1. Development of Heart, Respiratory Rate, and Oxygen Saturation Percentile Curves Using Continuous in Time Data for Mechanically Ventilated Children
Brian Walsh PhD RRT, Gaston Fiore MS, Craig Smallwood BS RRT, Jordan Rettig MD, Mauricio Santillana PhD, John Arnold MD

2. Conflict of Interest/Disclosure
The authors have no disclosures or conflicts of interest in the content of this presentation.
The authors have no related financial relationships with a commercial entity producing healthcare-related products and/or services.

3. Introduction
It has become increasingly possible to collect and analyze large amounts of physiologic data with systems designed to aggregate, store and display real-time patient data
Using continuous data to accurately identify vital signs concerning for clinical deterioration is key to further development of this technology
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4. Specific Aims
We sought to develop oxygen saturation (SpO2), heart rate (HR) and respiratory rate (RR) percentile curves for critically ill children requiring mechanical ventilation (MV)
This information will be used for the development of z scores to be used with a rounding tool and early warning system
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5. Methods
Performed a cross-sectional study of MV patients within our Medical Surgical PICU from January 1, 2013-August 2016
Vital signs were taken from the monitor at 5 second sampling rate
Excluded observations in which either vital sign met criteria for physiologic implausibility
HR > 300 or < 30
RR > 120 or < 5

6. Methods
To minimize sensor noise we downsample data into 1 minute bins and average values of timestamps falling into a bin
To minimize ascertainment bias we randomly select 100 samples from within each period of before, during, and after MV for each patient admission
If period wasn’t long enough to contain at least 100 samples, then it wasn’t considered
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7. Observations by Age and Epoch
Results
Demographics
Race/Ethnicity
Patients, n (%)
American Indian/Alaska Native
1 (0.1)
Asian
31 (3.7)
Black/African American
60 (7.2)
Declined to Answer
12 (1.4)
Other
159 (19.1)
Unable to Answer
97 (11.6)
Unknown
26 (3.1)
White
447 (53.7)
Total
834 (100)
Male
374 (45)
Females
460 (55)
Observations by Age
Age
Observations (%)
0-<3 mo
14740 (7)
3-<6 mo
7059 (3)
6-<9 mo
10018 (5)
9-<12 mo
8072 (4)
12-<18 mo
16013 (8)
18-<24 mo
14216 (7)
2-<3 y
8722 (4)
3-<4 y
8780 (4)
4-<6 y
16580 (8)
6-<8 y
11500 (6)
8-<12 y
24325 (12)
12-<15 y
20642 (10)
15-<18 y
19897 (10)
>18 y
21936 (11)
Total
(100)
Observations by Age and Epoch
Age
Before, n (%)
During, n (%)
After, n (%)
0-<3 mo
3921 (11.9)
7320 (7.9)
3499 (4.6)
3-<6 mo
2014 (6.1)
3248 (3.5)
1797 (2.3)
6-<9 mo
1449 (4.4)
4699 (5)
3870 (5)
9-<12 mo
1457 (4.4)
3333 (3.6)
3282 (4.3)
12-<18 mo
2701 (8.1)
7300 (7.9)
6012 (7.8)
18-<24 mo
2758 (8.3)
6618 (7.1)
4840 (6.3)
2-<3 y
1040 (3.2)
4182 (4.5)
3500 (4.6)
3-<4 y
860 (2.6)
4300 (4.6)
3620 (4.7)
4-<6 y
2500 (7.6)
7200 (7.8)
6880 (8.9)
6-<8 y
1400 (4.2)
5200 (5.6)
4900 (6.4)
8-<12 y
3100 (9.3)
11225 (12.1)
10000 (13)
12-<15 y
3062 (9.3)
9075 (9.8)
8505 (11.1)
15-<18 y
3338 (10.1)
8700 (9.4)
7859 (10.2)
>18 y
3400 (10.3)
10200 (11)
8336 (10.8)
Total
33000 (100)
92600 (100)
76900 (100)

8. Results – HR Before vs During MV
99%
Dotted Lines = Before MV
Solid Lines = During MV
50% 1%

9. Results – HR During vs Post MV
Dotted Lines = Post MV
Solid Lines = During MV
99%
50% 1%

10. Results – RR Before vs During MV
Dotted Lines = Before MV
Solid Lines = During MV
99%
50% 1%

11. Results – RR During vs Post MV
Dotted Lines = Post MV
Solid Lines = During MV
99%
50% 1%

12. Results – SpO2 Before vs During MV
Dotted Lines = Before MV
Solid Lines = During MV
50%
10% 1%

13. Results – SpO2 During vs Post MV
Dotted Lines = Post MV
Solid Lines = During MV
50%
10% 1%

14. Conclusion
We were able to successfully develop percentile curves from continuous HR, RR and SpO2 data.
The percentiles derived would be considered out of range according to existing ranges of non-ICU hospitalized children.
These percentiles serve as a useful reference to inform evidence-based vital sign alerts, goal and/or alarm setting within a medical surgical PICU.
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