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

Abstract

Very low SpO and tachycardia in post-operative patients are common and under-diagnosed by the EWS. Continuous monitoring can discover these micro events and potentially contribute to earlier detection and, potentially, result in prevention of clinical complications.

Hypoxemia following hospital discharge after fast‐track hip and knee arthroplasty – A prospective observational study subanalysis

“…About 4% of recorded data were removed due to artefacts and low signal quality from hypoperfusion. However, this is within what is reported from other studies with continuous pulse oximetry monitoring 4,5. The routine use of supplemental oxygen during thefirst post-operative night may have resulted in impaired detection of hypoventilation 29 and was not utilized following the first night or discharge.…”

“…5,21 Likewise, no studies have reported detailed data on saturation during the first post-operative week similar to ours. However, in a general surgical population in-hospital (including knee arthroplasty patients) with continuous monitoring 24 h/day for up to 48 hours immediately after PACU discharge, an incidence of 8% with ≥5 min/hour of <85% hypoxemia and 3% with >30 minutes lasting episodes of <80% hypoxemia were found, similar to our results 4.…”

“…However, since a relevant proportion of THA/TKA patients have reduced physical and cognitive function following THA/TKA, there is a need for an increased understanding of the early post-discharge recovery phase and potential underlying pathogenic mechanisms to further improve safety and outcome. 2 Hypoxemia may be a relevant factor for impaired post-operative recovery, occurring frequently during the first post-operative days across procedures although most often not detected by nurses' rounds, [3][4][5] and with little available literature on the post-discharge course. The few available studies suggest that oxygen desaturation events do occur after discharge, 6,7 but details on the severity and development over time in a well-defined surgical cohort are lacking.…”

Automated continuous noninvasive ward monitoring: future directions and challenges

“…Alterations in vital signs as warning signs of clinical deterioration are frequently not or only belatedly recognized by the conventional spot check-based monitoring strategy. In hospitalized patients recovering from non-cardiac surgery, severe prolonged hypoxemia is common and unfortunately seriously underestimated using intermittent vital sign checks [9, 10]. Similar patterns regarding the rate of recognized abnormal vital signs were observed for tachycardia, bradycardia, tachypnea, and bradypnea [10].…”

“…In hospitalized patients recovering from non-cardiac surgery, severe prolonged hypoxemia is common and unfortunately seriously underestimated using intermittent vital sign checks [9, 10]. Similar patterns regarding the rate of recognized abnormal vital signs were observed for tachycardia, bradycardia, tachypnea, and bradypnea [10]. In patients recovering from abdominal surgery on the general care ward, postoperative hypotension (mean arterial pressure < 65 mmHg for ≥ 15 min) has been shown to occur in about one fifth of patients and not to be recognized by routine vital sign assessments in about half of the cases [11].…”