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.