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Patient Monitoring Equipment

Remote patient monitoring finally mainstream

With patient monitoring technology having played a crucial part in care delivery during Covid-19, its use does not start and end with the pandemic. It is a lasting legacy, and here to stay.

The last decade has witnessed dramatic improvements in mobile, wearable, and digital health fields. In particular, there is rapid expansion and adoption of digital healthcare, fueled by the continuous advancement in electronics and recent breakthroughs in cloud computing, artificial intelligence (AI), and communication technologies, such as the Internet of Things (IoT) and 5G. Some of the vital-signs-monitoring capabilities have been built into phones, watches, and other smart wearable devices, and thus have become accessible to a much broader population. Increased awareness about health has given rise to the demand for small but high accuracy devices that can measure various vital signs and health markers, such as body temperature, heart rate, respiration rate, blood-oxygen saturation level (SpO2), blood pressure, and body composition. In particular, the Covid-19 pandemic has caused a surge in demand for devices capable of monitoring multiple vital signs, including temperature, SpO2, and heart rate, both in hospitals and at homes. The need for small and convenient health-tracking devices, preferably smart wearables, has reached historically high levels.

Even though the brunt of the pandemic appears to be behind us, medical professionals, realizing the benefits of remote patient monitoring (RPM), show no signs of backing down.

Global market dynamics
The global RPM market is expected to reach USD 117.1 billion by 2025, compared to USD 23.2 billion in 2020 – more than a fivefold increase in just five years, as reported by Forbes. This means that more companies are joining in on the RPM market. Both old and new companies are striving for innovation to make the most useful and cost-effective RPM devices. This high level of competition within the RPM market is amazing news across the board, but especially for people suffering from chronic illnesses like chronic kidney disease, diabetes, and chronic obstructive pulmonary disease, as this forces tech companies to make revolutionary devices that can help these patients.

The continuous measurement of patient parameters, such as heart rate and rhythm, respiratory rate, blood pressure, blood-oxygen saturation, and many other parameters, has become a common feature of the care of critically ill patients.

Delayed response to clinical deterioration as a result of intermittent vital sign monitoring is a cause of preventable morbidity and mortality. There is evidence of clinical benefit in implementing multi-parameter continuous non-invasive monitoring of vital signs (CoNiM) in non-intensive care unit patients.

Currently, CoNiM is only a standard practice in intensive care unit, but with the advent of wireless, light-weight and low-cost wearable sensors, there is a possibility of bringing CoNiM to all hospital in-patients.

Developments by technology companies, such as Apple and Google, have brought about advancements in sensor technologies, such as miniaturization, improved battery life, and reduction in production cost. These improvements have made bringing CoNiM into general hospital wards feasible.

Multi-parameter monitors are found in nearly every room of every hospital around the globe, continuously showing care providers their patients’ heart and respiratory rates, along with other various vital signs. Until recent years, these have been affixed to the patient and left for the nurses to periodically check on. With new technology, such as wireless sensors and communication devices, these monitors are now more proactive, notifying nurses sooner and sometimes even before an event takes place. These actions are, in turn, saving lives. Additionally, the multi-parameter-monitor segment is following the macro trends of AI and others in its efforts to proactively take care of the patient.

Paving a new era in resuscitation with AML biphasic defibrillator
Aditya Kohli
CFO and Director Sales,
Allied Medical Limited

Sudden cardiac arrest (SCA) causes thousands of deaths every year. Ventricular fibrillation (VF) is the presenting rhythm of SCA in many situations. As each minute passes, the chances of survival for a person suffering SCA drop by 10 percent. Even the best cardiopulmonary resuscitation cannot reverse this deadly heart rhythm. The only effective method of treatment is to deliver electric shocks, using a defibrillator. Although the first commercial defibrillator used a biphasic waveform for the treatment of ventricular fibrillation, commercial external defibrillators in the Western world adopted monophasic waveforms more than 30 years ago, and these have been used almost exclusively until recently. Thus, much of our clinical experience comes from the use of monophasic waveforms. Since the introduction of the first biphasic external defibrillator in 1996, there has been a growing acceptance that this technology offers an opportunity to increase the success of the defibrillation process.

Conventional defibrillators produce monophasic shocks, where the current flows in one direction. Biphasic waveform technology is developed from electrophysiological work on the design of implantable defibrillators. With biphasic shocks, the direction of the current flow is reversed at some point near the halfway of the electrical defibrillation cycle during the discharge from the defibrillator. External defibrillators that use biphasic waveforms are available for EMS applications, and the number of biphasic waveform technologies continue to increase.

Biphasic defibrillation waveforms increase the rate of successful conversion of ventricular fibrillation, reduce the myocardium’s exposure to high peak current, and have the potential to improve outcomes. Emerging data show that post-shock dysfunction, cellular injury, transmembrane effects, recovery time, and skin effects are reduced, and outcomes improved with clinically relevant defibrillation energies.

Allied Medical Limited (AML) is focused on manufacturing biphasic defibrillators in the name of Cardiasafe series that offers equal or better efficacy at lower energies than the traditional monophasic waveform defibrillators, with less risk of post-shock complications, such as myocardial dysfunction and skin burns. AML offers Cardiasafe defibrillators with biphasic waveforms to ensure that high-impedance persons will have the same chance for survival as those who are of low impedance. AML Cardiasafe is compact, lighter, less expensive, and less demanding of batteries, with minimal maintenance requirements. These technical advantages fulfil the requirement for lighter defibrillators with additional capability for patient monitoring.

The global multi-parameter patient-monitoring market is projected to reach a value of USD 6.1 billion in 2028, with demand growing at a moderate CAGR of 4.6 percent from 2022 to 2028. By the end of 2022, the target market will likely reach an estimated USD 4.6 billion. Due to the constantly growing need for better medical and healthcare services, from 2013 to 2021, the demand for multi-parameter patient monitors rose to a CAGR of 4.2 percent. Monitoring devices, like fetal monitors, 7-parameter patient monitors, and other medical monitoring devices, are anticipated to observe a spike in demand over the next 6 years with the increasing focus on patient monitoring all over the world.

The tabletop multi-parameter patient-monitoring segment will continue to make a significant contribution to the overall market. This segment will account for 57.4 percent of the global market share owing to extensive usage in hospital settings. However, the portable multi-parameter patient-monitoring segment will register a higher demand than the tabletop segment because of its growing popularity in various end-use settings.

Technology trends
Technological advancements, such as biosticker, AI, wearable patient-monitoring devices, functional near-infrared spectroscopy (fNIRS), a tricorder phototype for diagnosis and monitoring of multi-parameter, smart speakers for monitoring cardiac arrest and wireless neonatal body monitors have led to patient-monitoring devices that utilize faster, more accurate results.

Leading healthcare providers around the globe are experiencing firsthand how the latest AI solutions can improve patient care. Each stage of the patient care journey can be transformed with the right types of AI-assisted healthcare solutions and applications. Many of the healthcare providers and companies working with AI are making impacts on inference times, resource management, and remote patient monitoring. Using the latest technology, healthcare organizations can deliver a more accessible, personalized, and enhanced care experience.

The manufacturers are also integrating the patient-monitoring system with the wireless devices, such as smartphones for improving the end-user experience and introducing flexibility in patient monitoring. Moreover, the addition of wireless monitoring system adds the real-time data transmission from the system to the connected devices, which in turn is propelling the demand for patient-monitoring system.

With technological advancements in the patient-monitoring system, the contact-free patient monitoring is expected to be the new emerging trend in the global patient-monitoring systems market.

The leading manufacturers of patient-monitoring systems are increasingly investing in research and development process to improve the operational efficiency, and create a more technologically advanced patient-monitoring system.

Fluid balance monitoring system
Amrith Rangan
Akas Medical Equipment

Fluid balance is a term used to describe the balance of input and output of fluids in the body, to allow metabolic processes to function properly. Approximately 60 percent of body weight in males constitutes of total body fluid, with 52 percent in females. A reduction in body fluids can have major effects on the body – a reduction of 5 percent will cause thirst, a reduction of 8 percent will cause illness, and a 10-percent reduction in fluid can cause death. Age, gender, and body fat influence the proportion of body fluid.

There are a number of factors that will cause fluid loss and gain. An important factor in fluid loss to consider is the patient’s physical mobility/abilities. If a patient is physically disabled, they may not be able to access fluid. Some patients with continence problems may restrict their fluid intake believing this will alleviate the problem.

The nursing assessment of fluid balance should include the patient’s history, physical examination, clinical observation, and interpretation of laboratory results. A detailed account of the patient’s history should be taken, especially the fluid intake and output, which is done manually and is found to be a tedious process. Deviations from fluid balance, positive or negative, are of great importance in a wide range of medical and surgical conditions, and cause much loss of life.

To overcome such circumstances, Akas introduces application for fluid balance monitoring called Akas FBM. The intended use of Akas FBM application is to provide simple and easy solution for fluid balance. It provides a data management system that collects and stores the fluid balance data for every one hour, which represents in terms of graphical as well as tabular format.

To monitor urine output, Akas has dedicatedly developed a device called Uromon, which detects and monitors the urine output of the patient for the respective time intervals. The basic working principle of this application is to collect the input data from Akas infusion pumps and output data from Akas Uromon, and find the fluid balance of the patient by analyzing the periodic difference between drug input and urine output.

Wearable technology in healthcare includes electronic devices that consumers can wear, and are designed to collect the data of the user’s health and exercise. The advancement of wearable technology and growing demand from consumers to take control of their health has influenced the medical industry, including insurers, providers, and technology companies to develop more wearable devices. Wearable EEG monitors and blood pressure monitors are the examples of wearable patient monitors; wearable sensors can detect hidden anxiety and depression in children.

Functional near-infrared spectroscopy (fNIRS) is a wearable and portable brain-monitoring technology that tracks and monitors the cortical hemodynamic response, using near-infrared light sources and detectors placed over the scalp. It measures the changes of cortical deoxygenated and oxygenated hemoglobin concentrations non-invasively and safely in ecologically.

The tricorder is a portable multi-functioning device that diagnoses, monitors, and analyzes several parameters, such as diabetes, atrial fibrillation, chronic obstructive pulmonary disease, urinary tract infection, sleep apnea, leukocytosis, pertussis, stroke, tuberculosis, and pneumonia. Developed by Frontier Medical Devices, as part of Basil Leaf Technologies, the device is named as DxtER. It is a combination of smart tools, including a digital stethoscope, wrist sensor, chest sensor, spirometer, and blood pressure calibrator that feeds an AI program data to provide accurate diagnoses.

Smart speakers, like Google Home and Amazon Alexa, may detect the gasping sound of agonal breathing and call for help. The device is developed by researchers at the University of Washington, who have developed a new tool to monitor patients for cardiac arrest while patients are asleep without touching them. The device works by continuously and passively monitoring the bedroom for an agonal breathing event – it detected agonal breathing events 97 percent of the time with almost no false alarms in a proof-of-concept study.

Revolutionizing patient care with advanced patient monitoring technologies
Anil Kumar Srivastava
Chief Operating Officer,
Nihon Kohden India Pvt. Ltd.

Patient-monitoring devices are a vital component of every hospital’s workflow. These devices continuously measure parameters, such as heart rate, respiratory rate, blood pressure, blood oxygen saturation, and other advanced parameters. They facilitate clinicians in accurate and rapid decision making in ICUs, emergency rooms, operating rooms, general wards, and ambulatory surgical centers.

In recent years, there has been a great deal of innovation in patient-monitoring technologies. These innovations are attributed to ease-of-use, accuracy, patient comfort, connectivity, data and trends analysis, advanced parameters, etc. These developments are leading to a new generation of patient-monitoring technologies.

Academic research reveals that it is an early recovery of patients, a better prognosis, and preventive medical care. Nihon Kohden’s Life Scope G-series is designed to be a new platform to realize such medical care. With the Life Scope G-series, clinicians can spend more time with their patients. It supports a more accurate diagnosis and provides high-quality patient-centered care with advanced technologies, and seamless patient transport.

Nihon Kohden has been focused on the medical field for more than seven decades, and has been developing innovative human-machine interfaces. As Nihon Kohden researchers developed the principle of pulse oximetry, there has been developments in unique technologies for cardiopulmonary care, such as esCCO for continuous cardiac output measurement, Synec-I 18-lead ECG for the diagnosis of invisible cardiac ischemia, and many more.

In ER and ICUs, continuous neuromonitoring gives a better indication of the state of the brain during NCSE, or coma, helping clinicians better predict the outcome and, therefore, directly influencing the management of patients. With a compact EEG module or wireless EEG headset (AE-120A), Life Scope G-series monitors up to eight channels of EEG in real time. It enables quick data review with various trends, including density spectral array (DSA), compressed spectral array (CSA), and amplitude-integrated EEG (aEEG). These breakthrough technologies make invisible patient information visible and support a more accurate diagnosis.

The importance of evidence-based practice increases day by day. Clinicians who are seeking more advanced treatment may be struggling to collect data more efficiently. Life Scope G-series can send the patient’s vital sign data, including data from external devices, such as ventilators, to the hospital information system directly or through a gateway, using the HL7 protocol. This helps clinicians review the trends of patient’s vital sign data or perform statistical analysis of pathology. The advanced ViTrac viewer software allows clinicians to access monitoring information on multiple patients anywhere, anytime, on their mobile devices.

Neonates, who are admitted to neonatal intensive care (NICU) or pediatric intensive care (PICU), are monitored through a complex collection of sensors, which has a wire connected to a patient monitor. It is very difficult for parents to bond with their children and for clinicians to access the patients, hence Northwestern University engineers have developed flexible, wireless sensor patches that are capable of collecting the vital signs as wired devices. The new sensors can track the heart rate, respiration rate, temperature, and blood oxygenation as well as conventional sensors, and they also allow for monitoring of body movement and orientation, recording heart sounds, crying, and other audio biomarkers, and even provide a pretty accurate estimate of systolic blood pressure.

Advancements in patient monitoring
Dr Arathy R
Senior Design Engineer,
Skanray Technologies

To make proper assessments and decisions regarding the patient’s health condition and any therapeutic interventions that may be required, patient monitoring, a crucial component of patient care, may involve the intermittent, repeated, or continuous measurement of the patient’s physiological conditions, functions, or vital parameters.

Some recent practices in patient care monitoring system within the clinical environment are changing due to technological advancement, non-contact patient monitoring technologies, the use of IoT (internet-of-things) in remote and local systems, telemonitoring, cloud-based health care systems, and so on. Many modalities carry the advantage of machine learning (ML) and artificial intelligence (AI), embedded for speedier analysis of massive patient data for better predictability and sharing among the medical fraternity.

The modules estimating and reporting early warning scores (EWS), ventilation weaning readiness scores, etc., are a few among them. Further, the advent of more sophisticated systems, based on algorithms derived from physiological data and models, that can be decision-support solutions or predictive analytics is observed.

Considering the Covid-19 pandemic, with ICUs often overflowing with critical patients, and the shortage of intensive care specialists, as each patient’s vital signs are monitored repetitively, this data can be used in predictive analytics. Predictive algorithms can efficiently decide the patients with a high risk of condition deterioration, helping the health care practitioners act early, and avoid or minimise the effects.

Invasive monitoring techniques are used in critically ill patients; however, there is a constant drive to reduce invasiveness. Non-invasive monitoring may suffer from motion artefacts, placement, monitoring, etc. Still, improved accuracy and reliability of measurement techniques with state-of-the-art technology can be an alternative to the existing invasive technique. Introducing pulse contour analysis (PCA) from non-invasive finger cuff pressure monitoring is one of them. Considering the trade-off of non-invasive recording against accuracy and reliability, it may be less of an issue in lower acuity settings, where the trend is essential, and an offset may be acceptable.

Further, from the perspective of reduced patient constraint, wireless sensor connectivity on the patient is attractive, leading to wireless monitoring patches developed, which are used in lower-acuity care areas. Apart from this, the non-contact monitoring technologies have the potential to mobilize patients and are particularly well suited to lower acuity settings, where the wireless patch may not be a cost-effective solution.

With monitoring technology increasingly being placed in the hands of the patient, design and well-tested, well-researched ideas are more important than ever. Predictive analytics is enabling preventive health management on the population level, and the growing importance of care beyond the hospital increases demand for population health solutions. Remote monitoring technologies are continuing to play a critical role in home monitoring, potentially preventing readmissions.

Technological advancements in terms of accuracy and patient comfort, as well as connectivity and data analysis, will also be major growth drivers in this market in the foreseeable future. While the pandemic has presented challenges for some markets in the patient-monitoring space, others have grown. In either case, the market is set to stabilize and continue its trend of modest growth in coming years. 

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