Technological aided assessment of the acutely ill patient – The case of postoperative complications

Abstract

Surgical interventions come with complications and highly reported mortality after major surgery. The mortality may be a result of delayed detection of severe complications due to lower monitoring frequency in the general wards. Several studies have shown that continuous monitoring is superior to the manually intermittent recorded monitoring in terms of detecting abnormal physiological signs. Hopefully improved observations may result in earlier detection and clinical intervention. This narrative review will describe current monitoring possibilities for postoperative patients and how it may prevent complications. Several wireless systems are being developed for monitoring vital parameters, but many of these are not yet validated for critically ill patients. The ultimate goal with patient monitoring and detect of events is to prevent postoperative complications, death and costs in the health care system. A few studies indicate that monitoring systems detect deteriorating patients earlier than the nurses, and this was associated with less clinical instability. An important caveat of future devices is to assess their effect in relevant patient populations and not only in healthy test-subjects. Implementation of novel technologies is expensive although expected to be cost-effective if just few adverse events can be prevented. The future is here with promising devices and the possibility to give an unprecedented precise risk estimation of adverse post-surgical events. Next step is to integrate existing evidence based treatment algorithms to demonstrate the clinical efficacy of implementing the new technology.

Continuous vital sign monitoring after major abdominal surgery—Quantification of micro events

“…During these long hours without observation patients might deteriorate without detection, as suggested by previous studies where 90% of cases with desaturation <90% lasting longer than 60 minutes went undetected by routine ward rounds. Continuous monitoring may thus improve patient care by increasing the sensitivity and predictive accuracy of the detected deteriorations as well as detecting them sooner …”

Physiological abnormalities in patients admitted with acute exacerbation of COPD: an observational study with continuous monitoring

“…Limited data have been published regarding the clinical application of continuous multi-parameter wireless monitoring in hospitalised patients outside the ICU setting [17,28], however a number of studies are currently ongoing. Studies have been conducted in different settings across specialties, but we were unable to find studies specifically in patients admitted with AECOPD.…”

Of Railroads and Roller Coasters

“…This raises the important question of how we alert clinical staff about adverse physiologic deviations to ensure timely interventions in a way where alarms do not cause alarm fatigue and other causes for unresponsiveness to alerts. 7 This should be an important research objective, if results such as the ones found by Liem et al are to alter clinical practice.…”

“…1 However, from a physiologic standpoint, there is no reason to assume that deviations only occur in these units. 7 The literature suggests a paucity in our understanding of complications occurring in general wards and especially after discharge. 8 Future studies should also aim outside these highly specialized settings when caring for patients at high risk of cardiovascular and other surgical complications.…”