Non-Invasive Continuous Respiratory Monitoring on General Hospital Wards: A Systematic Review

BACKGROUND Failure to recognize acute deterioration in hospitalized patients may contribute to cardiopulmonary arrest, unscheduled intensive care unit admission and increased mortality. PURPOSE In this systematic review we aimed to determine whether continuous non-invasive respiratory monitoring improves early diagnosis of patient deterioration and reduces critical incidents on hospital wards. DATA SOURCES Studies were retrieved from Medline, Embase, CINAHL, and the Cochrane library, searched from 1970 till October 25, 2014. STUDY SELECTION Electronic databases were searched using keywords and corresponding synonyms 'ward', 'continuous', 'monitoring' and 'respiration'. Pediatric, fetal and animal studies were excluded. DATA EXTRACTION Since no validated tool is currently available for diagnostic or intervention studies with continuous monitoring, methodological quality was assessed with a modified tool based on modified STARD, CONSORT, and TREND statements. DATA SYNTHESIS Six intervention and five diagnostic studies were included, evaluating the use of eight different devices for continuous respiratory monitoring. Quantitative data synthesis was not possible because intervention, study design and outcomes differed considerably between studies. Outcomes estimates for the intervention studies ranged from RR 0.14 (0.03, 0.64) for cardiopulmonary resuscitation to RR 1.00 (0.41, 2.35) for unplanned ICU admission after introduction of continuous respiratory monitoring. LIMITATIONS The methodological quality of most studies was moderate, e.g. 'before-after' designs, incomplete reporting of primary outcomes, and incomplete clinical implementation of the monitoring system. CONCLUSIONS Based on the findings of this systematic review, implementation of routine continuous non-invasive respiratory monitoring on general hospital wards cannot yet be advocated as results are inconclusive, and methodological quality of the studies needs improvement. Future research in this area should focus on technology explicitly suitable for low care settings and tailored alarm and treatment algorithms.