System and methods for transitioning patient care from signal based monitoring to risk based monitoring
A risk-based patient monitoring system for critical care patients combines data from multiple sources to assess the current and the future risks to the patient, thereby enabling providers to review a current patient risk profile and to continuously track a clinical trajectory. A physiology observer module in the system utilizes multiple measurements to estimate Probability Density Functions (PDF) of a number of Internal State Variables (ISVs) that describe components of the physiology relevant to the patient treatment and condition. A clinical trajectory interpreter module in the system utilizes the estimated PDFs of ISVs to identify under which probable patient states the patient can be currently categorized and assign a probability value that the patient will be in each of the identified states. The combination of patient states and their probabilities is defined as the clinical risk to the patient.
1. A computer-based method of risk-based monitoring of a patient, the method comprising:
providing a set of sensors, each such sensor configured to be operably coupled with the patient to produce measurements of a corresponding internal state variable of the patient, the set of sensors including at least one of:
(i) a heart rate sensor, and
(ii) a pulse oximetry sensor;
generating, by the computer, predicted probability density functions of internal state variables for a subsequent time step (t k+1 ), wherein the predicted probability density functions are calculated using posterior estimated probability density functions from a preceding time step (t k );
acquiring, by a computer at subsequent time step (t k+1 ), physiological data from the set of sensors connected with the patient;
generating a conditional likelihood kernel for the subsequent time step (t k+1 ), the conditional likelihood kernel comprising conditional probability density functions of the physiological data acquired at subsequent time step (t k+1 ) given the predicted probability density functions of internal state variables for subsequent time step (t k+1 );
continuously estimating a risk that the patient is suffering a specific adverse medical condition, by:
generating, using Bayes theorem operating on (a) the conditional likelihood kernel and (b) predicted probability density functions of internal state variables for subsequent time step (t k+1 ), posterior probability density functions for the plurality of the internal state variables for the subsequent time step (t k+1 ); and
generating, for a particular internal state variable and based on the posterior probability density functions for the subsequent time step (t k+1 ), a probability that the particular internal state variable exceeds a corresponding pre-defined threshold for that particular internal state variable; and
generating, for display on a display device, a graphical depiction of the risk that the patient is suffering the specific adverse medical condition.
2. The method of claim 1 , further comprising ascertaining that each sensor of the set of sensors is operably coupled to the patient.
3. The method of claim 2 , wherein ascertaining that each sensor of the set of sensors is operably coupled to the patient comprises attaching to the patient at least one sensor of the set of sensors.
4. The method of claim 1 wherein:
the specific adverse medical condition comprises inadequate oxygen delivery; and
the corresponding threshold is mixed venous oxygen saturation at or below a given threshold.
5. The method of claim 1 wherein:
the specific adverse medical condition comprises inadequate ventilation of carbon dioxide; and
the corresponding threshold is arterial partial pressure of carbon dioxide (PaCO2) at or above a given threshold.
6. The method of claim 1 wherein:
the specific adverse medical condition comprises acidosis; and
the corresponding threshold is a blood pH below a given threshold.
7. The method of claim 1 wherein:
the specific adverse medical condition comprises hyperlactatemia; and
the corresponding threshold is a lactate blood level greater than given threshold.
8. A system for risk-based monitoring of a patient, the system comprising:
a data reception module configured to receive measurements of internal state variables from sensors operably coupled to the patient;
an observation model configured to produce a conditional likelihood kernel comprising conditional probability density functions of the physiological data acquired at subsequent time step (t k+1 ) given the predicted probability density functions of internal state variables for subsequent time step (t k+1 );
the system configured to continuously estimate a risk that the patient is suffering a specific adverse medical condition via:
an inference engine configured to generate, using Bayes theorem operating on (a) the conditional likelihood kernel and (b) predicted probability density functions of internal state variables for subsequent time step (t k+1 ), posterior probability density functions for the plurality of the internal state variables for the subsequent time step (t k+1 );
a clinical trajectory interpreter module configured to generate, for a particular internal state variable and based on the posterior probability density functions for the subsequent time step (t k+1 ), a probability that the particular internal state variable exceeds a corresponding pre-defined threshold for that particular internal state variable; and
a user interaction module configured to display, on a display device, the risk that the patient is suffering the medical specific condition.
9. The system of claim 8 wherein:
the specific adverse medical condition comprises inadequate oxygen delivery; and
the corresponding threshold is mixed venous oxygen saturation at or below a given threshold.
10. The system of claim 8 wherein:
the specific adverse medical condition comprises inadequate ventilation of carbon dioxide; and
the corresponding threshold is arterial partial pressure of carbon dioxide (PaCO2) at or above a given threshold.
11. The system of claim 10 , wherein the set of sensors further includes a respiratory rate sensor, and the measurements of internal state variables includes respiratory rate from the respiratory rate sensor.
12. The system of claim 8 wherein:
the specific adverse medical condition comprises acidosis; and
the corresponding threshold is a blood pH below a given threshold.
13. The system of claim 12 , wherein the set of sensors further includes a respiratory rate sensor, and the measurements of internal state variables includes respiratory rate from the respiratory rate sensor.
14. The system of claim 8 wherein:
the specific adverse medical condition comprises hyperlactatemia; and
the corresponding threshold is a lactate blood level greater than given threshold.
15. A non-transitory computer readable medium non-transient computer program product comprising executable code, the executable code executable by a computer processor, the executable code comprising:
code for causing the computer processor to receive, from a set of sensors each operably coupled to the patient, measurements of a corresponding internal state variables of the patient, the set of sensors including at least one of:
(i) a heart rate sensor, and
(ii) a pulse oximetry sensor;
code for causing the computer processor to generate predicted probability density functions of internal state variables for a subsequent time step (t k+1 ), wherein the predicted probability density functions are calculated using posterior estimated probability density functions from a preceding time step (t k );
code for causing the computer processor to generate a conditional likelihood kernel for the subsequent time step (t k+1 ), the conditional likelihood kernel comprising conditional probability density functions of the internal state variables, based on the measurements of the corresponding internal state variables of the patient acquired at subsequent time step (t k+1 ) and the predicted probability density functions of internal state variables for subsequent time step (t k+1 );
code for causing the computer processor to continuously estimate a risk that the patient is suffering a specific adverse medical condition, by:
generating, using Bayes theorem operating on (a) the conditional likelihood kernel and (b) predicted probability density functions of internal state variables for subsequent time step (t k+1 ), posterior probability density functions for the plurality of the internal state variables for the subsequent time step (t k+1 ); and
generating, for a hidden internal state variable and based on the posterior probability density functions for the subsequent time step (t k+1 ), a probability that the hidden internal state variable exceeds a corresponding pre-defined threshold for that particular hidden internal state variable, the probability defining a risk that the patient is suffering the adverse medical specific condition; and
code for causing the computer processor to generate, for display on a display device, a graphical depiction of the risk that the patient is suffering the adverse medical specific condition.
16. The non-transitory computer readable medium of claim 15 , wherein:
the specific adverse medical condition comprises inadequate oxygen delivery; and
the corresponding threshold is mixed venous oxygen saturation at or below a given threshold.
17. The non-transitory computer readable medium of claim 15 , wherein:
the specific adverse medical condition comprises inadequate ventilation of carbon dioxide; and
the corresponding threshold is arterial partial pressure of carbon dioxide (PaCO2) at or above a given threshold.
18. The non-transitory computer readable medium of claim 17 , wherein the set of sensors further includes a respiratory rate sensor, and the measurements of internal state variables includes respiratory rate from the respiratory rate sensor.
19. The non-transitory computer readable medium of claim 15 , wherein:
the specific adverse medical condition comprises acidosis; and
the corresponding threshold is a blood pH below a given threshold.
20. The non-transitory computer readable medium of claim 15 , wherein:
the specific adverse medical condition comprises hyperlactatemia; and
the corresponding threshold is a lactate blood level greater than given threshold.