Journal of Clinical Monitoring and Computing最新文献

{"title":"Evaluation of decision support to wean patients from mechanical ventilation in intensive care: a prospective study reporting clinical and physiological outcomes.","authors":"Marcela P Vizcaychipi, Dan S Karbing, Laura Martins, Amandeep Gupta, Jeronimo Moreno-Cuesta, Manu Naik, Ingeborg Welters, Suveer Singh, Georgina Randell, Leyla Osman, Stephen E Rees","doi":"10.1007/s10877-024-01231-5","DOIUrl":"10.1007/s10877-024-01231-5","url":null,"abstract":"<p><p>This study investigated the clinical and physiological response to use of the BEACON Caresystem, a bedside open-loop decision support system providing advice to guide clinicians when weaning patients from invasive mechanical ventilation. Multicenter prospective study conducted in five adult intensive care units in the UK. Following screening and assent, intubated patients mechanically ventilated for > 24 h were randomized to intervention or usual care. Intervention consisted of application of the BEACON Caresystem's advice on tidal volume/inspiratory pressure, inspired oxygen, respiratory rate and PEEP. Usual care was defined as local clinical practice. The primary outcome was duration of mechanical ventilation. Secondary outcomes quantified prolonged intubation and survival; adverse events; ventilator settings and physiological state; time spent in ventilator modes; links to other therapy; the frequency of advice utilization and time spent outside normal physiological limits. The study was terminated early with a total of 112 patients included. Fifty-four were randomised to the intervention arm and fifty-eight to usual care. The study was underpowered and no significant differences were seen in duration of mechanical ventilation (p = 0.773), prolonged intubation or survival. Intervention arm patients had lower rates of adverse events (p = 0.016), including fewer hypoxaemic events (p = 0.008) and lower values of PEEP (p = 0.030) and tidal volume (p = 0.042). Values of peak inspiratory pressure and pressure support were reduced but at the boarder of statistical significance (p = 0.104, p = 0.093, respectively). No differences were seen for time in ventilator mode or other therapy. Advice presented by the decision support system was applied at the beside an average of 88% of occasions, with a significantly increased number of changes only in inspired oxygen fraction. No significant differences were seen in time spent outside physiological limits. This study investigated the use of the BEACON Caresystem, an open loop clinical decision support system providing advice on ventilator settings. It was terminated early, with no significant difference shown in duration of mechanical ventilation, the primary outcome. Application of advice indicated potential for fewer adverse events and improved physiological status. (Trial registration ClinicalTrials.gov under NCT03249623. Registered 22nd June 2017).</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":"393-404"},"PeriodicalIF":2.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12049327/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621241","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":"Electrical cardiometry for non-invasive cardiac output monitoring: a method comparison study in patients after coronary artery bypass graft surgery.","authors":"Gillis Greiwe, Rami Saad, Alexander Hapfelmeier, Niklas Neumann, Pischtaz Tariparast, Bernd Saugel, Moritz Flick","doi":"10.1007/s10877-024-01246-y","DOIUrl":"10.1007/s10877-024-01246-y","url":null,"abstract":"<p><p>Cardiac output can be estimated non-invasively by electrical cardiometry with the ICON® monitor (Osypka Medical GmbH, Berlin, Germany). Conflicting results have been reported regarding the cardiac output measurement performance of electrical cardiometry. In this prospective method comparison study, we compared cardiac output measured using electrical cardiometry (EC-CO; test method) with cardiac output measured using intermittent pulmonary artery thermodilution (PATD-CO; reference method) in patients after coronary artery bypass graft (CABG) surgery. We calculated the mean of the differences with 95%-limits of agreement (95%-LOA) and their corresponding 95%-confidence intervals (95%-CI) using Bland-Altman analysis and calculated the percentage error. We also analyzed trending using four-quadrant plot analysis. We analyzed 157 paired cardiac output measurements of 41 patients. Mean ± standard deviation PATD-CO was 5.1 ± 1.3 L/min and mean EC-CO was 5.3 ± 1.3 L/min. The mean of the differences ± SD between PATD-CO and EC-CO was -0.2 (95%-CI -0.5 to 0.2) ± 1.2 L/min with a lower 95%-LOA of -2.6 (95%-CI -3.1 to -2.0) L/min and an upper 95%-LOA of 2.3 (95%-CI 1.6 to 2.9) L/min. The percentage error was 47% (95%-CI, 37 to 56%). The concordance rate for cardiac output changes was 48%. In this study, the agreement between EC-CO and PATD-CO was not clinically acceptable in patients after CABG surgery. The trending ability of EC-CO was poor.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":"371-376"},"PeriodicalIF":2.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12049288/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142807356","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":"Spontaneous recovery from rocuronium measured by mechanomyography during 100- or 200-Hz tetanic stimulations compared to normalized train-of-four with acceleromyography.","authors":"Philippe E Dubois, Fabien Moreillon, Benoit Bihin, Clotilde De Dorlodot, Sabrina Meyer, Adrien Maseri, Philippe A Passeraub, Alain A d'Hollander","doi":"10.1007/s10877-025-01282-2","DOIUrl":"https://doi.org/10.1007/s10877-025-01282-2","url":null,"abstract":"<p><p>Neuromuscular block recovery was evaluated using high-frequency tetanic ulnar nerve simulations compared to normalized train-of-four (NTOF) in anesthetized patients. Under intravenous general anesthesia, we compared rocuronium-induced neuromuscular recovery using 5 s 100- and 200-Hz tetanic stimulations via isometric mechanomyography to acceleromyographic NTOF in 20 consenting patients. The primary outcome was the comparison by Student's t-tests of 100- and 200-Hz tetanic fade ratios (residual force at the end of the contraction / maximal force reached during the 5 s) before rocuronium administration and at different recovery levels. The secondary outcome was the quantification of any significant fade occurring with 100- and 200-Hz stimulations after reaching the acceleromyographic NTOF ratio of 0.9 during subsequent stages of spontaneous recovery until their fade ratios exceeded 0.9. During early (TOF count ≥ 1) and intermediate (NTOF ratio ≥ 0.5) stages of recovery, both 100- and 200-Hz tetanic fade ratios were similarly low. However, during late recovery when NTOF ratio ≥ 0.9, 200-Hz stimulation induced a significantly deeper muscular fade than 100-Hz (tetanic fade ratio 0.20 ± 0.23 vs. 0.64 ± 0.29, P < 0.001). The delays between the recovery of NTOF ratio 0.9 and 100- or 200-Hz tetanic fade ratio 0.9 were 7.7 ± 7.1 and 43.6 ± 14.6 min, respectively. In anesthetized humans, mechanomyographic 200-Hz tetanic stimulation detects lighter levels of residual paralysis than NTOF and 100-Hz tetanic stimulation during a valuable additional period. Registered in the ClinicalTrials.gov Registry NCT05474638 on July 15th 2022.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752977","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":"A novel wearable bioimpedance sensor for continuous monitoring of fluid balance: a study on isotonic hypovolemia in healthy adults.","authors":"Harald Noddeland, Frida Bremnes, Anne Thorud, Katrine Rolid, Jørn Kvaerness, Ellen Andreassen Jaatun, Sigve Nyvik Aas","doi":"10.1007/s10877-024-01245-z","DOIUrl":"10.1007/s10877-024-01245-z","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to investigate the ability of a novel wearable bioimpedance sensor to monitor changes in fluid balance induced by furosemide. Because iso-osmotic fluid loss is expected to primarily comprise fluid from the extracellular compartment it was hypothesized that isotonic hypovolemia would increase the extracellular resistance (R_E).</p><p><strong>Methods: </strong>27 healthy adults (20 women, 7 men; 35 ± 10 year.) were continuously monitored by the bioimpedance sensor following administration of furosemide. Body weight, blood pressure, heart rate, sensation of thirst and selected blood parameters were tested before furosemide administration (t0), one hour (t1) and two hours (t2) after furosemide administration, and one hour after intake of a sports drink containing carbohydrate and electrolytes (t3). Urine elimination was measured throughout the intervention, and the change in extracellular fluid volume was estimated using urine elimination and established equations.</p><p><strong>Results: </strong>During hypovolemia body weight was reduced by 1.4 ± 0.2 kg (1.7 ± 0.4%). Total urine elimination during fluid loss was 1277 ± 190 mL. R_E increased significantly from t0 to t2 (13.6 ± 2.9%). A strong correlation was observed between the estimated change in extracellular fluid volume and the measured change in R_E during the isotonic fluid loss.</p><p><strong>Conclusion: </strong>This study demonstrates that the wearable bioimpedance device tested is very sensitive to furosemide-induced changes in fluid volume in healthy volunteers in a controlled environment. Additional research is needed to evaluate the ability of the device to track fluid status in a clinical setting.</p><p><strong>Trial registration: </strong>The study was registered at clinicaltrials.gov 29th of October 2021 (NCT05129358).</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":"379-391"},"PeriodicalIF":2.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12049328/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142769458","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":"Electroencephalogram monitoring during anesthesia and critical care: a guide for the clinician.","authors":"Nitin Manohara, Alessandra Ferrari, Adam Greenblatt, Andrea Berardino, Cristina Peixoto, Flávia Duarte, Zahra Moyiaeri, Chiara Robba, Fabio A Nascimento, Matthias Kreuzer, Susana Vacas, Francisco A Lobo","doi":"10.1007/s10877-024-01250-2","DOIUrl":"10.1007/s10877-024-01250-2","url":null,"abstract":"<p><p>Perioperative anesthetic, surgical and critical careinterventions can affect brain physiology and overall brain health. The clinical utility of electroencephalogram (EEG) monitoring in anesthesia and intensive care settings is multifaceted, offering critical insights into the level of consciousness and depth of anesthesia, facilitating the titration of anesthetic doses, and enabling the detection of ischemic events and epileptic activity. Additionally, EEG monitoring can aid in predicting perioperative neurocognitive disorders, assessing the impact of systemic insults on cerebral function, and informing neuroprognostication. This review provides a comprehensive overview of the fundamental principles of electroencephalography, including the foundations of processed and quantitative electroencephalography. It further explores the characteristic EEG signatures associated wtih anesthetic drugs, the interpretation of the EEG data during anesthesia, and the broader clinical benefits and applications of EEG monitoring in both anesthetic practice and intensive care environments.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":"315-348"},"PeriodicalIF":2.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142864512","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":"10.1007/s10877-025-01281-3","url":null,"abstract":"","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":"261-262"},"PeriodicalIF":2.0,"publicationDate":"2025-04-01","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":"Electrical impedance tomography causing interference on the electrocardiogram in neonatal ICU patients.","authors":"J J Wisse, T G Goos, A H Jonkman","doi":"10.1007/s10877-024-01242-2","DOIUrl":"10.1007/s10877-024-01242-2","url":null,"abstract":"","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":"377-378"},"PeriodicalIF":2.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12049380/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824276","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":"Automated mitochondrial oxygen consumption (mitoVO₂) analysis via a bi-directional long short-term memory neural network.","authors":"C J de Wijs, J R Behr, L W J M Streng, M E van der Graaf, F A Harms, E G Mik","doi":"10.1007/s10877-025-01291-1","DOIUrl":"https://doi.org/10.1007/s10877-025-01291-1","url":null,"abstract":"<p><p>Monitoring in vivo mitochondrial oxygen tension (mitoPO₂) enables the measurement of mitochondrial oxygen consumption (mitoVO₂), providing deeper insights into the skin's mitochondrial environment. However, current mitoVO₂ analysis often relies on manual identification of start and end points, which introduces substantial inter-user variability. Addressing this limitation is crucial for broader adoption, comparability, and reproducibility across research groups. Therefore, the aim of this study was to develop a neural network-based software that automatically analyzes mitoVO₂. A Bi-directional Long Short-Term Memory neural network was trained on 125 mitoPO₂ measurement sequences and optimized through Bayesian optimization. It identifies start points and measurement periods, then applies a modified Michaelis-Menten fit to calculate mitoVO₂. This framework, embedded in automated software, was validated against the consensus of 3 raters. Bayesian optimization yielded an overall network performance of 94.2% on the test set. The neural network identified 91% of mitoVO₂ start points within a ± 5-sample range of the manual consensus. Mean mitoVO₂ values for the consensus and software were 6.56 and 6.63 mmHg s^- 1, respectively, corresponding to a bias of -0.057 mmHg s^- 1. Multiple runs of the network on the same dataset produced identical results, confirming consistency and eliminating inter-user variability. The developed neural network-based software automatically and consistently analyzes mitoVO₂ measurements, substantially reducing reliance on subjective judgments. By enabling a standardized approach to mitoVO₂ analysis, this tool improves data comparability and reproducibility across research settings. Future work will focus on further refining precision and extending functionality through multi-center collaborations.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752972","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":"Non-invasive estimation of beat-by-beat aortic blood pressures from electrical impedance tomography data processed by machine learning.","authors":"Fabian Müller-Graf, Jacob P Thönes, Lisa Krukewitt, Paul Frenkel, Henryk Richter, Sascha Spors, Volker Kühn, Amelie R Zitzmann, Stephan H Boehm, Daniel A Reuter","doi":"10.1007/s10877-025-01274-2","DOIUrl":"https://doi.org/10.1007/s10877-025-01274-2","url":null,"abstract":"<p><p>Hypotension in perioperative and intensive care settings is a significant risk factor associated with complications such as myocardial infarction and kidney injury thereby increasing perioperative complications and mortality. Continuous blood pressure monitoring is essential, yet challenging due to the invasive nature of current methods. Non-invasive techniques like Electrical Impedance Tomography (EIT) have been explored but face challenges in accurate and consistent blood pressure estimation. A machine learning (ML) approach was used to predict aortic blood pressures from EIT voltage measurements in landrace pigs. A convolutional neural network (CNN) was trained on a dataset of 75 298 heartbeats, to predict systolic (SAP), mean (MAP), and diastolic arterial pressures (DAP) of individuals whose arterial pressures were unknown to the algorithm. The Intraclass Correlation Coefficient (3,1) with absolute agreement (ICC) was calculated and the concordance was estimated, comparing reference blood pressure measurements and ML-derived estimates. A risk classification was estimated for the calculated blood pressure as suggested by Saugel et al. 2018. The ML-model demonstrated moderate correlations with invasive blood pressure measurements (ICC for SAP of 0.530, for MAP of 0.563, and for DAP of 0.521.) with a low risk score for 75.8% of the SAP and 64.2% of MAP estimated blood pressures. ML-techniques using EIT-voltages showed promising preliminary results in non-invasive aortic blood pressure estimation. Despite limitations in the amount of available training data and the experimental setup, this study illustrates the potential of integrating ML in EIT signal processing for real-time, non-invasive blood pressure monitoring.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143710260","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":"Evaluation of non-invasive sensors for monitoring core temperature.","authors":"Shavin S Thomas, Katharyn L Flickinger, Jonathan Elmer, Clifton W Callaway","doi":"10.1007/s10877-025-01289-9","DOIUrl":"https://doi.org/10.1007/s10877-025-01289-9","url":null,"abstract":"<p><p>We evaluated the accuracy and precision of zero-heat flux (ZHF) and dual sensor (DS) non-invasive temperature probes in intensive care unit (ICU) patients undergoing hypothermic temperature control, hypothesizing that both devices would accurately estimate core temperature. In a single-center prospective cohort study, we enrolled 35 ICU patients and applied continuous, non-invasive ZHF and/or DS probes to the lateral forehead or anterior chest to collect 358 observations. Conditions potentially influencing temperature estimation were recorded. Using Bland-Altman analysis with multiple paired observations per individual, we compared the bias between non-invasive probes and direct core temperature measurements. Lin's concordance coefficient (LCC) was computed to quantify precision. The mean bias between the ZHF probe and invasive temperature was + 0.98 °C; for the DS probe, it was - 2.19 °C. In hypothermic patients, the ZHF probe's accuracy improved (bias + 0.28 °C, LCC 0.86), while the DS probe remained inaccurate (bias - 2.52 °C, LCC 0.07). Clinical confounders like vasoactive agents or temperature control devices did not consistently affect bias, accuracy, or precision. Neither the ZHF nor DS non-invasive probes provided sufficient accuracy or precision to guide clinical decisions in the ICU. These results contrast with previous studies reporting biases within ± 0.5 °C. However, the ZHF probe showed promising limited deviation, especially in hypothermic patients.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692338","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}