club meeting Celeste Dias mceleste.dias@gmail.com