Continuous monitoring of vital sign abnormalities; association to clinical complications in 500 postoperative patients

Haahr-Raunkjær, Camilla; Mølgaard, Jesper; Elvekjær, Mikkel; Rasmussen, Søren Møller; Achiam, Michael Patrick; Jørgensen, Lars N.; Søgaard, Mette; Grønbæk, K.; Oxbøll, Anne-Britt; Sørensen, Helge Bjarup Dissing; Meyhoff, Christian S.; Aasvang, Eske Kvanner

doi:10.1111/aas.14048

Cited by 26 publications

(30 citation statements)

References 40 publications

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“…In case of missing values in other variables used in the calculation of sustained deviations, the last observation was carried forward or backwards for a maximum of 30 mins in each direction. This is similar to other works from our group 13,14 . After a device was stopped, measurements were not carried forward.…”

Section: Methodssupporting

confidence: 78%

“…We performed a sample size calculation using the method from Happ et al 12 Using data from our previous study on postsurgical patients 13 where we found a median of 6 mins of cumulative SpO 2 < 85% postoperatively, based on the assumption that the median cumulative duration would be 1 min preoperatively. Using an 80% power and an alpha of 0.05, we calculated that we needed 33 observations.…”

Section: Methodsmentioning

confidence: 99%

“…This is similar to other works from our group. 13 , 14 After a device was stopped, measurements were not carried forward.…”

Section: Methodsmentioning

confidence: 99%

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Continuous wireless pre‐ and postoperative vital sign monitoring reveal new, severe desaturations after vascular surgery

Mølgaard

Rasmussen

Eiberg

et al. 2022

Acta Anaesthesiol Scand

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Objectives Postoperative deviating physiologic values (vital signs) may represent postoperative stress or emerging complications. But they can also reflect chronic preoperative values. Distinguishing between the two circumstances may influence the utility of using vital signs in patient monitoring. Thus, we aimed to describe the occurrence of vital sign deviations before and after major vascular surgery, hypothesising that preoperative vital sign deviations were longer in duration postoperatively. Methods In this prospective observational study, arterial vascular patients were continuously monitored wirelessly ‐ from the day before until 5 days after surgery. Recorded values were: heart rate, respiration rate, peripheral arterial oxygen saturation (SpO2) and blood pressure. The outcomes were 1. cumulative duration of SpO2 < 85% / 24 h, and 2. cumulative duration per 24 h of vital sign deviations. Results Forty patients were included with a median monitoring time of 21 h preoperatively and 42 h postoperatively. The median duration of SpO2 < 85% preoperatively was 14.4 min/24 h whereas it was 28.0 min/24 h during day 0 in the ward (p = .09), and 16.8 min/24 h on day 1 in the ward (p = 0.61). Cumulative duration of SpO2 < 80% was significantly longer on day 0 in the ward 2.4 min/24 h (IQR 0.0–4.6) versus 6.7 min/24 h (IQR 1.8–16.2) p = 0.01. Conclusion Deviating physiology is common in patients before and after vascular surgery. A longer duration of severe desaturation was found on the first postoperative day in the ward compared to preoperatively, whereas moderate desaturations were reflected in postoperative desaturations. Cumulative duration outside thresholds is, in some cases, exacerbated after surgery.

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Section: Methodssupporting

confidence: 78%

Section: Methodsmentioning

confidence: 99%

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Continuous wireless pre‐ and postoperative vital sign monitoring reveal new, severe desaturations after vascular surgery

Mølgaard

Rasmussen

Eiberg

et al. 2022

Acta Anaesthesiol Scand

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“…Conclusions can only be drawn for COVID-19 patients. For other patient populations, alternative vital signs and summary measures might be more informative [ 31 ]. Since the continuous monitoring system was not implemented alongside standard intermittent monitoring, we could not compare the performance of summary measures with care as usual.…”

Section: Discussionmentioning

confidence: 99%

Association of Continuously Measured Vital Signs With Respiratory Insufficiency in Hospitalized COVID-19 Patients: Retrospective Cohort Study

Goor¹,

Vernooij²,

Breteler³

et al. 2022

Interact J Med Res

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Background Continuous monitoring of vital signs has the potential to assist in the recognition of deterioration of patients admitted to the general ward. However, methods to efficiently process and use continuously measured vital sign data remain unclear. Objective The aim of this study was to explore methods to summarize continuously measured vital sign data and evaluate their association with respiratory insufficiency in COVID-19 patients at the general ward. Methods In this retrospective cohort study, we included patients admitted to a designated COVID-19 cohort ward equipped with continuous vital sign monitoring. We collected continuously measured data of respiratory rate, heart rate, and oxygen saturation. For each patient, 7 metrics to summarize vital sign data were calculated: mean, slope, variance, occurrence of a threshold breach, number of episodes, total duration, and area above/under a threshold. These summary measures were calculated over timeframes of either 4 or 8 hours, with a pause between the last data point and the endpoint (the “lead”) of 4, 2, 1, or 0 hours, and with 3 predefined thresholds per vital sign. The association between each of the summary measures and the occurrence of respiratory insufficiency was calculated using logistic regression analysis. Results Of the 429 patients that were monitored, 334 were included for analysis. Of these, 66 (19.8%) patients developed respiratory insufficiency. Summarized continuously measured vital sign data in timeframes close to the endpoint showed stronger associations than data measured further in the past (ie, lead 0 vs 1, 2, or 4 hours), and summarized estimates over 4 hours of data had stronger associations than estimates taken over 8 hours of data. The mean was consistently strongly associated with respiratory insufficiency for the three vital signs: in a 4-hour timeframe without a lead, the standardized odds ratio for heart rate, respiratory rate, and oxygen saturation was 2.59 (99% CI 1.74-4.04), 5.05 (99% CI 2.87-10.03), and 3.16 (99% CI 1.78-6.26), respectively. The strength of associations of summary measures varied per vital sign, timeframe, and lead. Conclusions The mean of a vital sign showed a relatively strong association with respiratory insufficiency for the majority of vital signs and timeframes. The type of vital sign, length of the timeframe, and length of the lead influenced the strength of associations. Highly associated summary measures and their combinations could be used in a clinical prediction score or algorithm for an automatic alarm system.

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“…The data were obtained at Rigshospitalet and Bispebjerg Hospital in Copenhagen, Denmark from February 2018 to August 2020. The Danish Data Protection Agency approved the study (2012-58-0004) and the trial registered at http://ClinicalTrials.gov (project: NCT03491137) [6].…”

Section: Datamentioning

confidence: 99%

Forecasting of Continuous Vital Sign Using Multivariate Auto-Regressive Models

Rasmussen

Mølgaard

Haahr-Raunkjær

et al. 2022

2022 44th Annual International Conference of the IEEE Engineering in Medicine &Amp; Biology Society (EMBC)

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This project assessed the use of multivariate autoregressive (MAR) models to create forecasts of continuous vital signs in hospitalized patients. A total of 20 hours continuous (1/60Hz) heart rate and respiration rate from eight postoperative patients, where used to fit a centered MAR model for forecasting in windows of 15 minutes. The model was fitted using Markov Chain Monte Carlo sampling, and the model was evaluated on data from five additional patients. The results demonstrate an average RMSE in the forecast window of 11.4 (SD: 7.30) beats per minute for heart rate and 3.3 (SD:1.3) breaths per minute for respiration rate. These results indicate potential for forecasting vital signs in a clinical setting.

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Continuous monitoring of vital sign abnormalities; association to clinical complications in 500 postoperative patients

Cited by 26 publications

References 40 publications

Continuous wireless pre‐ and postoperative vital sign monitoring reveal new, severe desaturations after vascular surgery

Continuous wireless pre‐ and postoperative vital sign monitoring reveal new, severe desaturations after vascular surgery

Association of Continuously Measured Vital Signs With Respiratory Insufficiency in Hospitalized COVID-19 Patients: Retrospective Cohort Study

Forecasting of Continuous Vital Sign Using Multivariate Auto-Regressive Models

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