New Hemodynamic Parameters in Peri-Operative and Critical Care-Challenges in Translation

A comprehensive review of digital twin in healthcare in the scope of simulative health-monitoring

Objective

Digital twins (DTs) emerged in the wake of Industry 4.0 and the creation of cyber-physical systems, motivated by the increased availability and variability of machine and sensor data. DTs are a concept to create a digital representation of a physical entity and imitate its behavior, while feeding real-world data to the digital counterpart, thus allowing enabling digital simulations related to the real-world entity. The availability of new data sources raises the potential for developing structured approaches for prediction and analysis. Similarly, in the field of medicine and digital healthcare, the collection of patient-focused data is rising. Medical DTs, a new concept of structured, exchangeable representations of knowledge, are increasingly used for capturing personal health, targeting specific illnesses, or addressing complex healthcare scenarios in hospitals.

Methods

This article surveys the current state-of-the-art in applying DTs in healthcare, and how these twins are generated to support smart, personalized medicine. These concepts are applied to a DT for a simulated health-monitoring scenario.

Results

The DT use case is implemented using AnyLogic multi-agent simulation, monitoring the patient's personal health indicators and their development.

Conclusion

The results indicate both possibilities and challenges and provide important insights for future DT implementations in healthcare. They have the potential to optimize healthcare in various ways, such as providing patient-centered health-monitoring.

Non-Invasive Hemodynamic Monitoring System Integrating Spectrometry, Photoplethysmography, and Arterial Pressure Measurement Capabilities

Minimally invasive and non-invasive hemodynamic monitoring technologies have recently gained more attention, driven by technological advances and the inherent risk of complications in invasive techniques. In this article, an experimental non-invasive system is presented that effectively combines the capabilities of spectrometry, photoplethysmography (PPG), and arterial pressure measurement. Both time- and wavelength-resolved optical signals from the fingertip are measured under external pressure, which gradually increased above the level of systolic blood pressure. The optical channels measured at 434-731 nm divided into three groups separated by a group of channels with wavelengths approximately between 590 and 630 nm. This group of channels, labeled transition band, is characterized by abrupt changes resulting from a decrease in the absorption coefficient of whole blood. External pressure levels of maximum pulsation showed that shorter wavelengths (<590 nm) probe superficial low-pressure blood vessels, whereas longer wavelengths (>630 nm) probe high-pressure arteries. The results on perfusion indices and DC component level changes showed clear differences between the optical channels, further highlighting the importance of wavelength selection in optical hemodynamic monitoring systems. Altogether, the results demonstrated that the integrated system presented has the potential to extract new hemodynamic information simultaneously from macrocirculation to microcirculation.

Perioperative Patients With Hemodynamic Instability: Consensus Recommendations of the Anesthesia Patient Safety Foundation

In November of 2022, the Anesthesia Patient Safety Foundation held a Consensus Conference on Hemodynamic Instability with invited experts. The objective was to review the science and use expert consensus to produce best practice recommendations to address the issue of perioperative hemodynamic instability. After expert presentations, a modified Delphi process using discussions, voting, and feedback resulted in 17 recommendations regarding advancing the perioperative care of the patient at risk of, or with, hemodynamic instability. There were 17 high-level recommendations. These recommendations related to the following 7 domains: Current Knowledge (5 statements); Preventing Hemodynamic Instability-Related Harm During All Phases of Care (4 statements); Data-Driven Quality Improvement (3 statements); Informing Patients (2 statements); The Importance of Technology (1 statement); Launch a National Campaign (1 statement); and Advancing the Science (1 statement). A summary of the recommendations is presented in Table 1 .