The effectiveness of continuous respiratory rate monitoring in predicting hypoxic and pyrexic events: a retrospective cohort study
| Autor: | Richard W. Costello, Thomas A. McCartan, Christopher Mulvey, Lorna Lombard, Joanne Walsh, Ruán Ó. Conluain, Garrett Greene, Myles Murray, Amy P Worrall, Fátimah Alaya, Vincent Brennan, Elaine MacHale |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Fever Respiratory rate Physiology 0206 medical engineering Biomedical Engineering Biophysics 02 engineering and technology 03 medical and health sciences 0302 clinical medicine Respiratory Rate Physiology (medical) medicine Humans Respiratory system Hypoxia Monitoring Physiologic Retrospective Studies Proportional hazards model business.industry Hazard ratio COVID-19 Retrospective cohort study Hypoxia (medical) Early warning score 020601 biomedical engineering Emergency medicine Breathing medicine.symptom business 030217 neurology & neurosurgery |
| Zdroj: | Physiological Measurement. 42:065005 |
| ISSN: | 1361-6579 0967-3334 |
| DOI: | 10.1088/1361-6579/ac05d5 |
| Popis: | Respiratory rate (RR) is routinely used to monitor patients with infectious, cardiac and respiratory diseases and is a component of early warning scores used to predict patient deterioration. However, it is often measured visually with considerable bias and inaccuracy.Objectives. Firstly, to compare distribution and accuracy of electronically measured RR (EMRR) and visually measured RR (VMRR). Secondly, to determine whether, and how far in advance, continuous electronic RR monitoring can predict oncoming hypoxic and pyrexic episodes in infectious respiratory disease.Approach.A retrospective cohort study analysing the difference between EMRR and VMRR was conducted using patient data from a large tertiary hospital. Cox proportional hazards models were used to determine whether continuous, EMRR measurements could predict oncoming hypoxic (SpO2 38 °C) episodes.Main results.Data were gathered from 34 COVID-19 patients, from which a total of 3445 observations of VMRR (independent of Hawthorne effect), peripheral oxygen saturation and temperature and 729 117 observations of EMRR were collected. VMRR had peaks in distribution at 18 and 20 breaths per minute. 70.9% of patients would have had a change of treatment during their admission based on the UK's National Early Warning System if EMRR was used in place of VMRR. An elevated EMRR was predictive of hypoxic (hazard ratio: 1.8 (1.05-3.07)) and pyrexic (hazard ratio: 9.7 (3.8-25)) episodes over the following 12 h.Significance.Continuous EMRR values are systematically different to VMRR values, and results suggest it is a better indicator of true RR as it has lower kurtosis, higher variance, a lack of peaks at expected values (18 and 20) and it measures a physiological component of breathing directly (abdominal movement). Results suggest EMRR is a strong marker of oncoming hypoxia and is highly predictive of oncoming pyrexic events in the following 12 h. In many diseases, this could provide an early window to escalate care prior to deterioration, potentially preventing morbidity and mortality. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|