Defining the Incidence of Cardiorespiratory Instability in Patients in Step-down Units Using an Electronic Integrated Monitoring System

Authors:
  • LELeslie Edwards
    Leslie Edwards
  • ACAmy Clontz
    Amy Clontz
  • CVCynthia Valenta
    Cynthia Valenta
  • MDMichael A. DeVita
    Michael A. DeVita
  • MPMichael R. Pinsky
    Michael R. Pinsky
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Abstract
Pressure to increase intensive care unit (ICU) bed availability grows as the need to streamline patient movement through acute care facilities intensifies nationally. Patients with higher illness acuity levels are transferred from ICUs to intermediate-care or step-down units (SDUs) to make room for sicker patients. Patients in SDUs are continuously monitored using noninvasive tools such as pulse oximetry, electrocardiography, and automated sphygmomanometry to give estimates of heart rate (HR), blood pressure (BP), respiratory rate (RR), and peripheral oxygen saturation by pulse oximetry (SpO2). However, it is not known whether such SDU noninvasive monitoring identifies cardiorespiratory instability accurately and reliably. First, it is unclear how often continuous monitoring is actually used in these patients. Second, the incidence of clinically relevant cardiorespiratory instability in this population is unknown. Third, in those patients who develop cardiorespiratory instability requiring acute intervention, it has not yet been shown in a continuously monitored population whether instability is more likely to occur rapidly or progressively. Fourth, present electronic bedside monitoring assesses and alarms for individual variable abnormalities and does not consider patterns of multiple cardiorespiratory variables in combination usually present with patient deterioration owing to sepsis, heart failure, or acute respiratory failure.

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