Journal of Clinical Monitoring and Computing最新文献

{"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}

{"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":"https://doi.org/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":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-06","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":"Comment on \"Forecasting intraoperative hypotension during hepatobiliary surgery\".","authors":"Jiajing Wang","doi":"10.1007/s10877-025-01275-1","DOIUrl":"https://doi.org/10.1007/s10877-025-01275-1","url":null,"abstract":"","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572865","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":"Postoperative use of fitness trackers for continuous monitoring of vital signs: a survey of hospitalized patients.","authors":"Philipp Helmer, Sebastian Hottenrott, Kathrin Wienböker, Jürgen Brugger, Christian Stoppe, Benedikt Schmid, Peter Kranke, Patrick Meybohm, Michael Sammeth","doi":"10.1007/s10877-025-01273-3","DOIUrl":"https://doi.org/10.1007/s10877-025-01273-3","url":null,"abstract":"<p><p>Wearables and Internet of Things (IoT) technologies are increasingly incorporated into healthcare, including perioperative settings. These devices offer continuous non-invasive monitoring of vital signs, patient position, and mobilization. Nonetheless, there is currently little information about tolerance and acceptance of wearables in postoperative patients. We therefore assessed opinions and user experience in postoperative patients who used three popular fitness trackers during their entire hospital stay. Specifically, we evaluate the Apple Watch 7, Garmin Fenix 6 Pro, and Withings ScanWatch. We used an investigator-designed patient questionnaire with 11 questions to quantify patient experience and opinions regarding inpatient and home monitoring. Secondarily, we evaluated compliance and the incidence of associated adverse events during daily patient visits. Data were analyzed using descriptive statistics and non-parametric tests. The majority of the answers to the questions (82.1%) were rated positively defined as Likert-Scale Scores 4 or 5 by the 33 analyzed patients, ranging between 72.7 and 97.0% agreement rate. Specific questions related to data sharing for research and overall user experience received high agreement rates (97.0 and 84.8%, respectively). Women reported slightly higher satisfaction with device comfort, as compared to men (LS-Score 4.8 vs. 4.0). No significant differences were found based on the device model or length of hospitalization. The use of wearable devices in healthcare is rated positively by postoperative inpatients, paving the way for future implementation of these devices in healthcare. However, besides validating the measurement accuracy and demonstrating clinical benefits, several regulatory hurdles must be overcome before implementing wearables in routine clinical care.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572915","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":"https://doi.org/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":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-06","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":"Influence of HeartMate 3™ on Bispectral Index™ monitor: a retrospective observational study.","authors":"Seiichi Azuma, Masaaki Asamoto, Shinichi Akabane, Mariko Ezaka, Mikiya Otsuji, Kanji Uchida","doi":"10.1007/s10877-025-01272-4","DOIUrl":"https://doi.org/10.1007/s10877-025-01272-4","url":null,"abstract":"<p><p>Electroencephalogram-derived monitors are affected by various artifacts. HeartMate 3™ operates at frequency bands that overlap with those used for calculating the electromyographic index (EMG) and bispectral index (BIS) on the Bispectral Index™ monitor. This study investigated whether HeartMate 3 elevates these values, a change not predicted with HeartMate II™. This retrospective observational study included data from patients who underwent HeartMate 3 or II implantation between April 2008 and December 2023 as extracted from our institutional database. Patient-wise median EMG and BIS were compared between the pre-LVAD period (from the start of surgery to initiation of cardiopulmonary bypass) and the post-LVAD period (from the end of cardiopulmonary bypass to end of surgery). Data were obtained from 33 and 43 patients who underwent HeartMate 3 and HeartMate II implantation, respectively. Patients with HeartMate 3 implantation showed significant elevation in the EMG (pre-LVAD, mean ± standard deviation, 26.1 ± 1.0 dB; post-LVAD, 39.5 ± 2.8 dB; P < 0.001) without a significant change in the BIS (pre-LVAD, 44.5 ± 8.1; post-LVAD, 45.5 ± 7.1; P = 0.35). In contrast, patients with HeartMate II implantation did not show significant changes in either the EMG (pre-LVAD, 26.1 ± 1.2 dB; post-LVAD, 27.1 ± 4.1 dB; P = 0.16) or BIS (pre-LVAD, 45.1 ± 9.2; post-LVAD, 43.0 ± 8.1; P = 0.071). HeartMate 3 significantly elevates EMG. Anesthesiologists should be aware of this to appropriately interpret EMG elevation in patients with HeartMate 3.Trial registration: Japan Registry for Clinical Trials identifier: jRCT1030230549 (date of registration: January 10, 2024.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572870","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":"Electrical impedance tomography for PEEP titration in ARDS patients: a systematic review and meta-analysis.","authors":"Carlos Sanchez-Piedra, Begoña Rodríguez-Ortiz-de-Salazar, Oriol Roca, Francisco-Javier Prado-Galbarro, Lilisbeth Perestelo-Perez, Luis-Maria Sanchez-Gomez","doi":"10.1007/s10877-025-01266-2","DOIUrl":"https://doi.org/10.1007/s10877-025-01266-2","url":null,"abstract":"<p><p>To assess the efficacy of electrical impedance tomography (EIT)-guided positive end-expiratory pressure (PEEP) titration in improving outcomes for patients with acute respiratory distress syndrome (ARDS). A systematic review and meta-analysis was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Randomized controlled trials and observational studies with a control group comparing EIT-guided PEEP titration to other strategies were included. Endpoints analysed included mortality, days of mechanical ventilation (MV), intensive care unit (ICU) length of stay (LOS), weaning success rate, barotrauma, driving pressure (∆P), mechanical power (MP), Sequential Organ Failure Assessment (SOFA) score and adverse events. Pooled results were presented as Risk Ratio (RR) for dichotomous outcomes and standardized difference in means (SMD) for continuous outcomes. A total of 4 studies were identified (3 randomized controlled trials and one observational study). All studies were single-center studies (N total = 271 patients). The main limitations were related to potential bias in selecting reported outcomes. EIT-guided PEEP titration was associated with a significant reduction in mortality among critically ill patients with ARDS (RR = 0.64, 95% CI: 0.45-0.91). No significant differences were found in other outcomes. Our findings suggest that EIT may be a valuable tool for PEEP titration in critically ill patients with ARDS. By optimizing lung mechanics, EIT-guided PEEP titration may potentially reduce mortality rates. While larger, multicenter studies are needed to definitively establish the clinical role of EIT in ARDS management, our results provide promising evidence for its potential clinical impact.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143515831","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":"https://doi.org/10.1007/s10877-025-01267-1","url":null,"abstract":"","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-02-26","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":"Predicting intraoperative hypoxemia in lung resection surgery: assessing the utility of oxygen reserve index measurements during one-lung ventilation before pleural opening.","authors":"Sang-Wook Lee, Ji-Yoon Kim, Dae-Kee Choi","doi":"10.1007/s10877-025-01278-y","DOIUrl":"https://doi.org/10.1007/s10877-025-01278-y","url":null,"abstract":"<p><p>One-lung ventilation (OLV) is crucial for collapsing the lung and improving access to the operative field during lung surgery. Intraoperative OLV may increase the intrapulmonary shunt, potentially leading to intraoperative hypoxemia. The Oxygen Reserve Index (ORI) is a continuous, noninvasive parameter that provides a broader range of oxygen reserve data than conventional oxygen saturation measurements. We aimed to determine whether ORI values measured during OLV before pleural opening are reliable predictors of intraoperative hypoxemia. We included 113 adult patients who underwent lung resection surgery at a tertiary medical center between January 2024 and April 2024. Patients were positioned laterally for surgery, and preemptive OLV was performed with a tidal volume of 5 mL/kg and a fraction of inspired oxygen (FiO₂) of 60% for at least 5 min before pleural opening, with concurrent ORI measurements. ORI values obtained during this period were analyzed using ROC curve analysis to predict intraoperative hypoxemia (SaO₂ ≤ 90%). AUC values were compared using DeLong's test. Among the 113 patients, 13 (11.5%) developed intraoperative hypoxemia. The predictive power of ORI measured 5 min after initiating OLV for intraoperative hypoxemia was reflected by an AUC of 0.955 (95% CI: 0.899-1.000). Additionally, the predictive power of the change in ORI over 5 min for intraoperative hypoxemia was demonstrated by an AUC of 0.966 (95% CI: 0.935-0.997). The optimal cut-off values for the ORI and its change measured 5 min after preemptive OLV to predict intraoperative hypoxemia were 0.040 and 0.110, respectively. In patients receiving OLV during lung surgery, ORI values and their changes measured during preemptive OLV before pleural opening can predict intraoperative hypoxemia. These findings support an individualized approach to intraoperative FiO₂ management, which may help prevent unnecessary oxygen overdose and enable early identification and intervention in patients at high risk of hypoxemia during OLV.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143515834","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}