scholarly journals Reliability of wireless monitoring using a wearable patch sensor in high-risk surgical patients at a step-down unit in the Netherlands: a clinical validation study

BMJ Open ◽  
2018 ◽  
Vol 8 (2) ◽  
pp. e020162 ◽  
Author(s):  
Martine J M Breteler ◽  
Erik Huizinga ◽  
Kim van Loon ◽  
Luke P H Leenen ◽  
Daan A J Dohmen ◽  
...  
Keyword(s):  
Heart Rate ◽  
High Risk ◽  
Outcome Measures ◽  
Vital Signs ◽  
Wireless Sensor ◽  
Surgical Patients ◽  
Data Loss ◽  
Limits Of Agreement ◽  
Patient Deterioration ◽  
Step Down

Background and objectivesIntermittent vital signs measurements are the current standard on hospital wards, typically recorded once every 8 hours. Early signs of deterioration may therefore be missed. Recent innovations have resulted in ‘wearable’ sensors, which may capture patient deterioration at an earlier stage. The objective of this study was to determine whether a wireless ‘patch’ sensor is able to reliably measure respiratory and heart rate continuously in high-risk surgical patients. The secondary objective was to explore the potential of the wireless sensor to serve as a safety monitor.DesignIn an observational methods comparisons study, patients were measured with both the wireless sensor and bedside routine standard for at least 24 hours.SettingUniversity teaching hospital, single centre.ParticipantsTwenty-five postoperative surgical patients admitted to a step-down unit.Outcome measuresPrimary outcome measures were limits of agreement and bias of heart rate and respiratory rate. Secondary outcome measures were sensor reliability, defined as time until first occurrence of data loss.Results1568 hours of vital signs data were analysed. Bias and 95% limits of agreement for heart rate were −1.1 (−8.8 to 6.5) beats per minute. For respiration rate, bias was −2.3 breaths per minute with wide limits of agreement (−15.8 to 11.2 breaths per minute). Median filtering over a 15 min period improved limits of agreement of both respiration and heart rate. 63% of the measurements were performed without data loss greater than 2 min. Overall data loss was limited (6% of time).ConclusionsThe wireless sensor is capable of accurately measuring heart rate, but accuracy for respiratory rate was outside acceptable limits. Remote monitoring has the potential to contribute to early recognition of physiological decline in high-risk patients. Future studies should focus on the ability to detect patient deterioration on low care environments and at home after discharge.

scholarly journals Vital Signs Monitoring with Wearable Sensors in High-risk Surgical Patients

2020 ◽  
Vol 132 (3) ◽  
pp. 424-439 ◽  
Author(s):  
Martine J. M. Breteler ◽  
Eline J. KleinJan ◽  
Daan A. J. Dohmen ◽  
Luke P. H. Leenen ◽  
Richard van Hillegersberg ◽  
...  
Keyword(s):  
High Risk ◽  
Wearable Sensors ◽  
Vital Signs ◽  
Surgical Patients ◽  
Major Surgery ◽  
Data Loss ◽  
Limits Of Agreement ◽  
Correct Treatment ◽  
Patient Deterioration ◽  
Vital Signs Monitoring

Abstract Background Vital signs are usually recorded once every 8 h in patients at the hospital ward. Early signs of deterioration may therefore be missed. Wireless sensors have been developed that may capture patient deterioration earlier. The objective of this study was to determine whether two wearable patch sensors (SensiumVitals [Sensium Healthcare Ltd., United Kingdom] and HealthPatch [VitalConnect, USA]), a bed-based system (EarlySense [EarlySense Ltd., Israel]), and a patient-worn monitor (Masimo Radius-7 [Masimo Corporation, USA]) can reliably measure heart rate (HR) and respiratory rate (RR) continuously in patients recovering from major surgery. Methods In an observational method comparison study, HR and RR of high-risk surgical patients admitted to a step-down unit were simultaneously recorded with the devices under test and compared with an intensive care unit–grade monitoring system (XPREZZON [Spacelabs Healthcare, USA]) until transition to the ward. Outcome measures were 95% limits of agreement and bias. Clarke Error Grid analysis was performed to assess the ability to assist with correct treatment decisions. In addition, data loss and duration of data gaps were analyzed. Results Twenty-five high-risk surgical patients were included. More than 700 h of data were available for analysis. For HR, bias and limits of agreement were 1.0 (–6.3, 8.4), 1.3 (–0.5, 3.3), –1.4 (–5.1, 2.3), and –0.4 (–4.0, 3.1) for SensiumVitals, HealthPatch, EarlySense, and Masimo, respectively. For RR, these values were –0.8 (–7.4, 5.6), 0.4 (–3.9, 4.7), and 0.2 (–4.7, 4.4) respectively. HealthPatch overestimated RR, with a bias of 4.4 (limits: –4.4 to 13.3) breaths/minute. Data loss from wireless transmission varied from 13% (83 of 633 h) to 34% (122 of 360 h) for RR and 6% (47 of 727 h) to 27% (182 of 664 h) for HR. Conclusions All sensors were highly accurate for HR. For RR, the EarlySense, SensiumVitals sensor, and Masimo Radius-7 were reasonably accurate for RR. The accuracy for RR of the HealthPatch sensor was outside acceptable limits. Trend monitoring with wearable sensors could be valuable to timely detect patient deterioration. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

Remote Monitoring of Patients with Hematologic Malignancies at High-Risk of Febrile Neutropenia (Preprint)

2021 ◽  
Author(s):  
Maxwell Jared Kroloff ◽  
Ramin Ramezani ◽  
Holly Wilhalme ◽  
Arash Naeim
Keyword(s):  
Heart Rate ◽  
High Risk ◽  
Febrile Neutropenia ◽  
Oxygen Saturation ◽  
Real Time ◽  
Monitoring System ◽  
Remote Monitoring ◽  
Vital Signs ◽  
Hematologic Malignancies ◽  
Remote Monitoring System

BACKGROUND Febrile neutropenia represents one of the most common oncologic emergencies and is associated with significant, preventable morbidity and mortality. The vast majority of patients suffering a febrile neutropenia episode are hospitalized, resulting in significant economic cost. OBJECTIVE This exploratory study implemented a remote monitoring platform including a digital infrared thermometer and a pulse oximeter with the capability to notify providers in real-time of vital signs abnormalities that could suggest early clinical deterioration, and thereby improve upon clinical outcomes. METHODS The remote monitoring system was implemented versus standard of care vital signs monitoring in hospitalized patients with underlying hematologic malignancies complicated by a febrile neutropenia episode in order to assess both feasibility and validity of the system. RESULTS Intraclass correlation coefficient analysis (ICC), confirmed the high repeatability and accuracy of heart rate assessment (ICC= 0.856), acting as a supplement to sole, remote temperature assessment. While the sensitivity and specificity for capturing tachycardia above a rate of 100 was excellent (88% and 97% respectively), the sensitivity of the remote monitoring system capturing temperature greater than 100 degrees Fahrenheit and oxygen saturation less than 92% was 45% and 50% respectively. CONCLUSIONS Overall, this novel approach including temperature, heart rate and oxygen saturation assessment successfully provides real-time, clinically valuable feedback to providers. While the temperature and oxygen saturation lags in terms of sensitivity when compared to a standard in-hospital system, the heart rate data helps overcome some of this deficit, and as a whole, the system provides additional information that can be applied to a clinically vulnerable population. By transitioning its application to the high-risk patients in the outpatient setting, the novel system can help prevent additional healthcare utilization through early provider intervention and potentially improve outcomes.

scholarly journals Feasibility of continuous monitoring of vital signs in surgical patients on a general ward: an observational cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e042735
Author(s):  
Jobbe P L Leenen ◽  
Eline M Dijkman ◽  
Joris D van Dijk ◽  
Henderik L van Westreenen ◽  
Cor Kalkman ◽  
...  
Keyword(s):  
Heart Rate ◽  
Cohort Study ◽  
Respiratory Rate ◽  
Vital Sign ◽  
Continuous Monitoring ◽  
Vital Signs ◽  
Observational Cohort Study ◽  
General Ward ◽  
Surgical Patients ◽  
Observational Cohort

ObjectiveTo determine feasibility, in terms of acceptability and system fidelity, of continuous vital signs monitoring in abdominal surgery patients on a general ward.DesignObservational cohort study.SettingTertiary teaching hospital.ParticipantsPostoperative abdominal surgical patients (n=30) and nurses (n=23).InterventionsPatients were continuously monitored with the SensiumVitals wearable device until discharge in addition to usual care, which is intermittent Modified Early Warning Score measurements. Heart rate, respiratory rate and axillary temperature were monitored every 2 min. Values and trends were visualised and alerts sent to the nurses.OutcomesSystem fidelity was measured by analysis of the monitoring data. Acceptability by patients and nurses was assessed using questionnaires.ResultsThirty patients were monitored for a median duration of 81 hours (IQR 47–143) per patient, resulting in 115 217 measurements per parameter. In total, 19% (n=21 311) of heart rate, 51% (n=59 184) of respiratory rate and 9% of temperature measurements showed artefacts (n=10 269). The system algorithm sent 972 alerts (median alert rate of 4.5 per patient per day), of which 90.3% (n=878) were system alerts and 9.7% (n=94) were vital sign alerts. 35% (n=33) of vital sign alerts were true positives. 93% (n=25) of patients rated the patch as comfortable, 67% (n=18) felt safer and 89% (n=24) would like to wear it next time in the hospital. Nurses were neutral about usefulness, with a median score of 3.5 (IQR 3.1–4) on a 7-point Likert scale, ease of use 3.7 (IQR 3.2–4.8) and satisfaction 3.7 (IQR 3.2–4.8), but agreed on ease of learning at 5.0 (IQR 4.0–5.8). Neutral scores were mostly related to the perceived limited fidelity of the system.ConclusionsContinuous monitoring of vital signs with a wearable device was well accepted by patients. Nurses’ ratings were highly variable, resulting in on average neutral attitude towards remote monitoring. Our results suggest it is feasible to monitor vital signs continuously on general wards, although acceptability of the device among nurses needs further improvement.

scholarly journals Elevated preoperative heart rate is associated with cardiopulmonary and autonomic impairment in high-risk surgical patients

2017 ◽  
Vol 119 (1) ◽  
pp. 87-94 ◽  
Author(s):  
T.E.F. Abbott ◽  
G. Minto ◽  
A.M. Lee ◽  
R.M. Pearse ◽  
G.L. Ackland
Keyword(s):  
Heart Rate ◽  
High Risk ◽  
Surgical Patients

Quality management in the prophylaxis of venous thrombembolism - Results of a survey including 464 medical and surgical patients

VASA ◽  
2011 ◽  
Vol 40 (2) ◽  
pp. 123-130
Author(s):  
Klein-Weigel ◽  
Richter ◽  
Arendt ◽  
Gerdsen ◽  
Härtwig ◽  
...  
Keyword(s):  
Renal Function ◽  
High Risk ◽  
Quality Management ◽  
High Risk Group ◽  
Surgical Patients ◽  
Medical Patients ◽  
Risk Status ◽  
Vte Prophylaxis ◽  
Safety Concerns

Background: We surveyed the quality of risk stratification politics and monitored the rate of entries to our company-wide protocol for venous thrombembolism (VTE) prophylaxis in order to identify safety concerns. Patients and methods: Audit in 464 medical and surgical patients to evaluate quality of VTE prophylaxis. Results: Patients were classified as low 146 (31 %), medium 101 (22 %), and high risk cases 217 (47 %). Of these 262 (56.5 %) were treated according to their risk status and in accordance with our protocol, while 9 more patients were treated according to their risk status but off-protocol. Overtreatment was identified in 73 (15.7 %), undertreatment in 120 (25,9 %) of all patients. The rate of incorrect prophylaxis was significantly different between the risk categories, with more patients of the high-risk group receiving inadequate medical prophylaxis (data not shown; p = 0.038). Renal function was analyzed in 392 (84.5 %) patients. In those patients with known renal function 26 (6.6 %) received improper medical prophylaxis. If cases were added in whom prophylaxis was started without previous creatinine control, renal function was not correctly taken into account in 49 (10.6 %) of all patients. Moreover, deterioration of renal function was not excluded within one week in 78 patients (16.8 %) and blood count was not re-checked in 45 (9.7 %) of all patients after one week. There were more overtreatments in surgical (n = 53/278) and more undertreatments in medical patients (n = 54/186) (p = 0.04). Surgeons neglected renal function and blood controls significantly more often than medical doctors (p-values for both < 0.05). Conclusions: We found a low adherence with our protocol and substantial over- and undertreatment in VTE prophylaxis. Besides, we identified disregarding of renal function and safety laboratory examinations as additional safety concerns. To identify safety problems associated with medical VTE prophylaxis and “hot spots” quality management-audits proved to be valuable instruments.

Closure of median sternotomy by the Sternal Talon®-system in high-risk cardiac surgical patients

2010 ◽  
Vol 58 (S 01) ◽  
Author(s):  
M Müller ◽  
C Heilmann ◽  
S Sorg ◽  
S Kueri ◽  
M Thoma ◽  
...  
Keyword(s):  
High Risk ◽  
Median Sternotomy ◽  
Surgical Patients

Implementation of a Cyber-Physical System Using Wireless Sensor Networks for Monitoring Patients

2015 ◽  
Vol 1 ◽  
pp. 26 ◽  
Author(s):  
Vo Que Son ◽  
Do Tan A
Keyword(s):  
Wireless Sensor Networks ◽  
Sensor Networks ◽  
Physical System ◽  
Patient Monitoring ◽  
High Reliability ◽  
Vital Signs ◽  
Wireless Sensor ◽  
Cyber Physical System ◽  
Self Administration ◽  
Hospital Units

Sensing, distributed computation and wireless communication are the essential building components of a Cyber-Physical System (CPS). Having many advantages such as mobility, low power, multi-hop routing, low latency, self-administration, utonomous data acquisition, and fault tolerance, Wireless Sensor Networks (WSNs) have gone beyond the scope of monitoring the environment and can be a way to support CPS. This paper presents the design, deployment, and empirical study of an eHealth system, which can remotely monitor vital signs from patients such as body temperature, blood pressure, SPO2, and heart rate. The primary contribution of this paper is the measurements of the proposed eHealth device that assesses the feasibility of WSNs for patient monitoring in hospitals in two aspects of communication and clinical sensing. Moreover, both simulation and experiment are used to investigate the performance of the design in many aspects such as networking reliability, sensing reliability, or end-to-end delay. The results show that the network achieved high reliability - nearly 97% while the sensing reliability of the vital signs can be obtained at approximately 98%. This indicates the feasibility and promise of using WSNs for continuous patient monitoring and clinical worsening detection in general hospital units.

External validation of a heart failure risk prediction model in a remote monitoring cohort submitted to cardiac resynchronization therapy

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
I Cardoso ◽  
M Coutinho ◽  
G Portugal ◽  
A Valentim ◽  
A.S Delgado ◽  
...  
Keyword(s):  
Heart Failure ◽  
Heart Rate ◽  
High Risk ◽  
Remote Monitoring ◽  
Hospital Admissions ◽  
External Validation ◽  
Left Ventricular Ejection ◽  
National Database ◽  
Failure Risk

Abstract Background Patients (P) submitted to cardiac ressynchronization therapy (CRT) are at high risk of heart failure (HF) events during follow-up. Continuous analysis of various physiological parameters, as reported by remote monitoring (RM), can contribute to point out incident HF admissions. Tailored evaluation, including multi-parameter modelling, may further increase the accuracy of such algorithms. Purpose Independent external validation of a commercially available algorithm (“Heart Failure Risk Status” HFRS, Medtronic, MN USA) in a cohort submitted to CRT implantation in a tertiary center. Methods Consecutive P submitted to CRT implantation between January 2013 and September 2019 who had regular RM transmissions were included. The HFRS algorithm includes OptiVol (Medtronic Plc., MN, USA), patient activity, night heart rate (NHR), heart rate variability (HRV), percentage of CRT pacing, atrial tachycardia/atrial fibrillation (AT/AF) burden, ventricular rate during AT/AF (VRAF), and detected arrhythmia episodes/therapy delivered. P were classified as low, medium or high risk. Hospital admissions were systematically assessed by use of a national database (“Plataforma de Dados de Saúde”). Accuracy of the HFRS algorithm was evaluated by random effects logistic regression for the outcome of unplanned hospital admission for HF in the 30 days following each transmission episode. Results 1108 transmissions of 35 CRT P, corresponding to 94 patient-years were assessed. Mean follow-up was 2.7 yrs. At implant, age was 67.6±9.8 yrs, left ventricular ejection fraction 28±7.8%, BNP 156.6±292.8 and NYHA class &gt;II in 46% of the P. Hospital admissions for HF were observed within 30 days in 9 transmissions. Stepwise increase in HFRS was significantly associated with higher risk of HF admission (odds ratio 12.7, CI 3.2–51.5). HFRS had good discrimination for HF events with receiving-operator curve AUC 0.812. Conclusions HFRS was significantly associated with incident HF admissions in a high-risk cohort. Prospective use of this algorithm may help guide HF therapy in CRT recipients. Funding Acknowledgement Type of funding source: None

Intranasal dexmedetomidine: the ideal drug for sedation in the pediatric echo lab?

2021 ◽  
pp. 1-5
Author(s):  
David E Saudek ◽  
Deborah Walbergh ◽  
Peter Bartz ◽  
Sara Shreve ◽  
Amy Schaal ◽  
...  
Keyword(s):  
Heart Rate ◽  
Heart Disease ◽  
Chart Review ◽  
Chloral Hydrate ◽  
Vital Signs ◽  
Cyanotic Heart Disease ◽  
Historical Cohort ◽  
Safety And Efficacy ◽  
Attractive Option ◽  
The Ideal

Abstract Background: Intranasal dexmedetomidine is an attractive option for procedural sedation in pediatrics due to ease of administration and its relatively short half-life. This study sought to compare the safety and efficacy of intranasal dexmedetomidine to a historical cohort of pediatric patients sedated using chloral hydrate in a pediatric echo lab. Methods: Chart review was performed to compare patients sedated between September, 2017 and October, 2019 using chloral hydrate and intranasal dexmedetomidine. Vital signs, time to sedation, duration of sedation, need for second dose of medication, rate of failed sedation, and impact on vital signs were compared between groups. Subgroup analysis was performed for those with complex and cyanotic heart disease. Results: Chloral hydrate was used in 356 patients and intranasal dexmedetomidine in 376. Patient age, complexity of heart disease, and duration of sedation were similar. Rates of failed sedation were very low and similar. Average heart rate and minimum heart rate were lower for those receiving intranasal dexmedetomidine than chloral hydrate. Impact on vital signs was similar for those with complex and cyanotic heart disease. No adverse events occurred in either group. Conclusions: Sedation with intranasal dexmedetomidine is comparable to chloral hydrate in regards to safety and efficacy for children requiring echocardiography. Consistent with the mechanism of action, patients receiving intranasal dexmedetomidine have a lower heart rate without morbidity.

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