Journal of Clinical Monitoring and Computing最新文献

{"title":"Evaluating the efficacy of intraoperative NIRS cutoff values in detecting spinal cord ischemia during surgery.","authors":"Sebastian Zinn, Nia Joseph, Travis Stanley CreveCoeur, Roman M Sniecinski, Paul S García","doi":"10.1007/s10877-025-01331-w","DOIUrl":"https://doi.org/10.1007/s10877-025-01331-w","url":null,"abstract":"<p><strong>Purpose: </strong>Paralysis is a serious complication of surgeries that interferes with the blood supply of the anterior spinal cord, with rates of spinal cord injury (SCI) from approximately 1% in general spine surgeries to 4-40% following thoracoabdominal aortic aneurysm (TAAA) repair. Near-infrared spectroscopy (NIRS) provides a non-invasive, real-time method for monitoring tissue oxygenation, largely unaffected by anesthetics. Given the heightened risk of neurologic injury during TAAA repair, this procedure is used to evaluate the effectiveness of standard regional spinal oxygen saturation (rSpO₂) cutoff values in predicting neurological outcomes.</p><p><strong>Methods: </strong>This retrospective study analyzed 25 patients undergoing open TAAA repair. NIRS data were recorded at the ischemic site and a reference location throughout surgery. Neurological outcomes were assessed postoperatively based on paralysis, hemiparesis, or extremity weakness. After excluding eight patients due to poor signal quality, 17 patients were included. NIRS values at six key time points were compared between outcome groups. Bayesian statistics assessed the relationship between significant NIRS \"drops\" (< 80% of baseline) and neurological outcomes.</p><p><strong>Results: </strong>Seven patients exhibited new neurological deficits (4 temporary). No credible association was found between intraoperative NIRS drops and postoperative neurological outcomes at any analyzed time point. A moderate effect was observed at the end of surgery (Hedges' g = - 1.21), suggesting a potential difference between groups, although the Bayesian credible interval included zero (posterior mean = - 0.82, 94% HDI [- 1.8, 0.18]).</p><p><strong>Conclusions: </strong>In this limited cohort, intraoperative NIRS cutoff values did not significantly correlate with postoperative neurological deficits following TAAA repair. Postoperative NIRS monitoring may be more informative for detecting spinal cord ischemia and preventing paralysis.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144690469","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":"Change in pulse wave transit time measured using ear plethysmography is a useful substitute for finger plethysmography.","authors":"Ryota Nakano, Midoriko Higashi, Kazuhiro Shirozu, Shoko Ozasa, Makoto Sumie, Tetsuhiro Fujiyoshi, Ken Yamaura","doi":"10.1007/s10877-025-01327-6","DOIUrl":"https://doi.org/10.1007/s10877-025-01327-6","url":null,"abstract":"<p><strong>Purpose: </strong>Plethysmography using the finger is affected by various clinical conditions, including sympathetic tone. This study aimed to evaluate whether pulse wave transit time (PWTT) calculated using ear plethysmography could be used as a substitute for finger PWTT.</p><p><strong>Methods: </strong>In this prospective observational study, 50 patients underwent elective hepatectomy between December 2021 and April 2022. PWTT was simultaneously measured using finger and ear plethysmography. The primary outcome was the global agreement of all PWTT measurements. The secondary outcome was trending ability during hemodynamic changes.</p><p><strong>Results: </strong>In total, 311 paired readings from 50 patients were collected. PWTT-ear was shorter than PWTT (68.1 ± 15.1 ms). For the percent change in PWTT from baseline (%ΔPWTT), linear regression analyses showed a strong correlation between %ΔPWTT-ear and %ΔPWTT (r = 0.85, P < 0.001). In Bland-Altman analyses, the bias between %ΔPWTT-ear and %ΔPWTT was - 0.04% and limits of agreement from - 0.17 to 0.17%, with a percentage error (2 standard deviation/mean %ΔPWTT) of 4.2%. The conductance rate of the two methods was 95.9% based on a four-quadrant plot analysis. The angular conductance rate was 98.9% with a radial limit of ± 25.3 based on a polar plot analysis.</p><p><strong>Conclusion: </strong>PWTT-ear was shorter than PWTT, but the % change in PWTT-ear was similar to that in PWTT. PWTT measured using ear plethysmography can be used as a substitute for measuring changes in PWTT.</p><p><strong>Trial registration: </strong>This study was registered in the UMIN-CTR Clinical Database (ID: UMIN000045950), https://center6.umin.ac.jp/cgi-open-bin/icdr_e/ctr_view.cgi?recptno=R000052326 on December 08, 2021.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144667748","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":"Validity of neuromuscular monitoring: beyond the technology's precision.","authors":"Thomas Fuchs-Buder","doi":"10.1007/s10877-025-01326-7","DOIUrl":"https://doi.org/10.1007/s10877-025-01326-7","url":null,"abstract":"","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649609","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":"Monitoring systemic ventriculoarterial coupling after cardiac surgery using continuous transoesophageal echocardiography and deep learning.","authors":"Jinyang Yu, Tomas Dybos Tannvik, Anders Austlid Taskén, Erik Andreas Rye Berg, Katrine Hordnes Slagsvold, Idar Kirkeby-Garstad, Eirik Skogvoll, Gabriel Kiss, Bjørnar Grenne, Svend Aakhus","doi":"10.1007/s10877-025-01328-5","DOIUrl":"https://doi.org/10.1007/s10877-025-01328-5","url":null,"abstract":"<p><p>Deterioration of ventriculoarterial coupling is detrimental to cardiovascular and left ventricular function. To enable continuous monitoring of left ventricular function, we have developed autoMAPSE, a new tool that combines transoesophageal echocardiography with deep learning for automatic measurement of mitral annular plane systolic excursion. We hypothesised that autoMAPSE could be used to monitor systemic ventriculoarterial coupling and detect alterations in postoperative cardiac biomarkers. To test this hypothesis, we monitored 50 patients for 120 min immediately after cardiac surgery by measuring autoMAPSE and mean arterial pressure (MAP) every 5 min. Postoperative N-terminal pro B-type natriuretic peptide (ProBNP) and high-sensitivity troponin-T (TnT) were measured twice daily until the evening of postoperative day 1. Ventriculoarterial coupling was assessed non-invasively by calculating arterial elastance and end-systolic elastance (Ea/Ees-ratio). The relationship between autoMAPSE and ventriculoarterial coupling was assessed by 1) correlating Ea/Ees-ratio with one simultaneous autoMAPSE measurement, and 2) relating the measurements of autoMAPSE with corresponding MAP within each patient using a linear mixed model with random slopes. We found that autoMAPSE correlated negatively with Ea/Ees-ratio (rho = - 0.61, P < 0.05). Furthermore, the individual slopes relating autoMAPSE to MAP were highly significant (P < 0.001) and markedly heterogeneous (both positive and negative), suggesting that ventriculoarterial coupling differs substantially in different individual patients. Finally, continuous autoMAPSE measurements were negatively correlated with both peak postoperative ProBNP (rho = - 0.46, P < 0.001) and TnT (rho = - 0.29, P < 0.05). In conclusion, continuous monitoring using autoMAPSE in the first two postoperative hours reflected ventriculoarterial coupling as well as peak ProBNP and TnT during the subsequent 24 h.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144659303","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":"Association of intraoperative hypotension and acute kidney injury in noncardiac surgery patients: a post hoc secondary analysis of the EU HYPROTECT registry.","authors":"Julian Runge, Carla D Grundmann, Carolina Mucha, Robin Denz, Karim Kouz, Manuel Ignacio Monge García, Elisabetta Cerutti, Luciano Frassanito, Michael Sander, Simon J Davies, Abele Donati, Javier Ripolles-Melchor, Daniel García-Lopez, Benjamin Vojnar, Etienne Gayat, Eric Nol, Tim van den Boom, Peter Bramlage, Bernd Saugel, Thomas W L Scheeren, Ulrich H Frey","doi":"10.1007/s10877-025-01329-4","DOIUrl":"https://doi.org/10.1007/s10877-025-01329-4","url":null,"abstract":"<p><strong>Purpose: </strong>Previous cohort studies suggest that intraoperative hypotension is associated with acute kidney injury (AKI) in noncardiac surgical patients. We sought to ascertain that intraoperative hypotension is independently associated with AKI within the first 3 days after surgery in a contemporary cohort of noncardiac surgery patients in whom clinicians strove to avoid profound intraoperative hypotension.</p><p><strong>Methods: </strong>This was a post hoc secondary analysis of the multicentre EU HYPROTECT registry, which includes patients undergoing major noncardiac surgery who underwent predictive blood pressure monitoring. The primary outcome of this secondary analysis was AKI within the first 3 days after surgery. To quantify the duration and severity of intraoperative hypotension we calculated the area under a mean arterial pressure (MAP) of 65 mmHg. We used logistic regression analysis to identify factors independently associated with AKI.</p><p><strong>Results: </strong>We analysed 697 patients. 62 of these 697 patients (9%) developed AKI within the first 3 days after surgery. In multivariable binary logistic regression analysis adjusted for confounding variables, the area under a MAP of 65 mmHg was independently associated with AKI within the first 3 days after surgery (OR 1.03 [95% CI 1.01-1.05] per 10 mmHg*min; P < 0.001).</p><p><strong>Conclusion: </strong>Our secondary analysis of the EU HYPROTECT registry shows that, in a contemporary population of noncardiac surgery patients in whom clinicians strove to avoid profound intraoperative hypotension, intraoperative hypotension is independently associated with AKI within the first 3 days after surgery.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144659368","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":"Intraoperative analgesia management by monitoring the analgesia nociception index in gynecological surgeries involving erector spinae plane block: a randomized controlled study.","authors":"Zeynep Koç, Çağdaş Baytar, Keziban Bollucuoğlu, Bengü Gülhan Köksal, Rahşan Dilek Okyay, Özcan Pişkin, Hilal Ayoğlu","doi":"10.1007/s10877-025-01330-x","DOIUrl":"https://doi.org/10.1007/s10877-025-01330-x","url":null,"abstract":"<p><p>To determine the effect of monitoring the Analgesia Nociception Index (ANI) on intraoperative opioid use, postoperative recovery, and analgesia in patients receiving preoperative bilateral erector spinae plane block (ESPB) for gynecological surgery under general anesthesia. Eighty patients classified in the American Society of Anesthesiologists physical status I-III scheduled for hysterectomy under general anesthesia were included in the study. After ultrasound-guided ESPB, patients were divided into 2 groups: control and ANI. In the control group, the intraoperative remifentanil infusion dose was adjusted using conventional methods; in the ANI group, the dose was adjusted according to ANI values of 50-70. Intraoperative remifentanil consumption, postoperative pain scores, additional analgesic requirements, and complications were recorded. Intraoperative remifentanil consumption was lower in the ANI group than in the control group (p < 0.001). Numerical rating scale (NRS) scores and requirements for additional analgesics in the postoperative recovery unit were both lower in the ANI group (p < 0.05). There were no significant differences between the groups in terms of nausea or vomiting in the recovery unit. ANI monitoring in patients undergoing gynecological surgery under general anesthesia with ESPB reduced opioid consumption during the intraoperative period. Intraoperative ANI monitoring enabled individualized opioid administration and guided determination of the required dose of analgesic agent.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144637102","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":"Effectiveness of diaphragmatic ultrasound as a predictor of successful weaning from mechanical ventilation.","authors":"Hanady Mohammed Elfeky, Janna Omaran, Noha S Shaban, Ahmed Elmohamady, Nagwa Doha, Noha Afify","doi":"10.1007/s10877-025-01317-8","DOIUrl":"https://doi.org/10.1007/s10877-025-01317-8","url":null,"abstract":"","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144626431","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":"Evaluating local ischemic preconditioning effects on skin perfusion using capillary refill time in healthy volunteers.","authors":"Elaine Cavalcante Dos Santos, Zoé Demailly, Jan Bakker, Fabio Silvio Taccone","doi":"10.1007/s10877-025-01324-9","DOIUrl":"https://doi.org/10.1007/s10877-025-01324-9","url":null,"abstract":"<p><p>Capillary refill time (CRT) is a vaso-occlusive test that allows the non-invasive assessment of skin perfusion. A vascular occlusive test (VOT) induces transient ischemia similar to that used in preconditioning ischemia. We hypothesized that CRT could be influenced by local tissue compression mimicking ischemic preconditioning when repeated measurements are performed. In healthy volunteers (n = 30), CRTs were performed twice on the index and middle fingers of the dominant hand and the index finger of the non-dominant hand at 15-minute intervals on the first day. On the second day, two CRT measurements were taken at 30-minute intervals. No significant differences were observed in CRT measurements repeated at 15- and 30-minute intervals. Additionally, baseline CRT values did not significantly differ between the fingers of the dominant and non-dominant hands on either study day. Repeated CRT measurements are not influenced by local ischemic preconditioning in the finger over short intervals.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144618134","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: Evaluation of non-invasive sensors for monitoring core temperature.","authors":"Shavin S Thomas, Katharyn L Flickinger, Jonathan Elmer, Clifton W Callaway","doi":"10.1007/s10877-025-01325-8","DOIUrl":"10.1007/s10877-025-01325-8","url":null,"abstract":"","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144608542","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":"Reproducibility of glycocheck measurements in patients under general anesthesia with muscle relaxants: A prospective observational study.","authors":"Takayuki Toki, Kazuyuki Mizunoya, Takashi Soejima, Yasunori Yagi, Naoko Nakamine, Yusuke Itosu, Ryo Takagi, Isao Yokota, Yuji Morimoto","doi":"10.1007/s10877-025-01322-x","DOIUrl":"https://doi.org/10.1007/s10877-025-01322-x","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the inter- and intraobserver reproducibility of sublingual microcirculatory indices measured using the GlycoCheck system, including the perfused boundary region (PBR), vascular density (VD), and red blood cell filling (RBCF), in patients under general anesthesia without any motion artifacts.</p><p><strong>Methods: </strong>Fifty patients who received general anesthesia for laparoscopic gastrointestinal surgery were included in this study. After the induction of general anesthesia, the leading observer and one of the five subobservers took two and one measurements of sublingual microcirculation with the GlycoCheck system, respectively. Inter- and intraobserver reproducibility was assessed using intraclass correlation coefficients (ICC). Interobserver reproducibility was calculated using the first measurements of the leading observer and subobservers, and intraobserver reproducibility was calculated using two consecutive measurements of the leading observer.</p><p><strong>Results: </strong>The interobserver reproducibility of a single measurement was poor for all three parameters. The interobserver ICCs for PBR were 0.13 [95% CI: -0.15, 0.39], for VD was - 0.01 [95%CI: -0.29, 0.27], and for RBCF were 0.31 [95%CI: -0.45, 0.78]. The intraobserver ICCs for PBR was 0.32 [95% CI: 0.05, 0.55] for all 50 cases, 0.17 [95% CI: -0.25, 0.53] for the first 25 cases, and 0.46 [95% CI: 0.09, 0.72] for the second 25 cases. The Bland-Altman plots indicated that the measurement errors were random.</p><p><strong>Conclusion: </strong>In patients under general anesthesia, single PBR, VD, and RBCF measurements using the GlycoCheck system showed poor interobserver reproducibility. Although the intraobserver reproducibility of PBR measurements was poor, improving measurement proficiency might improve reproducibility. Further research is required to establish measurement methods that achieve better reproducibility and adequate observer training.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144600614","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}