Perioperative medicine & outcomes
Continuous vital sign monitoring on surgical wards: The COSMOS pilot
An erratum to this article was published (J Clin Anesth, Jan 2026 ↗)
Authors' conclusion
We were able to select continuous saturation, heart rate, and respiratory rate thresholds that generated about 2 alerts per patient per day, nearly all of which were considered useful by nurses. Unblinded monitoring and nursing alerts led to interventions (mostly increasing oxygen delivery) that non-significantly reduced vital sign abnormalities by 25 %.
Study context
- Population
- Adults having major non-cardiac surgery on surgical wards, routine nurse vital sign monitoring at 4-h intervals100 phase one, 150 randomised
- Participants
- 250 adults
- Comparison
- Unblinded vs Blinded
- Primary endpoint
- 5-component composite of cumulative durations of vital sign abnormalities
Methodological detailsclinician-blinded continuous recording (phase one)
- Clinician-blinded continuous recording (phase one)
Primary result
As reported in the abstract
Phase two: average relative effect ratio of geometric duration means for vital signs exceeding thresholds (unblinded vs blinded monitoring, per the primary analysis)
0.75
Secondary outcomes
- Alerts deemed useful by nurses — Unblinded
- 82 %
Alarm settings (phase one)
- Average alerts per patient per day
- 2.3
- 6082 h of continuous data modelled; target ∼3 alarms per patient per day
Clinical interventions
- More interventions in unblinded patients
- 60 %
Original publication
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