Journal of Clinical Monitoring and Computing最新文献

{"title":"Personalized intraoperative arterial pressure management and mitochondrial oxygen tension in patients having major non-cardiac surgery: a pilot substudy of the IMPROVE trial.","authors":"Moritz Flick, Christina Vokuhl, Alina Bergholz, Kristina Boutchkova, Julia Y Nicklas, Bernd Saugel","doi":"10.1007/s10877-024-01260-0","DOIUrl":"https://doi.org/10.1007/s10877-024-01260-0","url":null,"abstract":"<p><p>The \"Cellular Oxygen METabolism\" (COMET) system (Photonics Healthcare, Utrecht, The Netherlands) non-invasively measures mitochondrial oxygen tension (mitoPO₂) in the skin. The effects of general anesthesia and major non-cardiac surgery on mitoPO₂ remain unknown. In this pre-planned pilot substudy of the \"Intraoperative blood pressure Management based on the individual blood PRessure profile: impact on postOperatiVE organ function\" (IMPROVE) trial, we measured mitoPO₂ from induction of general anesthesia until the end of surgery in 19 major non-cardiac surgery patients (10 assigned to personalized and 9 to routine intraoperative arterial pressure management). In the overall cohort, the median (25th to 75th percentile) preoperative awake mitoPO₂ was 63 (53 to 82) mmHg and mitoPO₂ after induction of general anesthesia was 42 (35 to 59) mmHg. The intraoperative average mitoPO₂ was 39 (30 to 50) mmHg. Thirteen patients (68%) had intraoperative mitoPO₂ values below 20 mmHg and the median percentage of surgical time with mitoPO₂ < 20 mmHg was 17 (0 to 31)%. MitoPO₂ was weakly correlated with mean arterial pressure (repeated measures correlation (r_rm(n); r_rm(984) = 0.26, 95% confidence interval 0.20 to 0.32; P < 0.001), but not meaningfully with heart rate (r_rm(984) = -0.05, 95% confidence interval -0.11 to 0.01; P = 0.117). There was no important difference in intraoperative average mitoPO₂ between patients assigned to personalized or to routine intraoperative arterial pressure management (P = 0.653). MitoPO₂ under general anesthesia was about a quarter lower than preoperative awake mitoPO₂, substantially fluctuated during major non-cardiac surgery, and transiently decreased below 20 mmHg in about two-thirds of the patients. Personalized - compared to routine - intraoperative arterial pressure management did not increase intraoperative mitoPO₂. Whether intraoperative decreases in mitoPO₂ are clinically meaningful warrants further investigation.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143370833","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":"Reversal of neuromuscular block with neostigmine and sugammadex: a retrospective cohort study in two centers using different types of neuromuscular monitoring.","authors":"Cyrus Motamed, Bernard Trillat, Marc Fischler, Morgan le Guen, Jean Louis Bourgain","doi":"10.1007/s10877-024-01192-9","DOIUrl":"10.1007/s10877-024-01192-9","url":null,"abstract":"<p><p>This bicentric retrospective cohort study evaluates reversal of muscle relaxation in real life achieved either by neostigmine or sugammadex in two hospitals using different types of neuromuscular monitoring (acceleromyography and kinemyography). The research question concerns compliance with recommendations. Patients who underwent an abdominal surgery under general anesthesia in the period from January 2017 through December 2020 with a neuromuscular block with rocuronium were included in the study. Data were extracted from the Centricity anesthesia information management system. In total, 2242 patients were assessed: 459 in center 1 (61 having received neostigmine and 398 sugammadex) and 1783 in center 2 (531 and 1252, respectively). Patients' characteristics differed between centers, with more high-risk patients in center 1. The mean train-of-four (TOF) ratio after supramaximal current determination (supramaximal threshold) was higher in center 1 (p < 0.001). Most patients received neostigmine while the TOF ratio was < 40% (68.6% in center 1 and 62.4% in center 2), while extubation was performed while the TOF ratio was > 90% in 61.0% in center 1 and in 32.1% in center 2 (p < 0.001). Patients received sugammadex irrespective of the number of responses to TOF before reversal, and extubation was performed while the TOF ratio was > 90% in 85.0% in center 1 and in 53.6% in center 2 (p < 0.001). No side effect was encountered. Despite guidelines for the TOF ratio before extubation, recommendations were not adequately respected and more vigilance is mandatory. The TOF test before use gave values that were 100% far apart with an underestimation with acceleromyography and an overestimation using kinemyography.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":"141-148"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141731249","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":"ASNM intraoperative SSEP position statement.","authors":"David Allison","doi":"10.1007/s10877-024-01213-7","DOIUrl":"10.1007/s10877-024-01213-7","url":null,"abstract":"","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":"257-258"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142288324","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":"Practical prognostic tools to predict the risk of postoperative delirium in older patients undergoing cardiac surgery: visual and dynamic nomograms.","authors":"Chernor Sulaiman Bah, Bongani Mbambara, Xianhai Xie, Junlin Li, Asha Khatib Iddi, Chen Chen, Hui Jiang, Yue Feng, Yi Zhong, Xinlong Zhang, Huaming Xia, Libo Yan, Yanna Si, Juan Zhang, Jianjun Zou","doi":"10.1007/s10877-024-01219-1","DOIUrl":"10.1007/s10877-024-01219-1","url":null,"abstract":"<p><strong>Purpose: </strong>Postoperative Delirium (POD) has an incidence of up to 65% in older patients undergoing cardiac surgery. We aimed to develop two dynamic nomograms to predict the risk of POD in older patients undergoing cardiac surgery.</p><p><strong>Methods: </strong>This was a single-center retrospective cohort study, which included 531 older patients who underwent cardiac surgery from July 2021 to June 2022 at Nanjing First Hospital, China. Univariable and multivariable logistic regression were used to identify the significant predictors used when constructing the models. We evaluated the performances and accuracy, validated, and estimated the clinical utility and net benefit of the models using the receiver operating characteristic (ROC), the 10-fold cross-validation, and decision curve analysis (DCA).</p><p><strong>Results: </strong>A total of 30% of the patients developed POD, the significant predictors in the preoperative model were ASA ( p < 0.001 OR = 3.220), cerebrovascular disease (p < 0.001 OR = 2.326), Alb (p < 0.037 OR = 0.946), and URE (p < 0.001 OR = 1.137), while for the postoperative model they were ASA (p = 0.044, OR = 1.737), preoperative MMSE score (p = 0.005, OR = 0.782), URE (p = 0.017 OR = 1.092), CPB duration (p < 0.001 OR = 1.010) and APACHE II (p < 0.001, OR = 1.353). The preoperative and postoperative models achieved satisfactory predictive performances, with AUC values of 0.731 and 0.799, respectively. The web calculators can be accessed at https://xxh152.shinyapps.io/Pre-POD/ and https://xxh152.shinyapps.io/Post-POD/ .</p><p><strong>Conclusion: </strong>We established two nomogram models based on the preoperative and postoperative time points to predict POD risk and guide the flexible implementation of possible interventions at different time points.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":"11-24"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142288326","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":"Understanding fluid dynamics and renal perfusion in acute kidney injury management.","authors":"Antonio Messina, Marta Calatroni, Gianluca Castellani, Silvia De Rosa, Marlies Ostermann, Maurizio Cecconi","doi":"10.1007/s10877-024-01209-3","DOIUrl":"10.1007/s10877-024-01209-3","url":null,"abstract":"<p><p>Acute kidney injury (AKI) is associated with an increased risk of morbidity, mortality, and healthcare expenditure, posing a major challenge in clinical practice, and affecting about 50% of patients in the intensive care unit (ICU), particularly the elderly and those with pre-existing chronic comorbidities. In health, intra-renal blood flow is maintained and auto-regulated within a wide range of renal perfusion pressures (60-100 mmHg), mediated predominantly through changes in pre-glomerular vascular tone of the afferent arteriole in response to changes of the intratubular NaCl concentration, i.e. tubuloglomerular feedback. Several neurohormonal processes contribute to regulation of the renal microcirculation, including the sympathetic nervous system, vasodilators such as nitric oxide and prostaglandin E2, and vasoconstrictors such as endothelin, angiotensin II and adenosine. The most common risk factors for AKI include volume depletion, haemodynamic instability, inflammation, nephrotoxic exposure and mitochondrial dysfunction. Fluid management is an essential component of AKI prevention and management. While traditional approaches emphasize fluid resuscitation to ensure renal perfusion, recent evidence urges caution against excessive fluid administration, given AKI patients' susceptibility to volume overload. This review examines the main characteristics of AKI in ICU patients and provides guidance on fluid management, use of biomarkers, and pharmacological strategies.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":"73-83"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142093219","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":"Pump-driven clinical infusions: laboratory comparison of pump types, fluid composition and flow rates on model drug delivery applying a new quantitative tool, the pharmacokinetic coefficient of short-term variation (PK-CV).","authors":"Anders Steen Knudsen, David E Arney, Robert D Butterfield, Nathaniel M Sims, Vineeth Chandran Suja, Robert A Peterfreund","doi":"10.1007/s10877-024-01200-y","DOIUrl":"10.1007/s10877-024-01200-y","url":null,"abstract":"<p><p>Critically ill or anesthetized patients commonly receive pump-driven intravenous infusions of potent, fast-acting, short half-life medications for managing hemodynamics. Stepwise dosing, e.g. over 3-5 min, adjusts physiologic responses. Flow rates range from < 0.1 to > 30 ml/h, depending on pump type (large volume, syringe) and drug concentration. Most drugs are formulated in aqueous solutions. Hydrophobic drugs are formulated as lipid emulsions. Do the physical and chemical properties of emulsions impact delivery compared to aqueous solutions? Does stepwise dose titration by the pump correlate with predicted plasma concentrations? Precise, gravimetric, flow rate measurement compared delivery of a 20% lipid emulsion (LE) and 0.9% saline (NS) using different pump types and flow rates. We measured stepwise delivery and then computed predicted plasma concentrations following stepwise dose titration. We measured the pharmacokinetic coefficient of short-term variation, (PK-CV), to assess pump performance. LE and NS had similar mean flow rates in stepwise rate increments and decrements between 0.5 and 32 ml/h and continuous flows 0.5 and 5 ml/h. Pharmacokinetic computation predictions suggest delayed achievement of intended plasma levels following dose titrations. Syringe pumps exhibited smaller variations in PK-CV than large volume pumps. Pump-driven deliveries of lipid emulsion and aqueous solution behave similarly. At low flow rates we observed large flow rate variability differences between pump types showing they may not be interchangeable. PK-CV analysis provides a quantitative tool to assess infusion pump performance. Drug plasma concentrations may lag behind intent of pump dose titration.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":"217-232"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142288327","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 review of machine learning methods for non-invasive blood pressure estimation.","authors":"Ravi Pal, Joshua Le, Akos Rudas, Jeffrey N Chiang, Tiffany Williams, Brenton Alexander, Alexandre Joosten, Maxime Cannesson","doi":"10.1007/s10877-024-01221-7","DOIUrl":"10.1007/s10877-024-01221-7","url":null,"abstract":"<p><p>Blood pressure is a very important clinical measurement, offering valuable insights into the hemodynamic status of patients. Regular monitoring is crucial for early detection, prevention, and treatment of conditions like hypotension and hypertension, both of which increasing morbidity for a wide variety of reasons. This monitoring can be done either invasively or non-invasively and intermittently vs. continuously. An invasive method is considered the gold standard and provides continuous measurement, but it carries higher risks of complications such as infection, bleeding, and thrombosis. Non-invasive techniques, in contrast, reduce these risks and can provide intermittent or continuous blood pressure readings. This review explores modern machine learning-based non-invasive methods for blood pressure estimation, discussing their advantages, limitations, and clinical relevance.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":"95-106"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142288322","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":"Analysis of perioperative autonomic nervous system activity to visualize stress in pediatric patients undergoing alveolar bone graft surgery.","authors":"Akari Uto, Kaoru Yamashita, Shusei Yoshimine, Minako Uchino, Toshiro Kibe, Mitsutaka Sugimura","doi":"10.1007/s10877-024-01210-w","DOIUrl":"10.1007/s10877-024-01210-w","url":null,"abstract":"<p><p>Perioperative stress in pediatric patients is often difficult to assess via interviews; thus, an objective measure to assess perioperative stress is needed. To visualize perioperative stress, we observed autonomic nervous system (ANS) activity, circulatory dynamics, and psychological status in pediatric patients undergoing alveolar bone grafting under general anesthesia. This prospective observational study included 40 patients aged 8-12 years who were scheduled for alveolar bone grafting in our hospital. ANS activity was analyzed using heart rate variability the day before surgery, during general anesthesia, 2 h postoperatively, 24 h postoperatively, and the day before discharge. ANS assessment included LF/HF (sympathetic nervous system activity) and HF (parasympathetic nervous system activity). Additionally, heart rate (HR), systolic blood pressure (SBP), face scale (FS) score were recorded. Data from 31 patients, excluding dropouts, were analyzed. The ratio of change to the preoperative value was compared. After surgery, the LF/HF, HR, SBP, and FS score significantly increased (P < 0.01) and HF significantly decreased (2 h postoperatively: P < 0.05, 24 h postoperatively, before discharge: P < 0.01). SBP recovered to preoperative values 24 h postoperatively, and HR and FS scores recovered to preoperative values before discharge. However, even before discharge, LF/HF remained significantly higher than preoperative values, and HF remained significantly lower than preoperative values (P < 0.01). Conclusion We observed perioperative stress from multiple perspectives. Circulatory dynamics and psychological status recovered by the day before discharge; however, ANS activity did not. Therefore, evaluating ANS activity may be useful in visualizing potential perioperative stress in pediatric patients.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":"45-52"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11821712/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142017677","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":"Forecasting intraoperative hypotension during hepatobiliary surgery.","authors":"Juan P Cata, Bhavin Soni, Shreyas Bhavsar, Parvathy Sudhir Pillai, Tatiana A Rypinski, Anshuj Deva, Jeffrey H Siewerdsen, Jose M Soliz","doi":"10.1007/s10877-024-01223-5","DOIUrl":"10.1007/s10877-024-01223-5","url":null,"abstract":"<p><p>Prediction and avoidance of intraoperative hypotension (IOH) can lead to less postoperative morbidity. Machine learning (ML) is increasingly being applied to predict IOH. We hypothesize that incorporating demographic and physiological features in an ML model will improve the performance of IOH prediction. In addition, we added a \"dial\" feature to alter prediction performance. An ML prediction model was built based on a multivariate random forest (RF) trained algorithm using 13 physiologic time series and patient demographic data (age, sex, and BMI) for adult patients undergoing hepatobiliary surgery. A novel implementation was developed with an adjustable, multi-model voting (MMV) approach to improve performance in the challenging context of a dynamic, sliding window for which the propensity of data is normal (negative for IOH). The study cohort included 85% of subjects exhibiting at least one IOH event. Males constituted 70% of the cohort, median age was 55.8 years, and median BMI was 27.7. The multivariate model yielded average AUC = 0.97 in the static context of a single prediction made up to 8 min before a possible IOH event, and it outperformed a univariate model based on MAP-only (average AUC = 0.83). The MMV model demonstrated AUC = 0.96, PPV = 0.89, and NPV = 0.98 within the challenging context of a dynamic sliding window across 40 min prior to a possible IOH event. We present a novel ML model to predict IOH with a distinctive \"dial\" on sensitivity and specificity to predict first IOH episode during liver resection surgeries.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":"107-118"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11821686/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142347645","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":"Wearable devices as part of postoperative early warning score systems: a scoping review.","authors":"E G Bignami, M Panizzi, F Bezzi, M Mion, M Bagnoli, V Bellini","doi":"10.1007/s10877-024-01224-4","DOIUrl":"10.1007/s10877-024-01224-4","url":null,"abstract":"<p><p>Postoperative deterioration is often preceded by abnormalities in vital parameters, but limited resources prevent their continuous monitoring in patients with no indication to ICU admission. The development of new technologies allowed the introduction of wearable devices (WDs), enabling the possibility of postoperative monitoring in surgical wards. We performed a Scoping Review to determine the current use of wearable devices as part of Continuous Remote Early Warning Score (CREWS) systems and their efficiency during postoperative period. This Scoping Review was conducted according to PRISMA-ScR guidelines. PICO framework was used before the search to define the review protocol. Systematic literature research has been performed on PubMed, MeSH, MEDLINE and Embase, considering a period between 2018 and February 2024. Prospective and retrospective studies involving patients undergoing cardiac and non-cardiac surgery are included. A total of 10 articles were included in the review. 11 different CE/FDA approved wearable devices were used in the studies analyzed. In all studies the WDs were applied the day of the surgery. The use of WDs as part of CREWS systems is feasible and safe. Furthermore, with the aid of other technologies (LoRa and Artificial Intelligence), they shorten Length of Stay (LOS) and reduce the number of ICU admissions with a reduction in healthcare costs. Continuous monitoring in surgical departments can facilitate the correct and timely identification of postoperative complications. This article is a starting point for the development of new protocols and for the application of these monitoring systems in clinical practice.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":"233-244"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11821718/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142390932","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}