Can Continuous Monitoring Inform Early Interventions in the ED?

Monitoring etCO2  can help EMS professionals critically assess patients with sepsis-like symptoms — and help prepare Emergency department staff for a potentially high-risk patient. After hospital admission, continuous, remote capnography monitoring can provide time-sensitive data — whether it’s on the general care floor or ICU.

In this blog post, we’ll address the following:

  • How early detection of sepsis data during prehospital transport helps shape patient outcomes
  • Risk factors associated with late detection of sepsis from the ED to ICU
  • The role of continuous patient monitoring

Early detection sepsis data during prehospital transport shapes patient outcomes

Sepsis carried an estimated $20 billion price tag for U.S. hospitals in 2011.1 The life-threatening condition affects about 30 million patients worldwide annually.2 A thorough patient assessment by EMS and Emergency Department clinicians can make a difference — especially if symptoms are missed.

To help improve patient outcomes, more hospitals require sepsis screening during prehospital evaluation. When Emergency departments receive prearrival notifications for patients suspected with sepsis infections — prompt treatment can start during early detection.3 

What is sepsis? Sepsis is a life-threatening infection accompanied by systemic inflammatory response organ dysfunction. Pneumonia can sometimes play a role in the infection.4

Using capnography to measure etCO2 can be a strong predictive tool for identifying sepsis during prehospital evaluation. Monitoring etCO2 levels provides data that helps heighten awareness for early interventions5 — and may help expedite lab orders, IV fluids, and treatments for septic patients.3

Monitoring prehospital patients’ etCO2 levels can help clinicians predict patient mortality rates among patients with severe sepsis — compared to using qSOFA scores alone.6

Did you know? When EMS providers can activate a sepsis alert from the field, it may help emergency room clinicians stabilize patients sooner and decrease ICU admissions.

Related: Learn why EMS should monitor EtCO2.

Risk factors with late detection from the ED to ICU

When patients are transferred from the ED to ICU, nurses may be dealing with the perils of shift change and patient vital signs are sometimes missed. When paired with continuous patient monitoring technology like the Vital Sync™ solution, measuring SpO2 levels with pulse oximetry can help clinicians identify subtle changes that contribute to patient decline.8

The Vital Sync™ system even allows you to access patient bedside data remotely, helping you detect the changes earlier and more effectively.

Patients diagnosed with sepsis have a mortality rate between 28 and 50 percent.9 Once the diagnosis is made, it’s critical to closely monitor septic patients in the initial hours. This helps clinicians ensure that urgent assessments and antibiotic treatments can be given when they’re most needed. Rapid fluid resuscitation may also help improve patient prognosis according to protocols from Surviving Sepsis Guidelines.10

To understand risk factors, it’s important to recognize some hallmark signs of sepsis. The common symptoms of sepsis include:11

  • ≥ 2 SOFA or qSOFA
  • Increased respirations
  • Systolic blood pressure drop
  • Changes in mental status

Related: Take a look at visual waveforms to see what information it provides clinicians in this training video.

Helping clinicians spot patient deterioration using continuous patient monitoring tools in septic patients

Delayed treatment can have fatal outcomes for septic patients, especially if they deteriorate into septic shock. Septic shock is associated with persistent hypotension and associated with multiple organ failure.11 When hypotension sets in — patient mortality increases about 7.6 percent .12

Studies suggest metabolic markers such as low etCO2 levels correlated with acidosis.13 Detecting acidosis can prompt clinical decisions for early intervention — Including aggressive resuscitation in septic patients.14 The Vital Sync™ remote monitoring solution can provide a rapid, visual way to see etCO2 levels when combined with bedside devices like Capnostream™ 20p bedside capnography monitor. These levels have an “inverse relationship” to lactate levels.13

Microstream™ capnography combines etCO2, SpO2, respiratory rate, and pulse rate data into one value to indicate patient respiratory status. Valuable information like this helps enhance your clinical assessment of patients.

When bedside monitoring isn’t an option, the Vital Sync™ remote patient monitoring platform offers clinicians a way to remotely monitor patients. Whether you’re operating from a telemedicine command center or transferring patients from general care to ICU, this solution helps you detect critical patient changes — early. In both scenarios, continuous patient monitoring capability stays with patients throughout the continuum of care.

In the fight against sepsis, the Vital Sync™ trend analysis tool helps you track subtle changes in patient hemodynamics.  Plus, the early warning score (EWS) technology combined with vital sign assessments helps you spot patient deterioration so you can intervene sooner. 

Did you know? Vital Sync™ remote patient monitoring uses two-way EMR connectivity, saving time charting patient records. 

References:
1. Torio CM, Andrews RM.  National inpatient hospital costs: The most expensive conditions by payer, 2011: Statistical Brief #160. In: Healthcare Cost and Utilization Project (HCUP). Statistical Briefs. Rockville (MD): Agency for Health Care Policy and Research (US). 2006–2013.
2. World Health Assembly. Fact sheet. https://www.who.int/news-room/fact-sheets/detail/sepsis. Published April 19, 2019. Accessed Feb 12, 2020.
3. Hunter C, Miller S. Hospital and EMS benefits of prehospital sepsis alerts. JEMS Website.  Issue 9, Volume 41. https://www.jems.com/2016/09/01/hospital-and-ems-benefits-of-prehospital-sepsis-alerts/. Published Sept. 1, 2016. Accessed Feb. 13, 2020.
4. Bullard MK, MD. Abstract: Abernathy’s Surgical Secrets (Seventh Edition). Elsevier Website. https://www.elsevier.com/books/abernathys-surgical-secrets/9780323478731. Published 2018. Accessed Feb. 26, 2020.
5. Hunter CL, Silvestri S, Ralls G, Stone A, Walker A, Papa L. A prehospital screening tool utilizing end-tidal carbon dioxide predicts sepsis and severe sepsis. Am J Emerg Med. 2016;34(5):813–819.
6. Hunter CL, Silvestri S, Ralls G, et al. Comparing quick sequential organ failure assessment scores to end-tidal carbon dioxide as mortality predictors in prehospital patients with suspected sepsis. West J Emerg Med. 2018;19(3):446–451.
7. Hunter CL, Silvestri S, Stone A, et al. Prehospital sepsis alert notification decreases time to initiation of CMS sepsis core measures. Am J Emerg Med. 2019;37(1):114–117.
8. Perez C. Effective monitoring of patients with sepsis. RT Magazine.  https://www.rtmagazine.com/disorders-diseases/critical-care/sepsis/effective-monitoring-patients-sepsis/. Published Sept. 21, 2015. Accessed Feb. 26, 2020.
9. Liu V, Escobar GJ, Greene JD, Soule J, Whippy A, Angus DC, Iwashyna TJ. Hospital deaths in patients with sepsis from 2 independent cohorts. JAMA. 2014 Jul 2; 312 (1):90-2.
10. Levy MM, Evans LE, Rhodes A. The Surviving Sepsis Campaign Bundle: 2018 Update. Crit Care Med. 2018;46(6):997–1000. Accessed PDF Feb 21, 2020.
11. Maggio PM. Sepsis and septic shock. Merck Manuals. https://www.merckmanuals.com/professional/critical-care-medicine/sepsis-and-septic-shock/sepsis-and-septic-shock . Published Jan 2020. Accessed on Feb 28, 2020.
12. Kumar A, Roberts D, Wood KE, et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med. 2006;34(6):1589–1596.
13. Hunter CL, Silvestri S, Dean M, Falk JL, Papa L. End-tidal carbon dioxide is associated with mortality and lactate in patients with suspected sepsis. Am J Emerg Med. 2013;31(1):64–71.
14. McGillicuddy DC, Tang A, Cataldo L, Gusev J, Shapiro NI. Evaluation of end-tidal carbon dioxide role in predicting elevated SOFA scores and lactic acidosis [published correction appears in Intern Emerg Med. 2009 Feb;4(1):95]. Intern Emerg Med. 2009;4(1):41–44.

 

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TOPIC: Microstream™ Capnography MonitoringEmergency Medical ServicesMedical-Surgical

About the Author

Robin Waggoner

Robin Waggoner is a principal clinical product specialist with the Medtronic Patient Monitoring business. Robin is also a nurse with more than 15 years’ experience in the critical care setting.

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