Early detection of deterioration in COVID-19 patients by continuous ward respiratory rate monitoring: a pilot prospective cohort study.
| Title: | Early detection of deterioration in COVID-19 patients by continuous ward respiratory rate monitoring: a pilot prospective cohort study. |
|---|---|
| Authors: | Rivas E; Department of Anesthesia, Hospital Clinic of Barcelona, IDIBAPS, Universidad de Barcelona, Barcelona, Spain.; Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, United States.; López-Baamonde M; Department of Anesthesia, Hospital Clinic of Barcelona, IDIBAPS, Universidad de Barcelona, Barcelona, Spain.; Sanahuja J; Department of Anesthesia, Hospital Clinic of Barcelona, IDIBAPS, Universidad de Barcelona, Barcelona, Spain.; Del Rio E; Department of Anesthesia, Hospital Clinic of Barcelona, IDIBAPS, Universidad de Barcelona, Barcelona, Spain.; Ramis T; Department of Anesthesiology and Critical Care, Hosptial Universitary Son Espases, Mallorca, Spain.; Recasens A; Department of Anesthesiology, Hospital del Mar. Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona, Barcelona, Spain.; López A; Department of Anesthesia, Hospital Clinic of Barcelona, IDIBAPS, Universidad de Barcelona, Barcelona, Spain.; Arias M; Department of Anesthesia, Hospital Clinic of Barcelona, IDIBAPS, Universidad de Barcelona, Barcelona, Spain.; Kampakis S; Circadia Technologies, Ltd., London, United Kingdom.; Lauteslager T; Circadia Technologies, Ltd., London, United Kingdom.; Awara O; Circadia Technologies, Ltd., London, United Kingdom.; Mascha EJ; Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, United States.; Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, United States.; Soriano A; Department of Infectious Disease, Hospital Clinic of Barcelona, IDIBAPS, Universidad de Barcelona, CIBERINF, Barcelona, Spain.; Badía JR; Department of Pneumology, Hospital Clinic of Barcelona, IDIBAPS, Universidad de Barcelona, Barcelona, Spain.; Castro P; Medical Intensive Care Unit, Hospital Clinic of Barcelona, IDIBAPS, Universidad de Barcelona, Barcelona, Spain.; Sessler DI; Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, United States. |
| Source: | Frontiers in medicine [Front Med (Lausanne)] 2023 Oct 31; Vol. 10, pp. 1243050. Date of Electronic Publication: 2023 Oct 31 (Print Publication: 2023). |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: Frontiers Media S.A Country of Publication: Switzerland NLM ID: 101648047 Publication Model: eCollection Cited Medium: Print ISSN: 2296-858X (Print) Linking ISSN: 2296858X NLM ISO Abbreviation: Front Med (Lausanne) Subsets: PubMed not MEDLINE |
| Imprint Name(s): | Original Publication: Lausanne, Switzerland : Frontiers Media S.A., [2014]- |
| Abstract: | Background: Tachypnea is among the earliest signs of pulmonary decompensation. Contactless continuous respiratory rate monitoring might be useful in isolated COVID-19 patients admitted in wards. We therefore aimed to determine whether continuous monitoring of respiratory patterns in hospitalized patients with COVID-19 predicts subsequent need for increased respiratory support.; Methods: Single-center pilot prospective cohort study in COVID-19 patients who were cared for in routine wards. COVID-19 patients who had at least one escalation of pulmonary management were matched to three non-escalated patients. Contactless respiratory monitoring was instituted after patients enrolled, and continued for 15 days unless hospital discharge, initiation of invasive mechanical ventilation, or death occurred. Clinicians were blinded to respiratory rate data from the continuous monitor. The exposures were respiratory features over rolling periods of 30 min, 24 h, and 72 h before respiratory care escalation. The primary outcome was a subsequent escalation in ventilatory support beyond a Venturi mask.; Results: Among 125 included patients, 13 exhibited at least one escalation and were each matched to three non-escalated patients. A total of 28 escalation events were matched to 84 non-escalation episodes. The 30-min mean respiratory rate in escalated patients was 23 breaths per minute (bpm) ranging from 13 to 40 bpm, similar to the 22 bpm in non-escalated patients, although with less variability (range 14 to 31 bpm). However, higher respiratory rate variability, especially skewness over 1 day, was associated with higher incidence of escalation events. Our overall model, based on continuous data, had a moderate accuracy with an AUC 0.81 (95%CI: 0.73, 0.88) and a good specificity 0.93 (95%CI: 0.87, 0.99).; Conclusion: Our pilot observational study suggests that respiratory rate variability as detected with continuous monitoring is associated with subsequent care escalation during the following 24 h. Continuous respiratory monitoring thus appears to be a valuable increment over intermittent monitoring.; Strengths and Limitations: Our study was the initial evaluation of Circadia contactless respiratory monitoring in COVID-19 patients who are at special risk of pulmonary deterioration. The major limitation is that the analysis was largely post hoc and thus needs to be confirmed in an out-of-sample population.; (Copyright © 2023 Rivas, López-Baamonde, Sanahuja, Del Rio, Ramis, Recasens, López, Arias, Kampakis, Lauteslager, Awara, Mascha, Soriano, Badía, Castro and Sessler.) |
| Competing Interests: | SK, TL, and OA were employed by Circadia Technologies, Ltd. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The authors declare that this study received funding from Circadia Technologies, Ltd. The funder had the following involvement in the study: SK is a Circadia employee and did the statistical analysis. TL is also a Circadia employee and helped interpret the data and reviewed and revised the manuscript. |
| References: | Front Digit Health. 2021 Sep 20;3:639827. (PMID: 34713111); Cureus. 2018 Jan 23;10(1):e2100. (PMID: 29581913); J Interv Card Electrophysiol. 2015 Aug;43(2):135-44. (PMID: 25917747); PLoS One. 2019 Oct 3;14(10):e0223155. (PMID: 31581207); Sensors (Basel). 2021 Jun 11;21(12):. (PMID: 34207961); ERJ Open Res. 2020 Sep 28;6(3):. (PMID: 33015146); Anesthesiology. 2016 Jul;125(1):193-203. (PMID: 27171828); Anesth Pain Med. 2021 Apr 21;11(2):e112424. (PMID: 34336617); Int J Surg. 2020 Sep;81:1-8. (PMID: 32730205); J Clin Monit Comput. 2020 Dec;34(6):1285-1293. (PMID: 31722079); Resuscitation. 2016 May;102:1-5. (PMID: 26898412); Ann Emerg Med. 2020 Oct;76(4):394-404. (PMID: 32563601); Ann Am Thorac Soc. 2014 Nov;11(9):1454-65. (PMID: 25296111); Anesth Analg. 2015 Sep;121(3):709-715. (PMID: 26287299); Front Digit Health. 2021 Sep 07;3:630273. (PMID: 34713102); Anesthesiology. 2002 Sep;97(3):592-8. (PMID: 12218525); Lancet. 2020 Mar 28;395(10229):1054-1062. (PMID: 32171076); Respir Med. 2002 Jan;96(1):31-3. (PMID: 11863207); Pacing Clin Electrophysiol. 2008 Nov;31(11):1371-82. (PMID: 18950293); Am J Emerg Med. 2008 Feb;26(2):237-9. (PMID: 18272111); Anesth Analg. 2020 Oct;131(4):1012-1024. (PMID: 32925318); Elife. 2020 Oct 12;9:. (PMID: 33044170); Anesthesiology. 2019 Apr;130(4):550-559. (PMID: 30875354) |
| Contributed Indexing: | Keywords: COVID-19; continuous monitoring; hospitalization ward; respiratory failure; respiratory rate |
| Entry Date(s): | Date Created: 20231129 Latest Revision: 20231201 |
| Update Code: | 20260130 |
| PubMed Central ID: | PMC10645134 |
| DOI: | 10.3389/fmed.2023.1243050 |
| PMID: | 38020176 |
| Database: | MEDLINE |
Journal Article