#9. The Practical Applications of Innovation | ANESTHESIOLOGY® 2018

TopMedTalk

Desiree Chappell: All righty, well, we are here at Anesthesiology 2018 at the American Society for Anesthesiologists' annual meeting. I am Desiree Chappell, host of TopMedTalk, and I'm joined this morning by Monty Mythen, Editor in Chief of TopMedTalk. Good morning, Monty.

Monty Mythen: Good, it's great to be back.

Desiree Chappell: (laughs).

Monty Mythen: Good to be here in San Francisco.

Desiree Chappell: It is. So, TopMedTalk, we're here on the Smiths Medical booth.

Monty Mythen: 1519, I've learned the number.

Desiree Chappell: 1519, yes.

Monty Mythen: Learnt to say it, I can remember it now.

Desiree Chappell: (laughs).

Monty Mythen: Can't remember my hotel room, but I remember 1519.

Desiree Chappell: You can remember the booth, that's right. And, uh, we're in the Connections Center.

Monty Mythen: Yep.

Desiree Chappell: So-

Monty Mythen: Which used to be called the Trade Exhibition for those people who are

Desiree Chappell: Right, I know, I know.

Monty Mythen: ... looking out for it.

Desiree Chappell: I'm so upset about that (laughing).

Monty Mythen: So they know- they know what we're talking about.

Desiree Chappell: But, uh, we are so fortunate to- to have space here, um, on the Smiths booth. We also have an education, uh, an education booth that, uh, the ASA granted us, which was wonderful that. And, um, TopMedTalk is actually the broadcasting arm of Evidence Based Perioperative Medicine.

Monty Mythen: Yep.

Desiree Chappell: Right? And-

Monty Mythen: So, 20... EB- EBPOM, uh, just cel- celebrated our 20th meeting in Dingle in the west coast of Ireland, we now have a global presence. I'm sorry, to- to keep banging on about it, but we're proud of it.

Desiree Chappell: Yep.

Monty Mythen: So we now have meetings, uh, around the world, Hong Kong, Australia, Singapore coming up. We now have a presence in the USA, so we have the Chicago meeting, and we have the Dallas meeting coming up in March next year for the first. So we're truly global with a 20-year pedigree, so we're very proud of that, and this is our broadcasting arm.

Desiree Chappell: It is. It is, and it- and it's great to be able to have different types of formats to share information. I know it's, you've all been passionate in that organization to share high-quality information, um, to the delegates.

Monty Mythen: Yep.

Desiree Chappell: And now we are able to u- utilize TopMedTalk to kind of reach a broader audience, so it's- it's good.

Monty Mythen: Ninety, over 90 countries.

Desiree Chappell: Yep.

Monty Mythen: And a- again, apologizing to the people who are tired of hearing this, but we're

Desiree Chappell: (laughs). That they keep hearing it.

Monty Mythen: ... very proud. We were aiming for 10,000 downloads in this calendar year.

Desiree Chappell: Yep.

Monty Mythen: And we just, I just checked, it went over 90,000 this morning.

Desiree Chappell: Whoo.

Monty Mythen: So we'll- we'll probably go over 100,000 at this meeting.

Desiree Chappell: Yeah.

Monty Mythen: Which is great.

Desiree Chappell: Yeah.

Monty Mythen: So that's a 10x overperformance. Man, I wish we were on bonuses.

Desiree Chappell: (laughs). I know, right?

Monty Mythen: I wish we had invested in this earlier.

Desiree Chappell: Me too.

Monty Mythen: (laughs). But there we go.

Desiree Chappell: Yeah, that's right. Well, um, here during, uh, Anesthesiology 2018, we wanted to focus on a theme, and we-

Monty Mythen: Yep.

Desiree Chappell: ... chose enhanced recovery.

Monty Mythen: Yep.

Desiree Chappell: Um, which something that both of us are v- very passionate about. And, um, so we're talking about everything in enhanced recovery, different elements, how to get it started, how to get by, and what people's experiences are. We had the privilege to speak with Henry, uh, Henrik K- Kellet.

Monty Mythen: Kellet.

Desiree Chappell: (laughs). Uh, the, yesterday. And, uh, kicked the- kicked the conference off, so that was really a unique and wonderful experience. Um, but this morning, we have a very special guest with us who's also gonna be talking about enhanced recovery but looking kind of towards the future and- and different things that we can utilize in practice, uh, in- in these different perioperative quality initiatives, and it is Frederic Michard. Good morning, Frederic, how are you?

Frederic Michard: Good morning Monty, good morning Desiree. My pleasure to be here.

Desiree Chappell: Well, thank you so much for joining us, we really ap- ap- appreciate you stopping by and, uh, chatting with us this morning. So, Frederic, tell us a little bit about what you're doing these days.

Frederic Michard: So what I'm doing these days, so I'm a medical doctor.

Desiree Chappell: You are.

Frederic Michard: I've spent, uh, 15 years working, uh, mainly in intensive care units, then I spent some time working for, uh, industry, for a big company actually based in the US. And, uh, three years ago, I started my own consulting business, so I'm based in, uh, Switzerland.

Desiree Chappell: Mm-hmm.

Frederic Michard: And I focus on, uh, medical innovation, technical innovation, that actually could help, uh, us, anesthesiologists, intensivists, nurses, uh, to, uh, improve patient safety, improve quality of surgical care.

Desiree Chappell: Wow, that's really cool. You always have seemed like you've an innovator and want to be in that space.

Frederic Michard: I'm not an innovator myself

Desiree Chappell: Yeah?

Frederic Michard: ... but- but I'm very interested in innovation, and that's why I really love what I'm doing now, because I'm, uh, I'm in the middle, you know?

Desiree Chappell: Yeah.

Frederic Michard: You know, I see all these, uh, startups developing, uh, fantastic, uh, things.

Desiree Chappell: Mm-hmm.

Frederic Michard: They also need support and help and the experience from, uh, bigger players, so I'm kind of a bridge between the two, and so I can watch what's happening and I can tell you it's very exciting. And I

Desiree Chappell: That's a good innovation in itself, actually.

Frederic Michard: And I think at the end of the day, it's gonna be useful, first of all, for the patients.

Desiree Chappell: Yeah, absolutely.

Monty Mythen: So, uh-

Desiree Chappell: Monty?

Monty Mythen: So, and you're saying you're not innovator, Frederic, but I just wanna challenge you there, cause the

Desiree Chappell: (laughs).

Monty Mythen: When, I've- I've got a slide in my slide set that has pulse pressure variation

Desiree Chappell: Yeah.

Monty Mythen: ... on it, a diagram of the arterial waveform going up and down as a result of positive pressure breaths, and at the bottom it says Michard and et al.

Frederic Michard: Yeah, it was a long time ago, Monty.

Monty Mythen: (laughs).

Frederic Michard: You know, we're- we're going to celebrate actually, uh, in a couple of weeks from now, you probably know, maybe you- you will be there for the European Society of Intensive Care medicine congress, we're going to celebrate the 25th anniversary for PPV.

Monty Mythen: (laughs).

Desiree Chappell: (laughs).

Frederic Michard: So I'll be there on stage, you're right, I'll be there on stage giving a lecture on PPV. I was really honored to be invited to celebrate this birthday, but I was, you know, it reminds me as well that I'm getting old.

Desiree Chappell: Oh stop (laughing).

Monty Mythen: At least- at least in 20... And there is other- there are other mentors, uh, people involved in that whole development, you know, the swing on the arterial waveform

Frederic Michard: Of course, of course, of course, Of course.

Monty Mythen: ... being described for a long time. But the, but- but a- a- a huge contribution, really, that the... Because, I mean, I- I think it's ubiquitously accepted now. There are debates about how you capture the signal, but I doubt anyone doubts the potential value of understanding why PPV exists in some people.

Frederic Michard: You know, it's- it's a long story. I mean, you mention, uh... No, you did not mention any names, but I'm going to mention names, like Asrael Pirel

Monty Mythen: Yep.

Frederic Michard: ... or Jean-Louis Teboul, Michael Pinsky

Monty Mythen: Absolutely.

Frederic Michard: ... François Jardin. I mean, uh, these guys developed the

Monty Mythen: Legends.

Frederic Michard: ... the physiological concept. Uh, before, with Jean-Louis, we clearly tried to make it easy, and we also tried to convince clinicians to look at this variable and to understand the- the- the clinical value. And- and we are, honestly, I am very proud today to realize that that's a tool displayed on most bedside and

Monty Mythen: Absolutely.

Desiree Chappell: Yep.

Frederic Michard: ... hemodynamic monitors. Clearly, there are many limitations we- we definitely acknowledge, uh, but I think in many patients, it helps to- to improve fluid management, to individualize fluid management, and at the end to decrease potential complications.

Monty Mythen: And it- it can be very easy to use, but it's also

Desiree Chappell: Yeah.

Monty Mythen: ... physiologically, it's a very complex signal, as you say, so the brain, the- the- the clever doctors also require... Or I should say practitioner, sorry, I shouldn't jump to doctors.

Frederic Michard: If- if you say so, Monty.

Desiree Chappell: (laughs).

Frederic Michard: (laughs).

Monty Mythen: (laughs). But that's not what we're here to talk about here today, but

Desiree Chappell: No. It's-

Monty Mythen: Twenty-five years, great celebration, older than

Frederic Michard: Twenty, twenty, not 25.

Monty Mythen: Oh? That's old.

Desiree Chappell: (laughs).

Frederic Michard: So not that old (laughing).

Monty Mythen: Okay, 20 years.

Desiree Chappell: (laughs). He's just got five years on you, that's correct.

Monty Mythen: But we're here to discuss a different topic, obviously.

Desiree Chappell: No, no. I mean, I think that just speaks to, um, the innovation. I think it's- it's cool. So, um, you have been, a- again, talking about these new technologies. What has inspired you to, um, go down the ward...

Uh, ward, but go down the road for some of the things that you're really interested in right now?

Frederic Michard: I think it's just, you know, when you read what people are publishing, uh, at some point we were really worried about fluid management. We are still, I know it's still

Desiree Chappell: Yeah.

Frederic Michard: ... a very hot topic. Uh, but I think we start to have more clarity regarding what should be done, you know, how much fluid should be given, and the fact that we should individualize everything we do during surgery. And then, if you read paper, you start to realize that, um, you know, problems are also observed on the wards.

Desiree Chappell: Yeah.

Frederic Michard: And I read a couple of papers, like the large, uh, EuSOS study published in The Lancet by Pearse, uh, I think five years ago.

Desiree Chappell: Mm-hmm.

Frederic Michard: And I was really shocked when I realized that most patients who were dying after surgery were actually dying on the wards. As an intensivist, I'm an intensivist by training, I had the feeling that, you know, most patients who are dying in acute settings like in the ICU.

Desiree Chappell: Mm-hmm.

Frederic Michard: Maybe in the cath lab, maybe sometimes in the emergency department, but not on the wards.

Desiree Chappell: Yeah.

Frederic Michard: And, uh, so there are a couple of recent studies highlighting the fact that most, the majority of patients, in hospitals are actually dying on the wards.

Desiree Chappell: Hmm.

Frederic Michard: And the paradox, that's what I call the monitoring paradox

Desiree Chappell: Hmm.

Frederic Michard: ... is that we do not really monitor, or at least we do not monitor closely, these patients.

Desiree Chappell: No, not all.

Frederic Michard: You know how it works. You know, the

Desiree Chappell: Yeah.

Frederic Michard: ... nurses are doing spot checks every four to six hours.

Desiree Chappell: Yeah, if that. Yes.

Frederic Michard: And, uh, and so that's clearly, I think, uh, a setting where we can potentially dramatically improve outcomes.

Desiree Chappell: Yeah.

Frederic Michard: It's completely, to me, it's completely in line with what I've done so far.

Desiree Chappell: Yeah.

Frederic Michard: Uh, and I think it's completely aligned also with EBPOM, with IRAS, who is the perioperative surgical org.

Desiree Chappell: Yeah.

Frederic Michard: Because the goal is clearly to continue to- to further improve postoperative outcomes.

Monty Mythen: So if- if, sorry to interrupt, but just for those folks who haven't read the details, I just looked it up, it's in the numbers, which are quite shocking in the EuSOS study. It was forty, just over 46,000 patients from just under 500 hospitals in 28 countries, and as you quite rightly say, they said 73% of patients who died were not admitted to a critical care unit.

Desiree Chappell: Oh my gosh.

Frederic Michard: Yeah.

Desiree Chappell: That's-

Monty Mythen: And th- that's, that is still shocking to very many people.

Desiree Chappell: Yeah.

Monty Mythen: Now, some people counter argue that and say, "Well, maybe they were, had do not resuscitate orders," et cetera, but there are other data that's included about cardiac arrests

Frederic Michard: Yeah.

Monty Mythen: ... in the UK.

Frederic Michard: Yeah.

Monty Mythen: It would appear that a lot of it is sudden, unexpected. The majority of it is not anticipated.

Frederic Michard: So it seems to be real. It's a real problem we have to face, uh, we have to solve. And, um, the other reason why I'm interested, it's because I think with- with new technologies, actually we can now envision, uh, monitoring these patients. It was not- it was not the case it the past until recently, because the goal-

Desiree Chappell: Yeah.

Frederic Michard: ... of course is not to create new ICU beds or to turn ward beds into ICU beds

Desiree Chappell: Right.

Frederic Michard: ... with big monitoring systems, all the wires, all the nurses we would need to- to look at these variables all the time.

Desiree Chappell: Costly.

Frederic Michard: So thanks to technological improvements, you know, there are small sensors now we can imagine to use. As a patch, uh, stick to the skin, uh, they are wireless. Uh, thanks to software innovation as well, we can filter out artifacts, uh, we always observe in ambulatory patients. Um, we can integrate the information, uh, and end up with smart early warning scores.

Desiree Chappell: Yeah.

Frederic Michard: And so, I mean, all these innovations are coming.

Desiree Chappell: Yeah.

Frederic Michard: At the same time, I think we started to realize that, uh, there are issues on the wards.

Desiree Chappell: Yeah.

Frederic Michard: And so that's why I'm, uh, focusing on that.

Monty Mythen: And so I'm just looking, uh, at an article, uh... To declare a conflict, I'm on the editorial board of the British Journal of- of Anesthesia.

Desiree Chappell: (laughs).

Monty Mythen: Joined also by you, Frederic, with Dan Sessler, who we know well on TopMedTalk.

Desiree Chappell: Yeah.

Frederic Michard: Yeah.

Monty Mythen: From the Cleveland Clinic. And it's called Ward Monitoring 3.0, so I think the clue is in the title.

Desiree Chappell: (laughs).

Frederic Michard: (laughs).

Monty Mythen: Which is there. And there's quite a shocking statement at the beginning, it says, "Patients who are admitted to hospital believe that they are entering a place of safety. They feel confident that should their condition deteriorate, they're in the best place for prompt and effective treatment, yet there is evidence for the contrary." And as you highlight in the article, that quite shocking statement comes from the, from NICE, from the National Institute for Health and Care Excellence in the UK. So it's kind of, it seems to be front and center that we know this is reality.

Desiree Chappell: Yeah.

Frederic Michard: Yeah, yeah, yeah. And I was shocked as well when I- when I found this statement on the web. Uh, and so clearly, I mean, it's not, uh, yeah, I'm not dreaming, it's not a bad dream, it's the reality. And so, I'm- I'm pretty confident that EBPOM and, uh, other org- organizations of that kind will embrace... Or I hope they will, because to be honest, you know, I did not, I arrived just, uh, two days ago, but already I was not impressed by the number of sessions where they were discussing about this issue.

Monty Mythen: Well, w- we-

Frederic Michard: So I think- I think, we- we need to bring awareness around this, uh, issue, because it's obviously, as you, as- as you just underlined

Monty Mythen: Uh-huh.

Frederic Michard: ... it's a big issue. And I still believe that very, um, many anesthesiologists are not aware, and many surgeons are not aware.

Monty Mythen: So we- we both attended, uh, over a year ago now, a round table about perioperative hypotension.

Frederic Michard: Yep.

Monty Mythen: And the post- the postoperative one.

Frederic Michard: Yeah.

Monty Mythen: Paper four, the sh... I think everyone, what everyone was shocked about is we didn't r- we didn't really have anything to discuss.

Desiree Chappell: (laughs).

Monty Mythen: Not that there wasn't a lot to discuss, is what I mean to say, but we didn't have any evidence to review, because it's all- it's all... There's- there's some out there, but it's such an under-reported area, and what was reported was shocking, in other words how frequently, from Dan Sessler again, that

Frederic Michard: Yes, yes.

Desiree Chappell: Yeah.

Monty Mythen: ... postoperative instability were recorded.

Frederic Michard: Yeah, yeah, yeah, yeah. But actually, when you start looking at, uh, at that more closely, you find studies.

Monty Mythen: Hmm.

Frederic Michard: There are already more than a few studies showing that, for example, uh, hypoxemia is very common on the wards.

Desiree Chappell: Oh yeah.

Frederic Michard: Um, you know, there are studies where actually they monitor blindly, uh, arterial oxygen saturation, uh, continuously on the wards. And then, uh, and then they were able to realize that, uh, first of all, hypoxemia is very common.

Desiree Chappell: Right.

Frederic Michard: And missed 90% of the time.

Desiree Chappell: Yeah.

Monty Mythen: Hmm.

Frederic Michard: There are, um, new studies coming soon, they are not yet published, but, um, with the exact same conclusions regarding blood pressure. Hypotension after surgery is very common

Desiree Chappell: Yeah.

Monty Mythen: Hmm.

Frederic Michard: ... and is missed most of the time just because, you know, we- we measure blood pressure every four to six hours.

Desiree Chappell: Yeah.

Frederic Michard: So-

Desiree Chappell: And once, usually y- you're grabbing them up and out of bed and they're already

Frederic Michard: I think the evidence is growing, and we even have outcome studies already published, not with wireless systems, but I think the concept is the same. You know, uh, studies from [inaudible 00:13:23], studies from [inaudible 00:13:24], uh, showing that when we use monitoring systems on the wards, we can decrease the number of ICU admissions, for example.

Desiree Chappell: Yeah.

Frederic Michard: We can, uh, decrease even mortality. There is a recent study from the UK, from Chris Subbe, showing a decrease in mortality after the implementation of such a system on the wards.

Monty Mythen: So if I may, Desiree, just one last thing.

Desiree Chappell: Yeah, please.

Monty Mythen: In- in the paper, table one, now we don't discuss specific products on the stand here, but there’s there’s-

Frederic Michard: Okay, okay.

Monty Mythen: But you have a- you have a table in there, which if- if I'm counting, right, there's 11

Frederic Michard: Yeah.

Monty Mythen: ... wearable-

Frederic Michard: Yeah, yeah.

Monty Mythen: Different, 11 different companies

Frederic Michard: Yeah, yeah.

Monty Mythen: ... and 11 different stick-on thingies.

Frederic Michard: Yeah.

Monty Mythen: And they look to me like, you know, big, they look about sort of the s- s- size of the distance from between your forefinger and your thumb at most, is most of them.

Desiree Chappell: Yeah.

Monty Mythen: Is that about right? Some of them are like the palm of your hand. But they're, they stick on

Frederic Michard: Yeah.

Monty Mythen: ... and they monitor pulse rate, heart rate, ECG, transcirculatory frequency. One of them does pulse oximetry, one of them has a go at blood pressure, a little bit about temperature.

Frederic Michard: Yeah.

Monty Mythen: It's, uh-

Frederic Michard: Yeah, yeah, yeah.

Monty Mythen: Everyone should have a look. Table one, uh, Michard and Sessler, British Journal of Anesthesia. Not providing any specific product, but there are 11 choices there in the table.

Desiree Chappell: Yeah.

Frederic Michard: And probably today it's more than 11, because what's funny with

Monty Mythen: Okay.

Desiree Chappell: (laughs).

Frederic Michard: What's funny with this editorial is that actually I had to update the table after the first revision and the second revision.

Desiree Chappell: Wow, because there was that many new ones coming out (laughing).

Frederic Michard: Yeah. (laughs). And that's also the beauty of what I'm doing now, is there- is there are so many companies, and I'm sure, by the way, I probably missed some- some products which are already approved for medical use.

Desiree Chappell: Yeah.

Frederic Michard: Because basically what you did not say, uh

Monty Mythen: Yeah.

Frederic Michard: ... Monty, is that these are not gadgets.

Monty Mythen: No.

Frederic Michard: These are products which are approved for medical use.

Desiree Chappell: Um, by the FDA.

Frederic Michard: At least in Europe or/and in the UA.

Desiree Chappell: Oh, okay.

Monty Mythen: So the title is Medical Grade Adhes

Frederic Michard: Exactly.

Desiree Chappell: Yeah.

Monty Mythen: ... Adhesive Patches for Physiological Monitoring, BP

Desiree Chappell: Yeah.

Monty Mythen: ... heart rate, pulse rate, et cetera, et cetera.

Desiree Chappell: Yeah.

Monty Mythen: So it's out there.

Frederic Michard: It's out there. Um, we need more validation studies.

Desiree Chappell: Mm-hmm.

Frederic Michard: These are new products, there are few validation studies, so, you know, we definitely need more studies to ensure they clearly measure what they are supposed to measure. And then, of course, the next step will be to also, um, see if there an impact on outcomes.

Desiree Chappell: Yeah. One- one thing I love- I love about it, and as a nurse, you know, uh, myself, and, um, have worked in the wards and knowing that your time is limited, and there are specific pat- or there are patients I can think back to and like it would have been wonderful to have a continuous monitor on them that was non-invasive, um, and that they didn't have to be attached to anything. So I think that's great. So with enhanced recovery programs, you know, we're sending people home a lot earlier than

Frederic Michard: Mm-hmm.

Desiree Chappell: ... we have ever before, and probably those patients may need, or should maybe have, a little bit more monitoring. Are these partic- particular devices, or are there other devices on the market that we can send them come with these, you know?

Frederic Michard: Yeah, clearly this is- this is, to me, the next step.

Desiree Chappell: Yeah.

Frederic Michard: But actually for many companies, this is not the next step, they start by home monitoring because, you know, it's a much bigger market.

Desiree Chappell: Yeah. (laughs).

Frederic Michard: So it's a much bigger opportunity for them (laughing). But personally, I think we should go step by step. Uh, I understand what, uh, these new technologies can- can bring us on the wards.

Desiree Chappell: Yeah.

Frederic Michard: It's under control. Uh, we- we better understand what's happening in the hospital than outside.

Desiree Chappell: Yeah.

Frederic Michard: But technically speaking, of course there is no reason to believe that in five years

Desiree Chappell: Yeah.

Frederic Michard: ... from now, a patient who will be discharged at a very early stage will be monitored from home and we'll have a smart system, uh, developed to inform clinicians, uh, when needed.

Desiree Chappell: Yeah, I think it's great. Well, um, yesterday we- we did, like I said, uh, we were able to speak with Henrik, uh, about some different things that he sees as the future of care and enhanced recovery. And- and I- I saw his presentation on Friday, and he actually, um, put your all's paper up, uh, and was talking about the importance of doing ward monitoring and- and failure to rescue- rescue patients, we shouldn't have that, you know, we should be able to, um, monitor these patients, uh, non-invasively. So that was really cool to kind of see the synergy, or to see all that working together.

Frederic Michard: Exactly.

Desiree Chappell: Yeah.

Frederic Michard: And honestly, a couple of years ago, when I met Henrik for the first time, I was really amazed because he's a pioneer, as you said, he's dev- he developed all these concepts, and when I started to discuss with him about, you know, my- my excitement, uh, about new technologies, he was- he was- he was already on board actually. He was already doing studies with, uh, with, um, wearable sensors to track activity.

Desiree Chappell: Yes.

Frederic Michard: You know?

Desiree Chappell: Yeah, he was talking about that. Mm-hmm.

Frederic Michard: To quantify rehabilitation.

Desiree Chappell: Yeah.

Frederic Michard: Early mobilization.

Desiree Chappell: Yep.

Frederic Michard: Because, you know, we often say we cannot improve what we don't measure, so now we even have tools. Uh, I'm not going to give any names, Monty, but there are even consumer products

Monty Mythen: Hmm.

Frederic Michard: ... which are, uh, used, uh, in hospitals to quantify the activity, physical activity, of patients, particularly

Desiree Chappell: Yeah.

Frederic Michard: ... after orthopedic surgery.

Desiree Chappell: Yeah, yeah. That's great.

Frederic Michard: So Henrik is clearly a, has patience for that as well.

Desiree Chappell: Yeah. (laughs).

Frederic Michard: And he's publishing, you know, you can check on PubMed, you will see publications from him about, uh, wire- wireless, uh, technologies.

Desiree Chappell: Yeah.

Monty Mythen: W- well-

Desiree Chappell: Yeah, that's cool.

Monty Mythen: Well, I think one of the messages we got from him yesterday is they, we've done, uh, quite a huge amount based upon his leadership

Desiree Chappell: Yeah.

Monty Mythen: ... to enhance surgical recovery, but we just, we still don't completely understand the pathophysiology of surgical recovery.

Desiree Chappell: Yeah.

Monty Mythen: So if we don't monitor it and measure it, we can't really understand it, and if we don't understand it, we can't look at the biology, which means we can't work out how to fix it. So I think they all feed into each other. Yeah.

Desiree Chappell: Yeah.

Frederic Michard: I agree, I agree. I think what you are- you are saying is that we are going to learn, actually. It's not only it’s not only having new technologies to monitor continuously something we understand very well today but monitor only intermittently, I think we are going to learn from the patterns, for example, blood pressure. We don't- we don't really know about the daily, uh, oscillation of blood

Desiree Chappell: The fluctuation, yeah.

Frederic Michard: ... pressure, you know, what's normal, what's not, uh, normal, what is associated with complications or not. So I think having also these continuous signals, uh, will be the opportunity to better understand the physiology and probably ultimately to treat our patients.

Desiree Chappell: Oh, absolutely.

Monty Mythen: Uh, y- yeah, cause we've done a number of interviews this year about artificial intelligence.

Desiree Chappell: Yeah.

Monty Mythen: We know that devices have been ap- approved now by regulators in Europe and the FDA that utilize artificial intelligence, machine learning, to look at the complexity in those signals. And- and as those signals get richer, that's only gonna get better and better, isn't it? Isn't that gonna change it?

Frederic Michard: Yeah, I think so. We have to be careful, because I think artificial intelligence is really a buzzword.

Monty Mythen: (laughs).

Desiree Chappell: (laughs).

Frederic Michard: So we have to- we have to be careful, we have to be, as we always did

Monty Mythen: Yeah.

Frederic Michard: ... You know, and, uh, and, um, perform clinical studies, technical studies, validation studies. But the potential is obviously huge. And I would say it's, even on that riff, you know, I mentioned that fact that if tomorrow we use these sensors in ambulatory patients, first of all we need to have very robust software to filter out the artifacts.

Monty Mythen: Yes.

Frederic Michard: And also, if we envision to monitor patients on the wards, there is no way we are going to give nurses five variables to look at at the same time.

Desiree Chappell: Right.

Frederic Michard: So for this integration, you know, so far, uh, what's very popular is to use early warning scores, but that's a very basic integration, you know, you just add a score for respiratory rate, another one for heart rate, and so on and so forth.

Desiree Chappell: Hmm.

Frederic Michard: We can do better. We already know we can do better with machine learning algorithms. There are already studies published from M- Marion Ravenak, for example, from, uh, UPMC, they can predict at an earlier stage just by combining these variables together with very smart algorithms.

Desiree Chappell: Hmm.

Monty Mythen: Can I ask one more thing? Does

Desiree Chappell: Please, yes.

Monty Mythen: So, um, I've got two more things, Frédéric, one is- one is bed sensors, and the other one is facial recognition.

Desiree Chappell: Mm-hmm.

Monty Mythen: So I went to visit a- a relative of mine who runs a care home in Ireland, they will all remain nameless

Desiree Chappell: (laughs).

Monty Mythen: ... but all their beds have sensors in them.

Frederic Michard: Yep.

Monty Mythen: So when the people, particularly in their dementia unit, get up in the middle of the night all of a sudden, the- the-

Frederic Michard: Mm-hmm.

Monty Mythen: ... it senses it. But also, their movement in the bed is sensed, so if their

Frederic Michard: Yeah. Yeah.

Monty Mythen: ... normal sleeping pattern is deranged; they get a more detailed cheek to see if they're becoming unwell or dehydrated. Is- is that

Frederic Michard: I mean, as- as you said, we are not going to give any names, but I mean, these technology or these kinds of technologies do exist, they are approved by the FDA. I will even tell you, uh, uh, there is even an outcome study showing that if you use a free, uh, um, a contact-free sensor, so it's basically

Monty Mythen: Yeah.

Desiree Chappell: Yeah, yeah.

Frederic Michard: ... a sensor you leave under the mattress.

Desiree Chappell: Yeah.

Frederic Michard: It's not only able to record, as you described, uh, the movement of the patient, it's also able to- to record or to feel the- the pulse, so the heart rate

Monty Mythen: Yeah.

Frederic Michard: ... and the respiratory rate. And- and there is already an outcome study published I think in the American Journal of Medicine, uh, showing the value for these technologies. The only limitation is, of course, it's not for ambulatory patients.

Monty Mythen: Yeah.

Desiree Chappell: Yeah.

Frederic Michard: And I think you will agree that, uh, early mobilization is one of the key elements of these programs.

Monty Mythen: Absolutely.

Desiree Chappell: (laughs).

Frederic Michard: Uh-

Desiree Chappell: Mm-hmm.

Monty Mythen: It also gives you a live bed census as well, which is important there, because often we don't know h- how many of our beds are filled in UK hospitals.

Desiree Chappell: (laughs).

Monty Mythen: My last one is facial recognition, which is being spoken

Frederic Michard: Yeah.

Monty Mythen: ... about quite a lot. That you can

Frederic Michard: Yeah.

Monty Mythen: A camera-

Frederic Michard: Yeah.

Monty Mythen: ... can detect a signal and see

Frederic Michard: Yeah, yeah. Yep.

Monty Mythen: ... illness.

Frederic Michard: So I- I think it's, today it's already possible to measure heart rate. It's pretty easy, actually, to detect the very small changes in the color of your face.

Monty Mythen: Mm-hmm.

Frederic Michard: Uh, with your heartbeats. So it's- it's- it's, uh

Desiree Chappell: Oh gosh (laughing).

Frederic Michard: Yeah, yeah, it's, uh, it's, um, it's... There are validation studies, uh, uh, showing that it's possible to measure heart rate actually even with- even with your cell phone there.

Desiree Chappell: It's simple, yeah.

Frederic Michard: I mean, there are apps, um, where you just look at your cell phone, but you don't take a selfie, okay, you ask the- the app to- to measure your heart rate, and then you have a

Desiree Chappell: (laughs).

Frederic Michard: ... then you have the information.

Desiree Chappell: Oh my gosh (laughing).

Frederic Michard: Uh, I know- I know some people, some companies, working on, uh, the measurement of SpO2, arterial oxygen saturation. Respiratory rate, it's also in the pipes.

Desiree Chappell: Yeah.

Frederic Michard: So you are right, Monty, you know, we can also

Desiree Chappell: That's cool.

Frederic Michard: ... envision to have, uh, not only patch on the skin, uh, but video cameras in the rooms, uh, able to monitor, uh, most vital signs. It's coming.

Desiree Chappell: Yeah. That's great. Well, Frederic, thank you so much for joining us and- and talking about all this really innovative, which, and you are an innovator, um, but talking about all this really cool tech. And really, kind of how we use it practically, how we're gonna be able to use it, um, in the future to take better care of our patients. So thank you so much, I appreciate it.

Frederic Michard: Thank you very much.

Monty Mythen: Um, we didn't, we are allowed to... If people wanna find you, Frederic, where, uh

Desiree Chappell: Yes.

Frederic Michard: Oh yeah. So I think the best is to visit my website.

Monty Mythen: Yep.

Frederic Michard: So it's, uh, michardconsulting.com.

Monty Mythen: And we'll get that up on the piece that we put out with it.

Desiree Chappell: Yes, do.

Monty Mythen: We'll put that in, that link in there.

Desiree Chappell: Yeah, and- and

Monty Mythen: Thank you so much.

Desiree Chappell: ... some links to the- the papers that you've done recently. Yeah.

Frederic Michard: They can find everything on my website.

Desiree Chappell: Perfect.

Frederic Michard: (laughs).

Monty Mythen: Fantastic. I know, the perfect website.

Desiree Chappell: Wonderful. I know. (laughs).

Monty Mythen: Do you do website as well?

Desiree Chappell: Yeah (laughing).

Frederic Michard: No, I-

Desiree Chappell: Website development.

Frederic Michard: Actually, I did it myself, but it's very easy.

Desiree Chappell: Yeah. (laughs).

Frederic Michard: Shh.

Desiree Chappell: I was just gonna say, I don't know.

Frederic Michard: Thank you very much again.

Desiree Chappell: Yeah, so thank you so much. We, um, are here at the Smiths Medical booth, booth 1519 in the Connections Center, at Anesthesiology 2018. Um, be sure to check us out, be sure to engage with us on slido.com, um, #tmtasa18, eighteen, and ask some questions. And please, be sure to subscribe and enter to win-

Monty Mythen: Free. Free if you subscribe now.

 Desiree Chappell: It is free if you subscribe, it is. TopMedTalk, all of our back catalog, all of our information, everything is free if you subscribe now. And, um, if you do that this weekend, you'll be entered to win a beautiful bespo- bespoke Martial amp speaker.

Monty Mythen: If you're here

Desiree Chappell: Um, if you're here at the conference. And, uh, um, I'm coveting it, so you'd better go ahead and do it now before I end up (laughing)

Monty Mythen: (laughs).

Desiree Chappell: ... deciding to take it for myself. So, anyway, thank you so much for listening and, uh, we'll get you back here, um, actually in just a bit with Michael Scott.

Monty Mythen: Great stuff.

Desiree Chappell: Thanks so much.

Monty Mythen: Thanks, everyone. Thanks for this.

TopMedTalk.