scholarly journals Adaptive threshold-based alarm strategies for continuous vital signs monitoring

2021 ◽  
Author(s):  
Mathilde C. van Rossum ◽  
Lyan B. Vlaskamp ◽  
Linda M. Posthuma ◽  
Maarten J. Visscher ◽  
Martine J. M. Breteler ◽  
...  
Keyword(s):  
Early Detection ◽  
Adverse Events ◽  
Vital Sign ◽  
Vital Signs ◽  
Adaptive Threshold ◽  
Situational Factors ◽  
Alarm Fatigue ◽  
Vital Signs Monitoring ◽  
Surgical Ward ◽  
Increased Sensitivity

AbstractContinuous vital signs monitoring in post-surgical ward patients may support early detection of clinical deterioration, but novel alarm approaches are required to ensure timely notification of abnormalities and prevent alarm-fatigue. The current study explored the performance of classical and various adaptive threshold-based alarm strategies to warn for vital sign abnormalities observed during development of an adverse event. A classical threshold-based alarm strategy used for continuous vital signs monitoring in surgical ward patients was evaluated retrospectively. Next, (combinations of) six methods to adapt alarm thresholds to personal or situational factors were simulated in the same dataset. Alarm performance was assessed using the overall alarm rate and sensitivity to detect adverse events. Using a wireless patch-based monitoring system, 3999 h of vital signs data was obtained in 39 patients. The clinically used classical alarm system produced 0.49 alarms/patient/day, and alarms were generated for 11 out of 18 observed adverse events. Each of the tested adaptive strategies either increased sensitivity to detect adverse events or reduced overall alarm rate. Combining specific strategies improved overall performance most and resulted in earlier presentation of alarms in case of adverse events. Strategies that adapt vital sign alarm thresholds to personal or situational factors may improve early detection of adverse events or reduce alarm rates as compared to classical alarm strategies. Accordingly, further investigation of the potential of adaptive alarms for continuous vital signs monitoring in ward patients is warranted.

scholarly journals Expectations of Continuous Vital Signs Monitoring for Recognizing Complications After Esophagectomy: Interview Study Among Nurses and Surgeons (Preprint)

2020 ◽  
Author(s):  
Mathilde van Rossum ◽  
Jobbe Leenen ◽  
Feike Kingma ◽  
Martine Breteler ◽  
Richard van Hillegersberg ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Clinical Outcome ◽  
Clinical Outcomes ◽  
Early Recognition ◽  
Vital Signs ◽  
Patient Characteristics ◽  
Situational Factors ◽  
Vital Signs Monitoring ◽  
Surgical Ward ◽  
The Impact

BACKGROUND Patients undergoing esophagectomy are at serious risk of developing postoperative complications. To support early recognition of clinical deterioration, wireless sensor technologies that enable continuous vital signs monitoring in a ward setting are emerging. OBJECTIVE This study explored nurses’ and surgeons’ expectations of the potential effectiveness and impact of continuous wireless vital signs monitoring in patients admitted to the ward after esophagectomy. METHODS Semistructured interviews were conducted at 3 esophageal cancer centers in the Netherlands. In each center, 2 nurses and 2 surgeons were interviewed regarding their expectations of continuous vital signs monitoring for early recognition of complications after esophagectomy. Historical data of patient characteristics and clinical outcomes were collected in each center and presented to the local participants to support estimations on clinical outcome. RESULTS The majority of nurses and surgeons expected that continuous vital signs monitoring could contribute to the earlier recognition of deterioration and result in earlier treatment for postoperative complications, although the effective time gain would depend on patient and situational factors. Their expectations regarding the impact of potential earlier diagnosis on clinical outcomes varied. Nevertheless, most caregivers would consider implementing continuous monitoring in the surgical ward to support patient monitoring after esophagectomy. CONCLUSIONS Caregivers expected that wireless vital signs monitoring would provide opportunities for early detection of postoperative complications in patients undergoing esophagectomy admitted to the ward and prevent sequelae under certain circumstances. As the technology matures, clinical outcome studies will be necessary to objectify these expectations and further investigate overall effects on patient outcome.

scholarly journals Expectations of Continuous Vital Signs Monitoring for Recognizing Complications After Esophagectomy: Interview Study Among Nurses and Surgeons

10.2196/22387 ◽  
2021 ◽  
Vol 4 (1) ◽  
pp. e22387
Author(s):  
Mathilde van Rossum ◽  
Jobbe Leenen ◽  
Feike Kingma ◽  
Martine Breteler ◽  
Richard van Hillegersberg ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Clinical Outcome ◽  
Clinical Outcomes ◽  
Early Recognition ◽  
Vital Signs ◽  
Patient Characteristics ◽  
Situational Factors ◽  
Vital Signs Monitoring ◽  
Surgical Ward ◽  
The Impact

Background Patients undergoing esophagectomy are at serious risk of developing postoperative complications. To support early recognition of clinical deterioration, wireless sensor technologies that enable continuous vital signs monitoring in a ward setting are emerging. Objective This study explored nurses’ and surgeons’ expectations of the potential effectiveness and impact of continuous wireless vital signs monitoring in patients admitted to the ward after esophagectomy. Methods Semistructured interviews were conducted at 3 esophageal cancer centers in the Netherlands. In each center, 2 nurses and 2 surgeons were interviewed regarding their expectations of continuous vital signs monitoring for early recognition of complications after esophagectomy. Historical data of patient characteristics and clinical outcomes were collected in each center and presented to the local participants to support estimations on clinical outcome. Results The majority of nurses and surgeons expected that continuous vital signs monitoring could contribute to the earlier recognition of deterioration and result in earlier treatment for postoperative complications, although the effective time gain would depend on patient and situational factors. Their expectations regarding the impact of potential earlier diagnosis on clinical outcomes varied. Nevertheless, most caregivers would consider implementing continuous monitoring in the surgical ward to support patient monitoring after esophagectomy. Conclusions Caregivers expected that wireless vital signs monitoring would provide opportunities for early detection of postoperative complications in patients undergoing esophagectomy admitted to the ward and prevent sequelae under certain circumstances. As the technology matures, clinical outcome studies will be necessary to objectify these expectations and further investigate overall effects on patient outcome.

Advance Monitoring of Blood Pressure and Respiratory Rate Using De-Noising Auto Encoder

2021 ◽  
Author(s):  
Seung-Ho Park ◽  
Kyoung-Su Park
Keyword(s):  
Blood Pressure ◽  
Respiratory Rate ◽  
Vital Sign ◽  
Superficial Temporal Artery ◽  
Vital Signs ◽  
Pulse Signal ◽  
Temporal Artery ◽  
Sinus Arrhythmia ◽  
Vital Signs Monitoring ◽  
Vital Sign Measurement

Abstract As the importance of continuous vital signs monitoring increases, the need for wearable devices to measure vital sign is increasing. In this study, the device is designed to measure blood pressure (BP), respiratory rate (RR), and heartrate (HR) with one sensor. The device is in earphone format and is manufactured as wireless type using Arduino-based bluetooth module. The device measures pulse signal in the Superficial temporal artery using Photoplethysmograghy (PPG) sensor. The device uses the Auto Encoder to remove noise caused by movement, etc., contained in the pulse signal. Extract the feature from the pulse signal and use them for the vital sign measurement. The device is measured using Slope transit time (STT) method for BP and Respiratory sinus arrhythmia (RSA) method for RR. Finally, the accuracy is determined by comparing the vital signs measured through the device with the reference vital signs measured simultaneously.

scholarly journals Reliability of a wearable wireless patch for continuous remote monitoring of vital signs in patients recovering from major surgery: a clinical validation study from the TRaCINg trial

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e031150 ◽  
Author(s):  
Candice Downey ◽  
Shu Ng ◽  
David Jayne ◽  
David Wong
Keyword(s):  
Monitoring System ◽  
Vital Sign ◽  
Vital Signs ◽  
University Hospital ◽  
Secondary Outcome ◽  
Major Surgery ◽  
Limits Of Agreement ◽  
Temperature Bias ◽  
Vital Signs Monitoring ◽  
Recorded Data

ObjectiveTo validate whether a wearable remote vital signs monitor could accurately measure heart rate (HR), respiratory rate (RR) and temperature in a postsurgical patient population at high risk of complications.DesignManually recorded vital signs data were paired with vital signs data derived from the remote monitor set in patients participating in the Trial of Remote versus Continuous INtermittent monitoring (TRaCINg) study: a trial of continuous remote vital signs monitoring.SettingSt James’s University Hospital, UK.Participants51 patients who had undergone major elective general surgery.InterventionsThe intervention was the SensiumVitals monitoring system. This is a wireless patch worn on the patient’s chest that measures HR, RR and temperature continuously. The reference standard was nurse-measured manually recorded vital signs.Primary and secondary outcome measuresThe primary outcomes were the 95% limits of agreement between manually recorded and wearable patch vital sign recordings of HR, RR and temperature. The secondary outcomes were the percentage completeness of vital sign patch data for each vital sign.Results1135 nurse observations were available for analysis. There was no clinically meaningful bias in HR (1.85 bpm), but precision was poor (95% limits of agreement −23.92 to 20.22 bpm). Agreement was poor for RR (bias 2.93 breaths per minute, 95% limits of agreement −8.19 to 14.05 breaths per minute) and temperature (bias 0.82°C, 95% limits of agreement −1.13°C to 2.78°C). Vital sign patch data completeness was 72.8% for temperature, 59.2% for HR and 34.1% for RR. Distributions of RR in manually recorded measurements were clinically implausible.ConclusionsThe continuous monitoring system did not reliably provide HR consistent with nurse measurements. The accuracy of RR and temperature was outside of acceptable limits. Limitations of the system could potentially be overcome through better signal processing. While acknowledging the time pressures placed on nursing staff, inaccuracies in the manually recorded data present an opportunity to increase awareness about the importance of manual observations, particularly with regard to methods of manual HR and RR measurements.

Remote wireless vital signs monitoring on the ward for early detection of deteriorating patients: A case series

2020 ◽  
Vol 104 ◽  
pp. 103515 ◽  
Author(s):  
L.M. Posthuma ◽  
C. Downey ◽  
M.J. Visscher ◽  
D.A. Ghazali ◽  
M. Joshi ◽  
...  
Keyword(s):  
Early Detection ◽  
Vital Signs ◽  
Case Series ◽  
Vital Signs Monitoring

Pulse oximetry and the enduring neglect of respiratory rate assessment: a commentary on patient surveillance

2019 ◽  
Vol 28 (19) ◽  
pp. 1256-1259
Author(s):  
Malcolm Elliott ◽  
Jill Baird
Keyword(s):  
Pulse Oximetry ◽  
Respiratory Rate ◽  
Vital Sign ◽  
Vital Signs ◽  
Clinical Tool ◽  
Vital Signs Monitoring ◽  
Poor Understanding ◽  
Clinical Surveillance ◽  
The Common ◽  
Assessment Research

Clinical surveillance provides essential data on changes in a patient's condition. The common method for performing this surveillance is the assessment of vital signs. Despite the importance of these signs, research has found that vital signs are not rigorously assessed in clinical practice. Respiratory rate, arguably the most important vital sign, is the most neglected. Poor understanding might contribute to nurses incorrectly valuing oxygen saturation more than respiratory rate. Nurses need to understand the importance of respiratory rate assessment as a vital sign and the benefits and limitations of pulse oximetry as a clinical tool. By better understanding pulse oximetry and respiratory rate assessment, nurses might be more inclined to conduct rigorous vital signs' assessment. Research is needed to understand why many nurses do not appreciate the importance of vital signs' monitoring.

scholarly journals A preliminary assessment of vital-signs-integrated patient-assisted intravenous opioid analgesia (VPIA) for postsurgical pain

2020 ◽  
Author(s):  
Ban Leong SNG ◽  
Daryl Jian'an Tan ◽  
Chin Wen TAN ◽  
Nian-Lin Reena HAN ◽  
Rehena SULTANA ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Pain Relief ◽  
Oxygen Saturation ◽  
Vital Sign ◽  
Infusion Pump ◽  
Vital Signs ◽  
Oxygen Desaturation ◽  
Opioid Analgesia ◽  
Median Percentage ◽  
Vital Signs Monitoring

Abstract Background: We developed a Vital-signs-integrated Patient-assisted Intravenous opioid Analgesia (VPIA) analgesic infusion pump, a closed-loop vital signs monitoring and drug delivery system which embodied in a novel algorithm that took into account patients’ vital signs (oxygen saturation, heart rate). The system aimed to allow responsive titration of personalized pain relief to optimize pain relief and reduce the risk of respiratory depression. Moreover, the system would be important to enable continuous monitoring of patients during delivery of opioid analgesia.Methods: Nineteen patients who underwent elective gynecological surgery with postoperative patient controlled analgesia (PCA) with morphine were recruited. The subjects were followed up from their admission to the recovery room/ ward for at least 24 hours until assessment of patient satisfaction on the VPIA analgesic infusion pump.Results: The primary outcome measure of incidence of oxygen desaturation showed all patients had at least one episode of oxygen desaturation (<95%) during the study period. Only 6 (31.6%) patients had oxygen desaturation that persisted for more than 5 minutes. The median percentage time spent during treatment that oxygen saturation fell below 95% was 1.9%. Fourteen (73.7%) out of 19 patients encountered safety pause, due to transient oxygen desaturation or bradycardia. The patients’ median [IQR] pain scores at rest and at movement after post-op 24 hours were 0.0 [2.0] and 3.0 [2.0], respectively. The average morphine consumption in the first 24 hours was 12.5 ± 7.1mg. All patients were satisfied with their experience with the VPIA analgesic infusion pump. Conclusions: The use of VPIA analgesic infusion pump, when integrated with continuous vital sign monitor and variable lockout algorithm, was able to provide pain relief with good patient satisfaction.Keywords: infusion pump, postoperative pain, vital sign monitoring, oxygen desaturation.Trial registration: This study was registered on clinicaltrials.gov registry (NCT02804022) on 28 Feb 2016.

scholarly journals Multiple Patient Monitoring in High Dependency Units: A Field Study

2019 ◽  
Vol 63 (1) ◽  
pp. 669-669
Author(s):  
Marie-Lys F. A. Deschamps ◽  
Penelope M. Sanderson
Keyword(s):  
Critical Care ◽  
Simulation Study ◽  
Vital Sign ◽  
Patient Monitoring ◽  
Vital Signs ◽  
Well Being ◽  
Alarm Fatigue ◽  
Critical Care Units ◽  
High Dependency ◽  
Australian Hospital

Much of the focus related to alarm fatigue has been directed towards reducing the number of alarms associated with vital sign monitoring. However, recent fieldwork conducted in four high dependency and critical care units of an Australian hospital suggests that the most problematic alarms were often unassociated with vital signs, such as IV pumps and mattress alarms. Many nurses indicated that they like alarms, even when false, because they support awareness of their patients’ well-being. Results of the fieldwork are guiding the design of a simulation study investigating clinical monitoring displays.

scholarly journals Preclinical evaluation of noncontact vital signs monitoring using real-time IR-UWB radar and factors affecting its accuracy

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jun-Young Park ◽  
Yonggu Lee ◽  
Ran Heo ◽  
Hyun-Kyung Park ◽  
Seok-Hyun Cho ◽  
...  
Keyword(s):  
Real Time ◽  
Vital Sign ◽  
Vital Signs ◽  
Embedded Processors ◽  
Sitting Position ◽  
Mixed Effect ◽  
Factors Affecting ◽  
Vital Signs Monitoring ◽  
Uwb Radar ◽  
The Absolute

AbstractRecently, noncontact vital sign monitors have attracted attention because of issues related to the transmission of contagious diseases. We developed a real-time vital sign monitor using impulse-radio ultrawideband (IR-UWB) radar with embedded processors and software; we then evaluated its accuracy in measuring heart rate (HR) and respiratory rate (RR) and investigated the factors affecting the accuracy of the radar-based measurements. In 50 patients visiting a cardiology clinic, HR and RR were measured using IR-UWB radar simultaneously with electrocardiography and capnometry. All patients underwent HR and RR measurements in 2 postures—supine and sitting—for 2 min each. There was a high agreement between the RR measured using radar and capnometry (concordance correlation coefficient [CCC] 0.925 [0.919–0.926]; upper and lower limits of agreement [LOA], − 2.21 and 3.90 breaths/min). The HR measured using radar was also in close agreement with the value measured using electrocardiography (CCC 0.749 [0.738–0.760]; upper and lower LOA, − 12.78 and 15.04 beats/min). Linear mixed effect models showed that the sitting position and an HR < 70 bpm were associated with an increase in the absolute biases of the HR, whereas the sitting position and an RR < 18 breaths/min were associated with an increase in the absolute biases of the RR. The IR-UWB radar sensor with embedded processors and software can measure the RR and HR in real time with high precision. The sitting position and a low RR or HR were associated with the accuracy of RR and HR measurement, respectively, using IR-UWB radar.

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