Non-contact monitoring of agitation and use of a sheltering device in patients with dementia in emergency departments: a feasibility study
Non-contact monitoring of agitation and use of a sheltering device in patients with dementia in emergency departments: a feasibility study
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DOI：
10.1186/s12888-020-02573-5
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发表时间：
2020-04-15
期刊：
影响因子：
4.4
通讯作者：
Somasundaram, Rajan
中科院分区：
文献类型：
--
作者：
Kroll, Lisa;Boehning, Nikolaus;Somasundaram, Rajan
背景躁动在认知障碍的老年患者中很常见，例如在急诊科（艾德）收治的痴呆（PWD）患者中。这可能是即将到来的谵妄的第一个迹象，并与不利的临床过程的风险较高。因此，监测生命体征和增强运动的指标即将到来的激动是必不可少的，在这些患者在他们的逗留在ED。由于PWD很少容忍固定的监测设备，一个新开发的非接触式监测系统（NCMSys）可能是一个适当的替代方案。本可行性研究的目的是测试NCMSys和帐篷状"Charite Dome"（ChD）的有效性，旨在为PWD提供庇护，使其免受忙碌的艾德环境的影响。此外，ChD对PWD的健康和躁动的影响进行了研究。方法两种装置均固定在病床上。在iDoc研究所对6名健康志愿者进行了NCMSys和ChD的技术有效性和安全性问题测试。在艾德的现实环境和老年-老年精神病病房中进行了一项可行性研究，评价了有和无ChD的NCMSys的可靠性。纳入19例患者，10例男性和9例女性;平均年龄：77.4（55 - 93）岁，其中14例为PWD。PWD入选标准为年龄≥ 55岁，痴呆诊断和书面同意（由患者或监护人）。排除标准为急性危及生命的情况和知情同意缺失。结果：NCMSys对心率、运动变化和声发射的测量是有效的，而患者运动影响呼吸频率测量。在我们的研究中，ChD不影响患者的生命体征或运动。然而，53%的PWD（7/13）和大多数无痴呆症的患者（4/5）在焦虑和整体健康方面受益于其使用。结论本可行性研究的结果鼓励未来在老年艾德患者（包括PWD）中进行对照临床试验，以进一步评估我们的非接触式生命体征和运动测量概念与"Charite Dome"相结合是否有助于预防ED中这一弱势患者群体即将发生的躁动。
Background Agitation is common in geriatric patients with cognitive impairment, e.g. in persons with dementia (PWD), who are admitted to an emergency department (ED). It might be a first sign of upcoming delirium and is associated with a higher risk of an unfavorable clinical course. Hence, monitoring of vital signs and enhanced movement as indicators of upcoming agitation is essential in these patients during their stay in the ED. Since PWD rarely tolerate fixed monitoring devices, a novel developed non-contact monitoring system (NCMSys) might represent an appropriate alternative. Aim of this feasibility study was to test the validity of a NCMSys and of the tent-like "Charite Dome" (ChD), aimed to shelter PWD from the busy ED environment. Furthermore, effects of the ChD on wellbeing and agitation of PWD were investigated. Methods Both devices were attached to patient's bed. Tests on technical validity and safety issues of NCMSys and ChD were performed at the iDoc institute with six healthy volunteers. A feasibility study evaluating the reliability of the NCMSys with and without the ChD was performed in the real-life setting of an ED and on a geriatric-gerontopsychiatric ward. 19 patients were included, ten males and nine females; mean age: 77.4 (55-93) years of which 14 were PWD. PWD inclusion criteria were age >= 55 years, a dementia diagnosis and a written consent (by patients or by a custodian). Exclusion criteria were acute life-threatening situations and a missing consent. Results Measurements of heart rate, changes in movement and sound emissions by the NCMSys were valid, whereas patient movements affected respiratory rate measurements. The ChD did not impact patients' vital signs or movements in our study setting. However, 53% of the PWD (7/13) and most of the patients without dementia (4/5) benefited from its use regarding their agitation and overall wellbeing. Conclusions The results of this feasibility study encourage a future controlled clinical trial in geriatric ED patients, including PWD, to further evaluate if our concept of non-contact measurement of vital signs and movement combined with the "Charite Dome" helps to prevent upcoming agitation in this vulnerable patient group in the ED.