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

Abstract

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.

Circadian vital sign characteristics in postoperative patients with and without subsequent complications

“…This study was registered on clinicaltrials.gov as NCT05347784. The study cohort consisted of patients from three surgical studies in the Wireless Assessment of Respiratory and circulatory Distress (WARD) project(NCT03491137, NCT04473001 and NCT04628858) after approval from the science ethics committee for the capital region of Denmark (H-17033535, H-20002220 and H-19086583) [16,20,21] all studies adhered to the Helsinki Declaration.…”

“…Ethics approval and consent to participate study cohort consisted of patients from three surgical studies in the Wireless Assessment of Respiratory and circulatory Distress (WARD) project(NCT03491137, NCT04473001 and NCT04628858) which were given approval from the local science ethics committee(H-17033535, H-20002220 and H-19086583)[16,20,21]. Informed consent was collected prior to study initiation on all participants.…”

The future of postoperative vital sign monitoring in general wards: improving patient safety through continuous artificial intelligence-enabled alert formation and reduction

“…The case of atrial fibrillation also supports that development of CVSM systems must consider any preexisting conditions as to reduce alerts caused by an abnormal but chronic condition, whilst identifying new important deviations in the same patient. Thus, a study of vascular patients showed that minor deviations may be explained by preoperative chronic conditions whereas severe deviations are not present preoperatively and as such cannot be dismissed as a chronic condition even in this highly comorbid population [17].…”