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PAT I ENT DET E RIORATION


it affordable to undertake monitoring for large numbers of patients, which has been essential during the coronavirus crisis: “We are not surprised by the sudden demand for the technology. We have been working on this with care teams in different countries, for a long time, with the aim of driving this technology into a new standard of care. But what we see now is not a ‘disruption’; it is a rapid acceleration of a process already taking place. “Although we did not anticipate the speed at which this has happened, we have been expecting something like this to occur, for some time. The scaling up of the technology is challenging, but we have taken on extra people and expanded into an additional unit to ramp up manufacturing. The question is: will this demand decrease as the pandemic slows? The requirement to deliver these systems in two or three days may come to an end, but the requirement for this type of intelligent monitoring technology will not subside. Everything else has gone wireless – why not hospitals?” he commented.


Early detection of neonatal sepsis While the technology has seen increased adoption for management of COVID patients, the PSE system is also helping to improve outcomes for other groups of patients and has been finding its way into a wide range of applications across different healthcare settings. For example, physicians at the Cohen


Children’s Medical Center (part of the Northwell Health Group, New York) carried out a major study using the PSE to monitor mothers during labour to investigate whether maternal fever is a predictor of early onset neonatal sepsis.


Using the PSE, doctors at the US hospital discovered that continuous measurement of maternal temperature during labour may be a better indicator of high-risk


Clinicians believe this close analysis of the heart rate could be valuable in detecting sepsis or whether the patient is going through a Cytokine release storm. Symptomatically, these can look the same but, in terms of treatment and physiology, they are very different.


infection in newborn babies compared to standard obstetrical practice of measuring oral temperature. They also discovered that continuous measurement of temperature during labour can detect times when significant fevers are missed by manual oral measurements.1


Managing advanced liver cirrhosis Working with the Patient Status Engine and Isansys engineers, hepatologists at the Royal Free Hospital in London have also developed a new data-driven biomarker that identifies patients with advanced cirrhosis of the liver most at risk of decomposition.2 The current standard procedure to


identify liver disease patients most at risk of decomposition is to bring them into the hospital for a blood-based lab test that takes at least a day to run. At the end of the day, depending on the test results, patients are informed as to whether they will need to be admitted or not.


The new biomarker offers several key benefits over the current test: (a) It requires only 10-20 mins of data from the Isansys Lifetouch; (b) The data can be analysed in real time; (c) The data can be collected in the patient’s own home.


One hundred and eleven patients were included in the collaborative study between


the University College London, Royal Free Hospital, UK, and the University of Bonn, Germany, which showed that a significant reduction in heart rate variability is a feature of acute decompensation of cirrhosis and predicts 90-day mortality in these patients. In a preliminary study, the London team validated the Patient Status Engine and Lifetouch sensor as an ideal remote monitoring system and used it to create a baseline heart rate variability (HRV) data set from a group of healthy volunteers. They then used the Lifetouch to assess HRV remotely and non-invasively on patients admitted to the Royal Free Hospital with an acute decompensation (a significant deterioration) of advanced cirrhosis. The results concluded that continuous, wireless monitoring of HRV is feasible in patients with advanced liver disease. The study also supported the hypothesis of both hospital teams that reduced HRV, correlates with severity of liver decompensation, facilitating the identification of high- risk patients, and allowing for timely interventions. In light of these findings, the study suggests the future potential for such continuous monitoring and the prospective health economic benefit of measuring HRV remotely.


The report stated: “Traditional ECG measurement of HRV encompasses short-term 5-minute ECG segments being interpreted separately as reflecting HRV in that specific time window, under stable physiological conditions. The Lifetouch system by contrast, not only facilitates continuous monitoring irrespective of the individuals’ daily activity or physical ill-health but also helps negate the short coming of limited ECG time capture which make further interpretation difficult. Using the remote monitoring device, it was possible to interpret HRV in all monitored in-patients with acute decompensation.”


Paediatric monitoring


Isansys has also been working with the Birmingham Women’s and Children’s Foundation Trust to improve outcomes for hospitalised children, using artificial intelligence. To assist in the early warning of deterioration in hospitalised children Duncan et al studied the feasibility of collecting


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