Clinical validation of video-based vital sign monitoring in the intensive care unit: a prospective cohort study

PURPOSE: Video-based monitoring technologies enable continuous and contactless monitoring of vital signs. This study evaluates the clinical concordance and determinants of performance of contactless video-based heart and respiratory rate monitoring compared with reference standards in a heterogeneous population of critically ill patients. METHODS: In this prospective observational study, 35 intensive care unit patients were continuously monitored for 24 h. Video-based heart rate and respiratory rate were compared with the clinical reference standard. Agreement was assessed using Bland-Altman plots, intraclass correlation coefficients (ICC), and error grid analyses. Generalized estimating equations (GEE) identified factors affecting agreement. RESULTS: For heart rate, bias was 2.1 bpm (limits - 33.6 to 37.7), with 81.9% within ± 5 bpm and 99.3% in error grid zones A/B. ICC was 0.43. For respiratory rate, bias was - 2.4 breaths/min (limits - 14.3 to 9.5), with 63.5% within ± 3 breaths and 87.5% in zones A/B. ICC was 0.41. High heart rate, atrial fibrillation, norepinephrine administration, and movement reduced agreement for heart rate; movement reduced agreement for respiratory rate. CONCLUSION: Video-based monitoring shows promise for detecting abnormal vital signs in critically ill patients, but improved robustness to motion is needed for reliable clinical implementation.