Mestrom Eveline, Deneer Ruben, Bonomi Alberto G, Margarito Jenny, Gelissen Jos, Haakma Reinder, Korsten Hendrikus H M, Scharnhorst Volkher, Bouwman R Arthur
Department of Anesthesiology, Catharina Hospital Eindhoven, Eindhoven, Netherlands.
Clinical Laboratory, Catharina Hospital Eindhoven, Eindhoven, Netherlands.
JMIR Cardio. 2021 Nov 4;5(2):e27765. doi: 10.2196/27765.
Measurement of heart rate (HR) through an unobtrusive, wrist-worn optical HR monitor (OHRM) could enable earlier recognition of patient deterioration in low acuity settings and enable timely intervention.
The goal of this study was to assess the agreement between the HR extracted from the OHRM and the gold standard 5-lead electrocardiogram (ECG) connected to a patient monitor during surgery and in the recovery period.
In patients undergoing surgery requiring anesthesia, the HR reported by the patient monitor's ECG module was recorded and stored simultaneously with the photopletysmography (PPG) from the OHRM attached to the patient's wrist. The agreement between the HR reported by the patient's monitor and the HR extracted from the OHRM's PPG signal was assessed using Bland-Altman analysis during the surgical and recovery phase.
A total of 271.8 hours of data in 99 patients was recorded simultaneously by the OHRM and patient monitor. The median coverage was 86% (IQR 65%-95%) and did not differ significantly between surgery and recovery (Wilcoxon paired difference test P=.17). Agreement analysis showed the limits of agreement (LoA) of the difference between the OHRM and the ECG HR were within the range of 5 beats per minute (bpm). The mean bias was -0.14 bpm (LoA between -3.08 bpm and 2.79 bpm) and -0.19% (LoA between -5 bpm to 5 bpm) for the PPG- measured HR compared to the ECG-measured HR during surgery; during recovery, it was -0.11 bpm (LoA between -2.79 bpm and 2.59 bpm) and -0.15% (LoA between -3.92% and 3.64%).
This study shows that an OHRM equipped with a PPG sensor can measure HR within the ECG reference standard of -5 bpm to 5 bpm or -10% to 10% in the perioperative setting when the PPG signal is of sufficient quality. This implies that an OHRM can be considered clinically acceptable for HR monitoring in low acuity hospitalized patients.
通过佩戴在手腕上的无创光学心率监测仪（OHRM）测量心率（HR），可以在低危环境中更早地识别患者病情恶化，并及时进行干预。
本研究的目的是评估手术期间及恢复期从OHRM提取的HR与连接到患者监护仪的金标准五导联心电图（ECG）之间的一致性。
在接受需要麻醉的手术患者中，记录患者监护仪ECG模块报告的HR，并与连接到患者手腕的OHRM的光电容积脉搏波描记图（PPG）同时存储。在手术和恢复阶段，使用Bland-Altman分析评估患者监护仪报告的HR与从OHRM的PPG信号中提取的HR之间的一致性。
OHRM和患者监护仪同时记录了99例患者共271.8小时的数据。中位覆盖率为86%（四分位间距65%-95%），手术和恢复期间无显著差异（Wilcoxon配对差异检验P=0.17）。一致性分析表明，OHRM和ECG HR之间差异的一致性界限（LoA）在每分钟5次心跳（bpm）范围内。与手术期间ECG测量的HR相比，PPG测量的HR的平均偏差为-0.14 bpm（LoA在-3.08 bpm至2.79 bpm之间）和-0.19%（LoA在-5 bpm至5 bpm之间）；在恢复期间，分别为-0.11 bpm（LoA在-2.79 bpm至2.59 bpm之间）和-0.15%（LoA在-3.92%至3.64%之间）。
本研究表明，当PPG信号质量足够时，配备PPG传感器的OHRM在围手术期可以在ECG参考标准-5 bpm至5 bpm或-10%至10%的范围内测量HR。这意味着OHRM在低危住院患者的HR监测中可被认为在临床上是可接受的。
