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Physiological abnormalities in patients admitted with acute exacerbation of COPD: an observational study with continuous monitoring

  • Mikkel ElvekjaerEmail author
  • Eske K. Aasvang
  • Rasmus M. Olsen
  • Helge B. D. Sørensen
  • Celeste M. Porsbjerg
  • Jens-Ulrik Jensen
  • Camilla Haahr-Raunkjær
  • Christian S. Meyhoff
  • for the WARD-Project Group
Original Research
  • 35 Downloads

Abstract

Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) may rapidly require intensive care treatment. Evaluation of vital signs is necessary to detect physiological abnormalities (micro events), but patients may deteriorate between measurements. We aimed to assess if continuous monitoring of vital signs in patients admitted with AECOPD detects micro events more often than routine ward rounds. In this observational pilot study (NCT03467815), 30 adult patients admitted with AECOPD were included. Patients were continuously monitored with peripheral oxygen saturation (SpO2), heart rate, and respiratory rate during the first 4 days after admission. Hypoxaemic events were defined as decreased SpO2 for at least 60 s. Non-invasive blood pressure was also measured every 15–60 min. Clinical ward staff measured vital signs as part of Early Warning Score (EWS). Data were analysed using Fisher’s exact test or Wilcoxon rank sum test. Continuous monitoring detected episodes of SpO2 < 92% in 97% versus 43% detected by conventional EWS (p < 0.0001). Events of SpO2 < 88% was detected in 90% with continuous monitoring compared with 13% with EWS (p < 0.0001). Sixty-three percent of patients had episodes of SpO2 < 80% recorded by continuous monitoring and 17% had events lasting longer than 10 min. No events of SpO2 < 80% was detected by EWS. Micro events of tachycardia, tachypnoea, and bradypnoea were also more frequently detected by continuous monitoring (p < 0.02 for all). Moderate and severe episodes of desaturation and other cardiopulmonary micro events during hospitalization for AECOPD are common and most often not detected by EWS.

Keywords

Continuous monitoring Wireless electronic devices Vital signs Physiological abnormalities Deterioration Chronic obstructive pulmonary disease 

Notes

Funding

M. E.: Received funding from Copenhagen Center for Health Technology (CACHET). The WARD-Project Group received funding from The Danish Cancer Society, The A. P. Møller Foundation, and Innovation Fund Denmark. Other authors: Departmental funding only.

Compliance with ethical standards

Conflict of interest

M. E. reports departmental research funding from Merck Sharp & Dome Corp. outside the submitted work. C S. M. reports direct and indirect research funding from Ferring Pharmaceuticals, Merck Sharp & Dohme Corp., and Boehringer Ingelheim outside the submitted work. Other authors report none.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg HospitalUniversity of CopenhagenCopenhagenDenmark
  2. 2.Copenhagen Center for Translational ResearchCopenhagen University Hospital, Bispebjerg and FrederiksbergCopenhagenDenmark
  3. 3.Department of Anaesthesiology, Centre for Cancer and Organ Dysfunction, RigshospitaletUniversity of CopenhagenCopenhagenDenmark
  4. 4.Biomedical Engineering, Department of Health TechnologyTechnical University of DenmarkKgs. LyngbyDenmark
  5. 5.Respiratory Research Unit, Bispebjerg and Frederiksberg HospitalUniversity of CopenhagenCopenhagenDenmark
  6. 6.Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
  7. 7.Department of Internal Medicine, Respiratory Medicine Section, Herlev and Gentofte HospitalUniversity of CopenhagenCopenhagenDenmark
  8. 8.CHIP& PERSIMUNE, Department of Infectious DiseasesRigshospitaletCopenhagenDenmark

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