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The DePPaRT Waveform Viewer

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Part of the DePPaRT study involved detailed analysis of continuous waveforms collected just prior to, during, and after the dying process of critically ill patients who died following withdrawal of life sustaining therapies in the intensive care unit. We collected continuous arterial blood pressure (ART), heart activity (ECG), and oxygen saturation (PLETH) data from all enrolled patients, and then looked at each waveform in detail to assess when activity stops, and whether it appears to resume or not after the declaration of death.

During the pilot study we used manual printouts of waveform data to assess this critical study outcome. For the collection of four continuous waveforms, this sometimes resulted in hundreds of pages of printouts for adjudicators to flip through. It was impractical to share waveform data between investigators for adjudication and comparison purposes, and comparison of waveforms was difficult. Collection of paper printouts for the 500 patients we aimed to enrol in DePPaRT would have been impractical and infeasible!

Enter Dr. Nathan Scales, our hardworking, personable, and innovative bioengineer. Working with a team of engineers and researchers at the Dynamical Analysis Laboratory (DAL) at the Ottawa Hospital Research Institute, Nathan has developed a waveform viewer that seamlessly integrates patient waveform data stored on our DePPaRT server.

The software has controls that allowed adjudicators viewing the data to easily manipulate the scale, switch between waveforms, zoom in on particular areas of interest, or select specific time points from plots of numerics. There are also built-in place markers, which allowed adjudicators to clearly indicate when they perceived events of interest to occur, such as cessation and resumption of a pulse. Because Nathan has developed the software himself he was able to modify and add to it while we tested its ease of use for the analysis of real patient data.

The DePPaRT waveform viewer was used successfully by our dedicated group of adjudicators as part of the analysis of DePPaRT data. Current work involves modifying the software for use in future variability studies. 

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