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This project aims to develop a small, cost-effective, and practical system for continuously measuring delirium in ICU patients. By using quantitative EEG to monitor sleep patterns, the proposed solution offers a noninvasive and accurate way to detect delirium in real time. The project team is currently working on modifying the Vitaport system and collecting data for further analysis.
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Delirium Detection Eric Mauri Michael Marquis Matthew Kasztejna Advised by: Dr. Wes Ely
Delirium Overview • Brain’s form of organ dysfunction • Defined as a disturbance of consciousness characterized by an acute onset and fluctuating course of impaired cognitive functioning. • Develops in over 80% of ICU patients • Direct consequence of medical conditions, medication, toxin exposure, or a combination of all of these.
Delirium Demographics • Occurs in 15-60% of general patients and most frequent complication of hospitalization in older patients • Complicates 2-3 million people yearly. • Involves over 17.5 million inpatient days. • Over $4 billion in Medicare expenditures. • Development of delirium selected as one of the top three most important areas for quality of care improvement in older adults.
How is it detected? • Arousal and Attention Assessment • Confusion Assessment Method (CAM) • Acute onset of mental changes • Inattention • Disorganized thinking • Alertness • Problems • Subjective • No Standardization • Time Intensive
Project Objectives • Develop system that can continuously measure delirium in ICU patients • Device must be small, cost-effective, comfortable, and practical • Real-Time measurements, data storage, and analysis of information (software)
Proposed Solution • Quantitative EEG • Acquire digital signal • Transform it into the frequency domain • Focus on certain frequency bands that have been clinically shown to be important to sleep. • Benefits • Inexpensive • Noninvasive • Software reduces man hours • Most importantly several studies have shown that EEG can be effectively used to monitor sleep
Possible Systems • Gold Standard EEG – Sleep Labs • Bispectral Index (BIS) – Aspect Medical • Sleep I/T • Vitaport - Temec
Ruled out systems • Gold standard EEG • Most complex • The 26 lead system is too complicated for use in the ICU. • BIS • Simplest • Derived from measurements of frequency, amplitude and coherence of EEG. • 3 lead system which produces a single number to describe changes in EEG that relate to levels of sedation and consciousness.
BIS Problems • Studies have shown that BIS is only effective for the first 3 stages of sleep. • During sleep the BIS number decreases as sleep progress from the first to third stage, however the number increases during REM sleep due to increased glucose metabolism in the brain. • Modified system would be too experimental for Dr. Ely’s work.
Remaining Possible Systems • Sleep I/T and Vitaport • Both systems are full clinical Polysomnographs (EEG, EOG, EMG, EKG, respiratory effort, oxygen saturation) • While currently too complex for ICU, the potential for simplification exists. • Dr. Ely prefers focus on Vitaport because it is seems to be best combination of (1) a validated sleep monitoring system and (2) a viable and practical method for use in ICU patients
Current Work • Educating ourselves about the Vitaport system and its features. • Currently in contact with Temec about obtaining a Vitaport system for experimentation. • Determining design changes to Vitaport as dictated by ICU environment. • Discussing possible modifications and requirements with Dr. Ely
Future Work • Continue working with Dr. Weinhouse and engineers at Temec. • After acquiring Vitaport system make necessary modifications. • Using the modified system collect actual data on ourselves and determine accuracy.
