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A ventilator system provides respiratory support to critically ill patients in the Intensive Care Unit. Increasing complexity in the user interface, features and functionalities of ventilator systems can cause medical errors and cost the life of a patient. Therefore, the usability of ventilator systems is most crucial to ensure patient safety. We have evolved a specialized set of heuristics combined with objectively defined usability indicators for the usability evaluation of touch screen based ventilator systems. Our study presents the heuristic evaluation of three touch screen based ventilator systems manufactured by three different companies. The heuristic evaluation has been performed by four different usability evaluators to ensure the reliability of heuristics proposed in this paper. The specialized set of heuristics linked with user interface components and the objectively defined usability indicators are found more reliable in identifying specific usability problems of ventilator systems. [ABSTRACT FROM AUTHOR]

The treatment of ICU seizures and status epilepticus may differ in the approach taken. With only one seizure, the focus should be more on defining the etiology than on treating the patient with antiepileptics, but with more prolonged or recurrent seizures, both should be pursued in parallel. Status epilepticus, if delayed or untreated, carries a grave prognosis and every ICU should have a protocol for rapid response to this neurological emergency. Continuous EEG monitoring should become mandatory, when treating status, because of the late dissociation between clinical convulsions and electrographic seizures and the inability to use the clinical examination as guide to the treatment. Focal and non-convulsive statuses have a different etiology and prognosis than generalized convulsive status epilepticus, and the treatment also differs. Several medications are available for treating seizures, but only few are available for parenteral, fast administration when treating status. The experience from using the newer antiepileptics in case of resistant status is therefore limited. Interactions between antiepileptics and common ICU medications may be significant and concurrent multi-organ failure may alter their metabolism. [ABSTRACT FROM AUTHOR]

Recent advances in computer technology have made it possible to perform prolonged digital continuous video EEG monitoring of many critically ill patients simultaneously. Recent studies using continuous EEG monitoring (cEEG) have found that these patients, especially those with coma, acute brain injury, or prior clinical seizures, often have nonconvulsive seizures (NCSz), and that these may contribute to secondary brain injury. The majority of seizures in the critically ill are nonconvulsive and can only be identified with EEG recording. Rapidly improving quantitative EEG (qEEG) software speeds data review to allow screening of multiple prolonged recordings to detect NCSz and has the potential to provide continuous information about changes in brain function in real time at the bedside. Optimal sensitivity and specificity of qEEG tools are obtained with full electrode montages and careful maintenance of scalp electrodes. New electrode technologies, such as MRI-compatible electrodes, help reduce the burden on EEG technologists while limiting interruptions in recordings. In addition to detecting NCSz, cEEG can also be used for dynamic detection of other changes in brain function such as ischemia, and can be coupled with other modalities of monitoring brain physiology such as microdialysis, tissue oximetry, and intracranial electrophysiology. Together, these tools can allow early detection of brain at risk for injury and alert the physician to intervene before the damage becomes irreversible. [ABSTRACT FROM AUTHOR]

Effective treatment of seizures associated with CNS infection and inflammation depends on rapid diagnosis and early attainment of bactericidal activity within the CSF with appropriate antimicrobial agents, or appropriate management of vasculitis-induced cerebral complications. There is nothing specific regarding the management of ICU seizures in these situations, except for a high suspicion by the medical staff, as seizures are not uncommon in this setting. Improvement in long-term neurologic outcome depends on both the therapy of the infectious/inflammatory process and the intensive care multisystem monitoring commonly warranted in this patient population. The primary goal of preserving CNS function is shared by both the neurologist and the intensivist, making a multidisciplinary approach essential. [ABSTRACT FROM AUTHOR]

Seizures are a common presentation of brain neoplasms. Both primary brain tumors and metastases can present with seizures, which are more commonly focal depending on the location and the pathology of the lesion. In general, more benign tumors have higher incidence of seizures than more malignant ones. These patients are admitted to an intensive care unit (ICU) either for preoperative monitoring or in the postoperative period. They should be treated with antiepileptics, if seizures are witnessed. The question remains whether they should be prophylactically treated with antiepileptic medications, if seizures have not occurred yet in the preand postoperative period and for how long. More recent data do not seem to support such prophylactic administration. [ABSTRACT FROM AUTHOR]