Monitoring (medicine)

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Display device of a medical monitor as used in anesthesia Monitor (medical).jpg
Display device of a medical monitor as used in anesthesia
A patient of an intensive care unit in a German hospital in 2015, with a monitoring screen displaying a graphical electrocardiogram, the heart rate and blood pressure all in real time Patient lying in hospital bed in intensive care unit in Germany in 2015.jpg
A patient of an intensive care unit in a German hospital in 2015, with a monitoring screen displaying a graphical electrocardiogram, the heart rate and blood pressure all in real time

In medicine, monitoring is the observation of a disease, condition or one or several medical parameters over time.

Contents

It can be performed by continuously measuring certain parameters by using a medical monitor (for example, by continuously measuring vital signs by a bedside monitor), and/or by repeatedly performing medical tests (such as blood glucose monitoring with a glucose meter in people with diabetes mellitus).

Transmitting data from a monitor to a distant monitoring station is known as telemetry or biotelemetry.

Classification by target parameter

Monitoring can be classified by the target of interest, including:

Vital parameters

An anesthetic machine with integrated systems for monitoring of several vital parameters, including blood pressure and heart rate Maquet Flow-I anesthesia machine.jpg
An anesthetic machine with integrated systems for monitoring of several vital parameters, including blood pressure and heart rate

Monitoring of vital parameters can include several of the ones mentioned above, and most commonly include at least blood pressure and heart rate, and preferably also pulse oximetry and respiratory rate. Multimodal monitors that simultaneously measure and display the relevant vital parameters are commonly integrated into the bedside monitors in critical care units, and the anesthetic machines in operating rooms. These allow for continuous monitoring of a patient, with medical staff being continuously informed of the changes in general condition of a patient. Some monitors can even warn of pending fatal cardiac conditions before visible signs are noticeable to clinical staff, such as atrial fibrillation or premature ventricular contraction (PVC).

Medical monitor

A medical monitor or physiological monitor is a medical device used for monitoring. It can consist of one or more sensors, processing components, display devices (which are sometimes in themselves called "monitors"), as well as communication links for displaying or recording the results elsewhere through a monitoring network.[ citation needed ]

Components

Sensor

Sensors of medical monitors include biosensors and mechanical sensors. For example, photodiode is used in pulse oximetry, Pressure sensor used in Non Invasive bood pressure measurement.

Translating component

The translating component of medical monitors is responsible for converting the signals from the sensors to a format that can be shown on the display device or transferred to an external display or recording device.

Display device

Physiological data are displayed continuously on a CRT, LED or LCD screen as data channels along the time axis. They may be accompanied by numerical readouts of computed parameters on the original data, such as maximum, minimum and average values, pulse and respiratory frequencies, and so on.[ citation needed ]

Besides the tracings of physiological parameters along time (X axis), digital medical displays have automated numeric readouts of the peak and/or average parameters displayed on the screen.

Modern medical display devices commonly use digital signal processing (DSP), which has the advantages of miniaturization, portability, and multi-parameter displays that can track many different vital signs at once.[ citation needed ]

Old analog patient displays, in contrast, were based on oscilloscopes, and had one channel only, usually reserved for electrocardiographic monitoring (ECG). Therefore, medical monitors tended to be highly specialized. One monitor would track a patient's blood pressure, while another would measure pulse oximetry, another the ECG. Later analog models had a second or third channel displayed on the same screen, usually to monitor respiration movements and blood pressure. These machines were widely used and saved many lives, but they had several restrictions, including sensitivity to electrical interference, base level fluctuations and absence of numeric readouts and alarms.[ citation needed ]

Several models of multi-parameter monitors are networkable, i.e., they can send their output to a central ICU monitoring station, where a single staff member can observe and respond to several bedside monitors simultaneously. Ambulatory telemetry can also be achieved by portable, battery-operated models which are carried by the patient and which transmit their data via a wireless data connection.

Digital monitoring has created the possibility, which is being fully developed, of integrating the physiological data from the patient monitoring networks into the emerging hospital electronic health record and digital charting systems, using appropriate health care standards which have been developed for this purpose by organizations such as IEEE and HL7. This newer method of charting patient data reduces the likelihood of human documentation error and will eventually reduce overall paper consumption. In addition, automated ECG interpretation incorporates diagnostic codes automatically into the charts. Medical monitor's embedded software can take care of the data coding according to these standards and send messages to the medical records application, which decodes them and incorporates the data into the adequate fields.

Long-distance connectivity can avail for telemedicine, which involves provision of clinical health care at a distance.

Other components

A medical monitor can also have the function to produce an alarm (such as using audible signals) to alert the staff when certain criteria are set, such as when some parameter exceeds of falls the level limits.

Mobile appliances

An entirely new scope is opened with mobile carried monitors, even such in sub-skin carriage. This class of monitors delivers information gathered in body-area networking (BAN) to e.g. smart phones and implemented autonomous agents.

Interpretation of monitored parameters

Monitoring of clinical parameters is primarily intended to detect changes (or absence of changes) in the clinical status of an individual. For example, the parameter of oxygen saturation is usually monitored to detect changes in respiratory capability of an individual.

Change in status versus test variability

When monitoring a clinical parameters, differences between test results (or values of a continuously monitored parameter after a time interval) can reflect either (or both) an actual change in the status of the condition or a test-retest variability of the test method.

In practice, the possibility that a difference is due to test-retest variability can almost certainly be excluded if the difference is larger than a predefined "critical difference". This "critical difference" (CD) is calculated as: [2]

, where: [2]

For example, if a patient has a hemoglobin level of 100 g/L, the analytical variation (CVa) is 1.8% and the intra-individual variability CVi is 2.2%, then the critical difference is 8.1 g/L. Thus, for changes of less than 8 g/L since a previous test, the possibility that the change is completely caused by test-retest variability may need to be considered in addition to considering effects of, for example, diseases or treatments.

Critical differences for some blood tests [2]
Sodium 3%
Potassium 14%
Chloride 4%
Urea 30%
Creatinine 14%
Calcium 5%
Albumin 8%
Fasting glucose 15%
Amylase 30%
Carcinoembryonic antigen 69%
C-reactive protein 43% [3]
Glycated hemoglobin 21%
Hemoglobin 8%
Erythrocytes 10%
Leukocytes 32%
Platelets 25%
Unless otherwise specified, then reference for critical values is Fraser 1989 [2]

Critical differences for other tests include early morning urinary albumin concentration, with a critical difference of 40%. [2]

Delta check

In a clinical laboratory, a delta check is a laboratory quality control method that compares a current test result with previous test results of the same person, and detects whether there is a substantial difference, as can be defined as a critical difference as per previous section, or defined by other pre-defined criteria. If the difference exceeds the pre-defined criteria, the result is reported only after manual confirmation by laboratory personnel, in order to exclude a laboratory error as a cause of the difference. [4] In order to flag samples as deviating from previously, the exact cutoff values are chosen to give a balance between sensitivity and the risk of being overwhelmed by false-positive flags. [5] This balance, in turn, depends on the different kinds of clinical situations where the cutoffs are used, and hence, different cutoffs are often used at different departments even in the same hospital. [5]

Techniques in development

The development of new techniques for monitoring is an advanced and developing field in smart medicine, biomedical-aided integrative medicine, alternative medicine, self-tailored preventive medicine and predictive medicine that emphasizes monitoring of comprehensive medical data of patients, people at risk and healthy people using advanced, smart, minimally invasive biomedical devices, biosensors, lab-on-a-chip (in the future nanomedicine [6] [7] devices like nanorobots) and advanced computerized medical diagnosis and early warning tools over a short clinical interview and drug prescription.

As biomedical research, nanotechnology and nutrigenomics advances, realizing the human body's self-healing capabilities and the growing awareness of the limitations of medical intervention by chemical drugs-only approach of old school medical treatment, new researches that shows the enormous damage medications can cause, [8] [9] researchers are working to fulfill the need for a comprehensive further study and personal continuous clinical monitoring of health conditions while keeping legacy medical intervention as a last resort.

In many medical problems, drugs offer temporary relief of symptoms while the root of a medical problem remains unknown without enough data of all our biological systems [10] . Our body is equipped with sub-systems for the purpose of maintaining balance and self healing functions. Intervention without sufficient data might damage those healing sub systems. [10] Monitoring medicine fills the gap to prevent diagnosis errors and can assist in future medical research by analyzing all data of many patients.

Given Imaging Capsule endoscopy CapsuleEndoscope.jpg
Given Imaging Capsule endoscopy

Examples and applications

The development cycle in medicine is extremely long, up to 20 years, because of the need for U.S. Food and Drug Administration (FDA) approvals, therefore many of monitoring medicine solutions are not available today in conventional medicine.

The PASCAL Dynamic Contour Tonometer. A monitor for detection of increased intraocular pressure. PASCAL tonometer.jpg
The PASCAL Dynamic Contour Tonometer. A monitor for detection of increased intraocular pressure.
Blood glucose monitoring
In vivo blood glucose monitoring devices can transmit data to a computer that can assist with daily life suggestions for lifestyle or nutrition and with the physician can make suggestions for further study in people who are at risk and help prevent diabetes mellitus type 2 . [11]
Stress monitoring
Bio sensors may provide warnings when stress levels signs are rising before human can notice it and provide alerts and suggestions. [12] Deep neural network models using photoplethysmography imaging (PPGI) data from mobile cameras can assess stress levels with a high degree of accuracy (86%). [13]
Serotonin biosensor
Future serotonin biosensors may assist with mood disorders and depression. [14]
Continuous blood test based nutrition
In the field of evidence-based nutrition, a lab-on-a-chip implant that can run 24/7 blood tests may provide a continuous results and a computer can provide nutrition suggestions or alerts.
Psychiatrist-on-a-chip
In clinical brain sciences drug delivery and in vivo Bio-MEMS based biosensors may assist with preventing and early treatment of mental disorders
Epilepsy monitoring
In epilepsy, next generations of long-term video-EEG monitoring may predict epileptic seizure and prevent them with changes of daily life activity like sleep, stress, nutrition and mood management. [15]
Toxicity monitoring
Smart biosensors may detect toxic materials such mercury and lead and provide alerts. [16]

See also

Related Research Articles

<span class="mw-page-title-main">Blood glucose monitoring</span> Use of a glucose monitor for testing the concentration of glucose in the blood

Blood glucose monitoring is the use of a glucose meter for testing the concentration of glucose in the blood (glycemia). Particularly important in diabetes management, a blood glucose test is typically performed by piercing the skin to draw blood, then applying the blood to a chemically active disposable 'test-strip'. The other main option is continuous glucose monitoring (CGM). Different manufacturers use different technology, but most systems measure an electrical characteristic and use this to determine the glucose level in the blood. Skin-prick methods measure capillary blood glucose, whereas CGM correlates interstitial fluid glucose level to blood glucose level. Measurements may occur after fasting or at random nonfasting intervals, each of which informs diagnosis or monitoring in different ways.

<span class="mw-page-title-main">Cardiac output</span> Measurement of blood pumped by the heart

In cardiac physiology, cardiac output (CO), also known as heart output and often denoted by the symbols , , or , is the volumetric flow rate of the heart's pumping output: that is, the volume of blood being pumped by a single ventricle of the heart, per unit time. Cardiac output (CO) is the product of the heart rate (HR), i.e. the number of heartbeats per minute (bpm), and the stroke volume (SV), which is the volume of blood pumped from the left ventricle per beat; thus giving the formula:

<span class="mw-page-title-main">Photoplethysmogram</span> Chart of tissue blood volume changes

A photoplethysmogram (PPG) is an optically obtained plethysmogram that can be used to detect blood volume changes in the microvascular bed of tissue. A PPG is often obtained by using a pulse oximeter which illuminates the skin and measures changes in light absorption. A conventional pulse oximeter monitors the perfusion of blood to the dermis and subcutaneous tissue of the skin.

Pulse oximetry is a noninvasive method for monitoring a person's blood oxygen saturation. Peripheral oxygen saturation (SpO2) readings are typically within 2% accuracy of the more accurate reading of arterial oxygen saturation (SaO2) from arterial blood gas analysis. But the two are correlated well enough that the safe, convenient, noninvasive, inexpensive pulse oximetry method is valuable for measuring oxygen saturation in clinical use.

<span class="mw-page-title-main">Polysomnography</span> Multi-parameter study of sleep and sleep disorders

Polysomnography (PSG), a type of sleep study, is a multi-parameter study of sleep and a diagnostic tool in sleep medicine. The test result is called a polysomnogram, also abbreviated PSG. The name is derived from Greek and Latin roots: the Greek πολύς, the Latin somnus ("sleep"), and the Greek γράφειν.

<span class="mw-page-title-main">Capnography</span> Monitoring of the concentration of carbon dioxide in respiratory gases

Capnography is the monitoring of the concentration or partial pressure of carbon dioxide (CO
2
) in the respiratory gases. Its main development has been as a monitoring tool for use during anesthesia and intensive care. It is usually presented as a graph of CO
2
(measured in kilopascals, "kPa" or millimeters of mercury, "mmHg") plotted against time, or, less commonly, but more usefully, expired volume (known as volumetric capnography). The plot may also show the inspired CO
2
, which is of interest when rebreathing systems are being used. When the measurement is taken at the end of a breath (exhaling), it is called "end tidal" CO
2
(PETCO2).

<span class="mw-page-title-main">Glucose meter</span> Medical device for determining the concentration of glucose in the blood

A glucose meter, also referred to as a "glucometer", is a medical device for determining the approximate concentration of glucose in the blood. It can also be a strip of glucose paper dipped into a substance and measured to the glucose chart. It is a key element of glucose testing, including home blood glucose monitoring (HBGM) performed by people with diabetes mellitus or hypoglycemia. A small drop of blood, obtained from slightly piercing a fingertip with a lancet, is placed on a disposable test strip that the meter reads and uses to calculate the blood glucose level. The meter then displays the level in units of mg/dL or mmol/L.

<span class="mw-page-title-main">Somnology</span> Scientific study of sleep

Somnology is the scientific study of sleep. It includes clinical study and treatment of sleep disorders and irregularities. Sleep medicine is a subset of somnology.

<span class="mw-page-title-main">Vital signs</span> Group of the 4-6 important medical signs that indicate the status of the bodys vital functions

Vital signs are a group of the four to six most crucial medical signs that indicate the status of the body's vital (life-sustaining) functions. These measurements are taken to help assess the general physical health of a person, give clues to possible diseases, and show progress toward recovery. The normal ranges for a person's vital signs vary with age, weight, sex, and overall health.

The respiratory rate is the rate at which breathing occurs; it is set and controlled by the respiratory center of the brain. A person's respiratory rate is usually measured in breaths per minute.

<span class="mw-page-title-main">Cardiac monitoring</span>

Cardiac monitoring generally refers to continuous or intermittent monitoring of heart activity to assess a patient's condition relative to their cardiac rhythm. Cardiac monitoring is usually carried out using electrocardiography, which is a noninvasive process that records the heart's electrical activity and displays it in an electrocardiogram. It is different from hemodynamic monitoring, which monitors the pressure and flow of blood within the cardiovascular system. The two may be performed simultaneously on critical heart patients. Cardiac monitoring for ambulatory patients is known as ambulatory electrocardiography and uses a small, wearable device, such as a Holter monitor, wireless ambulatory ECG, or an implantable loop recorder. Data from a cardiac monitor can be transmitted to a distant monitoring station in a process known as telemetry or biotelemetry.

<span class="mw-page-title-main">Masimo</span> American health technology company

Masimo Corporation is a health technology and consumer electronics company based in Irvine, California. The company primarily manufactures patient monitoring devices and technologies, including non-invasive sensors using optical technology, patient management, and telehealth platforms. In 2022, the company expanded into home audio by acquiring Sound United, and began to manufacture health-oriented wearable devices.

<span class="mw-page-title-main">Oxygen saturation (medicine)</span> Medical measurement

Oxygen saturation is the fraction of oxygen-saturated haemoglobin relative to total haemoglobin in the blood. The human body requires and regulates a very precise and specific balance of oxygen in the blood. Normal arterial blood oxygen saturation levels in humans are 96–100 percent. If the level is below 90 percent, it is considered low and called hypoxemia. Arterial blood oxygen levels below 80 percent may compromise organ function, such as the brain and heart, and should be promptly addressed. Continued low oxygen levels may lead to respiratory or cardiac arrest. Oxygen therapy may be used to assist in raising blood oxygen levels. Oxygenation occurs when oxygen molecules enter the tissues of the body. For example, blood is oxygenated in the lungs, where oxygen molecules travel from the air and into the blood. Oxygenation is commonly used to refer to medical oxygen saturation.

Integrated pulmonary index (IPI) is a patient pulmonary index which uses information from capnography and pulse oximetry to provide a single value that describes the patient's respiratory status. IPI is used by clinicians to quickly assess the patient's respiratory status to determine the need for additional clinical assessment or intervention.

Continuous noninvasive arterial pressure (CNAP) is the method of measuring beat-to-beat arterial blood pressure in real-time without any interruptions (continuously) and without cannulating the human body (noninvasive).

<span class="mw-page-title-main">Medical tricorder</span>

A medical tricorder is a handheld portable scanning device to be used by consumers to self-diagnose medical conditions within seconds and take basic vital measurements. While the device is not yet on the mass market, there are numerous reports of other scientists and inventors also working to create such a device as well as improve it. A common view is that it will be a general-purpose tool similar in functionality to a Swiss Army Knife to take health measurements such as blood pressure and temperature, and blood flow in a noninvasive way. It would diagnose a person's state of health after analyzing the data, either as a standalone device or as a connection to medical databases via an Internet connection.

Ambulatory glucose profile (AGP) is a single-page, standardized report for interpreting a patient's daily glucose and insulin patterns. AGP provides both graphic and quantitative characterizations of daily glucose patterns. First developed by Drs. Roger Mazze and David Rodbard, with colleagues at the Albert Einstein College of Medicine in 1987, AGP was initially used for the representation of episodic self-monitored blood glucose (SMBG). The first version included a glucose median and inter-quartile ranges graphed as a 24-hour day. Dr. Mazze brought the original AGP to the International Diabetes Center (IDC) in the late 1980s. Since then, IDC has built the AGP into the internationally recognized standard for glucose pattern reporting.

<span class="mw-page-title-main">Continuous glucose monitor</span> Blood glucose monitoring device

A continuous glucose monitor (CGM) is a device used for monitoring blood glucose on a continual basis instead of monitoring glucose levels periodically by drawing a drop of blood from a finger. This is known as continuous glucose monitoring. CGMs are used by people who treat their diabetes with insulin, for example people with type 1 diabetes, type 2 diabetes, or other types of diabetes, such as gestational diabetes.

Bioinstrumentation or Biomedical Instrumentation is an application of biomedical engineering which focuses on development of devices and mechanics used to measure, evaluate, and treat biological systems. The goal of biomedical instrumentation focuses on the use of multiple sensors to monitor physiological characteristics of a human or animal for diagnostic and disease treatment purposes. Such instrumentation originated as a necessity to constantly monitor vital signs of Astronauts during NASA's Mercury, Gemini, and Apollo missions.

<span class="mw-page-title-main">CardiacSense Ltd</span> Israeli medical products company

CardiacSense is a developer of a wearable technology for continuous cardiac arrhythmia detection and vital signs monitoring. CardiacSense is based in Caesarea, Israel.

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Further reading