Automated continuous noninvasive ward monitoring: future directions and challenges

Khanna, Ashish K.; Hoppe, Phillip; Saugel, Bernd

doi:10.1186/s13054-019-2485-7

Cited by 71 publications

(66 citation statements)

References 39 publications

(40 reference statements)

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“…The outcomes of interest were as follows: validation (eg, sensitivity, specificity, limits of agreement [LoA]), feasibility (eg, acceptability, user experiences, system fidelity), clinical outcomes (eg, mortality, length of stay, fail-to-rescue [FTR], intensive care unit [ICU] admission), and costs (eg, cost-minimization, cost-benefit, cost-effectiveness, or cost-utility outcomes) [ 25 , 32 - 35 ].…”

Section: Methodsmentioning

confidence: 99%

“…Therefore, continuous monitoring devices should preferably be portable, wireless, and wearable on an easily accessible body part [ 18 , 24 ]. Such wearable devices also have the potential to be used for continuous monitoring of the vital signs of the patients at home or in rehabilitation centers, thereby possibly leading to reduced length of hospital stay and preventing unplanned readmissions [ 25 ].…”

Section: Introductionmentioning

confidence: 99%

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Current Evidence for Continuous Vital Signs Monitoring by Wearable Wireless Devices in Hospitalized Adults: Systematic Review

Leenen¹,

Leerentveld²,

Dijk³

et al. 2020

J Med Internet Res

127

128

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Background Continuous monitoring of vital signs by using wearable wireless devices may allow for timely detection of clinical deterioration in patients in general wards in comparison to detection by standard intermittent vital signs measurements. A large number of studies on many different wearable devices have been reported in recent years, but a systematic review is not yet available to date. Objective The aim of this study was to provide a systematic review for health care professionals regarding the current evidence about the validation, feasibility, clinical outcomes, and costs of wearable wireless devices for continuous monitoring of vital signs. Methods A systematic and comprehensive search was performed using PubMed/MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials from January 2009 to September 2019 for studies that evaluated wearable wireless devices for continuous monitoring of vital signs in adults. Outcomes were structured by validation, feasibility, clinical outcomes, and costs. Risk of bias was determined by using the Mixed Methods Appraisal Tool, quality assessment of diagnostic accuracy studies 2nd edition, or quality of health economic studies tool. Results In this review, 27 studies evaluating 13 different wearable wireless devices were included. These studies predominantly evaluated the validation or the feasibility outcomes of these devices. Only a few studies reported the clinical outcomes with these devices and they did not report a significantly better clinical outcome than the standard tools used for measuring vital signs. Cost outcomes were not reported in any study. The quality of the included studies was predominantly rated as low or moderate. Conclusions Wearable wireless continuous monitoring devices are mostly still in the clinical validation and feasibility testing phases. To date, there are no high quality large well-controlled studies of wearable wireless devices available that show a significant clinical benefit or cost-effectiveness. Such studies are needed to help health care professionals and administrators in their decision making regarding implementation of these devices on a large scale in clinical practice or in-home monitoring.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Current Evidence for Continuous Vital Signs Monitoring by Wearable Wireless Devices in Hospitalized Adults: Systematic Review

Leenen¹,

Leerentveld²,

Dijk³

et al. 2020

J Med Internet Res

127

128

View full text Add to dashboard Cite

show abstract

“…By allowing continuous vital signs monitoring even while mobilizing, these technologies may aid early recognition of clinical deterioration in ward patients [ 14 - 18 ] and could therefore be of interest for patients undergoing esophagectomy. However, despite the potential promises, the technology is still immature, and further developments are needed to facilitate optimal implementation [ 19 , 20 ]. Furthermore, it is as of yet unclear how continuous monitoring should be integrated in current routines to promote effective care escalation.…”

Section: Introductionmentioning

confidence: 99%

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

Rossum¹,

Leenen²,

Kingma³

et al. 2021

JMIR Perioper Med

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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.

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“…The hypothesis is that the health status of patients admitted to hospitals is not suddenly deteriorating. Monitoring vital sign trends over time can provide early diagnosis and allow physicians or caregivers to make timely decisions [ 9 ]. In this study, we introduce a new approach using a contactless system that is based on the ballistocardiographic principle for detecting abnormal breathing events (ie, apneas and hypopneas) in an effort to address one of today’s health care issues.…”

Section: Introductionmentioning

confidence: 99%

A New Approach for Detecting Sleep Apnea Using a Contactless Bed Sensor: Comparison Study

Sadek¹,

Heng²,

Seet³

et al. 2020

J Med Internet Res

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Background At present, there is an increased demand for accurate and personalized patient monitoring because of the various challenges facing health care systems. For instance, rising costs and lack of physicians are two serious problems affecting the patient’s care. Nonintrusive monitoring of vital signs is a potential solution to close current gaps in patient monitoring. As an example, bed-embedded ballistocardiogram (BCG) sensors can help physicians identify cardiac arrhythmia and obstructive sleep apnea (OSA) nonintrusively without interfering with the patient’s everyday activities. Detecting OSA using BCG sensors is gaining popularity among researchers because of its simple installation and accessibility, that is, their nonwearable nature. In the field of nonintrusive vital sign monitoring, a microbend fiber optic sensor (MFOS), among other sensors, has proven to be suitable. Nevertheless, few studies have examined apnea detection. Objective This study aims to assess the capabilities of an MFOS for nonintrusive vital signs and sleep apnea detection during an in-lab sleep study. Data were collected from patients with sleep apnea in the sleep laboratory at Khoo Teck Puat Hospital. Methods In total, 10 participants underwent full polysomnography (PSG), and the MFOS was placed under the patient’s mattress for BCG data collection. The apneic event detection algorithm was evaluated against the manually scored events obtained from the PSG study on a minute-by-minute basis. Furthermore, normalized mean absolute error (NMAE), normalized root mean square error (NRMSE), and mean absolute percentage error (MAPE) were employed to evaluate the sensor capabilities for vital sign detection, comprising heart rate (HR) and respiratory rate (RR). Vital signs were evaluated based on a 30-second time window, with an overlap of 15 seconds. In this study, electrocardiogram and thoracic effort signals were used as references to estimate the performance of the proposed vital sign detection algorithms. Results For the 10 patients recruited for the study, the proposed system achieved reasonable results compared with PSG for sleep apnea detection, such as an accuracy of 49.96% (SD 6.39), a sensitivity of 57.07% (SD 12.63), and a specificity of 45.26% (SD 9.51). In addition, the system achieved close results for HR and RR estimation, such as an NMAE of 5.42% (SD 0.57), an NRMSE of 6.54% (SD 0.56), and an MAPE of 5.41% (SD 0.58) for HR, whereas an NMAE of 11.42% (SD 2.62), an NRMSE of 13.85% (SD 2.78), and an MAPE of 11.60% (SD 2.84) for RR. Conclusions Overall, the recommended system produced reasonably good results for apneic event detection, considering the fact that we are using a single-channel BCG sensor. Conversely, satisfactory results were obtained for vital sign detection when compared with the PSG outcomes. These results provide preliminary support for the potential use of the MFOS for sleep apnea detection.

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Automated continuous noninvasive ward monitoring: future directions and challenges

Cited by 71 publications

References 39 publications

Current Evidence for Continuous Vital Signs Monitoring by Wearable Wireless Devices in Hospitalized Adults: Systematic Review

Current Evidence for Continuous Vital Signs Monitoring by Wearable Wireless Devices in Hospitalized Adults: Systematic Review

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

A New Approach for Detecting Sleep Apnea Using a Contactless Bed Sensor: Comparison Study

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