Huaxi Hospital ICU teamed up with Nuonuo Technology and Zhikang Technology to fully launch the remote system of the intensive specialist alliance

It was learned that on November 17, 2018, the launching ceremony of Hangzhou Ni Nuo Technology Co., Ltd. (hereinafter referred to as “Niu Nuo Technology”) and the Department of Critical Care Medicine of West China Hospital of Sichuan University (hereinafter referred to as “Huaxi ICU”) was held in Chengdu. According to the release content, the two sides will give full play to their respective advantages and jointly develop brain function (rapid) evaluation system for critically ill patients, which is used for brain function evaluation and data mining of critically ill patients to solve the pain points and difficulties existing in the clinical application of EEG.

ICU has a strong demand for EEG monitoring

The visceral rate and mortality rate of severe central nervous system dysfunction in cerebrovascular disease is one of the conventional diseases affecting human health and quality of life. It is important to correctly evaluate brain function and prognosis. Severe central nervous system dysfunction is most common in neurology ICU, and it is the main difficult disease in the diagnosis and treatment of neurology.

In recent years, with the rapid development of imaging technology, CT, MRI, and transcranial Doppler have become routine auxiliary examination methods for evaluating the prognosis of cerebrovascular diseases. Imaging diagnosis can show the damaged area of ​​brain damage, but can not directly display the brain function status of the area. In the ICU, patients with severe neurological disorders often have disturbances of consciousness, and brain damage is more serious. It is urgent to perform major vital signs monitoring, ventilator treatment, drug treatment, etc., resulting in patients not being able to move at will, limiting imaging diagnosis.

Therefore, there is an urgent need for a more direct and simpler method to reflect the brain function status of such patients in clinical diagnosis and treatment, and then to make a preliminary judgment on the prognosis of patients.

Electroencephalogram (EEG) is a commonly used method for evaluating brain function. It has the advantages of simple non-invasive, continuous bedside monitoring, low cost, and good reproducibility. It is increasingly used for brain function monitoring in patients with clinical neurosis. EEG can reflect the changes of brain function early by recording the electrical activity of neurons in the brain, especially for brain tissue ischemia, hypoxia, metabolic abnormalities, etc., and its amplitude and frequency are related to brain tissue damage, and It can realize bedside, long-distance, repeated detection and convenient use. It is one of the ideal tools for monitoring and evaluating brain function in the current NICU (Nerve Severe Treatment Unit).

The Department of Critical Care Medicine of West China Hospital of Sichuan University is one of the largest comprehensive medical departments in China. At present, there are more than 200 open beds and more than 700 medical staff. The annual treatment of more than 10,000 critically ill patients has a very high demand for EEG monitoring.

According to Kang Yan, director of the Department of Critical Care Medicine, West China Hospital, about one-fourth of the more than 200 critically ill medical beds in West China Hospital need to do EEG monitoring every day. According to national statistics, the general hospitals in general hospitals account for about 2% to 8% of the total beds, that is, a hospital with a thousand beds has at least 20 critically ill patients. If calculated in terms of West China, then at least every day. Five patients need to do EEG monitoring.

It can be seen that the monitoring of the brain bed has a broad application prospect in the ICU, especially the NICU.

Although bedside EEG monitoring for critically ill patients in the NICU has received widespread attention, EEG itself still has many shortcomings, especially in the clinical application process and there is a certain distance from the doctor's needs. Specifically, it mainly manifests in the following three aspects:

First, most EEG devices are complicated to operate, causing doctors to spend a lot of time in the preliminary preparation, which usually takes more than half an hour.

Second, the anti-interference of EEG equipment in the market is generally poor, and in the environment of NICU, EEG equipment is extremely vulnerable to interference from various medical instruments such as monitors and ventilators, resulting in inaccurate EEG results and inability to guide Clinical treatment.

Third, the lack of continuous monitoring means, it is difficult to assess the short-term and long-term prognosis of brain function. Moreover, the massive EEG signal generated by long-term monitoring has a high degree of complexity and uncertainty, and it is necessary to rely on professional manual visual inspection, which is not only a large workload, but also difficult to judge in real time and feedback to the clinic for real-time processing. This shows that the key requirement of ICU EEG monitoring is real-time identification with AI intelligent algorithm blessing.

"The current development of EEG technology is limited. Even in the ICU, EEG monitoring is only intermittent, and continuous monitoring is not possible. The large amount of data generated by continuous monitoring is directly presented to the doctor if it is not well analyzed. For doctors, the workload of reading pictures is too large, and the data is basically useless." Kang Yan told the arterial network.

Professor Xie Qiqi, deputy director of ICU of West China Hospital of Sichuan University, believes that it is too difficult to rely on an instrument or system to solve these problems. We need to adopt some solutions to take some comprehensive measures.

To this end, Huaxi Hospital and Ni Nuo Technology intend to construct a critical brain function decision system for ICU through the analysis of continuous electroencephalogram monitoring (cEEG), and provide intelligent monitoring and evaluation of different critically ill patients on the one hand by artificial intelligence. To evaluate the prognosis of patients, provide assistants with early warning and decision-making, and improve the survival rate and prognosis of patients.

Ni Nuo Technology is a leading high-tech enterprise integrating EEG overall solution, AI algorithm technology research and software and hardware product development. The business covers EEG case database and algorithm, EEG big data cloud platform and EEG. Develop supporting hardware.

In terms of hardware, Ni Nuo Technology has a variety of EEG instruments that meet the quality of first-line manufacturers at home and abroad, including medical EEG instruments, portable EEG instruments, and headband EEG detectors. Customized EEG equipment for ICU application scenarios, enabling one-minute fast brain operation. Among them, the medical EEG series has passed the EU CE certification and the CFDA Class II medical device registration certificate. It is the only EEG instrument with 24Bit sampling precision chip that has obtained CFDA certification.

In terms of software and algorithms, Ni Nuo Technology has launched a unified platform for EEG data formats and a platform for EEG big data analysis, breaking the barriers of different brands of data formats, completing data standardization and free circulation of EEG cloud platform, and EEG data. Positive indicators for automatic screening, epilepsy recognition and early warning algorithms, brain function measurement and trend analysis system (severe patients, preoperative and postoperative brain function direction) construction. Ni Nuo Technology is currently the only company in China that has built a big brain data platform.

“This Huaxi Hospital cooperates with Ni Nuo Technology, hoping to develop a product that can meet the clinical needs. By exerting its maximum function, it will bring more reference and guidance to the clinic, bringing the gospel to clinicians and patients. Professor Xie Qiqi said.

Then, what kind of product is the rapid evaluation system for brain function of critically ill patients jointly developed by Huaxi and Ni Nuo? What are its highlights? What is the value?

Dai Kunyu, founder and CEO of Ni Nuo Technology, told reporters that the system mainly consists of two sections: ICU research brain function big data platform and ICU specialist AI expert decision system. Among them, the AI ​​expert decision-making system provides a set of analysis and evaluation system by online real-time monitoring of cEEG (continuous EEG) data of ICU patients.

First of all, it analyzes the patient's brain condition in real time in an intelligent way, and describes the real-time status of the patient, which can provide a basis for doctors to evaluate the patient's preoperative condition. Then, the system also uses intelligent learning algorithm to establish the disease evolution model, to predict the development of patients' condition, to provide doctors with intraoperative evaluation basis, and to assist clinical diagnosis decision-making. Finally, through the modeling of the patient's prognosis, the system will evaluate and analyze the prognosis of the patient and provide a prognostic analysis.

In general, the main functions of the system can be reflected in real-time analysis of the condition, prediction of disease progression and prognosis.

The cEEG data is highly complex and uncertain. The long-term monitoring of multi-channel EEG data can better describe the patient's brain condition, but the manual analysis of monitoring data will bring a huge workload. Therefore, the real-time analysis system developed by Ni Nuo Technology will provide a real-time intelligent reading tool, which will quickly extract relevant parameters of disease diagnosis. Direct voice alarm feedback can be detected early and intervened in real time to assist doctors in clinical operations and help patients to get safe early. Successfully passed the dangerous period.

It is reported that the current phase of the development of the system from the two aspects of brain function detection - the construction of comatose patients with brain function measurement and automatic detection of persistent non-convulsive seizures, followed by preoperative and postoperative brain function measurement and prediction and Multi-phase cooperation such as brain function rehabilitation, through the construction of multiple AI models, gradually build a rapid assessment system for brain function in critically ill patients.

The physiological index data of transient changes in the ICU not only has a large amount of data, but also a rapid rate of change, but these data are the basis for diagnosing the patient's condition and an important basis for the early warning of the patient's critical potential. These multidimensional and complex data often require high-level physicians to perform effective analysis with years of clinical experience in order to obtain the final diagnosis and treatment strategy. However, due to the massive amount of monitoring data, even excellent clinicians have difficulty in developing an optimal diagnosis and treatment plan for each patient.

The disease evolution prediction system will model the multi-modal historical data and real-time data, model the evolution of the disease, provide an automatic predictive analysis model for the disease, provide a reference for the evaluation of clinical diagnosis, and provide decision-making assistance for the doctor to adjust the treatment.

Early screening for poor prognosis, appropriate treatment withdrawal or limited treatment can reduce the patient's continued pain, reduce the waste of social medical resources, reduce the burden on individual families, and improve the patient's final outcome. Therefore, it is important to find a reliable, highly specific, highly sensitive, and reproducible prediction method.

The system uses machine learning algorithms to construct rehabilitation and risk scoring models, and feedbacks the model results to doctors in real time, which provides doctors with clinical decision support to a certain extent.

Director Kang Yan said that if the cooperation between Huaxi Hospital and Ni Nuo Technology is successful, the rapid assessment system for brain function of this critically ill patient will be expected to become a routine means of bedside EEG monitoring, which is of great significance to both West China and clinical.

According to Director Kang Yan, Huaxi Hospital and Zhikang Technology have been developing their own "severe clinical information system" for nearly five to ten years. Up to now, the system has also developed relatively mature, can well support the monitoring of blood ammonia function such as breathing and circulation, and can collect, organize, analyze and summarize all kinds of information generated by critically ill patients in ICU treatment. Various applications.

However, in the critical clinical information system of Huaxi, the monitoring and evaluation of neurological severe disease has been weak. The cooperation with Ni Nuo Technology may be able to make up for the lack of monitoring of neurological severe diseases to some extent, and improve the hospital's monitoring system for all important organs of the human body.

Speaking of the cooperation between Huaxi Hospital and Zhikang Technology, Dr. Xiao Jun of Huaxi Hospital said that the fate of Huaxi Hospital and Zhikang Technology began as early as 8 years ago. Since 2010, Huaxi Hospital has established a long-term friendly cooperative relationship with Zhikang Technology, established a research and practice base, provided a general idea for product research and development, and provided a good research platform for clinical trial use.

Zhikang Technology is the first high-tech enterprise in China to develop, generate and sell smart medical software products. It has a complete intellectual property product and solution provider in the field of medical big data mining and medical data analysis. In May 2018, in response to the State Council's General Office issued the “Guiding Opinions on Promoting the Construction and Development of Medical Complexes”, Zhikang Technology was based on the “ Telemedicine System” and “Severe Clinical Information System” as a technical basis to assist Huaxi in establishing the Severe Specialist Alliance. To build a medical system sinking system, a new model of three-level triage in the critical field: the Department of Remote Critical Care Medicine (Enhanced-ICU).

Zhikang Science and Technology supports the Huaxi Severe Specialist Alliance from four aspects: medical, teaching, research and management with the four systems of Severe Clinical Information System, Severe Medical Quality Control System, Real World Research Platform and Telemedicine System. It has successively reached cooperation with 10 hospitals including Guang'an People's Hospital, Ziyang First People's Hospital, Mianzhu People's Hospital, Ganluo County People's Hospital and Ganzi People's Hospital, using Internet technology to establish remote management, remote collaborative rounds, and remote consultations. Remote time coverage, distance education, in-service subject management, referral of green channels up and down, collaborative research and distance learning.

According to Kang Yan, the cooperation model of the China Specialized Medicine Specialist Alliance has been quite effective. The level of doctors in primary hospitals has improved significantly. The proportion of patients transferred from primary hospitals to higher hospitals has also dropped significantly. Patients can basically stay in the local area. Some hospitals are seriously ill. Medical beds have even appeared to be insufficient.

"Our goal is to make our alliance chain a remote ward similar to the Department of Critical Care Medicine in West China, to ensure the homogeneity of the clinical medical level among the members of the alliance, so that the gap is not too big. This is the most One of the core purposes." Kang Yan stressed.

In recent years, the state has always encouraged collaborative innovation in production, education and research. The cooperation between Huaxi Hospital and Ni Nuo Technology and Zhikang Technology fully demonstrates the importance of “medical cooperation and win-win development”. Only by deep cooperation with hospitals and using high-quality medical resources can enterprises develop “hands-on” products that meet clinical needs and suit clinical habits, and realize the transformation of innovation results.

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