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Dwayne R Westenskow

Dwayne R Westenskow

Adjunct Professor
Professor of Anesthesiology
Director Bioengineering Division, Department of Anesthesiology

E-mail:

http://abl.med.utah.edu/

Phone: 801-581-6393
Office: Dept Anesthesiology, room 3C444 SOM, 50 N Medical Dr.,Salt Lake City, Utah 84132<

Lab

Anesthesia Bioengineering Laboratory

Research

Research interests are to develop and apply technology in the design of medical devices for the operating room and intensive care unit. Specific areas of interest are neural networks, feedback control and digital signal processing.

Current Research

Data displays to improve medical decision making
Just-in-time training for CPR
Hypercapnia to improve patient safety during conscious sedation
CO2 rebreathing to speed emergence from inhalation anesthesia


The Bioengineering Division of the Department of Anesthesiology was formed in 1976. Initially research was funded by a NIH Burn Trauma Center grant. A monitor of oxygen consumption was developed and licensed to Drägerwerk in Germany and to Utah Medical. Three commercial devices were manufactured, one of which was used to monitor Barney Clark, the first artificial heart recipient. These devices are still used in the Burn Center to balance nutritional support to patients.

The Bioengineering Division next developed feedback controllers for an anesthesia machine, ventilator, fluid delivery pump and drug delivery pump. These devices have been commercialized by Dräger, Utah Medical, IVAC and Vital Signs.

In 1987 the Division was recognized with the University's Patent Award for its involvement in the development of a Raman gas analyzer. This system monitors the concentration of oxygen, carbon dioxide and other respiratory gases. Approximately 2000 of these units have been used in operating rooms across the U.S.

The Division has applied artificial neural networks to critical care monitoring. Neural networks have improved the accuracy of blood pressure, cardiac output, respiration and pulse-oximeter monitoring. Results show that a neural network- based alarm system helps anesthesiologist find life threatening equipment faults in 15 seconds, rather than 45 seconds.

Research into noninvasive cardiac output monitoring has resulted in a partial CO2 rebreathing technique that was licensed to Novametrix and known commercially as NICO2 Novametrix Medical Systems, Inc., Research in respiratory monitoring has produced a differential pressure flowmeter that has been incorporated in numerous OR and ICU products (KORR).

Over the past 20 years, 25 MS and 16 PhD students have completed their graduate research in the Division. Twenty graduates are currently employed at universities and 18 in the medical device industry. The Division's research has produced 109 journal publications, 24 book chapters, 20 patents, 11 licensing agreements and 9 commercial products.

Selected Publications

Johnson KB, Syroid ND, Gupta DK, Manyam SC, Pace NL, Lapierre CD, Egan TD, White JL, Tyler D, Westenskow DR, An Evaluation of Remifentanil-Sevoflurane Response Surface Models in Patients Emerging from Anesthesia: Model Improvement Using Effect-Site Sevoflurane Concentrations. Anesth Analg 2009 Oct 9;():

Görges M, Markewitz BA, Westenskow DR, Improving alarm performance in the medical intensive care unit using delays and clinical context. Anesth Analg 2009 May;108(5):1546-52

Sakata DJ, Matsubara I, Gopalakrishnan NA, Westenskow DR, White JL, Yamamori S, Egan TD, Pace NL, Flow-through versus sidestream capnometry for detection of end tidal carbon dioxide in the sedated patient. J Clin Monit Comput 2009 Apr;23(2):115-22

Johnson KB, Syroid ND, Drews FA, Ogden LL, Strayer DL, Pace NL, Tyler DL, White JL, Westenskow DR, Part Task and variable priority training in first-year anesthesia resident education: a combined didactic and simulation-based approach to improve management of adverse airway and respiratory events. Anesthesiology 2008 May;108(5):831-40

Johnson KB, Syroid ND, Gupta DK, Manyam SC, Egan TD, Huntington J, White JL, Tyler D, Westenskow DR, An evaluation of remifentanil propofol response surfaces for loss of responsiveness, loss of response to surrogates of painful stimuli and laryngoscopy in patients undergoing elective surgery. Anesth Analg 2008 Feb;106(2):471-9, table of contents

Sakata DJ, Gopalakrishnan NA, Orr JA, White JL, Westenskow DR, Rapid recovery from sevoflurane and desflurane with hypercapnia and hyperventilation. Anesth Analg 2007 Jul;105(1):79-82

Drews FA, Picciano P, Agutter J, Syroid N, Westenskow DR, Strayer DL, Development and evaluation of a just-in-time support system. Hum Factors 2007 Jun;49(3):543-51

Gopalakrishnan NA, Sakata DJ, Orr JA, McJames S, Westenskow DR, Hypercapnia shortens emergence time from inhaled anesthesia in pigs. Anesth Analg 2007 Apr;104(4):815-21

Manyam SC, Gupta DK, Johnson KB, White JL, Pace NL, Westenskow DR, Egan T , When Is a Bispectral Index of 60 Too Low?: Rational Processed Electroencephalographic Targets Are Dependent on the Sedative-Opioid Ratio. Anesthesiology 2007 Mar;106(3):472-483

Sakata DJ, Gopalakrishnan NA, Orr JA, White JL, Westenskow DR, Hypercapnic hyperventilation shortens emergence time from isoflurane anesthesia. Anesth Analg 2007 Mar;104(3):587-91

Visaria RK, Westenskow DR, Model-based detection of endobronchial intubation. Anesth Analg 2006 Oct;103(4):888-93

Manyam SC, Gupta DK, Johnson KB, White JL, Pace NL, Westenskow DR, Egan TD, Opioid-volatile anesthetic synergy: a response surface model with remifentanil and sevoflurane as prototypes. Anesthesiology 2006 Aug;105(2):267-78

Drews FA, Syroid N, Agutter J, Strayer DL, Westenskow DR, Drug delivery as control task: improving performance in a common anesthetic task. Hum Factors 2006 Spring;48(1):85-94

Drews FA, Westenskow DR, The right picture is worth a thousand numbers: data displays in anesthesia. Hum Factors 2006 Spring;48(1):59-71

Visaria RK, Westenskow DR, Model-based detection of partially obstructed endotracheal tube. Crit Care Med 2005 Jan;33(1):149-54; discussion 249-50

Syroid ND, Agutter J, Drews FA, Westenskow DR, Albert RW, Bermudez JC, Strayer DL, Prenzel H, Loeb RG, Weinger MB, Development and evaluation of a graphical anesthesia drug display. Anesthesiology 2002 Mar;96(3):565-75

Haryadi DG, Orr JA, Kuck K, McJames S, Westenskow DR, Partial CO2 rebreathing indirect Fick technique for non-invasive measurement of cardiac output. J Clin Monit Comput 2000;16(5-6):361-74

Haryadi DG, Westenskow DR, Critchley LA, Schookin SI, Zubenko VG, Beliaev KR, Morozov AA, Evaluation of a new advanced thoracic bioimpedance device for estimation of cardiac output. J Clin Monit Comput 1999 Feb;15(2):131-8

Bailey PL, McJames SW, Cluff ML, Wells DT, Orr JA, Westenskow DR, Kern SE, Evaluation in volunteers of the VIA V-ABG automated bedside blood gas, chemistry, and hematocrit monitor. J Clin Monit Comput 1998 Jul;14(5):339-46

Westenskow DR, Fundamentals of feedback control: PID, fuzzy logic, and neural networks. J Clin Anesth 1997 Sep;9(6 Suppl):33S-35S

Kern SE, Johnson JO, Westenskow DR, Fuzzy logic for model adaptation of a pharmacokinetic-based closed loop delivery system for pancuronium. Artif Intell Med 1997 Sep;11(1):9-31

Kern SE, Johnson JO, Orr JA, Westenskow DR, Clinical analysis of the flexor hallucis brevis as an alternative site for monitoring neuromuscular block from mivacurium. J Clin Anesth 1997 Aug;9(5):383-7

Michels P, Gravenstein D, Westenskow DR, An integrated graphic data display improves detection and identification of critical events during anesthesia. J Clin Monit 1997 Jul;13(4):249-59

Baker PD, Westenskow DR, Kück K, Theoretical analysis of non-invasive oscillometric maximum amplitude algorithm for estimating mean blood pressure. Med Biol Eng Comput 1997 May;35(3):271-8

Kern SE, Westenskow DR, Pharmacokinetic-based minibolus delivery as an alternative to continuous infusion for drugs that exhibit a biophase lag. J Pharmacokinet Biopharm 1997 Apr;25(2):191-208

Strong K, Westenskow DR, Fine PG, Orr JA, A preliminary laboratory investigation of air embolus detection and grading using an artificial neural network. Int J Clin Monit Comput 1997;14(2):103-7

Lee TK, Egbert TP, Westenskow DR, Supraorbital artery as an alternative site for oscillometric blood pressure measurement. J Clin Monit 1996 Jul;12(4):293-7

Lee TK, Silva FH, Egbert TP, Westenskow DR, Optimal sites for forehead oscillometric blood pressure monitoring. J Clin Monit 1995 Sep;11(5):298-304

Kern SE, Johnson JO, Westenskow DR, Orr JA, A comparison of dynamic and isometric force sensors for train-of-four measurement using submaximal stimulation current. J Clin Monit 1995 Jan;11(1):18-22

Narus SP, Kück K, Westenskow DR, Intelligent monitor for an anesthesia breathing circuit. Proc Annu Symp Comput Appl Med Care 1995;():96-100

Kern SE, Johnson JO, Westenskow DR, Orr JA, An effectiveness study of a new piezoelectric sensor for train-of-four measurement. Anesth Analg 1994 May;78(5):978-82

Orr JA, Westenskow DR, A breathing circuit alarm system based on neural networks. J Clin Monit 1994 Mar;10(2):101-9

Westenskow DR, Wallroth CF, Hattendorff HD, Best-Timmann R, Gippert KL, Standard gases used to calibrate anesthetic vapor analyzers: are they stable? J Clin Monit 1994 Jan;10(1):21-5

Krishna SA, Orr JA, Westenskow DR, Classification of red blood cell images using a neural network. Proc Annu Symp Comput Appl Med Care 1994;():975

Westenskow DR, Silva FH, Device to limit inflation of a pulmonary artery catheter balloon. Crit Care Med 1993 Sep;21(9):1365-8

Westenskow DR, Orr JA, Simon FH, Bender HJ, Frankenberger H, Intelligent alarms reduce anesthesiologist's response time to critical faults. Anesthesiology 1992 Dec;77(6):1074-9

Farrell RM, Orr JA, Kück K, Westenskow DR, Differential features for a neural network based anesthesia alarm system. Biomed Sci Instrum 1992;28():99-104

Heining MP, DeBey RK, McJames SW, Jordan WS, Westenskow DR, A system for automatic feedback control of plasma potassium concentration. Br J Anaesth 1991 Jul;67(1):120-6

Westenskow DR, Silva FH, Laboratory evaluation of the vital signs (ICOR) piezoelectric anesthetic agent analyzer. J Clin Monit 1991 Apr;7(2):189-94

Westenskow DR, Wallroth CF, Closed-loop control for anesthesia breathing systems. J Clin Monit 1990 Jul;6(3):249-56

Jaklitsch RR, Westenskow DR, A simulation of neuromuscular function and heart rate during induction, maintenance, and reversal of neuromuscular blockade. J Clin Monit 1990 Jan;6(1):24-38

Westenskow DR, Coleman DL, Raman scattering for respiratory gas monitoring in the operating room: advantages, specifications, and future advances. Biomed Instrum Technol 1989 Nov-Dec;23(6):485-9

Loughlin PJ, Bowes WA, Westenskow DR, An oil-based model of inhalation anesthetic uptake and elimination. Anesthesiology 1989 Aug;71(2):278-82

Westenskow DR, Roberts SE, Pace NL, Evaluation of a replenishment type oxygen consumption monitor. Crit Care Med 1989 Aug;17(8):798-802

Loeb RG, Brunner JX, Westenskow DR, Feldman B, Pace NL, The Utah anesthesia workstation. Anesthesiology 1989 Jun;70(6):999-1007

Brunner JX, Westenskow DR, Zelenkov P, Prototype ventilator and alarm algorithm for the NASA space station. J Clin Monit 1989 Apr;5(2):90-9

Westenskow DR, Smith KW, Coleman DL, Gregonis DE, Van Wagenen RA, Clinical evaluation of a Raman scattering multiple gas analyzer for the operating room. Anesthesiology 1989 Feb;70(2):350-5

Orr JA, Westenskow DR, Bauer A, A prototype gas exchange monitor for exercise stress testing aboard NASA Space Station. J Appl Physiol 1989 Jan;66(1):492-7

Westenskow DR, Coleman DL, Can the Raman scattering analyzer compete with mass spectrometers: an affirmative reply. J Clin Monit 1989 Jan;5(1):34-6

Brunner JX, Westenskow DR, How the rise time of carbon dioxide analysers influences the accuracy of carbon dioxide measurements. Br J Anaesth 1988 Nov;61(5):628-38

Westenskow DR, Schipke CA, Raymond JL, Saffle JR, Becker JM, Young EW, Cutler CA, Calculation of metabolic expenditure and substrate utilization from gas exchange measurements. JPEN J Parenter Enteral Nutr 1988 Jan-Feb;12(1):20-4

Jaklitsch RR, Westenskow DR, Pace NL, Streisand JB, East KA, A comparison of computer-controlled versus manual administration of vecuronium in humans. J Clin Monit 1987 Oct;3(4):269-76