Indwelling arterial lines, the clinical gold standard for continuous blood pressure (BP) monitoring in the pediatric intensive care unit (PICU), have significant drawbacks due to their invasive nature, ischemic risk, and impediment to natural body movement. A noninvasive, wireless, and accurate alternative would greatly improve the quality of patient care. Recently introduced classes of wireless, skin‐interfaced devices offer capabilities in continuous, precise monitoring of physiologic waveforms and vital signs in pediatric and neonatal patients, but have not yet been employed for continuous tracking of systolic and diastolic BP—critical for guiding clinical decision‐making in the PICU. The results presented here focus on materials and mechanics that optimize the system‐level properties of these devices to enhance their reliable use in this context, achieving full compatibility with the range of body sizes, skin types, and sterilization schemes typically encountered in the PICU. Systematic analysis of the data from these devices on 23 pediatric patients, yields derived, noninvasive BP values that can be quantitatively validated against direct recordings from arterial lines. The results from this diverse cohort, including those under pharmacological protocols, suggest that wireless, skin‐interfaced devices can, in certain circumstances of practical utility, accurately and continuously monitor BP in the PICU patient population.
- Award ID(s):
- 1635443
- NSF-PAR ID:
- 10301661
- Author(s) / Creator(s):
- ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; more »
- Date Published:
- Journal Name:
- Nature Communications
- Volume:
- 12
- Issue:
- 1
- ISSN:
- 2041-1723
- Format(s):
- Medium: X
- Sponsoring Org:
- National Science Foundation
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null (Ed.)The standard of clinical care in many pediatric and neonatal neurocritical care units involves continuous monitoring of cerebral hemodynamics using hard-wired devices that physically adhere to the skin and connect to base stations that commonly mount on an adjacent wall or stand. Risks of iatrogenic skin injuries associated with adhesives that bond such systems to the skin and entanglements of the patients and/or the healthcare professionals with the wires can impede clinical procedures and natural movements that are critical to the care, development, and recovery of pediatric patients. This paper presents a wireless, miniaturized, and mechanically soft, flexible device that supports measurements quantitatively comparable to existing clinical standards. The system features a multiphotodiode array and pair of light-emitting diodes for simultaneous monitoring of systemic and cerebral hemodynamics, with ability to measure cerebral oxygenation, heart rate, peripheral oxygenation, and potentially cerebral pulse pressure and vascular tone, through the utilization of multiwavelength reflectance-mode photoplethysmography and functional near-infrared spectroscopy. Monte Carlo optical simulations define the tissue-probing depths for source–detector distances and operating wavelengths of these systems using magnetic resonance images of the head of a representative pediatric patient to define the relevant geometries. Clinical studies on pediatric subjects with and without congenital central hypoventilation syndrome validate the feasibility for using this system in operating hospitals and define its advantages relative to established technologies. This platform has the potential to substantially enhance the quality of pediatric care across a wide range of conditions and use scenarios, not only in advanced hospital settings but also in clinics of lower- and middle-income countries.more » « less
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Abstract Background Millions of catheters for invasive arterial pressure monitoring are placed annually in intensive care units, emergency rooms, and operating rooms to guide medical treatment decision-making. Accurate assessment of arterial blood pressure requires an IV pole-attached pressure transducer placed at the same height as a reference point on the patient’s body, typically, the heart. Every time a patient moves, or the bed is adjusted, a nurse or physician must adjust the height of the pressure transducer. There are no alarms to indicate a discrepancy between the patient and transducer height, leading to inaccurate blood pressure measurements.
Methods We present a low-power wireless wearable tracking device that uses inaudible acoustic signals emitted from a speaker array to automatically compute height changes and correct the mean arterial blood pressure. Performance of this device was tested in 26 patients with arterial lines in place.
Results Our system calculates the mean arterial pressure with a bias of 0.19, inter-class correlation coefficients of 0.959 and a median difference of 1.6 mmHg when compared to clinical invasive arterial measurements.
Conclusions Given the increased workload demands on nurses and physicians, our proof-of concept technology may improve accuracy of pressure measurements and reduce the task burden for medical staff by automating a task that previously required manual manipulation and close patient surveillance.
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Accepted Manuscript1.0
- Journal Article:
- https://doi.org/10.1038/s41467-021-25324-w
