Detection of Hemodynamic Events during the Implementation of a Novel Indigenous Tele ICU System-An Observational Study

Abstract

Aim: To assess the incidence of hemodynamic events and their outcomes detected by remote monitoring of hospitalized patients during the implementation of a novel indigenous Tele-ICU system. Study Design: Prospective observational study. Place and Duration of Study: Department of Critical Care Medicine, Tele-ICU at Aster Ramesh Hospitals, Vijayawada, between 01-10- 2023 to 01-11- 2023. Methodology: This observational study was conducted by monitoring 11 ICU units in 9 hospitals, of which 3 were tertiary care and 6 peripheral care centers, remotely using the hub and spoke method by intensivists from the Tele-ICU hub. The study included 209 patients in Intensive Care Units (ICUs) and high dependency units (HDUs) admitted for various critical illnesses. Hemodynamic events like bradyarrhythmia, tachyarrhythmias- supra ventricular arrhythmias, and ventricular arrhythmias were noted. The tele-ICU hub contained audio-visual equipment with central monitoring software (CMS) which permitted monitoring of patient vitals and audio-visual feed from bedside. All the data were observed and inferred. The data was subject to descriptive analysis using cross-tabulation in IBM SPSS Statistics, Version 29. Results: A total of 314 events were detected and reported for immediate management. The most commonly observed event was Tachycardia (30.56%) followed by Bradycardia (19.42%), Hypoxia (12.73%), non-sustained ventricular tachycardia (7.64%), and Sinus tachycardia (7%). Life-threatening events like Ventricular tachycardia (VT) and Ventricular fibrillation (VF) occurred in 9.3 % (n = 19) and 0.98% (n = 2) cases respectively. Among these cases with life-threatening rhythms (VF, VT) 19 cases were revived and 2 cases couldn’t be revived. The overall mortality rate was 6.9 % (n = 14) of which 64.3 % (n = 9) cases were due to bradycardia and 35.7 % (n = 5) cases each of Ventricular fibrillation, Ventricular tachycardia, Tachycardia, Sinus Tachycardia and Sinus Bradycardia. Conclusion: If designed and implemented effectively, the Indigenous tele ICU system has the potential to be an effective tool for the detection of life-threatening hemodynamic events and thereby help reduce in-hospital cardiac arrest (IHCA) in tertiary and peripheral hospitals.