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

Sakiko Fukui,Haruka Tanaka,Miyae Yamakawa,Yutaka Hatano,Momoe Utsumi,Akari Higuchi,Yoko Higami,Isseki Maeda,Kasumi Ikuta,Satoshi Hattori

doi:10.1007/s00520-021-06346-y

Abstract

The present study aimed to explore the association between impending death and continual changes in respiratory and heart rates measured using a non-wearable monitor every minute for the final 2weeks of life in dying cancer patients. In this longitudinal study, we enrolled patients in a palliative care unit and continuously measured their respiratory and heart rates via a monitor and additionally captured their other vital signs and clinical status from medical records. A dataset was created comprising every 24-h data collected from every-minute raw data, including information from 240days prior to death from 24 patients (345,600 data); each patient's data were measured for 3-14days until death. After confirming the associations between the respiratory and heat rate values on the day of death (n = 24) or other days (2-14days before death, n = 216) and the mean, maximum, minimum, and variance of respiratory and heart rates every 24h 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 occurring within the following 3days (0-24h, 0-48h, and 0-72h), except for the maximum respiratory rate that occurs within 0-24h. The maximum respiratory rate and mean heart rate measured every minute using a monitor can warn family caregivers and care staff, with the support of palliative care professionals, of imminent death among dying patients at home or other facilities.

Highlights

The number of patients suffering from cancer and who have died from it has increased significantly in the last few decades worldwide.[1]
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

Summary

Introduction

The number of patients suffering from cancer and who have died from it has increased significantly in the last few decades worldwide.[1]. As Japan’s rapidly declining population will become a major social issue in the near future,[3] utilizing technology to provide qualified care may be a solution for the declining number of healthcare professionals. Prognostic tools, such as the Palliative Performance Scale, Palliative Prognostic Index, and Glasgow Prognostic Score, have recently been developed for the prognosis of cancer patients, as reviews have summarized.[4,5] These tools capture a wide range of clinical factors that, together with professional clinical assessment, can help make accurate predictions. 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

Results

Conclusion