1. 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

2. ‘Full’ Multimodal Brain Monitoring at NCCU
University Hospital of São João, Porto
Trauma Centre
778 beds
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

3. ‘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: 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 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.

4. ‘Full’ Multimodal Brain Monitoring at NCCU
March 2011, multimodal brain monitoring with ICM+
We start to use ICM+ in March 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!!!

5. 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

6. 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.

7. 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.

8. 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?

9. 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

10. 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

11. 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

12. 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

13. ‘Full’ Multimodal Brain Monitoring at NCCU
ICM+ user club meeting
Celeste Dias