Journal of Clinical Monitoring and Computing最新文献

{"title":"Clot formation risk in the clearing fluid after arterial catheter blood sampling: coagulation factors consumption over time - a prospective pilot study.","authors":"Jerome E Dauvergne, Elodie Boissier, Bertrand Rozec, Karim Lakhal, Damien Muller","doi":"10.1007/s10877-024-01252-0","DOIUrl":"10.1007/s10877-024-01252-0","url":null,"abstract":"<p><p>After blood sampling from an arterial catheter, the reinjection of the clearing fluid (a mixture of saline solution and blood) is proposed to limit blood loss. However, reinjecting clots may cause embolic complications. The primary objective was to assess fibrinogen consumption in the clearing fluid as an indicator of clot formation over time. Additionally, we searched for macroscopic clots, evaluated changes in prothrombin time, factors II and V. In this prospective observational pilot study, we enrolled adult patients in an intensive care unit with a radial artery catheter who required measurements of hemostasis parameters. We used a locally developed closed blood sampling system. Hemostasis parameters were measured in patients' pure blood (reference) and in the clearing fluid, at 2, 3, and 5 min after the complete filling of the reservoir. Thirty patients were included and 120 samples were analyzed. Fibrinogen levels decreased over time: median [interquartile range (IQR)] of 4.3 [IQR:3.1;5.9] as reference level, 3.6 [IQR:2.7;4.7] at 2 min (p < 0.001), 3.4 [IQR:2.1;4.3] at 3 min (p < 0.001) and 3.0 [IQR:1.7;4.1] g/L at 5 min (p < 0.001). No clot was macroscopically detected in any samples. An antiplatelet agent was administered in 11 (37%) patients. Unfractionated heparin anti-Xa activity was higher than 0.10 UI/ml in 17 (57%). Although no macroscopic clots were observed in the clearing fluid, its coagulation factors decreased over the 5 min following reservoir filling, indicating potential initiation of clot formation. Our findings stress the need for further studies assessing the safety of reinjecting clearing fluid as part of patient blood management.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":"607-612"},"PeriodicalIF":2.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813150","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":"Comment on \"Effect of postoperative peripheral nerve blocks on the analgesia nociception index under propofol anesthesia: an observational study.\"","authors":"Nobuhiro Tanaka, Mitsuru Ida, Masahiko Kawaguchi","doi":"10.1007/s10877-025-01268-0","DOIUrl":"10.1007/s10877-025-01268-0","url":null,"abstract":"<p><p>Kumagai et al. provided valuable insights into the effects of postoperative peripheral nerve blocks (PNB) on the high-frequency variability index (HFVI), a surrogate for nociception monitoring. However, the analysis excluded the impact of different brachial plexus block techniques, particularly the interscalene brachial plexus block (ISB), and role of laterality in HFVI variability. ISB produces a stellate ganglion block-like effect through local anesthetic diffusion, influencing autonomic function and heart rate variability, independent of nociceptive modulation. Provided that this study included various brachial plexus block approaches, stratifying HFVI changes according to technique and laterality could enhance their clinical relevance. Right-sided ISB may have a more pronounced autonomic effect than left-sided ISB. Further research is needed to clarify these effects and optimize the interpretation of HFVI during perioperative monitoring.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":"651-652"},"PeriodicalIF":2.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441099","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":"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":"625-630"},"PeriodicalIF":2.0,"publicationDate":"2025-06-01","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":"Comparison of time-series models for predicting physiological metrics under sedation.","authors":"Zheyan Tu, Sean D Jeffries, Joshua Morse, Thomas M Hemmerling","doi":"10.1007/s10877-024-01237-z","DOIUrl":"10.1007/s10877-024-01237-z","url":null,"abstract":"<p><p>This study presents a comprehensive comparison of multiple time-series models applied to physiological metric predictions. It aims to explore the effectiveness of both statistical prediction models and pharmacokinetic-pharmacodynamic prediction model and modern deep learning approaches. Specifically, the study focuses on predicting the bispectral index (BIS), a vital metric in anesthesia used to assess the depth of sedation during surgery, using datasets collected from real-life surgeries. The goal is to evaluate and compare model performance considering both univariate and multivariate schemes. Accurate BIS prediction is essential for avoiding under- or over-sedation, which can lead to adverse outcomes. The study investigates a range of models: The traditional mathematical models include the pharmacokinetic-pharmacodynamic model and statistical models such as autoregressive integrated moving average (ARIMA) and vector autoregression (VAR). The deep learning models encompass recurrent neural networks (RNNs), specifically Long Short-Term Memory (LSTM) and Gated Recurrent Units (GRU), as well as Temporal Convolutional Networks (TCNs) and Transformer models. The analysis focuses on evaluating model performance in predicting the BIS using two distinct datasets of physiological metrics collected from actual surgical procedures. It explores both univariate and multivariate prediction schemes and investigates how different combinations of features and input sequence lengths impact model accuracy. The experimental findings reveal significant performance differences among the models: In univariate prediction scenarios for predicting BIS, the LSTM model demonstrates a 2.88% improvement over the second-best performing model. For multivariate predictions, the LSTM model outperforms others by 6.67% compared to the next best model. Furthermore, the addition of Electromyography (EMG) and Mean Arterial Pressure (MAP) brings significant accuracy improvement when predicting BIS. The study emphasizes the importance of selecting and building appropriate time-series models to achieve accurate predictions in biomedical applications. This research provides insights to guide future efforts in improving vital sign prediction methodologies for clinical and research purposes. Clinically, with improvements in the prediction of physiological parameters, clinicians can be informed of interventions if an anomaly is detected or predicted.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":"595-605"},"PeriodicalIF":2.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545767","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":"Safe automation of interfering medical treatments via control barrier functions and reachability analysis: a fluid resuscitation-sedation-vasopressor infusion case study.","authors":"Weidi Yin, Hosam K Fathy, Jin-Oh Hahn","doi":"10.1007/s10877-025-01270-6","DOIUrl":"10.1007/s10877-025-01270-6","url":null,"abstract":"<p><p>Despite advances made toward the automation of medical treatments, existing work has predominantly focused on the automation of individual medical treatments while overlooking interferences between them. In our prior work, we developed an automation architecture to administer interfering medical treatments with safety, which (i) monitors internal physiological state of a patient using an extended Kalman filter, (ii) mediates medical treatments to bound the estimated internal state within a prescribed safe regime based on control barrier functions, and (iii) treats the patient to a prespecified treatment target through a number of intermediate targets derived from reachability analysis. The goal of this work was to investigate the scalability of this automation architecture in more complex and challenging medical treatment scenarios with a number of conflicts. Using a critical care resuscitation scenario including fluid resuscitation and intravenous sedative-vasopressor infusion, we examined if our automation architecture can achieve treatment goals while ascertaining the safety of internal state in a large number of diverse in silico patients. The results suggested that (i) the extended Kalman filter could continuously monitor a patient's internal physiological state, (ii) the control barrier functions could mediate interfering medical treatments and protect patients against unsafe internal physiological state, and (iii) the reachability analysis could treat a patient as closely as possible to a treatment target while ensuring the safety of the patient's internal physiological state, all despite complex and entangled conflicts between them. Our automation architecture may provide a viable means to autonomously de-conflict interfering medical treatments.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":"541-558"},"PeriodicalIF":2.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572971","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":"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":"653-654"},"PeriodicalIF":2.0,"publicationDate":"2025-06-01","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":"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":"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":"581-594"},"PeriodicalIF":2.0,"publicationDate":"2025-06-01","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":"Deep reinforcement learning for multi-targets propofol dosing.","authors":"Zheyan Tu, Sean Jeffries, Eric Pelletier, Oliver Cafferty, Joshua Morse, Avinash Sinha, Thomas Hemmerling","doi":"10.1007/s10877-025-01269-z","DOIUrl":"10.1007/s10877-025-01269-z","url":null,"abstract":"<p><p>The administration of propofol for sedation or general anesthesia presents challenges due to the complex relationship between patient factors and real-time physiological responses. This study explores the application of deep reinforcement learning (DRL) to automate propofol dosing, aiming to maintain multiple physiological parameters including bispectral index (BIS), heart rate (HR), respiratory rate (RR), and mean arterial pressure (MAP) within safe and desired ranges. A multi-variable pharmacokinetic-pharmacodynamic (PK/PD) simulation environment was developed to model the effects of propofol on the physiological parameters. An adjustable reward system was designed for multi-target anesthetic infusion. The DRL agent was trained using Twin Delayed Deep Deterministic Policy Gradient (TD3), interacting with the simulation environment and receiving rewards for maintaining physiological parameters close to their targets and above safety thresholds. The performance of the TD3 agent was compared to other DRL algorithms and traditional control methods. The TD3 algorithm demonstrated superior performance in achieving precise and safe control of multiple physiological parameters during propofol administration, outperforming other DRL algorithms and traditional control methods. The application of DRL, particularly TD3, offers a promising approach for automating propofol dosing, ensuring better management of physiological parameters and enhancing the safety and effectiveness of sedation and general anesthesia.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":"613-623"},"PeriodicalIF":2.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567234","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":"Effect of rocuronium and sugammadex under stable propofol-remifentanil anesthesia on the (processed) electroencephalogram.","authors":"Linassi Federico, Aydin Duygu, Zanatta Paolo, Schneider Gerhard, Kreuzer Matthias, Carron Michele","doi":"10.1007/s10877-025-01267-1","DOIUrl":"10.1007/s10877-025-01267-1","url":null,"abstract":"","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":"645-649"},"PeriodicalIF":2.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143515827","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":"Assessing fluid responsiveness by using functional hemodynamic tests in critically ill patients: a narrative review and a profile-based clinical guide.","authors":"Antonio Messina, Domenico Luca Grieco, Valeria Alicino, Guia Margherita Matronola, Andrea Brunati, Massimo Antonelli, Michelle S Chew, Maurizio Cecconi","doi":"10.1007/s10877-024-01255-x","DOIUrl":"10.1007/s10877-024-01255-x","url":null,"abstract":"<p><p>Fluids are given with the purpose of increasing cardiac output (CO), but approximately only 50% of critically ill patients are fluid responders. Since the effect of a fluid bolus is time-sensitive, it diminuish within few hours, following the initial fluid resuscitation. Several functional hemodynamic tests (FHTs), consisting of maneuvers affecting heart-lung interactions, have been conceived to discriminate fluid responders from non-responders. Three main variables affect the reliability of FHTs in predicting fluid responsiveness: (1) tidal volume; (2) spontaneous breathing activity; (3) cardiac arrythmias. Most FTHs have been validated in sedated or even paralyzed ICU patients, since, historically, controlled mechanical ventilation with high tidal volumes was the preferred mode of ventilatory support. The transition to contemporary methods of invasive mechanical ventilation with spontaneous breathing activity impacts heart-lung interactions by modifying intrathoracic pressure, tidal volumes and transvascular pressure in lung capillaries. These alterations and the heterogeneity in respiratory mechanics (that is present both in healthy and injured lungs) subsequently influence venous return and cardiac output. Cardiac arrythmias are frequently present in critically ill patients, especially atrial fibrillation, and intuitively impact on FHTs. This is due to the random CO fluctuations. Finally, the presence of continuous CO monitoring in ICU patients is not standard and the assessment of fluid responsiveness with surrogate methods is clinically useful, but also challenging. In this review we provide an algorithm for the use of FHTs in different subgroups of ICU patients, according to ventilatory setting, cardiac rhythm and the availability of continuous hemodynamic monitoring.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":"481-493"},"PeriodicalIF":2.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005795","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}