Journal of Clinical Monitoring and Computing最新文献

{"title":"Vital signs during complication-free recovery after major surgery: a retrospective analysis.","authors":"Casper H Guldager, Jesper Mølgaard, Helle K Hansen, Christian S Meyhoff, Eske K Aasvang","doi":"10.1007/s10877-026-01471-7","DOIUrl":"10.1007/s10877-026-01471-7","url":null,"abstract":"<p><p>Continuous vital sign monitoring (CVSM) is superior to intermittent manual vital sign assessment in detecting deviations, but alert thresholds have limited evidence, as a strong definition of physiologically normal variations are lacking. Consequences of too few alerts are missed detections of oncoming complications, and too many alerts result in over-alerting and over-treatment. This study aimed to describe duration and deviation of vital signs in postoperative patients without complications when monitored continuously. Adult patients admitted to the general ward after major surgery were included. Continuous wireless vital sign monitoring (CVSM) was performed during the early postoperative period, with data collection blinded to ward nurses. For peripheral oxygen saturation (SpO₂), systolic blood pressure, heart rate, and respiratory rate, the longest consecutive durations outside predefined thresholds were identified. The primary outcome was the longest consecutive duration of SpO₂ < 88%. A total of 600 patients were analyzed and of these, 277 patients had no complications of any kind. The longest sustained episodes with SpO₂ < 88% were median 9 min [IQR 2-31 min]. The maximum length of other vital sign sustained deviations had the following median duration in minutes: SpO₂ < 92%: 58[6 -129], HR > 110/min: 3 [0-13], HR < 50/min: 0 [0-1], RF > 24/min: 1 [0-4] and RF < 11/min: 4 [2-12]. Sustained episodes of severe desaturations, tachycardia and tachypnea were short, but moderate desaturations frequent. These findings indicate that vital signs in complication free patients should be carefully analyzed when monitored continuously after major surgery.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":"1147-1154"},"PeriodicalIF":2.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13562176/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148421423","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":"Nociception-guided opioid administration within multimodal analgesia for laparoscopic endometriosis surgery: a randomized controlled trial.","authors":"Hoang-Thi Buis, Joana Berger-Estilita, Sina Zirngast, Paul Ranner, Tihomir Piskor, Isabel Marcolino","doi":"10.1007/s10877-026-01459-3","DOIUrl":"10.1007/s10877-026-01459-3","url":null,"abstract":"<p><p>Women with endometriosis are at increased risk of severe postoperative pain due to nociceptive sensitization. While multimodal analgesia reduces opioid use, the added value of objective nociception monitoring remains unclear. This study evaluated whether NOL®-guided opioid titration improves perioperative outcomes within a standardized multimodal regimen. In this prospective, randomized, single-blinded trial, premenopausal women undergoing laparoscopic surgery for suspected endometriosis or adenomyosis were assigned to NOL®-guided analgesia or standard care based on clinical assessment. All patients received a standardized multimodal protocol. The primary outcome was total perioperative opioid consumption. Secondary outcomes included postoperative pain scores (NRS) and PACU length of stay. Exploratory analyses assessed the association between preoperative pain (Mankoski Pain Scale, MPS) and postoperative outcomes. A total of 111 patients were analyzed (NOL®: n = 54; control: n = 57). Total perioperative opioid consumption did not differ significantly between groups (adjusted mean difference = 14 μg for Fentanyl and 52 μg for Remifentanil; p = 0.8). Surgery duration was an independent predictor of opioid use (p < 0.001) and PACU length of stay (p = 0.01), whereas treatment group had no significant effect. Postoperative pain scores were comparable between groups at all time points. NOL®-derived metrics were not associated with opioid consumption or pain. Higher preoperative MPS scores independently predicted higher pain scores in the late PACU phase. NOL®-guided opioid titration did not reduce perioperative opioid consumption or improve early postoperative outcomes compared with standard multimodal analgesia in women undergoing laparoscopic surgery for endometriosis.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":"1011-1023"},"PeriodicalIF":2.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13562212/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148295191","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":"Continuous imputation of blood gas and metabolic panel laboratory values in the intensive care unit using machine learning.","authors":"Behrooz Mamandipoor, Martin Krause, Pragnya Korti, Chun-Nan Hsu, Rodney A Gabriel","doi":"10.1007/s10877-026-01470-8","DOIUrl":"10.1007/s10877-026-01470-8","url":null,"abstract":"<p><p>We developed machine learning (ML) models to perform continuous hourly prediction of arterial blood gas (ABG) and basic metabolic panel (BMP) laboratory values in critically ill patients. We evaluated its impact on prediction of the need for renal replacement therapy (RRT). We compared the performance of the deep learning models using laboratory variables imputed hourly by our ML estimators versus models using laboratory variables imputed by a previous-value baseline. Our ML model incorporated various predictors, including previous laboratory values, administered medications, clinical events, fluid input/output, hemodynamics, and ventilator settings. Accuracy of laboratory imputations were compared using mean absolute error (MAE) and root mean squared error (RMSE). We trained bi-directional long short-term memory models (Bi-LSTM) to predict need for renal replacement therapy (RRT) that differed only in how laboratory variables were imputed over time. We compared performance using area under the receiver operating characteristics curve (AUROC) and area under the precision-recall curve (AUPRC). XGBoost achieved an average error reduction of 33% in MAE and 32% in RMSE across ABG variables, and 19% and 21% across BMP variables, respectively. Bi-LSTM models using our ML-based hourly laboratory estimates (AUROC 0.951, 95% CI 0.942-0.960; AUPRC 0.419, 95% CI 0.375-0.465) outperformed models using previous-value laboratory imputation (AUROC 0.923, 95% CI 0.910-0.935; AUPRC 0.343, 95% CI 0.301-0.386). Our real-time imputation models led to significant error reduction of most ABG and BMP targets, improving deep learning model performance for the need of RRT.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":"1091-1102"},"PeriodicalIF":2.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13562130/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148562135","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":"Application of SPI-guided analgesia in laparoscopic gynecologic surgery: a randomized controlled trial evaluating the remifentanil-sparing effect and predictive value of time-weighted SPI.","authors":"Wei Liu, Ying Li, Ran Lin, Min Ke, Qin Lin, Wei Lin, Shu Zheng, Xiangfeng Wang","doi":"10.1007/s10877-026-01452-w","DOIUrl":"10.1007/s10877-026-01452-w","url":null,"abstract":"<p><p>This study aimed to achieve two primary objectives: (1) to evaluate the opioid-sparing effect of Surgical Pleth Index (SPI)-directed analgesia during surgery via a randomized controlled trial (RCT), and (2) to propose and preliminarily assess a novel dynamic metric, Threshold-based Time-Weighted SPI (Tb-TW-SPI), which integrates stimulus intensity and duration, for its predictive efficacy regarding postoperative moderate-to-severe pain. Employing an RCT combined with exploratory analysis, 61 patients undergoing elective laparoscopic gynecologic surgery were randomized into an SPI-directed analgesia group or a conventional analgesia group. The primary outcome was total intraoperative remifentanil consumption. Postoperatively, an exploratory analysis of the control group data evaluated the correlation between Tb-TW-SPI and Numeric Rating Scale (NRS) pain scores in the post-anesthesia care unit (PACU), calculating its predictive value for moderate-to-severe pain (NRS ≥ 4). Results: The SPI-directed group required significantly less intraoperative remifentanil than the conventional group [median (IQR): 5.84(5.02,6.62)vs. 6.96(5.81,8.19)µg/kg/h; P = 0.016]. Postoperative pain scores did not differ significantly between groups (P > 0.05). Exploratory analysis of the conventional analgesia group revealed that Tb-TW-SPI values were significantly higher in patients with moderate-to-severe postoperative pain (NRS ≥ 4) compared to those without (P = 0.0417).The area under the ROC curve for Tb-TW-SPI predicting this pain was 0.74 (95% CI: 0.52-0.96), with 67% sensitivity and 76% specificity at an optimal cutoff of 1210. This RCT suggests that SPI-directed analgesia can safely and moderately reduce intraoperative remifentanil consumption. Furthermore, the proposed Tb-TW-SPI metric, in this exploratory analysis, suggests potential for predicting postoperative pain, though this finding requires validation in larger cohorts with higher-frequency SPI sampling, offering a new direction for SPI interpretation. Large-scale, multicenter trials are warranted to validate the predictive utility of Tb-TW-SPI. Clinical Trial Registration, China Clinical Trial Registry: ChiCTR2400088444.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":"1001-1010"},"PeriodicalIF":2.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13562340/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148199111","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":"Esophageal pressures in supine and prone position: evaluation using high-resolution manometry.","authors":"Viktor Erbring, Magni Gudmundsson, Hannes Widing, Sophie Lindgren, Christian Rylander, Per Persson","doi":"10.1007/s10877-026-01456-6","DOIUrl":"10.1007/s10877-026-01456-6","url":null,"abstract":"<p><p>Esophageal pressure (PES), used as a substitute for pleural pressure in calculations of respiratory mechanics, are complex and influenced by several factors. High-resolution manometry (HRM) provides pressure readings over the esophageal length, which makes it possible to identify factors other than respiratory mechanics that influence esophageal pressure. The aim of this study was to describe and explore esophageal pressure in prone and supine position at different ventilatory settings. PES was measured using HRM in 20 mechanically ventilated patients before start of spinal surgery. PEEP of 5 and 12 cmH₂O were used in supine and prone position while data were recorded continuously. Mean end-expiratory (PES_EE) and tidal variation of esophageal pressures (ΔPES) from sensors in different esophageal regions were compared including a selection of sensors with theoretically optimal pressure readings (PES_OPT). PES_EE was significantly lower (MD 3.2-5.7), ΔPES was significantly higher (MD 0.8-1.6 cmH₂O) and cardiac oscillations were significantly smaller in prone compared to supine position. Differences were dependent on PEEP level and regions of esophagus included. Mean within patient variability of PES_EE and ΔPES was 38-540% depending on PEEP level and body position. End-expiratory PES_OPT was lower than mean PES_EE from larger esophageal regions and less variable. A large variation in PES is seen in both supine and prone position but depends on which sensors are included in calculations of PES. There are significant differences in absolute pressures and in influence from mediastinal organs between supine and prone position.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":"1177-1188"},"PeriodicalIF":2.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13562092/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148218032","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":"Operator wellbeing as a translational endpoint: a dimension missing from the AI implementation framework in anesthesiology.","authors":"Valentina Bellini, Matteo Panizzi, Elena Bignami","doi":"10.1007/s10877-026-01444-w","DOIUrl":"10.1007/s10877-026-01444-w","url":null,"abstract":"","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":"1199-1200"},"PeriodicalIF":2.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13562109/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148176040","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":"Alert burden when monitoring patients' vital signs continuously at home.","authors":"Emilie Sigvardt, Jesper Mølgaard, Hanne Nygaard, Christian S Meyhoff, Eske K Aasvang","doi":"10.1007/s10877-026-01465-5","DOIUrl":"10.1007/s10877-026-01465-5","url":null,"abstract":"<p><p>Continuous monitoring of vital signs after hospital discharge may support early recognition of deviating vital signs. However, the utility may be challenged by high alert frequencies. This exploratory study aimed to assess the impact of evidence-based augmented filtering algorithms on alert frequency following discharge. Adult patients (≥ 18 years) discharged after acute medical admission were monitored continuously using wearable devices that measured heart rate, respiratory rate, blood pressure, and oxygen saturation. The primary outcome was the number of alerts per patient per day. We compared outcomes across three filtering strategies: (1) no filtering, (2) artefact removal, and (3) filtering with artefact removal and clinical criteria based upon severity and duration. Ninety-eight patients were enrolled; the total vital sign alert frequency was reduced from a median of 74 [IQR 36-125] to 5 [IQR 1-13] alerts/patient/day following application of the clinical criteria filters, corresponding to an 84% reduction (p < 0.001). Alert frequency following the three filtering approaches was 74 [IQR 36-125], 67 [IQR 33-103], and 5 [IQR 1-13] alerts/patient/day, respectively, p < 0.001. Artefact removal and the application of filters based on severity and event duration significantly reduced alert frequency in patients continuously monitored at home after hospital discharge. Further studies are needed to evaluate clinical safety and predictive value.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":"1137-1146"},"PeriodicalIF":2.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13562282/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148375937","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":"Closed-loop vasopressor systems for hemodynamic control in perioperative and critical care settings: a systematic review and meta-analysis.","authors":"Jorge Iván Alvarado-Sánchez, Diana María Abril-Calderón, Isabella Sánchez-Quimbayo, Lucas Oñoro-Patiño, Camilo Vega-Useche, Juan Sebastián Reyes-Gonzales, Fredy Leonardo Carreño-Hernandez","doi":"10.1007/s10877-026-01463-7","DOIUrl":"10.1007/s10877-026-01463-7","url":null,"abstract":"<p><p>Maintaining mean arterial pressure (MAP) within a predefined target is central to haemodynamic management in surgical and critically ill adults receiving vasopressors. Closed-loop vasopressor (CLV) systems automate titration to optimise blood pressure control, but their clinical effectiveness remains uncertain. We performed a systematic review and meta-analysis comparing CLV with manual titration. This PRISMA 2020-compliant review was prospectively registered in PROSPERO (CRD420250655697). MEDLINE, Embase, Scopus, Web of Science, CENTRAL, and the Cochrane Library were searched (January 2000-June 2025). Randomised controlled trials enrolling adults receiving vasopressors in perioperative or intensive care settings were included. Primary outcomes were time within the MAP target range and time spent in hypotension or hypertension. Risk of bias was assessed using RoB 2.0 and certainty of evidence using GRADE. Random- or fixed-effects models were selected according to heterogeneity. Six randomized controlled trials (215 patients) were included in the systematic review, whereas five perioperative trials contributed to the meta-analysis of haemodynamic control outcomes, and one ICU-based study was summarized narratively because it did not report comparable MAP control endpoints. CLV increased time within the MAP target range (mean difference [MD] 33.94%, 95% CI 20.41-47.46; I² = 77%) and reduced time in hypotension (MD - 18.24%, 95% CI - 28.95 to - 7.53; I² = 73%). There was no significant difference in time in hypertension, cumulative norepinephrine dose, or major/minor adverse events. ICU length of stay was not pooled because of clinical and methodological heterogeneity. Certainty of evidence ranged from low to high (moderate for haemodynamic control outcomes). CLV systems improved haemodynamic control, primarily in perioperative settings, but heterogeneity and small samples limit confidence in effect size and generalisability. Evidence in critically ill populations remains limited, and larger trials are needed to determine whether improvements in these physiological surrogate endpoints translate into meaningful patient-centred outcomes.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":"1065-1076"},"PeriodicalIF":2.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13562163/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148549220","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":"Data availability and usability of a remote device for vital sign monitoring on general wards and home: a single-center prospective, observational study.","authors":"A Jonkers, M de Groot, M Duijvestein, P R de Reuver, G Huisman-de Waal, S J H Bredie, I M Spenkelink","doi":"10.1007/s10877-026-01448-6","DOIUrl":"10.1007/s10877-026-01448-6","url":null,"abstract":"<p><p>Continuous monitoring with wireless wearable devices enables early detection of clinical deterioration and supports post-discharge monitoring. This study evaluated data availability and patient usability of a novel upper-arm wearable sensor for continuous monitoring, on the general ward and at home, and compared its intramural performance with the current local standard. This prospective observational study was conducted at an academic hospital involving surgical and gastroenterological patients. The viQtor was used alongside ViSi Mobile during hospital admission and subsequently stand-alone for seven days post-discharge. Data availability was measured by analyzing the proportion of missing data, usability with the System Usability Scale (SUS), and data agreement by comparing in-hospital vital sign measurements between the viQtor and ViSi Mobile. Forty-five patients (median age 64 years) participated, of whom 35 (78%) continued using viQtor at home. Data gaps increased with patient activity during admission and at home. In-hospital data availability for the viQtor was similar for pulse rate (87% vs. 85%) but lower for respiratory rate (56% vs. 83%) and oxygen saturation (SpO₂) (48% vs. 84%) compared to ViSi Mobile. At home, the data availability of the viQtor for pulse rate, respiratory rate and SpO₂ was 77%, 46%, and 39%, respectively. ViQtor achieved a mean SUS score of 71.1, indicating acceptable usability. ViQtor showed slightly higher pulse rate values, and lower respiratory rate and SpO₂ values compared to ViSi Mobile. Data availability of the viQtor was high for pulse rate but limited for respiratory rate and SpO₂, compared to the ViSi Mobile. Activity lowered data availability of all parameters, particularly at home. Patient usability was acceptable. The viQtor showed small but significant vital-sign differences compared with the ViSi Mobile. Reducing activity-related data loss may further improve applicability for continuous monitoring.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":"1125-1135"},"PeriodicalIF":2.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13562157/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148317206","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":"Respiratory effects of recruitment maneuvers according to lung recruitability assessed by electrical impedance tomography in patients with acute respiratory distress syndrome.","authors":"Dinh Van Trung, Bui Thi Huong Giang, Dang Quoc Tuan, Nguyen Cong Tan, Pham The Thach, Bui Van Cuong, Nguyen Ba Cuong, Trinh The Anh, Nguyen Dang Thu, Do Ngoc Son","doi":"10.1007/s10877-026-01473-5","DOIUrl":"10.1007/s10877-026-01473-5","url":null,"abstract":"<p><p>Recruitment maneuvers (RM) can improve oxygenation in patients with acute respiratory distress syndrome (ARDS), but their physiological effects depend on lung recruitability. This secondary analysis of a randomized controlled trial (RCT) evaluated oxygenation, respiratory mechanics, regional ventilation, and cardiorespiratory adverse events responses to a RM followed by electrical impedance tomography (EIT)-guided PEEP titration, using EIT to assess lung recruitability. In this study, fifty patients with moderate-to-severe ARDS underwent a stepwise RM followed by individualized PEEP titration guided by EIT. Lung recruitability was determined using the collapse index at PEEP 6 cmH₂O (CL_PEEP6), defined as the proportion of collapsed lung at this PEEP level. Patients were classified into high- and low-recruitability groups based on median CL_PEEP6 values. Oxygenation (PaO₂/FiO₂), static compliance (Cstat), driving pressure (Pdriv), regional ventilation distribution, and cardiorespiratory adverse events were compared before and after RM, during subsequent individualized EIT-guided PEEP titration. In patients with high recruitability (CL_PEEP6 > 12.5), the PaO₂/FiO₂ ratio and Cstat increased significantly after RM (PaO₂/FiO₂: 100.8 ± 30.3 vs. 125.4 ± 38.3 mmHg, p < 0.05; Cstat: 21.5 ± 5.8 vs. 28.0 ± 7.0 mL/cmH₂O, p < 0.001), Pdriv decreased (19.1 ± 3.5 vs. 15.6 ± 3.2 cmH₂O, p < 0.001). EIT demonstrated a posterior redistribution of ventilation after RM. In contrast, patients with low recruitability (CL_PEEP6 ≤ 12.5) showed no significant mechanical or oxygenation improvement and transient hypotension, arrhythmia, and desaturation appeared numerically more common in this group. No barotrauma or cardiac arrest occurred, and ICU mortality was similar between groups. A strategy combining a RM with subsequent individualized EIT-guided PEEP titration was associated with improved oxygenation and lung mechanics in patients with high lung recruitability, whereas patients with low recruitability showed limited physiological benefit, with cardiorespiratory adverse events appearing numerically more frequent. The EIT-derived CL_PEEP6 index represents a feasible and clinically applicable https://clinicaltrials.gov/study/NCT06733168.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":"1167-1175"},"PeriodicalIF":2.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13562096/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148578873","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}