Difference between revisions of "Physiologic monitors"

Revision as of 22:46, 18 October 2016

Physiologic monitors monitor vital sign parameters and inform clinicians of changes in a patient's condition through the use of alarms. They consist of multiple components, including a central station, bedside monitors, and ambulatory telemetry transmitters and receivers [1]. Recently, smart devices that can be attached a patient’s body or even integrated into their garments have also been developed.

Advantages

Physiologic monitors allow for early detection of vital sign deterioration and work to alert responders to critical situations.

Disadvantages

Physiologic monitors are intended to prevent cardiac and respiratory arrest by generating alarms to alert clinicians to signs of instability. To minimize the probability that monitors will miss signs of deterioration, alarm algorithms are often set to maximize sensitivity, sacrificing specificity [2]. As a result, monitors generate large numbers of alarms that are either invalid and do not accurately represent the physiologic status of the patient or are valid but do not warrant clinical intervention.[3] In national surveys of healthcare staff, respondents report that high alarm rates interrupt patient care and lead clinicians to disable alarms.[4] Recent research has supported this, demonstrating that nurses exposed to higher numbers of alarms have slower response times to alarms.[5,6]

Applications

Smart devices can create a personal network with wireless transmission of physiologic monitoring. Any data can be sent to computer, allowing remote monitoring of real time data. There are also advantages and disadvantages to these smart devices. Advantages for these devices include early detection of vital sign deterioration, enhanced connectedness among patients and loved ones, providing reassurance to family and maintaining dignity and independence for patients, and providing clinicians with transformative real time physiologic data. In addition, they also allow for battlefield monitoring of soldiers and improvement in sports related conditioning. Disadvantages include the high expense of the devices, and similar to hospital physiologic monitors, sensitivity of these devices can also be a factor. These devices must be constantly updated in order to make sure that patient data is being displayed on the device accurately. Improper data can lead to improper diagnoses, which also leads to improper care for a patient [7].

Two such devices currently being developed and tested include the LifeGuard wireless physiologic monitor and the HealthGear real time physiologic monitoring system.

Lifeguard

The LifeGuard system is being developed by NASA to monitor the health of astronauts during space flights and extravehicular activities. Capabilities of the LifeGuard include:

• Heart rate
• Systolic and diastolic blood pressure
• Activity, (3-axis acceleration)
• ECG, (2 channels)
• Temperature
• Respiration rate
• Pulse oximetry

HealthGear

The HealthGear system is being developed by Microsoft, it is designed to be integrated into clothing and not only collects real time data but also performs algorithmic interpretation of the data for detecting sleep apnea episodes.

• Heart Rate
• Respiration rate
• Pulse oximetry
• Plethysmographic signal
• Modular format to allow addition of additional components

References

1. Physiologic monitoring systems. Health Devices. 2000 May;29(5):153-84. PubMed PMID: 10851651.

2. "Drew BJ, Califf RM, Funk M, et al. Practice standards for electrocardiographic monitoring in hospital settings: An American Heart Association scientific statement from the councils on cardiovascular nursing, clinical cardiology, and cardiovascular disease in the young. Circulation. 2004;110:2721–46. doi:10.1161/01.CIR.0000145144.56673.59

3. Paine CW, Goel V V., Ely E, et al. Systematic Review of Physiologic Monitor Alarm Characteristics and Pragmatic Interventions to Reduce Alarm Frequency. J. Hosp. Med. 2016;11:136–44. doi:10.1002/jhm.2520.

4. Korniewicz DM, Clark T, David Y. A national online survey on the effectiveness of clinical alarms. Am J Crit Care 2008;17:36–41. doi:17/1/36 [pii]

5. Bonafide CP, Lin R, Zander M, et al. Association between exposure to nonactionable physiologic monitor alarms and response time in a children’s hospital. J Hosp Med 2015;10:345–51. doi:10.1002/jhm.2331

6. Voepel-Lewis T, Parker ML, Burke CN, et al. Pulse oximetry desaturation alarms on a general postoperative adult unit: A prospective observational study of nurse response time. Int J Nurs Stud 2013;50:1351–8. doi:10.1016/j.ijnurstu.2013.02.006

7. Tran, T. Q., Boring, R. L., Dudenhoeffer, D. D., Keller, M. D., & Anderson, T. M. (2007, August). Advantages and disadvantages of physiological assessment for next generation control room design. Retrieved September 9, 2015, from http://www5vip.inl.gov/technicalpublications/ Documents/3775292.pdf

8. Emil Jovanov, Dejan Raskovic, John Price, John Chapman, Anthony Moore, Abhishek Krishnamurthy. Patient Monitoring Using Personal Area Networks of Wireless Intelligent Sensors.

9. Nuria Oliver & Fernando Flores-Mangas. HealthGear: A Real-time Wearable System forMonitoring and Analyzing Physiological .

10. Signals.http://www.nasa.gov/centers/ames/research/technology-onepagers/life-guard.html.