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Coeckelenbergh S, Vincent JL, Duranteau J, Joosten A, Rinehart J. Perioperative Fluid and Vasopressor Therapy in 2050: From Experimental Medicine to Personalization Through Automation. Anesth Analg 2024; 138:284-294. [PMID: 38215708 DOI: 10.1213/ane.0000000000006672] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024]
Abstract
Intravenous (IV) fluids and vasopressor agents are key components of hemodynamic management. Since their introduction, their use in the perioperative setting has continued to evolve, and we are now on the brink of automated administration. IV fluid therapy was first described in Scotland during the 1832 cholera epidemic, when pioneers in medicine saved critically ill patients dying from hypovolemic shock. However, widespread use of IV fluids only began in the 20th century. Epinephrine was discovered and purified in the United States at the end of the 19th century, but its short half-life limited its implementation into patient care. Advances in venous access, including the introduction of the central venous catheter, and the ability to administer continuous infusions of fluids and vasopressors rather than just boluses, facilitated the use of fluids and adrenergic agents. With the advent of advanced hemodynamic monitoring, most notably the pulmonary artery catheter, the role of fluids and vasopressors in the maintenance of tissue oxygenation through adequate cardiac output and perfusion pressure became more clearly established, and hemodynamic goals could be established to better titrate fluid and vasopressor therapy. Less invasive hemodynamic monitoring techniques, using echography, pulse contour analysis, and heart-lung interactions, have facilitated hemodynamic monitoring at the bedside. Most recently, advances have been made in closed-loop fluid and vasopressor therapy, which apply computer assistance to interpret hemodynamic variables and therapy. Development and increased use of artificial intelligence will likely represent a major step toward fully automated hemodynamic management in the perioperative environment in the near future. In this narrative review, we discuss the key events in experimental medicine that have led to the current status of fluid and vasopressor therapies and describe the potential benefits that future automation has to offer.
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Affiliation(s)
- Sean Coeckelenbergh
- From the Department of Anesthesiology and Intensive Care, Hôpitaux Universitaires Paris-Saclay, Université Paris-Saclay, Hôpital Paul-Brousse, Paris, France
- Outcomes Research Consortium, Cleveland, Ohio
| | - Jean-Louis Vincent
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Jacques Duranteau
- From the Department of Anesthesiology and Intensive Care, Hôpitaux Universitaires Paris-Saclay, Université Paris-Saclay, Hôpital Paul-Brousse, Paris, France
- Department of Anesthesiology and Intensive Care, Hôpitaux Universitaires Paris-Saclay, Université Paris-Saclay, Hôpital De Bicêtre, Paris, France
| | - Alexandre Joosten
- From the Department of Anesthesiology and Intensive Care, Hôpitaux Universitaires Paris-Saclay, Université Paris-Saclay, Hôpital Paul-Brousse, Paris, France
- Department of Anesthesiology and Intensive Care, Hôpitaux Universitaires Paris-Saclay, Université Paris-Saclay, Hôpital De Bicêtre, Paris, France
| | - Joseph Rinehart
- Outcomes Research Consortium, Cleveland, Ohio
- Department of Anesthesiology & Perioperative Care, University of California, Irvine, California
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Lunkiewicz J, Fries D, Milovanovic P, Noethiger CB, Tscholl DW, Gasciauskaite G. Pediatric Anesthesia Providers' Perspective on the Real-Life Implementation of the Philips Visual Patient Avatar: A Qualitative Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1841. [PMID: 38136043 PMCID: PMC10741887 DOI: 10.3390/children10121841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/16/2023] [Accepted: 11/21/2023] [Indexed: 12/24/2023]
Abstract
The Philips Visual Patient Avatar represents an alternative method of patient monitoring that, according to computer-based simulation studies, enhances diagnostic accuracy and confidence and reduces workload. After its clinical integration, we assessed pediatric anesthesia providers' perspectives on this technology. This is a single-center qualitative study, conducted at the University Hospital Zurich using in-depth individual interviews. We aimed to identify the advantages and limitations of the Visual Patient Avatar in pediatric anesthesia and to assess children's and parents' reactions from caregivers' perspectives. Thematic analysis was used to identify the dominant themes. Fourteen members of the institution's pediatric anesthesia team were interviewed. The most prevalent themes were children's positive reactions towards the Visual Patient Avatar (92.9%) and enhanced speed in problem identification (71.4%). Additionally, 50% of participants reported finding the Visual Patient Avatar useful for diverting children's attention during anesthesia induction, and 50% suggested that its vital sign thresholds should be adaptable for different age groups. The study revealed that the Visual Patient Avatar was recognized as a tool in pediatric anesthesia, enabling prompt identification of underlying issues and receiving positive feedback from both children and parents. The most commonly voiced wish for improvement in the study was the ability to customize the Visual Patient Avatar's thresholds for different age groups.
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Affiliation(s)
| | | | | | | | - David W. Tscholl
- Institute of Anesthesiology, University and University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland; (J.L.); (D.F.); (P.M.); (C.B.N.); (G.G.)
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Viautour J, Naegeli L, Braun J, Bergauer L, Roche TR, Tscholl DW, Akbas S. The Visual Patient Avatar ICU Facilitates Information Transfer of Written Information by Visualization: A Multicenter Comparative Eye-Tracking Study. Diagnostics (Basel) 2023; 13:3432. [PMID: 37998568 PMCID: PMC10670428 DOI: 10.3390/diagnostics13223432] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/20/2023] [Accepted: 10/24/2023] [Indexed: 11/25/2023] Open
Abstract
Patient monitoring is crucial in critical care medicine. Perceiving and interpreting multiple vital signs requires a high workload that can lead to decreased situation awareness and consequently inattentional blindness, defined as impaired perception of unexpectedly changing data. To facilitate information transfer, we developed and validated the Visual-Patient avatar. Generated by numerical data, the animation displays the status of vital signs and patient installations according to a user-centered design to improve situation awareness. As a surrogate parameter for information transfer in patient monitoring, we recorded visual attention using eye-tracking data. In this computer-based study, we compared the correlation of visually perceived and correctly interpreted vital signs between a Visual-Patient-avatar ICU and conventional patient monitoring. A total of 50 recruited study participants (25 nurses, 25 physicians) from five European study centers completed five randomized scenarios in both modalities. Using a stationary eye tracker as the primary endpoint, we recorded how long different areas of interest of the two monitoring modalities were viewed. In addition, we tested for a possible association between the length of time an area of interest was viewed and the correctness of the corresponding question. With the conventional monitor, participants looked at the installation site the longest (median 2.13-2.51 s). With the Visual-Patient-avatar ICU, gaze distribution was balanced; no area of interest was viewed for particularly long. For both modalities, the longer an area was viewed, the more likely the associated question was answered incorrectly (OR 0.97, 95% CI 0.95-0.99, p = 0.008). The Visual-Patient-avatar ICU facilitates and improves information transfer through its visualizations, especially with written information. The longer an area of interest was viewed, the more likely the associated question was answered incorrectly.
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Affiliation(s)
- Julie Viautour
- Institute of Anesthesiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland; (J.V.); (L.B.); (T.R.R.); (D.W.T.)
| | - Lukas Naegeli
- Master Program in Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland;
| | - Julia Braun
- Departments of Epidemiology and Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland;
| | - Lisa Bergauer
- Institute of Anesthesiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland; (J.V.); (L.B.); (T.R.R.); (D.W.T.)
| | - Tadzio R. Roche
- Institute of Anesthesiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland; (J.V.); (L.B.); (T.R.R.); (D.W.T.)
| | - David W. Tscholl
- Institute of Anesthesiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland; (J.V.); (L.B.); (T.R.R.); (D.W.T.)
| | - Samira Akbas
- Institute of Anesthesiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland; (J.V.); (L.B.); (T.R.R.); (D.W.T.)
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Lunkiewicz J, Gasciauskaite G, Roche TR, Akbas S, Nöthiger CB, Ganter MT, Meybohm P, Hottenrott S, Zacharowski K, Raimann FJ, Rivas E, López-Baamonde M, Beller EA, Tscholl DW, Bergauer L. User Perceptions of Avatar-Based Patient Monitoring for Intensive Care Units: An International Exploratory Sequential Mixed-Methods Study. Diagnostics (Basel) 2023; 13:3391. [PMID: 37958287 PMCID: PMC10650006 DOI: 10.3390/diagnostics13213391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/18/2023] [Accepted: 10/27/2023] [Indexed: 11/15/2023] Open
Abstract
Visual Patient Avatar ICU is an innovative approach to patient monitoring, enhancing the user's situation awareness in intensive care settings. It dynamically displays the patient's current vital signs using changes in color, shape, and animation. The technology can also indicate patient-inserted devices, such as arterial lines, central lines, and urinary catheters, along with their insertion locations. We conducted an international, multi-center study using a sequential qualitative-quantitative design to evaluate users' perception of Visual Patient Avatar ICU among physicians and nurses. Twenty-five nurses and twenty-five physicians from the ICU participated in the structured interviews. Forty of them completed the online survey. Overall, ICU professionals expressed a positive outlook on Visual Patient Avatar ICU. They described Visual Patient Avatar ICU as a simple and intuitive tool that improved information retention and facilitated problem identification. However, a subset of participants expressed concerns about potential information overload and a sense of incompleteness due to missing exact numerical values. These findings provide valuable insights into user perceptions of Visual Patient Avatar ICU and encourage further technology development before clinical implementation.
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Affiliation(s)
- Justyna Lunkiewicz
- Department of Anesthesiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland; (J.L.); (T.R.R.); (S.A.); (C.B.N.); (E.A.B.)
| | - Greta Gasciauskaite
- Department of Anesthesiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland; (J.L.); (T.R.R.); (S.A.); (C.B.N.); (E.A.B.)
| | - Tadzio Raoul Roche
- Department of Anesthesiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland; (J.L.); (T.R.R.); (S.A.); (C.B.N.); (E.A.B.)
| | - Samira Akbas
- Department of Anesthesiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland; (J.L.); (T.R.R.); (S.A.); (C.B.N.); (E.A.B.)
| | - Christoph B. Nöthiger
- Department of Anesthesiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland; (J.L.); (T.R.R.); (S.A.); (C.B.N.); (E.A.B.)
| | - Michael T. Ganter
- Institute of Anesthesiology and Critical Care Medicine, Clinic Hirslanden Zurich, 8032 Zurich, Switzerland;
| | - Patrick Meybohm
- Department of Anesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, University of Wuerzburg, 97070 Wuerzburg, Germany; (P.M.); (S.H.)
| | - Sebastian Hottenrott
- Department of Anesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, University of Wuerzburg, 97070 Wuerzburg, Germany; (P.M.); (S.H.)
| | - Kai Zacharowski
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University Frankfurt, 60629 Frankfurt, Germany
| | - Florian Jürgen Raimann
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University Frankfurt, 60629 Frankfurt, Germany
| | - Eva Rivas
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Hospital Clinic of Barcelona, University of Barcelona, 08007 Barcelona, Spain; (E.R.); (M.L.-B.)
| | - Manuel López-Baamonde
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Hospital Clinic of Barcelona, University of Barcelona, 08007 Barcelona, Spain; (E.R.); (M.L.-B.)
| | - Elisabeth Anna Beller
- Department of Anesthesiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland; (J.L.); (T.R.R.); (S.A.); (C.B.N.); (E.A.B.)
| | - David Werner Tscholl
- Department of Anesthesiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland; (J.L.); (T.R.R.); (S.A.); (C.B.N.); (E.A.B.)
| | - Lisa Bergauer
- Department of Anesthesiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland; (J.L.); (T.R.R.); (S.A.); (C.B.N.); (E.A.B.)
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Gasciauskaite G, Lunkiewicz J, Roche TR, Spahn DR, Nöthiger CB, Tscholl DW. Human-centered visualization technologies for patient monitoring are the future: a narrative review. Crit Care 2023; 27:254. [PMID: 37381008 PMCID: PMC10308796 DOI: 10.1186/s13054-023-04544-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 06/22/2023] [Indexed: 06/30/2023] Open
Abstract
Medical technology innovation has improved patient monitoring in perioperative and intensive care medicine and continuous improvement in the technology is now a central focus in this field. Because data density increases with the number of parameters captured by patient-monitoring devices, its interpretation has become more challenging. Therefore, it is necessary to support clinicians in managing information overload while improving their awareness and understanding about the patient's health status. Patient monitoring has almost exclusively operated on the single-sensor-single-indicator principle-a technology-centered way of presenting data in which specific parameters are measured and displayed individually as separate numbers and waves. An alternative is user-centered medical visualization technology, which integrates multiple pieces of information (e.g., vital signs), derived from multiple sensors into a single indicator-an avatar-based visualization-that is a meaningful representation of the real-world situation. Data are presented as changing shapes, colors, and animation frequencies, which can be perceived, integrated, and interpreted much more efficiently than other formats (e.g., numbers). The beneficial effects of these technologies have been confirmed in computer-based simulation studies; visualization technologies improved clinicians' situation awareness by helping them effectively perceive and verbalize the underlying medical issue, while improving diagnostic confidence and reducing workload. This review presents an overview of the scientific results and the evidence for the validity of these technologies.
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Affiliation(s)
- Greta Gasciauskaite
- Institute of Anesthesiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Justyna Lunkiewicz
- Institute of Anesthesiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Tadzio R Roche
- Institute of Anesthesiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Donat R Spahn
- Institute of Anesthesiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Christoph B Nöthiger
- Institute of Anesthesiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - David W Tscholl
- Institute of Anesthesiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
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