Journal of Clinical Monitoring and Computing最新文献

{"title":"Near-infrared spectroscopy for estimating mixed venous oxygen saturation and cardiac output during off-pump coronary artery bypass grafting: a prospective observational study.","authors":"Chahyun Oh, Soomin Lee, Sujin Baek, Hyeyoung Choi, Man-Shik Shim, Sang-Jun Park, Yunseo Ku, Boohwi Hong, Yoon-Hee Kim","doi":"10.1007/s10877-026-01477-1","DOIUrl":"https://doi.org/10.1007/s10877-026-01477-1","url":null,"abstract":"<p><p>To evaluate whether jugular venous NIRS (rSjvO₂) and baseline-calibrated cerebral NIRS (cal-rScO₂) can serve as surrogates for mixed venous oxygen saturation (SvO₂), and whether these inputs can support continuous cardiac output (CO) estimation during off-pump coronary artery bypass grafting (OPCAB). In this prospective observational study, 25 adults undergoing elective OPCAB were enrolled at a single tertiary center. NIRS sensors were placed over the left internal jugular vein (IJV) under ultrasound guidance and over the bilateral forehead. Pulmonary artery catheter measurements served as the reference for SvO₂ and thermodilution CO (CO_TD). Agreement was assessed using Bland-Altman analysis with linear mixed-effects modeling, and trending ability by error grid analysis. CO was estimated using a previously derived modified Fick equation. rSjvO₂ showed modest bias versus SvO₂ (2.0%) but wide limits of agreement (LoA, - 14.9 to 18.9%). Accuracy varied with jugular anatomy, with the lowest error at an IJV depth of 1.38 cm. Cal-rScO₂ showed better agreement (bias 0.8%; LoA, - 7.8 to 9.4%), excellent discrimination for SvO₂ <65% (AUC, 0.970), and good trending ability. In contrast, NIRS-based CO estimation showed significant proportional bias, 33.0% percentage error (95% CI, 27.4 to 41.5%), and poor trending ability. Cal-rScO₂ appears to be a useful surrogate for SvO₂ trending during OPCAB after simple one-point calibration. Jugular NIRS may be useful in selected patients, whereas NIRS-based CO estimation remained clinically insufficient.Trial registration: Clinical Research Information Service (CRIS), Republic of Korea (KCT0007918 November 18, 2022).</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148793904","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":"Development and internal validation of the Low Cardiac Index Score: a simplified bedside tool for continuous intraoperative screening.","authors":"Karam Azem, Philip Heesen, Roussana Aranbitski, Ariel Ronen, Alexander Avidan, Yair Binyamin, Dror Ben Leviner, Sharon Orbach-Zinger, Shaul Lev, Benjamin Zribi, Shai Fein","doi":"10.1007/s10877-026-01482-4","DOIUrl":"https://doi.org/10.1007/s10877-026-01482-4","url":null,"abstract":"<p><p>Advanced haemodynamic monitoring of cardiac index is restricted to selected high-risk cases, leaving most patients undergoing major surgery without real-time assessment. We aimed to develop and internally validate a simplified bedside score for continuous, minute-by-minute screening of low cardiac index using routinely available parameters. Retrospective single-centre study of adults undergoing major abdominal surgery with advanced haemodynamic monitoring (January 2023 to February 2026). Low cardiac index was defined as pulse contour cardiac index < 2.2 l.min^- 1.m^- 2. The dataset was split 80/20 at the patient level. Twelve candidate features were ranked using SHapley Additive exPlanations (SHAP) values; the top five were used to fit a generalised linear mixed model, yielding the integer-weighted Low Cardiac Index (LCI) score. A rule-out threshold (sensitivity ≥ 0.90) was selected, and test-set performance was evaluated with patient-level cluster bootstrap. The analysis cohort comprised 136 patients and 42,346 timepoints (15.5% low cardiac index prevalence). The derived formula was LCI score = 57 + (2 × DBP) + (0.5 × Age) + PPV - HR - SBP. At a threshold of ≥ 30, the score achieved an area under the receiver operating characteristic curve of 0.84 (95% confidence interval 0.75, 0.91), sensitivity 0.92 (0.80, 0.99), and negative predictive value 0.97 (0.92, 1.00). Performance was stable across 20 random splits and outperformed individual haemodynamic parameters. The LCI score is a simple bedside rule-out tool for low cardiac index, with a score below 30 yielding a negative predictive value of 0.97. External validation and prospective assessment of clinical impact are warranted.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148793838","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":"Alterations in arterial pressure waveform morphology following volume loading versus vasopressor administration in critically ill patients.","authors":"Tetsuhito Hara, Kansuke Koyama, Daisuke Horiguchi, Wataru Matsuzawa, Masamitsu Sanui","doi":"10.1007/s10877-026-01480-6","DOIUrl":"https://doi.org/10.1007/s10877-026-01480-6","url":null,"abstract":"<p><p>Arterial pressure waveform analysis has been used to assess hemodynamic status, however, investigations focusing on waveform morphology remain limited. In this study, we examined changes in selected morphological features of the arterial pressure waveform following volume loading versus vasopressor administration in critically ill patients. In this retrospective observational study, we analyzed adult patients admitted to an intensive care unit between April 2022 and June 2023. Participants were included if they exhibited increased mean arterial pressure (MAP) following either blood return during hemodiafiltration discontinuation (Volume group) or intravenous phenylephrine administration (Pressor group). Arterial waveforms were extracted from one minute before to four minutes after the intervention. We compared 21 waveform-derived features and their normalized parameters at peak MAP with baseline values. Pre- and post-intervention differences for each parameter were assessed using the Wilcoxon matched-pairs signed-rank test. The Volume group comprised 26 patients, and the Pressor group included 20 patients. Systolic angle, systolic dP/dt, and systolic area under the curve (AUC) increased in both groups following intervention. After pulse-pressure normalization, however, systolic AUC increased significantly in the Volume group (median paired difference 4.6 [-0.3-10.2] ms, 95% CI 1.9 to 7.9, P = 0.0038) but not in the Pressor group. This elevation in systolic AUC occurred mainly during the systolic descending phase (4.4 [1.1-9.5] ms, 95% CI 2.7 to 9.1, P = 0.00021). The systolic descending duration exhibited a significant prolongation in the Volume group, whereas no significant change was observed in the Pressor group. Arterial waveform morphology exhibited different patterns of change following blood return versus phenylephrine administration, particularly in the systolic descending phase. Waveform morphology analysis may provide complementary physiological information for monitoring the mechanisms underlying hemodynamic changes.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148764852","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":"Agreement between intra-bladder and insufflation pressure readings during laparoscopic surgery.","authors":"Salar Tayebi, Patrick Beer, Phillip Jenkins, Michael Jaggi, Mohamed Hussein, Tim McKinney, Dipak Delvadia, Marc-Alan Levine, Luca Malbrain, Johan Stiens, Wojciech Dabrowski, Leo C Mercer, Manu L N G Malbrain","doi":"10.1007/s10877-026-01430-2","DOIUrl":"10.1007/s10877-026-01430-2","url":null,"abstract":"","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":"857-865"},"PeriodicalIF":2.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13391732/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147574000","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":"Intraocular pressure changes during ventilator weaning: a prospective observational study highlighting PaCO₂-related physiological monitoring signals in ICU patients.","authors":"Sevim Şenol Karataş, Sait Fatih Öner, Oğuz Kağan Bulut, Duygu Erdem","doi":"10.1007/s10877-026-01442-y","DOIUrl":"10.1007/s10877-026-01442-y","url":null,"abstract":"<p><p>Purpose This study aimed to evaluate intraocular pressure (IOP) as a time-dependent physiological monitoring parameter during ventilator weaning and to explore its association with PaCO₂-related respiratory changes. Methods In this prospective observational study, adult ICU patients receiving mechanical ventilation and undergoing weaning were enrolled. Patients with glaucoma, prior ocular surgery, or inability to tolerate weaning were excluded. IOP was measured in both eyes before weaning (T0), during spontaneous breathing (T1), and after completion of weaning (T2). Ventilator mode, positive end-expiratory pressure (PEEP), sedative agents, and spontaneous breathing trial (SBT) method (pressure support ventilation [PSV] or T-piece) were recorded. A protocol-defined IOP increase was defined as an elevation of ≥ 1.0 mmHg in at least one eye between T0 and T2. Associations between clinical variables and IOP changes were analyzed using repeated-measures analysis and multivariable logistic regression. All measurements were performed under standardized bedside ICU conditions; T1 was obtained 30 min after initiation of spontaneous breathing and T2 30 min after completion of weaning. Results Sixty-four patients were assessed, and 45 were included in the final analysis. Mean IOP values showed minimal change over time. In exploratory multivariable logistic regression, an increase in arterial carbon dioxide tension during weaning (ΔPaCO₂) was associated with the protocol-defined IOP increase (odds ratio [OR] = 1.66; 95% confidence interval [CI], 1.13-2.45; p = 0.010). No significant associations were observed with other ventilator-related or clinical variables. Conclusion The transition from mechanical ventilation to spontaneous breathing in ICU patients was not associated with a significant increase in mean IOP. However, small individual-level IOP increases were observed, and these were associated with increases in PaCO₂ during weaning. These findings should be interpreted as exploratory physiological observations. Further studies are required to determine whether these observations have clinical relevance.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":"887-896"},"PeriodicalIF":2.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13391791/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147972705","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":"Clinical agreement and physiological relevance of the zero-heat-flux temperature measurement in trauma patients during operating room resuscitation.","authors":"Jiyoung Lee, Hyoeun Ahn, Hye-Min Sohn, Seung Ho Song, In Kyong Yi","doi":"10.1007/s10877-026-01441-z","DOIUrl":"10.1007/s10877-026-01441-z","url":null,"abstract":"<p><strong>Background: </strong>Hypothermia is common in trauma patients and related to increased mortality; therefore, monitoring of core temperature is important. Conventional measuring methods have limitations in trauma setting. The 3 M™ Bair Hugger™ Temperature Monitoring System provides noninvasive zero-heat-flux temperature but has not been evaluated in trauma patients.</p><p><strong>Methods: </strong>This retrospective study included trauma patients who were monitored with esophageal and ZHF temperature monitoring during operating room resuscitation between January to October 2021 at a level I trauma center. Patients with severe facial or head trauma were excluded. Temperature data, automatically recorded every 5 min, were analyzed using Bland-Altman analysis and Lin's concordance correlation with correction for repeated measurement.</p><p><strong>Results: </strong>A total of 54 patients (mean Injury Severity Score 27.2 ± 14.8) and 1,737 paired measurements were analyzed. Mean bias was - 0.22 °C (95% limits of agreement [LOA], - 1.30 to 0.85 °C; p < 0.001), indicating that esophageal temperature was slightly lower than zero-heat-flux temperature. Lin's concordance correlation coefficient was 0.759 (95% CI, 0.674-0.825), showing moderate agreement. After excluding hypothermic values (< 34 °C), 1,591 paired measurements remained. Bias was - 0.23 ± 0.45 °C (95% LOA, - 1.11 to 0.65 °C), and concordance improved to 0.846 (95% CI, 0.716-0.864).</p><p><strong>Conclusion: </strong>Zeto-heat-flux temperature measured by the 3 M Bair Hugger system shows moderate agreement with esophageal temperature, with improved precision when extreme hypothermia is excluded. Although not interchangeable, it may serve as a safe, noninvasive option for trend monitoring in emergency trauma surgery.</p><p><strong>Trial registration: </strong>NCT05770830 (ClinicalTrials.gov).</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":"867-873"},"PeriodicalIF":2.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13391676/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838358","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":"Short-term modulations in cardiopulmonary bypass flow enhance urine output: ancillary analysis of the FLOWMAPCA trial.","authors":"Olivier Desebbe, Melab Djoulene, Lila Delmotte, Joseph Ngola, Bertrand Delannoy, Alexandre Joosten","doi":"10.1007/s10877-026-01414-2","DOIUrl":"10.1007/s10877-026-01414-2","url":null,"abstract":"","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":"957-958"},"PeriodicalIF":2.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13391441/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146113390","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":"Dynamic response of optic nerve sheath diameter to PaCO₂ fluctuations: A prospective clinical monitoring study of the lung-brain axis.","authors":"Büşra Pekince, Yeşim Şerife Bayraktar, Yasemin Cebeci, Dilara Cari Güngör, Jale Bengi Çelik","doi":"10.1007/s10877-026-01447-7","DOIUrl":"10.1007/s10877-026-01447-7","url":null,"abstract":"<p><p>This study aimed to compare optic nerve sheath diameter (ONSD) measurements obtained during hypercapnic and normocapnic periods in mechanically ventilated patients and to describe changes in ONSD in relation to ventilation-associated carbon dioxide levels. The study included sixty intubated patients admitted to the intensive care unit with a diagnosis of pneumonia and who underwent mechanical ventilation. ONSD measurements were performed during periods of hypercapnia identified during routine monitoring. After adjustment of ventilator settings, arterial blood gas analysis (ABG) was obtained one hour later, and ONSD measurements were repeated when normocapnia was achieved. The mean age of the patients was 61.6 ± 17.9 years. During the hypercapnic period, the mean ONSD (average of both eyes) was 4.88 ± 0.31 mm. Following the achievement of normocapnia, the mean ONSD decreased significantly to 4.61 ± 0.24 mm (p < 0.001). Furthermore, a significant positive correlation was found between the change (∆) in PaCO₂ and the reduction in mean ONSD (r = 0.538, p < 0.001). ONSD measurements differed significantly between hypercapnic and normocapnic periods defined by PaCO₂ levels. These findings suggest that ONSD may reflect physiological responses across different ventilatory CO₂ states.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":"897-904"},"PeriodicalIF":2.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13391803/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148138050","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":"Augmented reality for ultrasound-guided venipuncture: a pilot study on a simulated vascular access model.","authors":"Cosimo Aliani, Alberto Morelli, Simona Cristina Aiello, Fulvio Pinelli, Gianluca Villa, Stefano Romagnoli, Leonardo Bocchi","doi":"10.1007/s10877-026-01437-9","DOIUrl":"10.1007/s10877-026-01437-9","url":null,"abstract":"<p><p>To evaluate the feasibility of a low-cost augmented reality (AR) workflow for ultrasound-guided venipuncture and whether AR visualisation is non-inferior to conventional monitor guidance in total procedure time while improving user experience. Real-time ultrasound video from a conventional scanner was captured via an HDMI-to-USB device, pre-processed with a Python/OpenCV pipeline, and streamed over Wi-Fi to a HoloLens 2 headset using WebSocket. A turkey-thigh model with an embedded fluid-filled catheter simulated a peripheral vein. One experienced implantation nurse performed 58 venipuncture attempts with standard monitor guidance and 58 with AR (monitor blanked during AR). Total procedure time (TPT) was recorded for each attempt, and a questionnaire assessed perceived difficulty, image quality, usability, reliability, and ergonomic comfort. With all data included, overall TPT was comparable between standard and AR guidance ([Formula: see text] s vs. [Formula: see text] s; [Formula: see text]). After excluding predefined outliers, overall TPT remained non-significantly lower with AR ([Formula: see text] s vs. [Formula: see text] s; [Formula: see text]); on day 2 the p-value decreased to 0.103 ([Formula: see text] s vs. [Formula: see text] s). Questionnaire responses favoured AR for gaze continuity, perceived coordination, usability, and ergonomic comfort, with acceptable image quality. AR-assisted ultrasound-guided venipuncture was feasible and did not add measurable temporal overhead for an expert operator, while improving perceived ergonomics. Larger, multi-operator clinical studies are needed to confirm performance effects and clinical impact.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":"917-922"},"PeriodicalIF":2.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13391783/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147690490","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":"Regional tissue perfusion index (RTPI): a new optical-based metric for quantifying regional tissue perfusion.","authors":"Babak Shadgan, Iman Amani Tehrani, Sadra Khosravi, Zahra Askari, Amir Parham Pirhadi Rad, Ali Bashashati","doi":"10.1007/s10877-026-01424-0","DOIUrl":"10.1007/s10877-026-01424-0","url":null,"abstract":"","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":"785-807"},"PeriodicalIF":2.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13391701/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147284030","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}