A wearable six-minute walk-based system to predict postoperative pulmonary complications after cardiac valve surgery: an exploratory study_Journal of Biomedical Engineering

Authors：

WANG Yuqiang ¹ , WANG Jiachen ² , ZHANG Jian ³ , LUO Zeruxin ⁴ , GUO Yingqiang ¹ ,  ZHANG Zhengbo ⁵ ,  YU Pengming ⁴

1. Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. General Hospital of Tibet Military Region, Lhasa 850007, P. R. China;
3. Medical School of Chinese PLA, Beijing 100853, P. R. China;
4. Rehabilitation Medical Center, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
5. Center for Artificial Intelligence in Medicine, Chinese PLA General Hospital, Beijing 100853, P. R. China;

Corresponding author：

ZHANG Zhengbo, Email: zhengbozhang@126.com; YU Pengming, Email: 13438201451@126.com

Keywords：

6-Minute Walk Test; Continuous monitoring; Cardiac valve surgery; Postoperative pulmonary complications; Predictive model

DOI：

10.7507/1001-5515.202305007

Video：

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In recent years, wearable devices have seen a booming development, and the integration of wearable devices with clinical settings is an important direction in the development of wearable devices. The purpose of this study is to establish a prediction model for postoperative pulmonary complications (PPCs) by continuously monitoring respiratory physiological parameters of cardiac valve surgery patients during the preoperative 6-Minute Walk Test (6MWT) with a wearable device. By enrolling 53 patients with cardiac valve diseases in the Department of Cardiovascular Surgery, West China Hospital, Sichuan University, the grouping was based on the presence or absence of PPCs in the postoperative period. The 6MWT continuous respiratory physiological parameters collected by the SensEcho wearable device were analyzed, and the group differences in respiratory parameters and oxygen saturation parameters were calculated, and a prediction model was constructed. The results showed that continuous monitoring of respiratory physiological parameters in 6MWT using a wearable device had a better predictive trend for PPCs in cardiac valve surgery patients, providing a novel reference model for integrating wearable devices with the clinic.

Citation： WANG Yuqiang, WANG Jiachen, ZHANG Jian, LUO Zeruxin, GUO Yingqiang, ZHANG Zhengbo, YU Pengming. A wearable six-minute walk-based system to predict postoperative pulmonary complications after cardiac valve surgery: an exploratory study. Journal of Biomedical Engineering, 2023, 40(6): 1117-1125. doi: 10.7507/1001-5515.202305007 Copy

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2.	Hulzebos E H J, Helders P J M, Favié N J, et al. Preoperative intensive inspiratory muscle training to prevent postoperative pulmonary complications in high-risk patients undergoing CABG surgery: a randomized clinical trial. JAMA, 2006, 296(15): 1851-1857.
3.	Ibañez J, Riera M, Amezaga R, et al. Long-term mortality after pneumonia in cardiac surgery patients: a propensity-matched analysis. J Intensive Care Med, 2016, 31(1): 34-40.
4.	Garcia-Delgado M, Navarrete-Sanchez I, Colmenero M. Preventing and managing perioperative pulmonary complications following cardiac surgery. Curr Opin Anaesthesiol, 2014, 27(2): 146-152.
5.	ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med, 2002, 166: 111-117.
6.	Roberts M M, Cho J G, Sandoz J S, et al. Oxygen desaturation and adverse events during 6-min walk testing in patients with COPD. Respirology, 2015, 20(3): 419-425.
7.	AL-Khalidi F Q, Saatchi R, Burke D, et al. Respiration rate monitoring methods: A review. Pediatr Pulmonol, 2011, 46(6): 523-529.
8.	Gupta A, Chakraborty C, Gupta B. Advanced telemedicine system for remote healthcare monitoring// Rashid T A, Chakraborty C, Fraser K. Advances in telemedicine for health monitoring: Technologies, design and applications. London: The Institution of Engineering and Technology, 2020: 163-185.
9.	Cheong S H R, Ng Y J X, Lau Y, et al. Wearable technology for early detection of COVID-19: A systematic scoping review. Prev Med, 2022: 107170.
10.	Demkowicz P C, Dhruva S S, Spatz E S, et al. Physician responses to apple watch-detected irregular rhythm alerts. Am Heart J, 2023, 262: 29-37.
11.	Escobar-Linero E, Muñoz-Saavedra L, Luna-Perejón F, et al. Wearable health devices for diagnosis support: Evolution and future tendencies. Sensors, 2023, 23(3): 1678.
12.	Xu Haoran, Yang Zhicheng, She Yingjia, et al. Physio6: A sensor-based monitoring system for 6-minute walking test in the era of COVID-19// 2021 7th IEEE International Conference on Network Intelligence and Digital Content (IC-NIDC). Beijing: IEEE, 2021: 133-137.
13.	Xu Haoran, Li Peiyao, Yang Zhicheng, et al. Construction and application of a medical-grade wireless monitoring system for physiological signals at general wards. J Med Syst, 2020, 44: 1-15.
14.	Khodadad D, Nordebo S, Müller B, et al. Optimized breath detection algorithm in electrical impedance tomography. Physiol Meas, 2018, 39(9): 094001.
15.	曹德森, 李德玉, 张政波, 等. 随行生理监护系统设计及性能初步验证. 生物医学工程学杂志, 2019, 36(1): 121-130.
16.	王佳晨, 梁洪, 王雅静, 等. 基于可穿戴系统的呼吸模式参数量化分析研究. 生物医学工程学杂志, 2021, 38(5): 893-902.
17.	Nashef S A M, Roques F, Sharples L D, et al. EuroSCORE II. Eur J Cardiothorac Surg, 2012, 41(4): 734-745.
18.	Reeve J C, Nicol K, Stiller K, et al. Does physiotherapy reduce the incidence of postoperative pulmonary complications following pulmonary resection via open thoracotomy? A preliminary randomised single-blind clinical trial. Eur J Cardiothorac Surg, 2010, 37(5): 1158-1166.
19.	Tanner T G, Colvin M O. Pulmonary complications of cardiac surgery. Lung, 2020, 198(6): 889-896.
20.	Baig M M, GholamHosseini H, Moqeem A A, et al. A systematic review of wearable patient monitoring systems–current challenges and opportunities for clinical adoption. J Med Syst, 2017, 41: 1-9.
21.	Misu S, Kaneko M, Sakai H, et al. Exercise-induced oxygen desaturation as a predictive factor for longitudinal decline in 6-minute walk distance in subjects with COPD. Respir Care, 2019, 64(2): 145-152.
22.	Lin B S, Jhang R J, Lin B S. Wearable cardiopulmonary function evaluation system for six-minute walking test. Sensors, 2019, 19(21): 4656.
23.	Nicolò A, Bazzucchi I, Felici F, et al. Mechanical and electromyographic responses during the 3-min all-out test in competitive cyclists. J Electromyogr Kinesiol, 2015, 25(6): 907-913.
24.	Nicolò A, Marcora S M, Sacchetti M. Respiratory frequency is strongly associated with perceived exertion during time trials of different duration. J Sports Sci, 2016, 34(13): 1199-1206.
25.	Aliverti A. The respiratory muscles during exercise. Breathe, 2016, 12(2): 165-168.
26.	Grimby G, Bunn J, Mead J. Relative contribution of rib cage and abdomen to ventilation during exercise. J Appl Physiol, 1968, 24(2): 159-166.
27.	Grimby G, Oxhøj H, Bake B. Effects of abdominal breathing on distribution of ventilation in obstructive lung disease. Clin Sci Mol Med, 1975, 48(3): 193-199.
28.	Henke K G, Sharratt M, Pegelow D, et al. Regulation of end-expiratory lung volume during exercise. J Appl Physiol, 1988, 64(1): 135-146.
29.	Aliverti A, Stevenson N, Dellaca R L, et al. Regional chest wall volumes during exercise in chronic obstructive pulmonary disease. Thorax, 2004, 59(3): 210-216.
30.	Amft O, Lukowicz P. From backpacks to smartphones: Past, present, and future of wearable computers. IEEE Pervas Comput, 2009, 8(3): 8-13.
31.	Ryvlin P, Ciumas C, Wisniewski I, et al. Wearable devices for sudden unexpected death in epilepsy prevention. Epilepsia, 2018, 59: 61-66.
32.	Hsu W C, Sugiarto T, Lin Y J, et al. Multiple-wearable-sensor-based gait classification and analysis in patients with neurological disorders. Sensors, 2018, 18(10): 3397.
33.	Rutkowski S, Buekers J, Rutkowska A, et al. Monitoring physical activity with a wearable sensor in patients with COPD during in-hospital pulmonary rehabilitation program: A pilot study. Sensors, 2021, 21(8): 2742.
34.	Gutierrez G, Williams J, Alrehaili G A, et al. Respiratory rate variability in sleeping adults without obstructive sleep apnea. Physiol Rep, 2016, 4(17): e12949.

1. Szelkowski L A, Puri N K, Singh R, et al. Current trends in preoperative, intraoperative, and postoperative care of the adult cardiac surgery patient. Curr Probl Surg, 2015, 52(1): 531-569.
2. Hulzebos E H J, Helders P J M, Favié N J, et al. Preoperative intensive inspiratory muscle training to prevent postoperative pulmonary complications in high-risk patients undergoing CABG surgery: a randomized clinical trial. JAMA, 2006, 296(15): 1851-1857.
3. Ibañez J, Riera M, Amezaga R, et al. Long-term mortality after pneumonia in cardiac surgery patients: a propensity-matched analysis. J Intensive Care Med, 2016, 31(1): 34-40.
4. Garcia-Delgado M, Navarrete-Sanchez I, Colmenero M. Preventing and managing perioperative pulmonary complications following cardiac surgery. Curr Opin Anaesthesiol, 2014, 27(2): 146-152.
5. ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med, 2002, 166: 111-117.
6. Roberts M M, Cho J G, Sandoz J S, et al. Oxygen desaturation and adverse events during 6-min walk testing in patients with COPD. Respirology, 2015, 20(3): 419-425.
7. AL-Khalidi F Q, Saatchi R, Burke D, et al. Respiration rate monitoring methods: A review. Pediatr Pulmonol, 2011, 46(6): 523-529.
8. Gupta A, Chakraborty C, Gupta B. Advanced telemedicine system for remote healthcare monitoring// Rashid T A, Chakraborty C, Fraser K. Advances in telemedicine for health monitoring: Technologies, design and applications. London: The Institution of Engineering and Technology, 2020: 163-185.
9. Cheong S H R, Ng Y J X, Lau Y, et al. Wearable technology for early detection of COVID-19: A systematic scoping review. Prev Med, 2022: 107170.
10. Demkowicz P C, Dhruva S S, Spatz E S, et al. Physician responses to apple watch-detected irregular rhythm alerts. Am Heart J, 2023, 262: 29-37.
11. Escobar-Linero E, Muñoz-Saavedra L, Luna-Perejón F, et al. Wearable health devices for diagnosis support: Evolution and future tendencies. Sensors, 2023, 23(3): 1678.
12. Xu Haoran, Yang Zhicheng, She Yingjia, et al. Physio6: A sensor-based monitoring system for 6-minute walking test in the era of COVID-19// 2021 7th IEEE International Conference on Network Intelligence and Digital Content (IC-NIDC). Beijing: IEEE, 2021: 133-137.
13. Xu Haoran, Li Peiyao, Yang Zhicheng, et al. Construction and application of a medical-grade wireless monitoring system for physiological signals at general wards. J Med Syst, 2020, 44: 1-15.
14. Khodadad D, Nordebo S, Müller B, et al. Optimized breath detection algorithm in electrical impedance tomography. Physiol Meas, 2018, 39(9): 094001.
15. 曹德森, 李德玉, 张政波, 等. 随行生理监护系统设计及性能初步验证. 生物医学工程学杂志, 2019, 36(1): 121-130.
16. 王佳晨, 梁洪, 王雅静, 等. 基于可穿戴系统的呼吸模式参数量化分析研究. 生物医学工程学杂志, 2021, 38(5): 893-902.
17. Nashef S A M, Roques F, Sharples L D, et al. EuroSCORE II. Eur J Cardiothorac Surg, 2012, 41(4): 734-745.
18. Reeve J C, Nicol K, Stiller K, et al. Does physiotherapy reduce the incidence of postoperative pulmonary complications following pulmonary resection via open thoracotomy? A preliminary randomised single-blind clinical trial. Eur J Cardiothorac Surg, 2010, 37(5): 1158-1166.
19. Tanner T G, Colvin M O. Pulmonary complications of cardiac surgery. Lung, 2020, 198(6): 889-896.
20. Baig M M, GholamHosseini H, Moqeem A A, et al. A systematic review of wearable patient monitoring systems–current challenges and opportunities for clinical adoption. J Med Syst, 2017, 41: 1-9.
21. Misu S, Kaneko M, Sakai H, et al. Exercise-induced oxygen desaturation as a predictive factor for longitudinal decline in 6-minute walk distance in subjects with COPD. Respir Care, 2019, 64(2): 145-152.
22. Lin B S, Jhang R J, Lin B S. Wearable cardiopulmonary function evaluation system for six-minute walking test. Sensors, 2019, 19(21): 4656.
23. Nicolò A, Bazzucchi I, Felici F, et al. Mechanical and electromyographic responses during the 3-min all-out test in competitive cyclists. J Electromyogr Kinesiol, 2015, 25(6): 907-913.
24. Nicolò A, Marcora S M, Sacchetti M. Respiratory frequency is strongly associated with perceived exertion during time trials of different duration. J Sports Sci, 2016, 34(13): 1199-1206.
25. Aliverti A. The respiratory muscles during exercise. Breathe, 2016, 12(2): 165-168.
26. Grimby G, Bunn J, Mead J. Relative contribution of rib cage and abdomen to ventilation during exercise. J Appl Physiol, 1968, 24(2): 159-166.
27. Grimby G, Oxhøj H, Bake B. Effects of abdominal breathing on distribution of ventilation in obstructive lung disease. Clin Sci Mol Med, 1975, 48(3): 193-199.
28. Henke K G, Sharratt M, Pegelow D, et al. Regulation of end-expiratory lung volume during exercise. J Appl Physiol, 1988, 64(1): 135-146.
29. Aliverti A, Stevenson N, Dellaca R L, et al. Regional chest wall volumes during exercise in chronic obstructive pulmonary disease. Thorax, 2004, 59(3): 210-216.
30. Amft O, Lukowicz P. From backpacks to smartphones: Past, present, and future of wearable computers. IEEE Pervas Comput, 2009, 8(3): 8-13.
31. Ryvlin P, Ciumas C, Wisniewski I, et al. Wearable devices for sudden unexpected death in epilepsy prevention. Epilepsia, 2018, 59: 61-66.
32. Hsu W C, Sugiarto T, Lin Y J, et al. Multiple-wearable-sensor-based gait classification and analysis in patients with neurological disorders. Sensors, 2018, 18(10): 3397.
33. Rutkowski S, Buekers J, Rutkowska A, et al. Monitoring physical activity with a wearable sensor in patients with COPD during in-hospital pulmonary rehabilitation program: A pilot study. Sensors, 2021, 21(8): 2742.
34. Gutierrez G, Williams J, Alrehaili G A, et al. Respiratory rate variability in sleeping adults without obstructive sleep apnea. Physiol Rep, 2016, 4(17): e12949.

Journal of Biomedical Engineering

A wearable six-minute walk-based system to predict postoperative pulmonary complications after cardiac valve surgery: an exploratory study

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