Advances in Non-Invasive Monitoring

Michael O’Reilly, M.D., M.S.Chief Medical OfficerMasimo Corporation

Professor of Anesthesiology and Perioperative CareUniversity of California-IrvineAdjunct Associate Professor

University of Michigan

Technology and Patient Safety

Michael O’Reilly, M.D., M.S.Chief Medical OfficerMasimo Corporation

Professor of Anesthesiology and Perioperative CareUniversity of California-IrvineAdjunct Associate Professor

University of Michigan

Technology Convergence

Monito

ring Information

Communication

Conflict of Interest Statement

Masimo Corporation

The influence of anesthesia care on surgical outcomes

ACS-NSQIP

(ACS=American College of Surgeons)

1

0

2

3

NSQIP Annual Report – FY 2000Mortality O/E Ratios for All Operations

But No Intraoperative Data!No…Estimated Blood Loss (EBL)BP, HR, SPO2, TemperatureDuration of SurgeryUrine Output………Nothing.

But they have 30 Day Outcome.

Surgery meets Anesthesiology

Lancet 2012; 380: 1059–65

European Surgical Outcomes Study (EuSOS) group for the Trials groups of the European Society of Intensive Care Medicine and the European Society of Anaesthesiology

Lancet 2012; 380: 1059–65

Methods:• 7 day cohort study• Consecutive patients aged ≥16 years • Inpatient non-cardiac surgery• 498 hospitals• 28 European nations• Patients followed up to 60 days• Primary endpoint in-hospital mortality• Secondary outcome LOS and ICU

admission

Lancet 2012; 380: 1059–65

Results:• 46 539 patients

• 1855 (4%) died before hospital discharge• 3599 (8%) patients were admitted to critical

care• median LOS of 1・ 2 days (IQR 0・ 9–3・

6) • 1358 (73%) patients who died were not

admitted to critical care at any stage after surgery.

• Crude mortality rates between countries (from 1.2% for Iceland to 21.5% for Latvia)

Lanc

et 2

012;

380

: 105

9–65

Note the Log Scale!

Lancet 2012; 380: 1059–65

Conclusion:The mortality rate for patients undergoing inpatient non-cardiac surgery was higher than anticipated.

Variations in mortality between countries suggest the need for national and international strategies to improve care for this group of patients.

From the Michigan Surgical Collaborativefor Outcomes Research and Evaluation,the Department of Surgery, University ofMichigan, Ann Arbor.

n engl j med 361:14; 2009

• 84,730 patients • Inpatient general and vascular surgery• Data from the American College of Surgeons National

Surgical Quality Improvement Program (NSQIP)• Hospitals ranked according to risk-adjusted overall rate of

death• Divided into five groups

Each overall mortality quintile assessed the incidence of overall and major complications and the rate of death among patients with major complications.

METHODS

n engl j med 361:14; 2009

n en

gl j

med

361

:14;

200

9

CONCLUSION“In addition to efforts aimed at avoiding complications in the first place, reducing mortality associated with inpatient surgery will require greater attention to the timely recognition and management of complications once they occur.”

n engl j med 361:14; 2009

Preventing “Failure to Rescue”

Data

We have a lot of data!

Information

But what we really need is information!

Decisions

So we make the right decisions

Actions

Leading to the right action.

DataSensors InformationLight-SpO2

-SpHb

-Cerebral oximetry

-Tissue Oximetry

Electrical-EKG

-EEG

-Impedance

Acoustic

Radar

Ultrasound

EHR Lab

Pharmacy

Sensors Information Decisions ActionsData

Providers

Different roles, different locations

Technology Convergence

Monito

ring Information

Communication

Peter Pronovost, MD

!. Hand washing

2. Full barrier precautions

3. Clean the site with chlorhexidine

4. Avoid the femoral site

5. Remove unnecessary catheters

Preventing CLABSI

“To really make progress, need cooperation of

vendors, clinicians and administrators.”

Implement known patient safety practices.

Get vendors to provide open access to data.

Technology Convergence

Monito

ring Information

Communication

© 2009-2010 Masimo Corporation - CONFIDENTIAL

Critical Care Medicine 2:317; 1974C

© 2009-2010 Masimo Corporation - CONFIDENTIAL

Critical Care Medicine 2:317; 1974C

Liver TransplantContinuous Noninvasive Hemoglobin

A blood transfusion is an organ transplant.

Qian F. Et al. Ann Surg. 2013 Feb;257(2):266-78

Variation of blood transfusion in patients undergoing major non-

cardiac surgery

Goodnough L.T. Shander A. A&A 2012

The 1-3units of RBC transfused

Blood Transfusion: Who is at risk

Remote Monitoring & Clinician Notification System

Anesthesiology 112:284-9; 2010

Transfers to ICU

Comparison Unit 2

Comparison Unit 1 PSN

5.02.6

Anesthesiology 112:284-9; 2010

Reduction in Rescue Calls

PSN Comparison Unit 1 Comparison Unit 2

3.41.0

Taenzer, et al., Anesthesiology 112:284-9; 2010

Significant Financial Implications

Over a 12 month period decreased transfers to the ICU from 54 to 28 for one unit.

With an average LOS of 6.3 days, translates into 163 ICU days saved

© 2012 Masimo Corporation