Abstract
BackgroundFailure to recognize acute deterioration in hospitalized patients may contribute to cardiopulmonary arrest, unscheduled intensive care unit admission and increased mortality.PurposeIn this systematic review we aimed to determine whether continuous non-invasive respiratory monitoring improves early diagnosis of patient deterioration and reduces critical incidents on hospital wards.Data SourcesStudies were retrieved from Medline, Embase, CINAHL, and the Cochrane library, searched from 1970 till October 25, 2014.Study SelectionElectronic databases were searched using keywords and corresponding synonyms ‘ward’, ‘continuous’, ‘monitoring’ and ‘respiration’. Pediatric, fetal and animal studies were excluded.Data ExtractionSince no validated tool is currently available for diagnostic or intervention studies with continuous monitoring, methodological quality was assessed with a modified tool based on modified STARD, CONSORT, and TREND statements.Data SynthesisSix intervention and five diagnostic studies were included, evaluating the use of eight different devices for continuous respiratory monitoring. Quantitative data synthesis was not possible because intervention, study design and outcomes differed considerably between studies. Outcomes estimates for the intervention studies ranged from RR 0.14 (0.03, 0.64) for cardiopulmonary resuscitation to RR 1.00 (0.41, 2.35) for unplanned ICU admission after introduction of continuous respiratory monitoring,LimitationsThe methodological quality of most studies was moderate, e.g. ‘before-after’ designs, incomplete reporting of primary outcomes, and incomplete clinical implementation of the monitoring system.ConclusionsBased on the findings of this systematic review, implementation of routine continuous non-invasive respiratory monitoring on general hospital wards cannot yet be advocated as results are inconclusive, and methodological quality of the studies needs improvement. Future research in this area should focus on technology explicitly suitable for low care settings and tailored alarm and treatment algorithms.
Highlights
In high care facilities, like an Intensive Care Unit (ICU), monitors are often continuously reporting physiological patient variables, such as heart rate or respiratory rate
We reviewed publications on the use of continuous non-invasive respiratory monitoring in patients admitted to a general hospital ward in clinical practice
As methodological quality assessment tools for this type of research are currently unavailable, we summarize methodological pitfalls in the design and reporting of monitoring studies based on our findings in this systematic review
Summary
Like an Intensive Care Unit (ICU), monitors are often continuously reporting physiological patient variables, such as heart rate or respiratory rate. Since respiratory failure is the most common primary cause of ICU admission from general hospital wards [5,6,7], an abnormal respiratory rate (generally above 30 breaths per minute [1,8]) could be an important and sensitive clinical predictor for current or future serious adverse events.[4,9,10] In daily practice respiration is only intermittently observed by caregivers and expressed as an approximate respiratory rate, sometimes combined with rough estimates of tidal volume (‘deep’, ‘shallow’), intermittent pulse oximetry, or more subjective parameters such as the patient’s skin color including apparent signs of cyanosis Such intermittent subjective observations are supported by reliable electronic or mechanical bedside equipment.[11].
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