Journal of Clinical Monitoring and Computing最新文献

{"title":"Fluid management methods for severely burned patients: a narrative review.","authors":"Yi Yao, Tianzhen Hua, Yucong Li, Meiqing Zhang, Wei Liu","doi":"10.1007/s10877-025-01365-0","DOIUrl":"https://doi.org/10.1007/s10877-025-01365-0","url":null,"abstract":"<p><p>Burn shock is a major early complication in the treatment of severely burned patients, and precise and timely fluid management is essential for survival. Traditional clinical indicators such as urine output, blood pressure, central venous pressure (CVP), and blood lactate are commonly used, but each has significant limitations. Invasive hemodynamic monitoring technologies, such as Pulmonary Artery Catheterization (PAC) and Pulse Contour Cardiac Output (PiCCO), have improved the accuracy of fluid assessment, but carry risks of infection and procedural complications and require experienced clinical interpretation within the context of the patient's overall condition. Non-invasive ultrasound-based methods, including critical care ultrasonography and the Venous Excess Ultrasound Score (VExUS), are emerging as promising alternatives, particularly in resource-limited settings. This review summarizes current methods for fluid management in severely burned patients, with a focus on the concepts of fluid responsiveness and fluid tolerance, and provides recommendations for clinical practice.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145300640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing tidal volume estimation from electrical impedance tomography (EIT) by applying human anthropometric information.","authors":"Amelie Zitzmann, Anna Strübing, Daniel A Reuter, Andreas Waldmann, Stephan H Böhm, Fabian Müller-Graf","doi":"10.1007/s10877-025-01367-y","DOIUrl":"https://doi.org/10.1007/s10877-025-01367-y","url":null,"abstract":"<p><strong>Purpose: </strong>Electrical impedance tomography (EIT) is a functional imaging technique to monitor regional ventilation. However, the quantification of clinically used ventilation parameters like tidal volume (VT) has not been possible yet since EIT measures relative and not absolute changes in impedance. Thus, the study aimed to evaluate the relationship between impedance changes (dZ) and VT in humans and to identify influencing factors.</p><p><strong>Methods: </strong>27 patients undergoing elective surgery under general anaesthesia were equipped with a commercially available EIT belt. Measurements were performed at four VTs (6, 8, 10 and 12 mL/BW) on each of four PEEP levels (0, 5, 10 and 15 cmH₂O). Linear regression analysis was performed for normalized dZ and VT per ideal bodyweight (VT_IBW). Additionally, PEEP, gender, age, height and weight were analysed as potential influencing factors.</p><p><strong>Results: </strong>Regression analysis for individual patients showed good correlations between VT_IBW and normalized dZ (mean R² 0.890 ± 0.15). However, for the group of patients, correlations were rather weak (R² 0.485). Including additional factors improved the model (adjusted R² 0.767), with VT_IBW having the biggest impact, followed by weight, height and PEEP; age did not contribute to it significantly. Higher VT_IBW, PEEP and height increased, while female gender and higher weight decreased normalized dZ.</p><p><strong>Conclusion: </strong>Normalized dZ correlated strongly with VT_IBW in the individual ventilated humans but more weakly when analyzing the cohort. PEEP, gender, weight and height were identified as additional influencing factors.</p><p><strong>Trial registration: </strong>This study was prospectively registered at the German Register of Clinical Studies (Deutsches Register Klinischer Studien; DRKS00027226) on 3rd December 2021.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145292380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Protective mechanical ventilation controlled by the real-time mechanical power measurement.","authors":"Filip Burša, Michal Frelich, Peter Sklienka, Zuzana Kučerová, Jiří Sagan, David Oczka, Marek Penhaker, Michal Burda, Jan Máca","doi":"10.1007/s10877-025-01369-w","DOIUrl":"https://doi.org/10.1007/s10877-025-01369-w","url":null,"abstract":"<p><strong>Background: </strong>Despite the substantial advancements in mechanical ventilation (MV), mortality remains high. Mechanical power (MP), MV forces are associated with outcomes. Real-time monitoring of MP and the adjustment of MV according to MP may result in ventilation with lower MP.</p><p><strong>Methods: </strong>Randomized controled trial conducted at the ECMO Centre Ostrava, Czech Republic, from March 2023 to March 2024 enrolled adult patients on MV (with or without extracorporeal membrane oxygenation, ECMO) with acute respiratory failure. A system for real-time MP monitoring (geometric method and simplified Becher´s formula) has been developed. In the intervention arm, the physician was able to observe the MP in real time and adjust the MV parameters accordingly. In the control group, the MP was concealed.</p><p><strong>Results: </strong>A total of 494 subjects were screened and 33 patients were randomized (further 7 ECMO patients). There was no significant difference between the control and intervention groups. Median MP_Geom was 3.22 J/min (maximum 15.2 J/min) and MP_Becher of 5.94 J/min (maximum 18.4 J/min). Only a weak (but significant, p = 0.0001) correlation between MP_Geom and MP_Becher was observed. A highly significant difference was observed in MP between day and night (6 a.m. - 6 p.m.) with higher MP at night.</p><p><strong>Conclusion: </strong>Although real-time MP measurement is feasible, there was no significant difference in MP between the control and intervention groups with low MP in both groups. Experience physicians was capable of safe MV, even if they do not know the exact MP value. The night shift was a high-risk period for developing lung damage due to elevated MP.</p><p><strong>Trial registration: </strong>ClinicalTrials NCT06035146.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145274582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of low tidal volume on dynamic arterial elastance in patients undergoing laparoscopic surgery.","authors":"Yusuke Iizuka, Ikumi Sawada, Kentaro Fukano, Yoshihiko Chiba, Keika Miyazawa, Asuka Kitajima, Keisuke Kajitani, Yuji Otsuka, Masamitsu Sanui","doi":"10.1007/s10877-025-01364-1","DOIUrl":"https://doi.org/10.1007/s10877-025-01364-1","url":null,"abstract":"<p><p>Purpose To evaluate the effect of reducing tidal volume from 8 mL/kg predicted body weight (PBW) to 6 mL/kg PBW on dynamic arterial elastance (Eadyn) in patients scheduled for laparoscopic surgery.</p><p><strong>Method: </strong>After the start of intra-abdominal insufflation, if MAP became < 65 mmHg and SVV > 10%, then the tidal volume was reduced from 8 mL/kg PBW to 6 mL/kg PBW. One min later, 250 mL of lactate Ringer's solution was administered over 10 min. MAP responsiveness was defined as a > 10% increase in MAP following a fluid challenge.</p><p><strong>Results: </strong>This study included 46 patients, 11 MAP non-responders and 35 MAP responders. Both PPV and SVV decreased significantly (- 19.4 ± 11% and - 19.7 ± 9.9%, respectively) following tidal volume reduction. However, the magnitude of the decrease differed. As a result, the change in Eadyn was minimal on average, although inter-individual variability was observed. Bland-Altman analysis revealed a mean difference of - 0.004, with 95% limits of agreement ranging from - 0.285 to + 0.278. Eadyn values before and after tidal volume reduction failed to predict MAP responsiveness (at 8 mL/kg PBW: area under the ROC curve [AUC] 0.514, at 6 mL/kg PBW: AUC 0.508).</p><p><strong>Conclusion: </strong>The reduction in tidal volume had a clinically negligible effect on Eadyn. Neither Eadyn values at tidal volume of 8 mL/kg PBW and 6 mL/kg PBW could not predict MAP increase after a fluid challenge during laparoscopic surgery.</p><p><strong>Trial registration: </strong>This study was registered in the UMIN-CTR Clinical Database (ID: UMIN000054061) on April 4th, 2024. https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi? recptno=R000061722.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145251586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to the comment on the article: Reduction of the acquisition time needed to obtain somatosensory evoked potentials by estimation of the required averaging sweep count by an algorithm.","authors":"Clemens Bothe","doi":"10.1007/s10877-025-01368-x","DOIUrl":"https://doi.org/10.1007/s10877-025-01368-x","url":null,"abstract":"","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145251533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Application of a time series foundation model to noninvasively estimate intracranial pressure.","authors":"Murad Megjhani, Bennett Weinerman, Tammam Alalqum, Yanwei Li, Ziyi Zhou, Brandon Lau, Soon Bin Kwon, Yunseo Ku, Angela Velazquez, Shivani Ghoshal, David J Roh, Sachin Agarwal, E Sander Connolly, Jan Claassen, Soojin Park","doi":"10.1007/s10877-025-01366-z","DOIUrl":"https://doi.org/10.1007/s10877-025-01366-z","url":null,"abstract":"","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145251495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations between baseline cerebral oxygen saturation, preoperative B-type natriuretic peptide and hemoglobin levels, and mortality after cardiac surgery in non-dialysis patients.","authors":"Maho Kakemizu-Watanabe, Masakazu Hayashida, Shihoko Iwata, Masataka Fukuda, Megumi Hayashi, Atsuko Hara, Yasuyuki Tsushima, Yuichiro Sato, Daisuke Endo, Izumi Kawagoe","doi":"10.1007/s10877-025-01352-5","DOIUrl":"https://doi.org/10.1007/s10877-025-01352-5","url":null,"abstract":"<p><p>Baseline cerebral regional oxygen saturation (rSO₂) measured with the INVOS 5100C near-infrared spectroscopy (NIRS) device has been reported to correlate primarily with preoperative B-type natriuretic peptide (BNP) and hemoglobin levels. It has also been reported to be associated with postoperative mortality. This study evaluated whether similar associations exist for other NIRS-derived indicators, including tissue oxygenation index (TOI) and tissue oxygen saturation (StO₂), measured with the NIRO-200NX and FORESIGHT Elite devices, respectively. We retrospectively analyzed 510, 468, and 510 non-dialysis adult patients undergoing cardiac surgery in whom baseline rSO₂, TOI, and StO₂, respectively, were measured on the forehead before anesthesia and mixed venous oxygen saturation (SmvO₂) was measured after induction of anesthesia. Correlations between 37 preoperative blood test variables and NIRS or SmvO₂ values were evaluated using Spearman's correlation coefficient. Associations between baseline NIRS values and postoperative in-hospital mortality were assessed using logistic regression. Across all three devices, baseline NIRS values and SmvO₂ values were most significantly correlated with BNP and hemoglobin (all p < 0.00001) of the 37 preoperative blood test variables. Baseline rSO₂, TOI, and StO₂ values were each significantly associated with postoperative mortality (p = 0.00101, 0.00111, and 0.01122, respectively). For all NIRS-derived indicators examined, baseline NIRS values before anesthesia and SmvO₂ values after induction of anesthesia were primarily correlated with BNP and hemoglobin levels. In addition, baseline NIRS values showed a significant association with postoperative in-hospital mortality, suggesting their potential utility as a prognostic marker, although this requires confirmation in larger studies.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145238718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Opioid administration guided by Surgical Pleth Index in patients with a combination of general and regional anaesthesia during trauma and orthopaedic surgery: a double-blind, randomised controlled trial.","authors":"Kim C Koschmieder, Hans O Pinnschmidt, Lea-Sophie Borst, Gillis Greiwe, Elena Kainz, Marlene Fischer, Rainer Nitzschke","doi":"10.1007/s10877-025-01363-2","DOIUrl":"https://doi.org/10.1007/s10877-025-01363-2","url":null,"abstract":"<p><strong>Purpose: </strong>This randomised controlled trial investigated the effect of Surgical Pleth Index (SPI) guided sufentanil administration on intraoperative sufentanil consumption compared to routine care in patients with a combination of general anaesthesia and regional anaesthesia having trauma and orthopaedic surgery.</p><p><strong>Methods: </strong>Eighty patients with a combination of general anaesthesia and regional anaesthesia undergoing trauma or orthopaedic surgery were randomised into two groups to receive either sufentanil guided by SPI monitoring or by routine care (Control). The primary endpoint was intraoperative sufentanil consumption. Secondary endpoints were postoperative pain level, opioid consumption, incidence of nausea, duration of time in the post-anaesthesia care unit (PACU) and quality of recovery.</p><p><strong>Results: </strong>The median intraoperative sufentanil administration adjusted to bodyweight and surgery duration did not differ between the groups: SPI guided group 2.29 (interquartile range, IQR 0.29 to 6.91), Control 1.65 (IQR 0.83 to 2.63) µg·kg^-1·min^-1*1000 (P = 0.906). The relative risk for receiving intraoperative sufentanil was RR 0.909 (95% CI 0.723 to  1.143, P = 0.414). Median morphine equivalents administered in the 24 h after discharge from the PACU were 3.8 (IQR 0.0 to 22.5) in the SPI guided group and 19.1 (IQR 3.8 to 30.0) mg (P = 0.021) in the control group without adjustment for multiple testing. Other secondary endpoints showed no differences.</p><p><strong>Conclusion: </strong>SPI guided sufentanil administration did not reduce intraoperative sufentanil consumption compared to routine care in patients having trauma and orthopaedic surgery with a combination of general anaesthesia and regional anaesthesia.</p><p><strong>Trial registration: </strong>Clinicaltrials.gov identifier NCT06040307 (registered September 8, 2023).</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145212753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-effectiveness of data driven personalised antibiotic dosing in critically ill patients with sepsis or septic shock.","authors":"Hana M Broulikova, Jacqueline Wallage, Luca Roggeveen, Lucas Fleuren, Tingjie Guo, Paul W G Elbers, Judith E Bosmans","doi":"10.1007/s10877-024-01257-9","DOIUrl":"10.1007/s10877-024-01257-9","url":null,"abstract":"<p><strong>Purpose: </strong>This study provides an economic evaluation of bedside, data-driven, and model-informed precision dosing of antibiotics in comparison with usual care among critically ill patients with sepsis or septic shock.</p><p><strong>Methods: </strong>This economic evaluation was conducted alongside an AutoKinetics randomized controlled trial. Effect measures included quality-adjusted life years (QALYs), mortality and pharmacokinetic target attainment. Costs were measured from a societal perspective. Missing data was multiply imputed, and bootstrapping was used to estimate statistical uncertainty. Differences in effects and costs were estimated using bivariate regression and used to calculate incremental cost-effectiveness ratios.</p><p><strong>Results: </strong>Patients in the intervention group had higher costs (€42,684 vs. 39,475), lower mortality (42% vs. 49%), more QALYs (0.184 vs. 0.153), and higher pharmacokinetic target attainment (69% vs. 48%). Only the difference for target attainment was found statistically significant. An additional €18,129, €55,576, and €123,493 needs to be invested to attain the targeted plasma levels for one more patient, to save one life and gain one QALY, respectively. The probability of cost-effectiveness for all effect outcomes is below 60% for most acceptable willingness-to-pay thresholds.</p><p><strong>Conclusions: </strong>Data-driven personalised antibiotic dosing in critically ill patients as implemented in the AutoKinetics trial cannot be recommended for implementation as a cost-effective intervention.</p><p><strong>Trial registration: </strong>The trial was prospectively registered at Netherlands Trial Register (NTR), NL6501/NTR6689 on 25 August 2017 and at the European Clinical Trials Database (EudraCT), 2017-002478-37 on 6 November 2017.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":"937-946"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12474602/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143032854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Detection of fluid responsiveness by changes of perfusion index and pleth-variability index during passive leg raising in spontaneously breathing post-surgical patients: a prospective interventional study.","authors":"Simon Rauch, Paolo Mario Seraglio, Tomas Dal Cappello, Giulia Roveri, Markus Falk, Matthias Bock","doi":"10.1007/s10877-025-01292-0","DOIUrl":"10.1007/s10877-025-01292-0","url":null,"abstract":"<p><p>Predicting fluid responsiveness is crucial in treating circulatory failure, as only about half of patients benefit from volume expansion by increasing cardiac output (CO). Dynamic tests like passive leg raising (PLR) are preferred over static parameters. While PLR reliably predicts fluid responsiveness, it typically requires invasive measurement of stroke volume (SV) or CO. The perfusion index (PI) and pleth variability index (PVI) are non-invasive metrics derived from oxygen saturation signals. PI has been shown to correlate with SV, and PVI has predicted fluid responsiveness in mechanically ventilated patients, but their role in spontaneously breathing patients remains unclear. This study aimed to assess whether PI and PVI could predict fluid responsiveness in post-surgical, spontaneously breathing patients during a PLR test. The hypothesis was that PI would increase and PVI would decrease in fluid responders. The prospective study included spontaneously breathing patients after major abdominal surgery in the ICU of Merano Hospital, Italy. SV and CO were measured using the FloTrac™ system, and PI and PVI were assessed using the Radical 7^® monitor. Patients were considered responders if SV increased by ≥ 10% during the PLR test. Of the 47 patients enrolled, 23 (48.9%) were fluid responders. The percentage change in PI from baseline to 60 s into the PLR test was + 41.2% in responders and + 11.3% in non-responders. A PI increase of ≥ 23% predicted responders with 70% sensitivity and 75% specificity, with an area under the ROC curve of 0.74. Twenty-two patients (47%) were inside the grey zone. PVI did not differ significantly between groups. In conclusion, PI could be a helpful non-invasive tool for predicting fluid responsiveness during a PLR test in spontaneously breathing patients, though its diagnostic accuracy appears to be moderate.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":"929-936"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12474676/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143795535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}