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Monitoring patients after cancer surgery (CALMS-2 study)

Research summary

Researchers: Marco Pimentel, Sara Khalid, Dr Lei Clifton, Prof. Lionel Tarassenko

Clinical collaborator: Dr Peter Watkinson (Intensive Care Unit, John Radcliffe Hospital)

Funding: Oxford Biomedical Research Centre (OxBRC)

Patients who undergo major upper gastro-intestinal (GI) surgery have a high incidence of post-operative complications. These complications are frequently delayed; despite an apparently straightforward peri-operative course and initial recovery, patients may require admission to the intensive care unit (ICU) several days after surgery, most commonly with respiratory failure or anastomotic leaks. Their subsequent stay in ICU is prolonged and their mortality is high. They utilise more ICU resources than any other group of surgical patients.

The CALMS-2 (Computer Alerting Monitoring System 2 (CALMS-2 study) is designed to assess whether continuous monitoring of vital signs with automated alerting to detect patient deterioration reduces patient length of stay in hospital by alerting staff to clinical deterioration more effectively than the current paper-based track-and-trigger systems. More than 220 patients were recruited in the first phase of the trial (data collection only). Analysis of the data has yielded new results regarding physiological instability in post-operative surgical patients. These patients have characteristic patterns of recovery following surgery, necessitating the design of an early warning score which takes the changing physiology into account.

Finally, we have evaluated a state-of-the-art system in which ambulatory patients on the ward are monitored in real-time using telemetry, wi-fi and data fusion (Visensia software from OBS Medical). During the second phase of the trial (the intervention phase), patients have been monitored with this system, which allows continuous monitoring and alerting of patients through the ambulatory phase of recovery to discharge.