Variations in vital signs at the end of life in non-cancer patients: a retrospective study

Hosoi, Takahiro; Ozone, Sachiko; Hamano, Jun

doi:10.21037/apm-20-1054

Cited by 7 publications

(3 citation statements)

References 17 publications

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“…To the best of our knowledge, no study has investigated the prognosis prediction accuracy by focusing on continuous measurement of respiratory and heart rates using a nonwearable monitor in dying cancer patients during the last days of life, excepting two studies for non-cancer patients. 12,13 In recent years, reviews that examine the association between changes in vital signs and patient outcomes by utilizing technology have been published. These include palliative cancer patients to monitor early changes in their conditions, 14 cancer survivors to summarize the effectiveness of behavioral trials, 15 and non-cancer patients to detect early deteriorations.…”

Section: Introductionmentioning

confidence: 99%

Association between respiratory and heart rate fluctuations and death occurrence in dying cancer patients: continuous measurement with a non-wearable monitor

Fukui

Ikuta

Maeda³

et al. 2021

Support Care Cancer

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Background: The cancer deaths at home and in care facilities are increasing worldly. If we can identify imminent death using a monitoring device and inform it to family members and care staff, it will help them, even in the absence of healthcare professionals at all times. We examined the association between impending death and continual changes in respiratory and heart rates measured by a non-wearable monitor every minute for the nal 2 weeks of dying cancer patients. In this longitudinal study, we enrolled patients in a palliative-care-unit and continuously measured their respiratory/heart rates by a monitor, capturing their other vital signs and clinical status from medical records.Result: A dataset was created with 240 patient-days from every minute data to death (345,600 data) among 24 patients for 3-14 days to death. We analyzed this 240 patient-day data. After con rming the associations between the value of death day (n=24) or other days (2-14 days before death, n=216) and the mean, maximum, minimum, and variance of respiratory and heart rates every 24 hours by univariate analyses, we conducted a repeated measures logistic regression analysis using a generalized estimating equation. Finally, the maximum respiratory rate and mean heart rate were signi cantly associated with death at 24, 48, and 72 hours later, other than the respiratory rate of the last 24 hours. Conclusion:The maximum respiratory rate and mean heart rate measured every minute by a monitor can warn imminent death during the last days of life among dying patients. Our ndings can help for caregivers to aware imminent death among dying patients at home or in facilities, in collaboration with palliative care professionals.

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Section: Introductionmentioning

confidence: 99%

Association between respiratory and heart rate fluctuations and death occurrence in dying cancer patients: continuous measurement with a non-wearable monitor

Fukui

Ikuta

Maeda³

et al. 2021

Support Care Cancer

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“…Our recent findings on terminal noncancer patients revealed that vital signs exhibited similar changes in the last seven days of life in cancer and noncancer patients. 20 Noncancer patients may have a similar clinical course, including physical signs, as terminal cancer patients in the last days of life. Therefore, the SID in terminal cancer patients may be applied to end-of-life prognostication in noncancer patients.…”

Section: Introductionmentioning

confidence: 99%

Prediction Models for Impending Death Using Physical Signs and Vital Signs in Noncancer Patients: A Prospective Longitudinal Observational Study

Hosoi

Ozone

Hamano

et al. 2021

Palliative Medicine Reports

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Background: Accurate information on the prognosis in the last days of life is essential for providing better end-of-life care; however, few studies have examined the signs of impending death (SID) or developed short-term prediction models in noncancer patients. Objective: To investigate the prevalence and onset of SID and to develop models that predict death within 7 days, 72 hours, and 24 hours in noncancer patients. Design: This is a prospective longitudinal observational study. Setting/Subjects: Subjects were noncancer patients admitted to a hospital in Japan between 2019 and 2020. Measurements: We investigated 11 physical signs and vital signs every 12 hours until death after confirming a reduced daily oral intake to less than a few mouthfuls. Results: We analyzed data from 50 noncancer patients. The prediction model “pulselessness of the radial artery OR respiration of mandibular movement OR the shock Index (SI) >1.0” predicted death within 7 days with an accuracy of 83.9%, whereas the models developed to predict death within 72 and 24 hours had an accuracy of 65.0% or less. The median onset of all signs was within 3 days of death. The frequencies of decreased response to verbal stimuli and decreased response to visual stimuli were 76.0% and 74.0%, respectively. Conclusions: The prediction model using physical signs and SI predicted death within 7 days in noncancer patients with high accuracy. The prediction of death within 72 and 24 hours in noncancer patients requires investigation of physical signs not examined in this study.

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“…To the best of our knowledge, no study has investigated the prognosis prediction accuracy by focusing on continuous measurement of respiratory and heart rates using a non-wearable monitor in dying cancer patients during the last days of life, excepting two studies for non-cancer patients. 12,13 In recent years, reviews that examine the association between changes in vital signs and patient outcomes by utilizing technology have been published. These include palliative cancer patients to monitor early changes in their conditions, 14 cancer survivors to summarize the effectiveness of behavioral trials, 15 and non-cancer patients to detect early deteriorations.…”

Section: Introductionmentioning

confidence: 99%

Association between respiratory and heart rate fluctuations and death occurrence in dying cancer patients: Continuous measurement with a non-wearable monitor

Fukui

Ikuta

Maeda³

et al. 2021

Preprint

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Background The present study aimed to explore the association between impending death and continual changes in respiratory and heart rates measured by a non-wearable monitor every minute for the final 2 weeks of dying cancer patients. Methods In this longitudinal study, we enrolled patients in a palliative-care-unit and continuously measured their respiratory/heart rates by a monitor, capturing their other vital signs and clinical status from medical records. Result A dataset was created with 240 patient-days from every minute data to death (345,600 data) among 24 patients for 3–14 days to death. We analyzed this 240 patient-day data. After confirming the associations between the value of death day (n = 24) or other days (2–14 days before death, n = 216) and the mean, maximum, minimum, and variance of respiratory and heart rates every 24 hours by univariate analyses, we conducted a repeated measures logistic regression analysis using a generalized estimating equation. Finally, the maximum respiratory rate and mean heart rate were significantly associated with death at 24, 48, and 72 hours later, other than the respiratory rate of the last 24 hours. Conclusion The maximum respiratory rate and mean heart rate measured every minute by a monitor can warn imminent death during the last days of life among dying patients. Our findings can help for family caregivers and care staff to aware imminent death among dying patients at home or in facilities, in collaboration with palliative care professionals.

show abstract

Variations in vital signs at the end of life in non-cancer patients: a retrospective study

Cited by 7 publications

References 17 publications

Association between respiratory and heart rate fluctuations and death occurrence in dying cancer patients: continuous measurement with a non-wearable monitor

Association between respiratory and heart rate fluctuations and death occurrence in dying cancer patients: continuous measurement with a non-wearable monitor

Prediction Models for Impending Death Using Physical Signs and Vital Signs in Noncancer Patients: A Prospective Longitudinal Observational Study

Association between respiratory and heart rate fluctuations and death occurrence in dying cancer patients: Continuous measurement with a non-wearable monitor

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