Steinhubl Steven R, Feye Dawit, Levine Adam C, Conkright Chad, Wegerich Stephan W, Conkright Gary
Scripps Translational Science Institute, La Jolla, California, USA.
International Medical Corps Ebola Treatment Center, Makeni, Sierra Leone.
BMJ Glob Health. 2016 Jul 5;1(1):e000070. doi: 10.1136/bmjgh-2016-000070. eCollection 2016.
The recent Ebola epidemic in West Africa strained existing healthcare systems well beyond their capacities due to the extreme volume and severity of illness of the patients. The implementation of innovative digital technologies within available care centres could potentially improve patient care as well as healthcare worker safety and effectiveness.
We developed a Modular Wireless Patient Monitoring System (MWPMS) and conducted a proof of concept study in an Ebola treatment centre (ETC) in Makeni, Sierra Leone. The system was built around a wireless, multiparametric 'band-aid' patch sensor for continuous vital sign monitoring and transmission, plus sophisticated data analytics. Results were used to develop personalised analytics to support automated alerting of early changes in patient status.
During the 3-week study period, all eligible patients (n=26) admitted to the ETC were enrolled in the study, generating a total of 1838 hours of continuous vital sign data (mean of 67.8 hours/patient), including heart rate, heart rate variability, activity, respiratory rate, pulse transit time (inversely related to blood pressure), uncalibrated skin temperature and posture. All patients tolerated the patch sensor without problems. Manually determined and automated vital signs were well correlated. Algorithm-generated Multivariate Change Index, pulse transit time and arrhythmia burden demonstrated encouraging preliminary findings of important physiological changes, as did ECG waveform changes.
In this proof of concept study, we were able to demonstrate that a portable, deployable system for continuous vital sign monitoring via a wireless, wearable sensor supported by a sophisticated, personalised analytics platform can provide high-acuity monitoring with a continuous, objective measure of physiological status of all patients that is achievable in virtually any healthcare setting, anywhere in the world.
近期西非的埃博拉疫情使现有的医疗系统不堪重负，因为患者数量极多且病情严重。在现有的护理中心采用创新数字技术可能会改善患者护理以及医护人员的安全与效率。
我们开发了一种模块化无线患者监测系统（MWPMS），并在塞拉利昂马克尼的一个埃博拉治疗中心（ETC）进行了概念验证研究。该系统围绕一个无线多参数“创可贴”贴片传感器构建，用于持续监测和传输生命体征，同时具备复杂的数据分析功能。研究结果用于开发个性化分析，以支持对患者状态早期变化的自动警报。
在为期3周的研究期间，ETC收治的所有符合条件的患者（n = 26）均纳入研究，共产生了1838小时的持续生命体征数据（平均每位患者67.8小时），包括心率、心率变异性、活动、呼吸频率、脉搏传输时间（与血压呈负相关）、未校准的皮肤温度和姿势。所有患者对贴片传感器耐受良好。手动测定的生命体征与自动测定的生命体征相关性良好。算法生成的多变量变化指数、脉搏传输时间和心律失常负担显示出重要生理变化的初步结果令人鼓舞，心电图波形变化也是如此。
在这项概念验证研究中，我们能够证明，通过一个复杂的个性化分析平台支持的无线可穿戴传感器进行持续生命体征监测的便携式、可部署系统，可以提供高灵敏度监测，以持续、客观地测量所有患者的生理状态，这在世界任何地方的几乎任何医疗环境中都可以实现。
