Journal of Clinical Monitoring and Computing最新文献

{"title":"Bedside monitoring of the vascular response to norepinephrine in early septic shock: VNERi trajectories and comparison with dynamic clinical measures.","authors":"Yusuf Karancı, Fulya Çiyiltepe, Gizem Akçın, Halil Beggi","doi":"10.1007/s10877-026-01516-x","DOIUrl":"https://doi.org/10.1007/s10877-026-01516-x","url":null,"abstract":"<p><strong>Purpose: </strong>The vascular norepinephrine response index [VNERi = diastolic arterial pressure / (norepinephrine dose × heart rate)] is a bedside index computed from already-monitored signals. It has been studied only at baseline. We described its 48-hour course and tested whether it adds prognostic information beyond dynamic clinical measures.</p><p><strong>Methods: </strong>We studied a single-center prospective cohort of 94 adults with septic shock started on first-line norepinephrine. VNERi was computed at hours T0-T48. Course parameters (mean level, minimum, slope) were compared for 28-day mortality against the change in Sequential Organ Failure Assessment (SOFA) score (ΔSOFA) and lactate clearance, using the area under the receiver operating characteristic curve (AUC) with the DeLong test, nested logistic regression, and time-dependent Cox regression adjusted for time-varying SOFA(t) and lactate(t). Phenotypes came from a latent class mixed model.</p><p><strong>Results: </strong>Mortality was 32% (30/94). Baseline VNERi did not separate outcomes (AUC 0.59; most had a preserved response). The course parameters did (mean-level AUC 0.73) but did not outperform ΔSOFA (AUC 0.84, window-matched DeLong p = 0.02). Added to a dynamic clinical model, VNERi gave a small gain (integrated discrimination improvement 0.05-0.06, likelihood-ratio p ≈ 0.02). In time-dependent Cox, a higher VNERi(t) was linked to survival (hazard ratio 0.48) but weakened to non-significance after adjusting for SOFA(t) (0.68, p = 0.08). Three exploratory course phenotypes separated survival (log-rank p = 0.002).</p><p><strong>Conclusion: </strong>Serial bedside VNERi monitoring is feasible and carries a partly independent signal that adds a small amount to dynamic clinical severity without outperforming it. These findings are hypothesis-generating and need validation in a hyporesponsive population.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149149019","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":"Accuracy of minimally invasive hemoglobin monitoring in the perioperative period: transcutaneous hemoglobin monitoring and point-of-care testing devices: prospective observational study.","authors":"Shotaro Sakimura, Kaiki Oya, Yuka Sakaguchi, Ken Yamaura","doi":"10.1007/s10877-026-01510-3","DOIUrl":"https://doi.org/10.1007/s10877-026-01510-3","url":null,"abstract":"<p><p>To evaluate the perioperative performance of two minimally/non-invasive hemoglobin monitoring modalities-continuous pulse hemoglobin (SpHb) (Revision O: rev. O) and intermittent point-of-care testing (POCT) using HemoCue® Hb801-against an automated hematology analyzer as the reference standard. Fifty patients undergoing general anesthesia with invasive arterial monitoring for surgery with anticipated blood loss were enrolled prospectively. A total of 281 arterial blood samples were analyzed by an automated hematology analyzer (reference standard), a blood gas analyzer, and HemoCue® Hb801; all comparisons, including HemoCue®, used arterial rather than capillary blood. SpHb (rev. O) was monitored continuously. Correlation and Bland-Altman analyses were performed, and polar plot analysis of changes between successive sampling points assessed SpHb trend-tracking. HemoCue® Hb801 agreed closely with the reference (r = 0.979; bias 0.119 g/dL; limits of agreement [LOA] -0.687 to +0.925 g/dL). SpHb correlated with the reference (r = 0.777) but showed wide LOA (- 2.114 to +2.811 g/dL), proportional bias, and greater random error at perfusion index <1.4 (87/281 measurements, 31.0%). In polar plot analysis of 23 successive-change pairs from 9 patients, angular bias was - 5.8° (95% CI -12.2° to +0.5°) and four-quadrant concordance 100%, but radial limits of agreement (- 36.3° to +24.6°) exceeded the ±30° criterion. HemoCue® Hb801 provided accurate Hb measurement from a minimal arterial sample. SpHb (rev. O) had limited absolute accuracy and could not quantify the magnitude of change within accepted limits, but reliably indicated its direction. A hybrid approach-continuous SpHb monitoring triggering confirmatory HemoCue® measurement-may support safer perioperative hemoglobin management.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149136983","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":"Perioperative monitoring in oesophageal atresia and congenital diaphragmatic hernia patients - exploring the impact of diagnosis on neurocardiovascular coupling.","authors":"Sophie de Munck, Eris van Twist, Anne-Fleur R L van Hal, Dries Hendrikx, Sophie A Costerus, Maarten De Vos, John Vlot, René M H Wijnen, Gunnar Naulaers, Rogier C J de Jonge","doi":"10.1007/s10877-026-01502-3","DOIUrl":"https://doi.org/10.1007/s10877-026-01502-3","url":null,"abstract":"<p><p>Neonates undergoing major surgical procedures are at risk for neurodevelopmental impairment. Previous research in patients with congenital diaphragmatic hernia (CDH) showed that signal interaction graphs, which combine data on near-infrared spectroscopy (NIRS), amplitude integrated electroencephalography (aEEG) and clinical monitoring, are a promising way of investigating cerebral physiology. Yet, variability in treatment and disease severity, inherent to CDH, complicated analysis. In contrast, neonates with isolated oesophageal atresia (OA) undergo major surgery but are typically hemodynamically stable and pathophysiologically homogeneous. We aimed to evaluate and compare the effects of anaesthesia and surgery on perioperative cerebral physiology in patients with OA and CDH. For this observational cohort study, we included neonates with CDH or OA who underwent surgical treatment between 2018 and 2022. Exclusion criteria were major cardiac or chromosomal anomalies and syndromes associated with major neurodevelopmental impairment. Patients underwent NIRS and aEEG monitoring alongside standard perioperative monitoring. Signal interaction graphs and connectivity measures (neurovascular coupling, the coupling between neuronal activity and cerebral blood flow (NVC), cerebral autoregulation, baroreflex and heart rate passivity) were computed using an established data pipeline. Significantly stronger NVC intraoperatively was found in CDH patients compared to OA patients. A higher median dosage sevoflurane was associated with weaker NVC. Surgical technique (open versus minimally invasive) did not affect any of the connectivity measures. Except for NVC, perioperative connectivity measures do not differ between patients with CDH and OA. Future research should validate these integrative monitoring models in healthy populations and connect them to long-term outcomes, to support development of an interpretable bedside tool for risk stratification and personalized interventions.Trial registration: NL-OMON49066, URL: https://onderzoekmetmensen.nl/en/trial/49066 .</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137000","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":"Performance validation of a new finger-root-adapted ring-shaped oximeter sensor during stepwise steady-state inspired hypoxia.","authors":"Yihan Zhang, Lan Gao, Wenxiu Zhu, Weiqiang Chen, Yue Liu, Huixin Chen, Yanling Wang, Yalan Li, Fei Huang, Jieke Tang, Shangrong Li","doi":"10.1007/s10877-026-01500-5","DOIUrl":"https://doi.org/10.1007/s10877-026-01500-5","url":null,"abstract":"<p><p>Peripheral pulse oxygen saturation (SpO₂) is a widely applied substitute parameter to arterial oxygen saturation (SaO₂). Optimized morphological design and geometrical arrangement of the light-source and photodetector without compromising their precision, can maximize the clinical utility of the SpO₂ sensors. We analyzed data of 36 participants collected from two multicenter trials that examined the performances of 3 transmittance oximeter sensors. A finger-root-adapted ring-shaped sensor with light-source and detector located on the sides of the finger, was compared with 2 fingertip-adapted designs (finger-clip and finger-case), whose light-sources and detectors were located on the antero-posterior axis of the finger. A stepwise steady-state inspired hypoxia protocol according to ISO 80,601 2-61: 2017 were adopted to examine the SpO₂ measurements of all the sensors obtained at 5 different SaO₂ levels (100%-97%, 92% - 96%, 85% ~ 91%, 78% ~ 84%, 70% ~ 77) under either quiescent or motion condition as well as in darkly or lightly pigmented populations. Under each tested condition, all the sensors presented an accuracy root mean square (Arms) within 2%. Bland-Altman analysis of all the sensors demonstrated narrow limits of agreement. Paired SaO₂ and SpO₂ values were fitted to linear regression lines and yielded high coefficients of determination (R² > 0.97) for all sensors, indicating excellent distribution matches. The finger-ring sensor was rated by the participants to offer higher finger-movement flexibility, attachment stability and more comfortable experiences to users. The finger-root-adapted ring-shaped oximetry sensor demonstrated high precision and is more user-friendly for SpO₂ monitoring.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127553","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":"Correction: First-pass success in video laryngoscopy with transcutaneous infrared illumination in patients with normal airways-a clinical pilot study.","authors":"Abdulrahman Dardeer, Muhammad Firas Alhammad, Khaled J Zaza, Anas N Shallik, Yasser Ali Hammad, El-Sayed Mohamed Elkarta, Nabil A Shallik","doi":"10.1007/s10877-026-01495-z","DOIUrl":"https://doi.org/10.1007/s10877-026-01495-z","url":null,"abstract":"","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110346","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":"Closed-loop vasopressor systems: surrogate benefit, heterogeneous targets, and uncertain generalisability.","authors":"Tuhin Mistry, Abhijit Sukumaran Nair","doi":"10.1007/s10877-026-01512-1","DOIUrl":"https://doi.org/10.1007/s10877-026-01512-1","url":null,"abstract":"","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110316","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":"Preoperative pulse rate variability and the hemodynamic response to tracheal intubation: a retrospective secondary analysis.","authors":"Gayeon Ryu, Jae Moon Choi, Byung-Moon Choi, Hangsik Shin","doi":"10.1007/s10877-026-01506-z","DOIUrl":"https://doi.org/10.1007/s10877-026-01506-z","url":null,"abstract":"<p><p>Individual hemodynamic responses to tracheal intubation vary considerably. We examined whether preoperative pulse rate variability (PRV), a photoplethysmography-derived surrogate of heart rate variability, is associated with this response. In this retrospective secondary analysis, 183 adults undergoing elective surgery under general anesthesia were analyzed. A 3-min photoplethysmogram was recorded in the supine, resting, unsedated state immediately before induction, and time-domain (mean pulse-to-pulse interval [mean PPI], RMSSD, and pNN50) and frequency-domain (LF power, HF power, and LF/HF) PRV indices were computed. A hemodynamic response was defined as a systolic blood pressure rise >15 mmHg, or a heart rate rise to >90 beats/min or by >30% (≥ 10% if baseline ≥90 beats/min); patients were classified as response-present or response-absent. Of 183 patients, 101 (55.2%) were response-present and 82 (44.8%) response-absent. LF/HF was higher in the response-present group (1.84 [1.32-2.60] vs 1.37 [0.78-2.44]; unadjusted P = 0.018), but no index remained significant after correction for multiple comparisons (LF/HF adjusted P = 0.109; all others adjusted P ≥ 0.301). Discrimination was limited (AUC 0.602; 95% CI 0.518-0.684). In a sensitivity analysis using a blood-pressure-only response definition, no PRV index differed significantly. After correction for multiple comparisons, no preoperative PRV index differed significantly between patients with and without a hemodynamic response to tracheal intubation. LF/HF was higher in the response-present group before correction, but the effect size was small and the discriminative performance limited. These findings do not support preoperative PRV for identifying patients at risk and are hypothesis-generating only. Trial Registration number: KCT0005840.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110351","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":"Beyond processed depth targets: frontal EEG patterns, brain vulnerability, and postoperative delirium in older adults.","authors":"Vikas Chauhan","doi":"10.1007/s10877-026-01507-y","DOIUrl":"https://doi.org/10.1007/s10877-026-01507-y","url":null,"abstract":"<p><p>Limited-channel frontal electroencephalography is widely used during anesthesia through processed EEG platforms, but clinical interpretation often remains centered on numerical depth indices. This narrative review examines whether frontal EEG signals, including raw waveforms, suppression behavior, spectral features, and processed index behavior, may provide information beyond hypnotic depth in older adults at risk for postoperative delirium. A targeted literature search was performed in PubMed/MEDLINE and Google Scholar for articles published from database inception through April 30, 2026. Priority was given to randomized trials, systematic reviews, meta-analyses, consensus statements, prospective observational studies, and mechanistic studies relevant to processed EEG monitoring, frontal EEG interpretation, postoperative delirium, aging, frailty, anesthesia, and critical care. Evidence from randomized trials and systematic reviews suggests that processed EEG-guided anesthetic titration and suppression minimization alone do not reliably prevent postoperative delirium. However, several clinically accessible frontal EEG patterns may provide contextual information about anesthetic sensitivity and reduced cerebral reserve. These include reduced frontal alpha power, early or disproportionate burst suppression, spectral slowing or low spectral edge frequency, and disorganized emergence. Their interpretation depends on anesthetic dose and agent, hemodynamics, signal quality, artifact burden, frailty, baseline cognition, and postoperative recovery context. Limited-channel frontal EEG should be interpreted as a contextual brain-monitoring signal rather than a single-number depth target. Future studies should test whether multimodal frameworks integrating frontal EEG patterns with physiologic and patient-level variables improve postoperative neurocognitive outcomes.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110413","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":"Echocardiography before non-cardiac surgery: current knowledge, guideline recommendations, and clinical evidence - a narrative review.","authors":"Viktoria Mertin, Alexandra Stroda, Tobias Bruns, Giovanna Lurati Buse","doi":"10.1007/s10877-026-01457-5","DOIUrl":"10.1007/s10877-026-01457-5","url":null,"abstract":"<p><p>This narrative review provides an overview of the evidence on transthoracic echocardiography (TTE) at rest in patients undergoing non-cardiac surgery with regard to detection of new diagnoses, TTE-driven management changes, and outcome impact of preoperative TTE. It summarizes the evidence on preoperative TTE and reviews the current recommendations by professional societies from both Europe and Northern America. TTE is a very important non-invasive diagnostic tool to obtain information on cardiac function before surgery. While studies on the effectiveness of preoperative TTE are limited, there is evidence that TTE before non-cardiac surgeries can detect new diagnoses in a relevant proportion of patients. Also, data on changes in management based on TTE findings is scarce. Both the American Heart Association and the American College of Cardiologists and the European Society of Cardiology have recently published updated recommendations regarding the use of TTE before non-cardiac surgery. While both societies are in favour of TTE in symptomatic patients and do not recommend TTE to be performed routinely, several differences remain. Information on outcome benefits in patients having received TTE prior to surgery is not conclusive. In this review we could detect several knowledge gaps concerning the yield and impact on management and outcome of preoperative TTE in non-cardiac surgery patients.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":"1057-1063"},"PeriodicalIF":2.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13562307/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148271773","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":"Safety and efficacy of distal versus conventional radial artery cannulation for invasive blood pressure monitoring: a systematic review and meta-analysis.","authors":"Tian Hao, Yuhan Sha, Wenxiu Niu, Haohao Xie, Jie Cheng, Lin Zhang, Ruirui Qi, Xiaomeng Han, Fei Zheng, Tingwei Wang, Ruofan Zhang, Jie Li, Kejing Mu, Zhan Hao, Zhigang Zhang","doi":"10.1007/s10877-026-01451-x","DOIUrl":"10.1007/s10877-026-01451-x","url":null,"abstract":"<p><p>To compare the safety and effectiveness of distal radial artery (DRA) versus conventional radial artery (CRA) catheterization for invasive arterial blood pressure monitoring. This meta-analysis followed PRISMA guidelines. Randomized controlled trials published up to December 30, 2025 were systematically searched in PubMed, Embase, Web of Science, the Cochrane Library, CINAHL, CNKI, Wanfang, VIP, and SinoMed. Two reviewers independently screened studies, extracted data, and assessed risk of bias. Meta-analyses were conducted using Review Manager 5.4 and Stata 18.0, and evidence quality was evaluated with the GRADE system. 12 randomized controlled trials (RCTs) involving 1,790 participants were included. For the primary outcomes, compared with CRA, DRA was associated with lower incidences of haematoma (RR = 0.42, 95% CI: 0.24-0.73), catheter blockage (RR = 0.33, 95% CI: 0.14-0.81), and bleeding (RR = 0.25, 95% CI: 0.11-0.59), but a longer catheter insertion time (MD = 26.89, 95% CI: 5.28-48.50). For the secondary outcomes, DRA was associated with a shorter haemostasis time and reduced waveform instability, with no significant differences in first-attempt success rate or pain scores. Subgroup analysis showed a higher first-attempt success rate in patients aged ≤ 65 years (RR = 1.14, 95% CI: 1.02-1.28). DRA catheterization for invasive arterial blood pressure monitoring appears to be associated with fewer complications and more stable arterial waveform acquisition than CRA catheterization, despite a longer insertion time. DRA may represent a feasible alternative in surgical and intensive care settings; however, further high-quality studies are needed to confirm its long-term safety and generalizability.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":"1045-1056"},"PeriodicalIF":2.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13562207/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148338636","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}