Journal of clinical monitoring and computing
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J Clin Monit Comput · Dec 2016
Sensor fusion methods for reducing false alarms in heart rate monitoring.
Automatic patient monitoring is an essential resource in hospitals for good health care management. While alarms caused by abnormal physiological conditions are important for the delivery of fast treatment, they can be also a source of unnecessary noise because of false alarms caused by electromagnetic interference or motion artifacts. One significant source of false alarms is related to heart rate, which is triggered when the heart rhythm of the patient is too fast or too slow. ⋯ Twenty recordings selected from the MIMIC database were used to validate the system. The results showed that neural networks fusion had the best false alarm reduction of 92.5 %, while the Bayesian technique had a reduction of 84.3 %, fuzzy logic 80.6 %, majority voter 72.5 % and the heart rate variability index 67.5 %. Therefore, the proposed algorithms showed good performance and could be useful in bedside monitors.
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J Clin Monit Comput · Dec 2016
Low intraoperative heart rate volatility is associated with early postoperative mortality in general surgical patients: a retrospective case-control study.
Heart rate volatility (HRVO) is hypothesized to be a physiological measure of sympathetic activity and is defined by the standard deviation (SD) of the heart rate (HR) in beats per minutes (BPM) over fixed time intervals. To investigate the relationship between low HRVO (SD < 0.5 BPM) during surgical procedures and mortality within 48 h post-procedure. We retrospectively reviewed all adult general surgical procedures performed at our center from January 1, 2003 through July 1, 2013 to identify patients who died within 48 h post-procedure. ⋯ Patients who died had a 39 % increase in frequency of low HRVO episodes compared to patients who survived (RR 1.39, 95 % CI 1.13-1.72; p = 0.003). Low HRVO during surgical procedure is associated with increased mortality risk within 48 h after procedure. Strategies to identify HRVO early and modify it may lead to improvement in outcomes.
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J Clin Monit Comput · Dec 2016
Utility of the bispectral index for assessing natural physiological sleep stages in children and young adults.
Polysomnography (PSG) is the gold standard for the analysis of sleep architecture but is not always available in routine practice, as it is time consuming and cumbersome for patients. Bispectral index (BIS), developed to quantify the deepness of general anesthesia, may be used as a simplified tool to evaluate natural sleep depth. We objectively recorded sleep architecture in young patients using the latest BIS Vista monitor and correlated BIS values with PSG sleep stages in order to determine BIS thresholds. ⋯ BIS threshold that identified stage N3 was <55 (AUC = 0.964, p < 0.001) with an 87 %-sensitivity and a 93 %-specificity. BIS identified stage N3 with satisfactory sensitivity and specificity but is limited by its inability to distinguish REM sleep from wake. Further studies combining BIS with chin electromyogram and/or electrooculogram could be of interest.
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J Clin Monit Comput · Dec 2016
Case ReportsElectroencephalographic evoked pain response is suppressed by spinal cord stimulation in complex regional pain syndrome: a case report.
Pain is a subjective response that limits assessment. The purpose of this case report was to explore how the objectivity of the electroencephalographic response to thermal stimuli would be affected by concurrent spinal cord stimulation. A patient had been implanted with a spinal cord stimulator for the management of complex regional pain syndrome of both hands for 8 years. ⋯ The patient reported a clinically significant reduction in thermal induced pain using the numerical rating scale (71.4 % reduction) with spinal cord stimulator switched on. Analysis of electroencephalogram recordings indicated the occurrence of contact heat evoked potentials (N2-P2) with spinal cord stimulator off, but not with spinal cord stimulator on. This case report suggests that thermal pain can be reduced in complex regional pain syndrome patients with the use of spinal cord stimulation and offers objective validation of the reported outcomes with this treatment.
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J Clin Monit Comput · Dec 2016
Multi-parameter vital sign database to assist in alarm optimization for general care units.
Continual vital sign assessment on the general care, medical-surgical floor is expected to provide early indication of patient deterioration and increase the effectiveness of rapid response teams. However, there is concern that continual, multi-parameter vital sign monitoring will produce alarm fatigue. The objective of this study was the development of a methodology to help care teams optimize alarm settings. ⋯ Plots of vital sign distributions in the cloud-hosted database were similar to other large databases published by different authors. The cloud-hosted database can be used to run simulations for various alarm thresholds and annunciation delays to predict the total alarm burden experienced by nursing staff. This methodology might, in the future, be used to help reduce alarm fatigue without sacrificing the ability to continually monitor all vital signs.