Journal of Clinical Monitoring and Computing最新文献

{"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":"https://doi.org/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":""},"PeriodicalIF":2.0,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraoperative use of processed electroencephalogram in a quaternary center: a quality improvement audit.","authors":"Zahra Moaiyeri, Jumana Mustafa, Massimo Lamperti, Francisco A Lobo","doi":"10.1007/s10877-024-01189-4","DOIUrl":"10.1007/s10877-024-01189-4","url":null,"abstract":"<p><p>Although intraoperative electroencephalography (EEG) is not consensual among anesthesiologists, growing evidence supports its use to titrate anesthetic drugs, assess the level of arousal/consciousness, and detect ischemic cerebrovascular events; in addition, intraoperative EEG monitoring may decrease the incidence of postoperative neurocognitive disorders. Based on the known and potential benefits of intraoperative EEG monitoring, an educational program dedicated to staff anesthesiologists, residents of Anesthesiology and anesthesia technicians was started at Cleveland Clinic Abu Dhabi in May 2022 and completed in June 2022, aiming to have all patients undergoing general anesthesia with adequate brain monitoring and following international initiatives promoting perioperative brain health. All the surgical cases performed under General Anesthesia at 24 daily locations were prospectively inspected during 15 consecutive working days in March 2023. The use or absence of a processed EEG monitor was registered. Of 379 surgical cases distributed by 24 locations under General Anesthesia, 233 cases (61%) had processed EEG monitoring. The specialty with the highest use of EEG monitoring was Cardiothoracic Surgery, with 100% of cases, followed by interventional Cardiology (90%) and Vascular Surgery (75%). Otorhinolaryngology (29%), Gastrointestinal Endoscopy (25%), and Interventional Pulmonology (20%) were the areas with the lowest use of EEG monitoring. Of note, in the Neuroradiology suite, no processed EEG monitor was used in cases under General Anesthesia. We identified a reasonable use of EEG monitoring during general anesthesia, unfortunately not reaching our target of 100%. The educational and support program previously implemented within the Anesthesiology Institute needs to be continued and improved, including workshops, online discussions, and journal club sessions, to increase the use of EEG monitoring in underused areas.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":"1263-1268"},"PeriodicalIF":2.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141426989","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":"Post-anesthesia care unit hypotension in low-risk patients recovering from non-cardiac surgery: a prospective observational study.","authors":"Moritz Flick, Anneke Lohr, Friederike Weidemann, Ashkan Naebian, Phillip Hoppe, Kristen K Thomsen, Linda Krause, Karim Kouz, Bernd Saugel","doi":"10.1007/s10877-024-01176-9","DOIUrl":"10.1007/s10877-024-01176-9","url":null,"abstract":"<p><p>Intraoperative hypotension is common and associated with organ injury. Hypotension can not only occur during surgery, but also thereafter. After surgery, most patients are treated in post-anesthesia care units (PACU). The incidence of PACU hypotension is largely unknown - presumably in part because arterial pressure is usually monitored intermittently in PACU patients. We therefore aimed to evaluate the incidence, duration, and severity of PACU hypotension in low-risk patients recovering from non-cardiac surgery. In this observational study, we performed blinded continuous non-invasive arterial pressure monitoring with finger-cuffs (ClearSight system; Edwards Lifesciences, Irvine, CA, USA) in 100 patients recovering from non-cardiac surgery in the PACU. We defined PACU hypotension as a mean arterial pressure (MAP) < 65 mmHg. Patients had continuous finger-cuff monitoring for a median (25th percentile, 75th percentile) of 64 (44 to 91) minutes. Only three patients (3%) had PACU hypotension for at least one consecutive minute. These three patients had 4, 4, and 2 cumulative minutes of PACU hypotension; areas under a MAP of 65 mmHg of 17, 9, and 9 mmHg x minute; and time-weighted averages MAP less than 65 mmHg of 0.5, 0.3, and 0.2 mmHg. The median volume of crystalloid fluid patients were given during PACU treatment was 200 (100 to 400) ml. None was given colloids or a vasopressor during PACU treatment. In low-risk patients recovering from non-cardiac surgery, the incidence of PACU hypotension was very low and the few episodes of PACU hypotension were short and of modest severity.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":"1331-1336"},"PeriodicalIF":2.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11604811/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140957727","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":"Effects of hand catalepsy on subjective trance perception and relative parasympathetic tone in healthy volunteers during pleasant hypnotic session: a randomized controlled study.","authors":"E Boselli, S Radoykov, X Paqueron, C Virot","doi":"10.1007/s10877-024-01178-7","DOIUrl":"10.1007/s10877-024-01178-7","url":null,"abstract":"<p><p>This study was designed to evaluate the effects on hand catalepsy on parasympathetic tone assessed using Analgesia/Nociception Index (ANI) and on subjective rating of absorption, dissociation, and time perception among healthy volunteers. This was a randomized controlled trial including participants to a medical hypnosis congress in France. Ninety volunteers were randomized in two arms, all receiving a fifteen-minute positive hypnotic trance, with or without hand catalepsy. The relative parasympathetic tone assessed by ANI (Analgesia/Nociception Index), heart rate and respiratory rate were recorded at different times of the study protocol. The actual duration of the hypnotic session, calculated from eye closing to eye opening, was also recorded. At the end of the hypnotic trance, participants subjectively rated their level of absorption and dissociation on a 0-10 scale. They were also asked to estimate the duration of the hypnotic session from eye closing to eye opening. In total, ninety subjects were included in the study. One subject was excluded because of deviation in the protocol standard, leaving eighty-nine subjects for analysis. Subject characteristics were similar between groups. There was a statistically different increase in ANI and decrease in both heart rate and respiratory rate over time with no difference with or without hand catalepsy. There was no statistically significant difference in absorption and dissociation subjective scales between groups. The median [Q1-Q3] actual duration of hypnotic sessions was similar between the catalepsy and the control groups (9 [8-10] min vs. 8 [7-10] min, respectively). However, subjects in the catalepsy group estimated a longer duration of the hypnotic session (12 [10-15] min) than in the control group (10 [5-10] min) with a mean ± SD overestimation of 3 ± 4 min (p < 0.001). Parasympathetic comfort increased during the hypnotic trance with no difference between groups. However, adding hand catalepsy to a pleasant hypnotic trance did not appear to increase feelings of absorption or dissociation but created time distortion on the longer side that could be useful in some clinical settings. Nevertheless, further study is still needed to determine more precisely the physiological and psychological effects on hand catalepsy during the hypnotic trance.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":"1291-1296"},"PeriodicalIF":2.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141174234","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":"Comparing the compensatory reserve metric obtained from invasive arterial measurements and photoplethysmographic volume-clamp during simulated hemorrhage.","authors":"Kevin L Webb, Wyatt W Pruter, Ruth J Poole, Robert W Techentin, Christopher P Johnson, Riley J Regimbal, Kaylah J Berndt, David R Holmes, Clifton R Haider, Michael J Joyner, Victor A Convertino, Chad C Wiggins, Timothy B Curry","doi":"10.1007/s10877-024-01166-x","DOIUrl":"10.1007/s10877-024-01166-x","url":null,"abstract":"<p><strong>Purpose: </strong>The compensatory reserve metric (CRM) is a novel tool to predict cardiovascular decompensation during hemorrhage. The CRM is traditionally computed using waveforms obtained from photoplethysmographic volume-clamp (PPG_VC), yet invasive arterial pressures may be uniquely available. We aimed to examine the level of agreement of CRM values computed from invasive arterial-derived waveforms and values computed from PPG_VC-derived waveforms.</p><p><strong>Methods: </strong>Sixty-nine participants underwent graded lower body negative pressure to simulate hemorrhage. Waveform measurements from a brachial arterial catheter and PPG_VC finger-cuff were collected. A PPG_VC brachial waveform was reconstructed from the PPG_VC finger waveform. Thereafter, CRM values were computed using a deep one-dimensional convolutional neural network for each of the following source waveforms; (1) invasive arterial, (2) PPG_VC brachial, and (3) PPG_VC finger. Bland-Altman analyses were used to determine the level of agreement between invasive arterial CRM values and PPG_VC CRM values, with results presented as the Mean Bias [95% Limits of Agreement].</p><p><strong>Results: </strong>The mean bias between invasive arterial- and PPG_VC brachial CRM values at rest, an applied pressure of -45mmHg, and at tolerance was 6% [-17%, 29%], 1% [-28%, 30%], and 0% [-25%, 25%], respectively. Additionally, the mean bias between invasive arterial- and PPG_VC finger CRM values at rest, applied pressure of -45mmHg, and tolerance was 2% [-22%, 26%], 8% [-19%, 35%], and 5% [-15%, 25%], respectively.</p><p><strong>Conclusion: </strong>There is generally good agreement between CRM values obtained from invasive arterial waveforms and values obtained from PPG_VC waveforms. Invasive arterial waveforms may serve as an alternative for computation of the CRM.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":"1337-1346"},"PeriodicalIF":2.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140908908","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":"Associations between intraoperative nociceptive response index and early postoperative acute kidney injury in patients undergoing non-cardiac surgery under general anesthesia: a single-center retrospective cohort study.","authors":"Mayuu Kobata, Kazunori Miyamoto, Shohei Ooba, Ayano Saeki, Hiroai Okutani, Ryusuke Ueki, Nobutaka Kariya, Munetaka Hirose","doi":"10.1007/s10877-024-01184-9","DOIUrl":"10.1007/s10877-024-01184-9","url":null,"abstract":"<p><p>Both tissue hypoperfusion and elevated surgical stress during surgery are involved in the pathogenesis of postoperative acute kidney injury (AKI). Although intraoperative hypotension, which evokes renal hypoperfusion, has been reported to be associated with the development of postoperative AKI, there is no consensus on the association between surgical stress responses (e.g., hypertension and inflammation) and postoperative AKI. Given that intraoperative values of nociceptive response (NR) index are reportedly associated with surgical stress responses, the present study was performed to assess associations between intraoperative NR index and postoperative AKI in patients undergoing non-cardiac surgery. In this single-institutional retrospective cohort study, data of the highest and lowest values of NR index during surgery were obtained in consecutive adult patients undergoing non-cardiac surgery under general anesthesia from February 2022 to August 2023. Data on highest and lowest mean blood pressure (MBP) during surgery were also obtained. In 5,765 patients enrolled, multivariate regression analysis revealed that the development of early postoperative AKI was significantly associated with highest NR during surgery ≥ 0.920, lowest MBP during surgery < 54 mmHg, age ≥ 48 years, male sex, ASA-PS ≥ III, emergency, and duration of surgery ≥ 226 min. In addition to intraoperative hypotension, a higher level of intraoperative NR index is likely associated with higher incidence of early postoperative AKI in adult patients undergoing non-cardiac surgery under general anesthesia.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":"1297-1304"},"PeriodicalIF":2.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141283868","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":"Beyond the debut: unpacking six years of Hypotension Prediction Index software in intraoperative hypotension prevention - a systematic review and meta-analysis.","authors":"Myrto A Pilakouta Depaskouale, Stela A Archonta, Dimitrios M Katsaros, Nikolaos A Paidakakos, Antonia N Dimakopoulou, Paraskevi K Matsota","doi":"10.1007/s10877-024-01202-w","DOIUrl":"10.1007/s10877-024-01202-w","url":null,"abstract":"<p><strong>Purpose: </strong>Intraoperative hypotension (IOH) during general anesthesia is associated with higher morbidity and mortality, although randomized trials have not established a causal relation. Historically, our approach to IOH has been reactive. The Hypotension Prediction Index (HPI) is a machine learning software that predicts hypotension minutes in advance. This systematic review and meta-analysis explores whether using HPI alongside a personalized treatment protocol decreases intraoperative hypotension.</p><p><strong>Methods: </strong>A systematic search was performed in Pubmed and Scopus to retrieve articles published from January 2018 to February 2024 regarding the impact of the HPI software on reducing IOH in adult patients undergoing non-cardio/thoracic surgery. Excluded were case series, case reports, meta-analyses, systematic reviews, and studies using non-invasive arterial waveform analysis. The risk of bias was assessed by the Cochrane risk-of-bias tool (RoB 2) and the Risk Of Bias In Non-randomised Studies (ROBINS-I). A meta-analysis was undertaken solely for outcomes where sufficient data were available from the included studies.</p><p><strong>Results: </strong>9 RCTs and 5 cohort studies were retrieved. The overall median differences between the HPI-guided and the control groups were - 0.21 (95% CI:-0.33, -0.09) - p < 0.001 for the Time-Weighted Average (TWA) of Mean Arterial Pressure (MAP) < 65mmHg, -3.71 (95% CI= -6.67, -0.74)-p = 0.014 for the incidence of hypotensive episodes per patient, and - 10.11 (95% CI= -15.82, -4.40)-p = 0.001 for the duration of hypotension. Notably a large amount of heterogeneity was detected among the studies.</p><p><strong>Conclusions: </strong>While the combination of HPI software with personalized treatment protocols may prevent intraoperative hypotension (IOH), the large heterogeneity among the studies and the lack of reliable data on its clinical significance necessitate further investigation.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":"1367-1377"},"PeriodicalIF":2.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141759064","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":"Imitating the respiratory activity of the brain stem by using artificial neural networks: exploratory study on an animal model of lactic acidosis and proof of concept.","authors":"Gaetano Perchiazzi, Rafael Kawati, Mariangela Pellegrini, Jasmine Liangpansakul, Roberto Colella, Paolo Bollella, Pramod Rangaiah, Annamaria Cannone, Deepthi Hulithala Venkataramana, Mauricio Perez, Sebastiano Stramaglia, Luisa Torsi, Roberto Bellotti, Robin Augustine","doi":"10.1007/s10877-024-01208-4","DOIUrl":"10.1007/s10877-024-01208-4","url":null,"abstract":"<p><p>Artificial neural networks (ANNs) are versatile tools capable of learning without prior knowledge. This study aims to evaluate whether ANN can calculate minute volume during spontaneous breathing after being trained using data from an animal model of metabolic acidosis. Data was collected from ten anesthetized, spontaneously breathing pigs divided randomly into two groups, one without dead space and the other with dead space at the beginning of the experiment. Each group underwent two equal sequences of pH lowering with pre-defined targets by continuous infusion of lactic acid. The inputs to ANNs were pH, ΔPaCO₂ (variation of the arterial partial pressure of CO₂), PaO₂, and blood temperature which were sampled from the animal model. The output was the delta minute volume (ΔV_M), (the change of minute volume as compared to the minute volume the animal had at the beginning of the experiment). The ANN performance was analyzed using mean squared error (MSE), linear regression, and the Bland-Altman (B-A) method. The animal experiment provided the necessary data to train the ANN. The best architecture of ANN had 17 intermediate neurons; the best performance of the finally trained ANN had a linear regression with R² of 0.99, an MSE of 0.001 [L/min], a B-A analysis with bias ± standard deviation of 0.006 ± 0.039 [L/min]. ANNs can accurately estimate ΔV_M using the same information that arrives at the respiratory centers. This performance makes them a promising component for the future development of closed-loop artificial ventilators.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":"1269-1280"},"PeriodicalIF":2.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11604730/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142004350","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":"Comparing the haemodynamic effects of high- and low-dose opioid anaesthesia: a secondary analysis of a randomised controlled trial.","authors":"O M Marges, J P Nieboer, I N de Keijzer, R Rettab, K van Amsterdam, T W L Scheeren, A R A Absalom, H E M Vereecke, M M R F Struys, J J Vos, J P van den Berg","doi":"10.1007/s10877-024-01195-6","DOIUrl":"10.1007/s10877-024-01195-6","url":null,"abstract":"<p><p>Post-induction hypotension (MAP < 65 mmHg) occurs frequently and is usually caused by the cardiovascular adverse effects of the anaesthetic induction drugs used. We hypothesize that a clinically significant difference in the incidence and severity of hypotension will be found when different doses of propofol and remifentanil are used for induction of anaesthesia.</p><p><strong>Methods: </strong>This is a secondary analysis of a randomised controlled trial wherein four groups (A-D) of patients received one out of four different combinations of propofol and remifentanil, titrated to a predicted equipotency in probability of tolerance to laryngoscopy (PTOL) according to the Bouillon interaction model. In group A, a high dose of propofol and a low dose of remifentanil was administered, and across the groups this ratio was gradually changed until it was reversed in group D. Mean and systolic arterial blood pressure (MAP, SAP) were compared at four time points (T_baseline, T_post-bolus, T_3min, T_nadir) within and between groups Heart rate, bispectral index (BIS) and the incidence of hypotension were compared.</p><p><strong>Results: </strong>Data from 76 patients was used. At T_post-bolus a statistically significant lower MAP and SAP was found in group A versus D (p = 0.011 and p = 0.002). A significant higher heart rate was found at T_3min and T_nadir between groups A and B when compared to groups C and D (p = < 0.001 and p = 0.002). A significant difference in BIS value was found over all groups at T_3min and T_nadir (both p < 0.001). All other outcomes did not differ significantly between groups.</p><p><strong>Conclusion: </strong>Induction of anaesthesia with different predicted equipotent combinations of propofol and remifentanil did result in statistically different but clinically irrelevant differences in haemodynamic endpoints during induction of anaesthesia. Our study could not identify preferable drug combinations that decrease the risk for hypotension after induction, although they all yield a similar predicted PTOL.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":"1347-1355"},"PeriodicalIF":2.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11604680/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141731118","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":"Prognostic value of heart rate variability for risk of serious adverse events in continuously monitored hospital patients.","authors":"Nikolaj Aagaard, Markus Harboe Olsen, Oliver Wiik Rasmussen, Katja K Grønbaek, Jesper Mølgaard, Camilla Haahr-Raunkjaer, Mikkel Elvekjaer, Eske K Aasvang, Christian S Meyhoff","doi":"10.1007/s10877-024-01193-8","DOIUrl":"10.1007/s10877-024-01193-8","url":null,"abstract":"<p><p>Technological advances allow continuous vital sign monitoring at the general ward, but traditional vital signs alone may not predict serious adverse events (SAE). This study investigated continuous heart rate variability (HRV) monitoring's predictive value for SAEs in acute medical and major surgical patients. Data was collected from four prospective observational studies and two randomized controlled trials using a single-lead ECG. The primary outcome was any SAE, secondary outcomes included all-cause mortality and specific non-fatal SAE groups, all within 30 days. Subgroup analyses of medical and surgical patients were performed. The primary analysis compared the last 24 h preceding an SAE with the last 24 h of measurements in patients without an SAE. The area under a receiver operating characteristics curve (AUROC) quantified predictive performance, interpretated as low prognostic ability (0.5-0.7), moderate prognostic ability (0.7-0.9), or high prognostic ability (> 0.9). Of 1402 assessed patients, 923 were analysed, with 297 (32%) experiencing at least one SAE. The best performing threshold had an AUROC of 0.67 (95% confidence interval (CI) 0.63-0.71) for predicting cardiovascular SAEs. In the surgical subgroup, the best performing threshold had an AUROC of 0.70 (95% CI 0.60-0.81) for neurologic SAE prediction. In the medical subgroup, thresholds for all-cause mortality, cardiovascular, infectious, and neurologic SAEs had moderate prognostic ability, and the best performing threshold had an AUROC of 0.85 (95% CI 0.76-0.95) for predicting neurologic SAEs. Predicting SAEs based on the accumulated time below thresholds for individual continuously measured HRV parameters demonstrated overall low prognostic ability in high-risk hospitalized patients. Certain HRV thresholds had moderate prognostic ability for prediction of specific SAEs in the medical subgroup.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":"1315-1329"},"PeriodicalIF":2.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11604769/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142004378","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}