Journal of Clinical Monitoring and Computing最新文献

{"title":"Evaluation of non-invasive sensors for monitoring core temperature.","authors":"Shavin S Thomas, Katharyn L Flickinger, Jonathan Elmer, Clifton W Callaway","doi":"10.1007/s10877-025-01289-9","DOIUrl":"https://doi.org/10.1007/s10877-025-01289-9","url":null,"abstract":"<p><p>We evaluated the accuracy and precision of zero-heat flux (ZHF) and dual sensor (DS) non-invasive temperature probes in intensive care unit (ICU) patients undergoing hypothermic temperature control, hypothesizing that both devices would accurately estimate core temperature. In a single-center prospective cohort study, we enrolled 35 ICU patients and applied continuous, non-invasive ZHF and/or DS probes to the lateral forehead or anterior chest to collect 358 observations. Conditions potentially influencing temperature estimation were recorded. Using Bland-Altman analysis with multiple paired observations per individual, we compared the bias between non-invasive probes and direct core temperature measurements. Lin's concordance coefficient (LCC) was computed to quantify precision. The mean bias between the ZHF probe and invasive temperature was + 0.98 °C; for the DS probe, it was - 2.19 °C. In hypothermic patients, the ZHF probe's accuracy improved (bias + 0.28 °C, LCC 0.86), while the DS probe remained inaccurate (bias - 2.52 °C, LCC 0.07). Clinical confounders like vasoactive agents or temperature control devices did not consistently affect bias, accuracy, or precision. Neither the ZHF nor DS non-invasive probes provided sufficient accuracy or precision to guide clinical decisions in the ICU. These results contrast with previous studies reporting biases within ± 0.5 °C. However, the ZHF probe showed promising limited deviation, especially in hypothermic patients.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692338","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":"Continuous monitoring of intracranial pressure and end tidal carbon dioxide variations in traumatic brain injury: introducing the carbon dioxide reactivity index (CO2Rx).","authors":"Paolo Gritti, Marco Bonfanti, Rosalia Zangari, Ezio Bonanomi, Maria Di Matteo, Davide Corbella, Alessia Farina, Lorenzo Lecchi, Tommaso Togni, Pietro Mandelli, Luigi Andrea Lanterna, Francesco Biroli, Ferdinando Luca Lorini","doi":"10.1007/s10877-025-01285-z","DOIUrl":"https://doi.org/10.1007/s10877-025-01285-z","url":null,"abstract":"<p><strong>Purpose: </strong>The continuous monitoring of cerebral metabolic autoregulation in patients with severe traumatic brain injury (TBI) is poorly documented in the literature and largely absent from clinical practice. This study aimed to assess whether variations in intracranial pressure (ICP) and end-tidal carbon dioxide (ETCO2) can form the basis of an index for cerebrovascular autoregulation reactivity, and whether this index can improve the prediction of clinical outcomes in both adult and pediatric TBI patients.</p><p><strong>Methods: </strong>Data from adult and pediatric patients with severe TBI were retrospectively analyzed. The Carbon Dioxide Reactivity Index (CO2Rx) was introduced as a novel tool to assess cerebrovascular reactivity in response to variations in CO2 and ICP. CO2Rx was calculated by analyzing the relationship between ICP and ETCO2, sampled at approximately 5-minute intervals, using linear correlation within moving time windows ranging from 40 to 180 min in 10-minute increments. The discriminatory power of CO2Rx in predicting clinical outcomes was evaluated through Receiver Operating Characteristic (ROC) curve analysis. The primary outcome measures included in-hospital mortality and the 12-month Glasgow Outcome Scale-Extended (GOSE) score.</p><p><strong>Results: </strong>The study included 218 TBI patients (40 pediatric and 178 adult). CO2Rx values showed a significant correlation with outcomes, with a CO2Rx threshold of 0.28 effectively distinguishing between favorable and unfavorable outcomes. For the fatal/non-fatal outcome, the CO2Rx crude model alone had an Area Under the Curve (AUC) of 0.737. When combined with other predictors (Impact Core + ICP + CO2Rx), this model achieved the highest AUC of 0.929.</p><p><strong>Conclusion: </strong>CO2Rx demonstrated significant predictive value for mortality and unfavorable outcomes in TBI patients, serving as a continuous index of cerebrovascular reactivity to CO2. It holds potential to improve severe TBI management by optimizing the interaction between ventilation and metabolic autoregulation.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT NCT05043545.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692334","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":"Haemodynamic monitoring and management during non-cardiac surgery: a survey among German anaesthesiologists.","authors":"Benjamin Vojnar, Patrick Achenbach, Moritz Flick, Daniel Reuter, Michael Sander, Bernd Saugel, Ann-Kristin Schubert, Christine Gaik","doi":"10.1007/s10877-025-01284-0","DOIUrl":"https://doi.org/10.1007/s10877-025-01284-0","url":null,"abstract":"<p><p>In 2023, the first German guideline on intraoperative haemodynamic monitoring and management for adults having non-cardiac surgery was published. The aim of this survey was to identify how anaesthetists in Germany managed intraoperative haemodynamics and blood pressure before its publication. In September to October 2023, members of the German Society of Anaesthesiology and Intensive Care Medicine (DGAI) were invited via email to participate in this anonymous online survey. Thirty-one questions covered demographics, clinical experience, approaches to perioperative blood pressure measurement and common thresholds, as well as the use of advanced haemodynamic monitoring and its potential therapeutic implications. 1,079 fully completed questionnaires were included in the analysis. When intermittent oscillometry was used to measure blood pressure, a 3-minute interval was usually applied during induction of anaesthesia (42%; 451/1,079). For invasive blood pressure monitoring, more than half (53%; 574/1,079) inserted an arterial line after induction of anaesthesia. Nearly all (94%; 1,012/1,079) focused on the mean arterial pressure for blood pressure monitoring, with a large majority (77%; 779/1012) considering values below 60-65 mmHg to be critically low. Intraoperative hypotension was managed based on an internal protocol by only 21% (223/1,079). Regarding advanced haemodynamic monitoring, 43% (459/1,079) frequently used pulse contour analysis, while 67% (721/1,079) reported that monitors with finger-cuff technology were not available in their department. 47% (504/1,079) cited a lack of experience as one of the main reasons for the infrequent use of cardiac output monitoring. This survey among DGAI members provides important insights into current practices of haemodynamic monitoring and management prior to the publication of the recent German guideline on 'Intraoperative haemodynamic monitoring and management of adults having non-cardiac surgery'.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692349","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":"Empirical pharmacodynamic model of phenylephrine and intrathecal bupivacaine for mean arterial pressure prediction in obstetric patients presenting for elective cesarean delivery under spinal anesthesia.","authors":"Sherwin C Davoud, Basak Ozaslan, Eleonora M Aiello, Ricardo Kleinlein, Braden Eberhard, Hassan Hassan, Francis J Doyle, Vesela P Kovacheva","doi":"10.1007/s10877-025-01288-w","DOIUrl":"https://doi.org/10.1007/s10877-025-01288-w","url":null,"abstract":"<p><p>Cesarean delivery under spinal anesthesia may be complicated by hypotension in up to 80% of the patients. The response to standard-of-care prophylactic phenylephrine infusion varies, and there is little guidance on achieving optimal blood pressure control. In this work, we developed a data-driven pharmacodynamic relationship between intravenous phenylephrine, intrathecal bupivacaine, and maternal mean arterial pressure (MAP) in patients presenting for cesarean delivery. In this single-center cohort study, secondary use data were available for normotensive patients presenting for cesarean delivery. Intraoperative MAP, intrathecal bupivacaine, and intravenous phenylephrine doses were recorded prospectively every minute. The recorded data were used to identify and confirm a time series (Autoregressive with Exogenous Input (ARX)) model for predicting the MAP using MATLAB 2021a System Identification Toolbox and the Prediction Error Method. An independent model validation was conducted using a second dataset collected after the model fitting stage. Model identification was performed on 172 patients, using 70% for model fitting and 30% for testing. The final ARX model, which takes the past three data points to make predictions, performed 48.9% better than a mean constant model for one-minute ahead MAP predictions with a root mean square error (RMSE) of 3.6 ± 1.3 mmHg. Similar performance was observed on independent validation using a second dataset (N = 84), yielding an RMSE of 4.2 ± 1.6 mmHg for one-minute ahead MAP predictions. Our ARX model showed good performance at up to a three-minute prediction horizon and could be used for future decision support applications to guide phenylephrine dose titration.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692336","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":"Response to comments on \"Effect of postoperative peripheral nerve blocks on the analgesia nociception index under propofol anesthesia: an observational study.\"","authors":"Motoi Kumagai, Masahiro Wakimoto, Shohei Ogawa, Sho Watanabe, Kenji S Suzuki","doi":"10.1007/s10877-025-01283-1","DOIUrl":"https://doi.org/10.1007/s10877-025-01283-1","url":null,"abstract":"<p><p>Tanaka et al. suggested that the increase in high-frequency variability index (HFVI) after peripheral nerve block (PNB) may result from autonomic effects mediated by the stellate ganglion block when an interscalene brachial plexus block (ISB) is performed. To investigate this, we analyzed patients receiving PNB with (ISB group; n = 8) or without ISB (non-ISB group; n = 22). HFVI increased significantly in both groups to a similar extent. These findings suggest that ISB's direct autonomic influence on HFVI is minimal. Additionally, laterality effects could not be assessed due to limited cases. We conclude that HFVI elevation is more likely due to PNB's analgesic effects rather than ISB's autonomic influence. Further studies are needed to confirm these findings.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657345","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":"Reliability of an all-in-one wearable sensor for continuous vital signs monitoring in high-risk patients: the NIGHTINGALE clinical validation study.","authors":"Martine J M Breteler, Ellen Leigard, Lisa C Hartung, John R Welch, David A Brealey, Sebastian J Fritsch, David Konrad, Daniel Hertzberg, Max Bell, Heleen Rienstra, Frank E Rademakers, Cor J Kalkman","doi":"10.1007/s10877-025-01279-x","DOIUrl":"https://doi.org/10.1007/s10877-025-01279-x","url":null,"abstract":"<p><p>Continuous vital signs monitoring with wearable systems may improve early recognition of patient deterioration on hospital wards. The objective of this study was to determine whether the wearable Checkpoint Cardio's CPC12S, can accurately measure heart rate (HR), respiratory rate (RR), oxygen saturation (SpO2), blood pressure (BP) and temperature continuously. In an observational multicenter method comparison study of 70 high-risk surgical patients admitted to high-dependency wards; HR, RR, SpO2, BP and temperature were simultaneously measured with the CPC12S system and with ICU-grade monitoring systems in four European hospitals. Outcome measures were bias and 95% limits of agreement (LoA). Clinical accuracy was assessed with Clarke Error Grid analyses for HR and RR. A total of 3,212 h of vital signs data (on average 26 h per patient) were analyzed. For HR, bias (95% LoA) of the pooled analysis was 0.0 (-3.5 to 3.4), for RR 1.5 (-3.7 to 7.5) and for SpO2 0.4 (-3.1 to 4.0). The CPC12S system overestimated BP, with a bias of 8.9 and wide LoA (-23.3 to 41.2). Temperature was underestimated with a bias of -0.6 and LoA of -1.7 to 0.6. Clarke Error Grid analyses showed that adequate treatment decisions regarding changes in HR and RR would have been made in 99.2% and 92.0% of cases respectively. The CPC12S system showed high accuracy for measurements of HR. The accuracy of RR, SpO2 were slightly overestimated and core temperature underestimated, with LoA outside the predefined clinical acceptable range. The accuracy of BP was unacceptably low.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657341","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":"Comparison of supramaximal currents obtained by acceleromyography and electromyography for monitoring the adductor pollicis muscle in pediatric patients.","authors":"Hajime Iwasaki, Kenichi Takahoko, Chihiro Yamagata, Yudai Nambu, Ayaka Suzuki, Yui Takada, Sarah Kyuragi Luthe, Hiroshi Makino","doi":"10.1007/s10877-025-01286-y","DOIUrl":"https://doi.org/10.1007/s10877-025-01286-y","url":null,"abstract":"<p><p>The aim of this study was to compare the supramaximal currents obtained simultaneously by acceleromyography (AMG) TOF-Watch^® SX and electromyography (EMG) AF-201P in pediatric patients. Patients aged 2-11 years who underwent elective surgery under general anesthesia were enrolled. AMG and EMG monitors were placed on opposite arms of the patient to stimulate the ulnar nerve and monitor the adductor pollicis muscles following the induction of general anesthesia. After the monitors were calibrated, rocuronium 0.6 mg/kg was administered. Endotracheal intubation was performed when the EMG showed a train-of-four (TOF) count of 0. The primary outcome was the supramaximal current set by each device's calibration. The secondary outcomes were the time from the administration of rocuronium to a TOF count of 0, the baseline and final TOF ratios, and the conditions surrounding intubation. The paired t test and the Wilcoxon signed-rank test were used to analyze parametric and nonparametric data. A P value < 0.05 indicated statistical significance. Clinical data from 25 pediatric patients were analyzed. The supramaximal current was significantly lower with EMG than with AMG (27.4 ± 6.1 vs. 54.2 ± 8.4 mA, p <.001). The time to a TOF count of 0 was significantly shorter with EMG than with AMG (58 [24-170] vs. 75 [26-236] seconds, p <.001). Both the baseline and final TOF ratios were significantly lower with EMG than with AMG. The ease of laryngoscopy was rated as excellent for all patients. The vocal cords were abducted in 76% of patients, and no movement to insertion of the endotracheal tube was confirmed in 96% of patients. We found that the supramaximal current was significantly lower with EMG than with AMG.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630588","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":"NIRS monitoring missing brain death in an ECMO patient.","authors":"Nawfel Ben-Hamouda, Zied Ltaief, Matthias Kirsch, Jean-Daniel Chiche, Andrea O Rossetti","doi":"10.1007/s10877-025-01280-4","DOIUrl":"https://doi.org/10.1007/s10877-025-01280-4","url":null,"abstract":"","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630590","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":"Continuous measurement of carotid-femoral pulse wave velocity (PWV_cf.) during general anaesthesia using Doppler: a preliminary study.","authors":"Théophile Harlé, Jona Joachim, Pierre Boutouyrie, Joaquim Mateo, Jade Perdereau, Alexandre Mebazaa, Jérome Cartailler, Fabrice Vallée","doi":"10.1007/s10877-024-01256-w","DOIUrl":"https://doi.org/10.1007/s10877-024-01256-w","url":null,"abstract":"<p><p>This study explores the feasibility of continuous pulse wave velocity (PWV) monitoring during general anaesthesia (GA), particularly in response to blood pressure fluctuations. Our aim is to evaluate whether dynamic PWV can provide new insight to detect cardiovascular risks. From December 2022 to February 2023, continuous carotid and femoral Doppler monitoring was performed on patients scheduled for surgery with GA, to collect PWV data at awakening (PWV_AW) and during GA (PWV_GA). The study investigated PWV's response to MAP fluctuations using the α-angle, a dynamic stiffness parameter. We evaluated PWV and α-angle efficacy in discriminating between low (CVR-) and high (CVR+) cardiovascular risk patients. Among 43 patients, 41 (95%) had successful PWV measurements. PWV_AW was significantly higher than PWV_GA (8.1 vs. 7.4 m.s^-1, p < 0.0001). This difference vanished after matching MAP levels. A strong correlation was found between PWV_AW and PWV_GA (r = 0.88, and r = 0.97 at the same MAP levels). PWV_GA, α-angle and their product (α x PWV_GA) were significantly higher in CVR + patients (8.1 vs. 6.9 m.s^-1, p < 0.01; 2.6 vs. 1.3 degrees, p < 0.001; 21.8 vs. 8.1 degrees.m.s^-1, p < 0.001, respectively), with AUC values indicating good predictive capabilities for cardiovascular risk (PWV_GA: AUC [95%CI] = 0.80 [0.65-0.95]; α-angle: 0.83 [0.69-0.96]; product: 0.86 [0.74-0.97]). Measurement of PWV under GA using carotid and femoral Doppler is a feasible method to continuously assess arterial stiffness under general anaesthesia. Further studies are required to validate the α-angle parameter in different physiological conditions.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143624909","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":"Editors' note: Comments on alleged editor misconduct in anesthesiology journals.","authors":"Moritz Flick, Francisco A Lobo","doi":"10.1007/s10877-025-01281-3","DOIUrl":"https://doi.org/10.1007/s10877-025-01281-3","url":null,"abstract":"","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572868","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}