J Clin Monit Comput [JOURNAL]
Sun
200 papers
Clinical validation of video-based vital sign monitoring in the intensive care unit: a prospective cohort study : Clinical validation of video-based vital sign monitoring.
Cramer I, van Esch R, Verstappen C … +10 more , Kloeze C, Twisk J, Stuijk S, Bergmans J, Zinger S, De Bie Dekker A, van 't Veer M, Bouwman RA, Dekker L, Montenij L
J Clin Monit Comput · 2026 May · PMID 42126775 · Publisher ↗
PURPOSE: Video-based monitoring technologies enable continuous and contactless monitoring of vital signs. This study evaluates the clinical concordance and determinants of performance of contactless video-based heart and...
PURPOSE: Video-based monitoring technologies enable continuous and contactless monitoring of vital signs. This study evaluates the clinical concordance and determinants of performance of contactless video-based heart and respiratory rate monitoring compared with reference standards in a heterogeneous population of critically ill patients. METHODS: In this prospective observational study, 35 intensive care unit patients were continuously monitored for 24 h. Video-based heart rate and respiratory rate were compared with the clinical reference standard. Agreement was assessed using Bland-Altman plots, intraclass correlation coefficients (ICC), and error grid analyses. Generalized estimating equations (GEE) identified factors affecting agreement. RESULTS: For heart rate, bias was 2.1 bpm (limits - 33.6 to 37.7), with 81.9% within ± 5 bpm and 99.3% in error grid zones A/B. ICC was 0.43. For respiratory rate, bias was - 2.4 breaths/min (limits - 14.3 to 9.5), with 63.5% within ± 3 breaths and 87.5% in zones A/B. ICC was 0.41. High heart rate, atrial fibrillation, norepinephrine administration, and movement reduced agreement for heart rate; movement reduced agreement for respiratory rate. CONCLUSION: Video-based monitoring shows promise for detecting abnormal vital signs in critically ill patients, but improved robustness to motion is needed for reliable clinical implementation.
Clinical agreement and physiological relevance of the zero-heat-flux temperature measurement in trauma patients during operating room resuscitation.
Lee J, Ahn H, Sohn HM … +2 more , Song SH, Yi IK
J Clin Monit Comput · 2026 May · PMID 42101749 · Publisher ↗
BACKGROUND: 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™...
BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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. TRIAL REGISTRATION: NCT05770830 (ClinicalTrials.gov).
A temporal deep learning algorithm for prediction of extubation failures in critical care patients.
Shen J, Lu S, Wu Y … +6 more , Liu L, Wang Y, An Y, Zhu F, Tang B, Zhao H
J Clin Monit Comput · 2026 May · PMID 42095985 · Publisher ↗
Extubation failure in ICU patients is associated with poor outcomes. Existing prediction models often rely on static data, missing dynamic disease fluctuations. This study introduces TrAcE, a deep learning-based model in...
Extubation failure in ICU patients is associated with poor outcomes. Existing prediction models often rely on static data, missing dynamic disease fluctuations. This study introduces TrAcE, a deep learning-based model integrating static and temporal data for improved extubation failure prediction with explainable results. The model was trained and validated using MIMIC-III (Medical Information Mart for Intensive Care-III) data and tested on the LOCAL-Ext (a local database for extubation) dataset. A Transformer-based neural network with temporal fusion was used to screen extubation records (Patients planned for post-extubation non-invasive ventilation or tracheostomy were excluded). Model performance was assessed using AUROC (area under the receiver operating curve) and AUPRC (area under the precision recall curve). Explainability was ensured via Captum's occlusion method, identifying feature attributions at both population and individual levels. TrAcE's extubation timing was compared to the spontaneous breathing test (SBT) in LOCAL-Ext. From MIMIC-III, 5,895 patients (4,126 for training, 1,729 for validation) were selected. LOCAL-Ext included 6,765 test patients. TrAcE outperformed other models, achieving AUROCs of 0.823 (95% CI: 0.808-0.838) in validation and 0.859 (95% CI: 0.836-0.881) in testing, with favorable AUPRCs (0.734 and 0.757, respectively). Compared to SBT in LOCAL-Ext, TrAcE identified suitable extubation days earlier (4.32 [IQR 0-20] vs. 5.65 [IQR 0-23], p < 0.01). In the present study, we developed a deep learning model (TrAcE) for predicting extubation failure in critical care patients. This model can process both static and dynamic data, provides risk prediction and explainability in real-time. Furthermore, it demonstrated an advantage over SBT procedures in promptly identifying patients ready for extubation.
From prediction to practice: closing the translation gap in artificial intelligence for anesthesia.
Baliga J, Seshadri N
J Clin Monit Comput · 2026 Apr · PMID 42018224 · Publisher ↗
Artificial intelligence (AI) and machine learning (ML) techniques are rapidly advancing in anesthesiology, showing promise in patient monitoring, outcome prediction, clinical decision support, and automated drug delivery...
Artificial intelligence (AI) and machine learning (ML) techniques are rapidly advancing in anesthesiology, showing promise in patient monitoring, outcome prediction, clinical decision support, and automated drug delivery. However, a substantial gap remains between algorithmic capability and practical implementation at the bedside. This narrative review examines the current state of AI/ML applications in anesthesia, including predictive analytics, closed-loop control systems, AI-assisted imaging, workflow optimization, and anesthesia planning, and explores the translational barriers that have limited routine clinical adoption. We discuss technical, organizational, regulatory, and cultural challenges impeding translation, including data quality issues, EHR interoperability constraints, lack of outcome-oriented clinical evidence, business model uncertainty, interpretability concerns, alarm fatigue, and regulatory ambiguity. Strategies to close this gap are proposed, including rigorous prospective validation, interdisciplinary collaboration with industry and payers, post-deployment model surveillance, training data transparency, user-centered design, and implementation science principles. Ethical and legal considerations, encompassing algorithmic bias, accountability for autonomous AI recommendations, privacy beyond de-identification, and equitable access, are also reviewed. A conceptual framework, summary table of applications, and practical implementation checklist are provided. Bridging the translational divide is essential for AI to fulfill its potential in improving anesthesia care, and will require coordinated action from clinicians, researchers, technologists, regulators, and healthcare institutions.
The Anesthesia Preparedeness Clinic (APC) triage score tool: an integrated electronic health record tool for improving resource allocation for preoperative care clinics.
Meineke MN, Chien A, Mawdsley SW … +4 more , Meyer M, Park BH, Kim E, Gabriel RA
J Clin Monit Comput · 2026 Apr · PMID 41989525 · Publisher ↗
Pre-anesthesia clinics have been associated with improved patient outcomes, but with the rising surgical volume, there is a need to improve allocation of preoperative evaluations. We developed the Anesthesia Preparedenes...
Pre-anesthesia clinics have been associated with improved patient outcomes, but with the rising surgical volume, there is a need to improve allocation of preoperative evaluations. We developed the Anesthesia Preparedeness Clinic (APC) Triage Score tool that was integrated into the electronic health record system and calculated a score based on preoperative factors. It was used to allocate preoperative evaluations for patients to either in-person, telehealth, or nursing phone screens. A retrospective cohort analysis was performed compare how resources were allocated prior to and after implementation (Pre-APC and Post-APC, respectively). There were a total of 9,986 and 10,487 surgical patients included in the analysis in the Pre-APC and Post-APC cohorts, respectively. The correlation coefficient between the triage score and American Society of Anesthesiologists Physical Status (ASA PS) score based on Spearmen test was 0.59 (P < 0.001). The median (quartiles) APC Triage Score in patients who were ASA PS 1 was 0 (0, 1.5), ASA PS 2 was 3.0 (1.0, 6.0), ASA PS 3 was 9.5 (4.5, 17.0) and ASA PS 4 was 21.0 (11.5, 29.5). Patients that received an in-person visit tended to have higher APC Triage Scores in the Post-APC versus Pre-APC cohort with a median (quartiles) score of 17.0 (12.0, 25.5) versus 10.0 (6.0, 19.5), respectively (P < 0.001). Patients that received a telehealth visit tended to have higher APC Triage Scores in the Post-APC versus Pre-APC cohort with a median (quartiles) score of 8.0 (5.0, 13.5) versus 7.0 (3.5, 13.0), respectively (P < 0.001). Finally, patients that received a phone visit tended to have a lower APC Triage Score in the Post-APC versus Pre-APC cohorts with a median (quartiles) score of 3.0 (1.0, 7.0) versus 4.0 (1.0, 8.5), respectively (P < 0.001). Our study demonstrated that implementation of the tool was associated with improved preoperative allocations.
Intraoperative respiratory exchange ratio to predict complications after cardiopulmonary bypass surgery: a retrospective cohort study.
Riesemann S, Wachtendorf LJ, Braeuer BLP … +8 more , Sahli SD, Paschold BS, Tenge T, Marcus C, Santer P, Matyal R, Schaefer MS, Robitaille MJ
J Clin Monit Comput · 2026 Apr · PMID 41984141 · Publisher ↗
The respiratory exchange ratio (RER), defined as the ratio of carbon dioxide (CO2) production to oxygen (O2) consumption, may be a non-invasive and continuously measurable alternative to lactate for identifying patients...
The respiratory exchange ratio (RER), defined as the ratio of carbon dioxide (CO2) production to oxygen (O2) consumption, may be a non-invasive and continuously measurable alternative to lactate for identifying patients at risk of postoperative complications that has been examined in non-cardiac surgery. We investigated whether intraoperative RER predicts blood lactate levels and postoperative complications in cardiac surgery. This retrospective cohort study included adult patients undergoing cardiac surgery with cardiopulmonary bypass at Beth Israel Deaconess Medical Center in Boston, USA, between 2008 and 2020. Intraoperative minute-by-minute data of inspired and expired fractions of CO2 and O2 were analyzed. Univariable and a priori-defined multivariable logistic regression models were used to evaluate the association between the median RER during surgery, intraoperative lactate and 7-day major postoperative complications (European Perioperative Clinical Outcome Definitions). 324,646 RER calculations of 4,058 patients were included. 1,745 (43.0%) patients experienced 7-day postoperative complications. The median (IQR) RER was 0.64 (0.48–0.92) before and 0.65 (0.48–0.97) after bypass. The RER within 10 min prior to lactate testing was associated with lactate levels > 2 mmol/l (adjusted odds ratio [ORadj] 1.11, 95% confidence interval [CI] 1.01–1.23, p = 0.031). Neither RER before nor after bypass was associated with 7-day postoperative complications (before bypass: ORadj 1.02, 95%CI 0.95–1.10, p = 0.55; after bypass: ORadj 1.03, 95%CI 0.95–1.13, p = 0.46). While RER showed a modest relationship with hyperlactatemia, its utility as a predictor of postoperative complications appears limited in real-world data. Further research is needed to clarify its role and potential for clinical applicability.
Augmented reality for ultrasound-guided venipuncture: a pilot study on a simulated vascular access model.
Aliani C, Morelli A, Aiello SC … +4 more , Pinelli F, Villa G, Romagnoli S, Bocchi L
J Clin Monit Comput · 2026 Apr · PMID 41984140 · Publisher ↗
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 imp...
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.
Admixture of anesthetic drugs in the era of precision monitoring: a dangerous convenience.
Vacas S, Introna M, Lobo F
J Clin Monit Comput · 2026 Jun · PMID 41949684 · Full text
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Nociception index-monitored extubation is associated with improved hemodynamic stability and recovery efficiency in the post-anesthesia care unit: a single-center randomized controlled trial.
Qian Q, Zhou Y, Chou L … +6 more , Hu W, Cai W, Lin H, Wang Y, Chen L, Zhou P
J Clin Monit Comput · 2026 Apr · PMID 41926003 · Publisher ↗
Extubation in the post-anesthesia care unit (PACU) is a high-risk transition, frequently accompanied by hemodynamic fluctuations and respiratory events. Current practice relies mainly on subjective assessments and the bi...
Extubation in the post-anesthesia care unit (PACU) is a high-risk transition, frequently accompanied by hemodynamic fluctuations and respiratory events. Current practice relies mainly on subjective assessments and the bispectral index (BIS), which reflects cortical activity but not nociceptive responses. The electroencephalography-derived Nociception Index (NOX) may provide an objective measure of nociception–analgesia balance during extubation. This study aimed to evaluate whether NOX-monitored extubation improves hemodynamic stability and recovery efficiency in the PACU. In this single-center randomized controlled trial (July 2023–March 2025), 120 patients undergoing surgery with postoperative intubation were randomized to NOX-monitored extubation (n = 60) or standard monitoring (n = 60). Extubation criteria included consciousness, tidal volume ≥ 5 mL/kg, SpO₂ ≥90%, hemodynamic stability (SBP < 180 mmHg, HR < 100 bpm). Hemodynamic and respiratory parameters, extubation timing, PACU discharge time, and complications were compared between groups. Baseline characteristics were comparable except for higher hypertension prevalence in the NOX group (21.7% vs. 0%). At awakening, the NOX group showed attenuated blood-pressure responses (SBP − 7.3%, DBP − 9.0% vs. controls; both p < 0.05). PACU discharge was faster in the NOX group (median 27.5 vs. 50.5 min; p < 0.001; ≈42% reduction). However, greater heart-rate increases (+ 14.5 vs. + 7.4 bpm; p = 0.008) and oxygen desaturation (–2.28% vs. − 0.70%; p < 0.001) were observed. Complication rates were similar (11.7% vs. 18.3%; p = 0.306). NOX-monitored extubation improved hemodynamic stability and reduced PACU recovery time but was associated with paradoxical cardiorespiratory trade-offs. Larger multicenter trials are required to refine thresholds and validate its clinical utility.Clinical registration: The study was first posted on ChiCTR.org.cn on August 02, 2022, and the first research participant was enrolled on June 12, 2023.
Effects of remimazolam and propofol on parasympathetic activity during general anesthesia induction in patients with severe aortic stenosis: a randomized controlled trial utilizing high-frequency variability index.
Kotani T, Ida M, Naito Y … +2 more , Tanaka N, Kawaguchi M
J Clin Monit Comput · 2026 Apr · PMID 41926002 · Publisher ↗
In this study, we aimed to compare the effects of remimazolam and propofol on parasympathetic activity during general anesthesia induction in patients with severe aortic stenosis using heart rate variability (HRV) analys...
In this study, we aimed to compare the effects of remimazolam and propofol on parasympathetic activity during general anesthesia induction in patients with severe aortic stenosis using heart rate variability (HRV) analysis. In this single-center randomized controlled trial, 28 patients scheduled for elective transcatheter aortic valve replacement were assigned to receive either remimazolam or propofol for anesthesia induction at a tertiary emergency medical facility. Parasympathetic activity was assessed using the high-frequency variability index (HFVI), derived from spectral analysis of HRV based on electrocardiographic R–R intervals. HFVI was recorded for 3 min before and after induction. Remimazolam or propofol was administered at 6 mg/kg/h or 2.0 µg/ml via target-controlled infusion, respectively. The primary outcome was the difference in mean HFVI values recorded between the 3-min period before and after induction. Hemodynamic parameters, including mean blood pressure, heart rate, cardiac output, stroke volume variation, pulse pressure variation, and dynamic arterial elastance, were also measured. Baseline HFVI values did not differ significantly between groups. After induction, HFVI decreased significantly more in the remimazolam group than in the propofol group (ΔHFVI: 16 vs. 3, P = 0.010). Heart rate increased in the remimazolam group but decreased in the propofol group (P = 0.006). No significant intergroup differences were observed in other hemodynamic parameters. These findings suggest that remimazolam may be associated with distinct autonomic responses during anesthesia induction.
Agreement between intra-bladder and insufflation pressure readings during laparoscopic surgery.
Tayebi S, Beer P, Jenkins P … +10 more , Jaggi M, Hussein M, McKinney T, Delvadia D, Levine MA, Malbrain L, Stiens J, Dabrowski W, Mercer LC, Malbrain MLNG
J Clin Monit Comput · 2026 Mar · PMID 41910862 · Publisher ↗
Following the recognition of intra-abdominal pressure (IAP) as a vital sign in critically ill patients, substantial research has focused on improving IAP monitoring techniques and devices. The Abdominal Compartment Socie...
Following the recognition of intra-abdominal pressure (IAP) as a vital sign in critically ill patients, substantial research has focused on improving IAP monitoring techniques and devices. The Abdominal Compartment Society’s guidelines state that any novel IAP measurement method must be validated against a reference method. Literature shows that insufflators are commonly used during laparoscopic surgeries as a reference, although their use poses challenges and requires several precautions. This research aims to investigate the agreement between IAP measurements via the bladder and insufflators during laparoscopic surgeries and to address whether insufflators can be used as a reference method to examine new IAP measurement techniques via the bladder. A prospective observational study was conducted in patients undergoing laparoscopic surgery. A total of 202 paired IAP measurements were performed in 18 patients. Patients were stratified into two study groups according to the baseline IAP (IAP0 < 12 mmHg or IAP0 ≥ 12 mmHg). The agreement between IAP measurement via the TraumaGuard bladder catheter (IAPTG) and IAP obtained via Stryker or Conmed insufflator (IAPinsuf) was assessed using correlation, concordance, Bland–Altman, and error-grid analyses. The average IAP0 was 7.5 ± 1.9 mmHg and 15.4 ± 2.6 mmHg in patients without and with IAH. We found a two-way mixed-effects absolute agreement intraclass correlation coefficient of 0.7 for patients without baseline IAH and –0.3 for the patients with baseline IAH, indicating moderate agreement between bladder and insufflation pressures only in patients without baseline IAH. Nevertheless, Pearson’s correlation coefficient revealed a high linear relationship between the measured variables in both groups. Bland and Altman’s analysis showed a bias of 2.8 ± 2.7 mmHg, with ± 5.3 mmHg as the limits of agreement for patients without IAH. In contrast, patients with IAH had a bias of 10.6 ± 5.3 and limits of agreement of ± 10.4 mmHg. The findings support not using insufflation pressure as a gold standard reference for future validation studies due to its inherent limitations.
AI-assisted videolaryngoscopy improves intubation success: results from a randomized simulation trial.
Comaniciu A, Schurter D, Kanapari A … +5 more , Lorenzoni G, Lazaridou A, Ganter MT, Gregori D, Hofer CK
J Clin Monit Comput · 2026 Mar · PMID 41910861 · Publisher ↗
Video laryngoscopy has become an integral part of today's airway management. Despite its advantages, loss of depth perception and increased cognitive load remain a challenge and not all airway scenarios can be successful...
Video laryngoscopy has become an integral part of today's airway management. Despite its advantages, loss of depth perception and increased cognitive load remain a challenge and not all airway scenarios can be successfully managed and resolved. This study aims to evaluate the efficacy of larynGuide, an AI-based software integrated with the C-MAC video laryngoscope, in improving tracheal intubation success rates. This prospective, randomized, 2 × 2 crossover, simulation-based study included 74 medical professionals, 35 experienced and 39 inexperienced participants. Each participant performed tracheal intubations using a C-MAC video laryngoscope with and without the larynGuide AI overlay in both easy and difficult airway scenarios. The primary outcome was the first attempt success rate. Secondary outcomes included overall success rate, time to intubation, procedural performance scores, and incidence of dental injury. Data were analyzed using mixed effects models with binomial response and non-parametric tests as appropriate. The overall first attempt success rate was 89% with larynGuide and 85% with standard C-MAC, the odds of successful intubation were 72% higher with larynGuide (OR = 1.72, 95%CI = 1.08, 2.73; p = 0.022). Among experienced participants, the benefit was more pronounced (OR = 3.37, 95%CI = 1.2, 8.9; p = 0.016). Time to intubation was longer with larynGuide (median = 29 s) compared to standard C-MAC (median = 23 s, p < 0.01). The incidence of dental damage was lower with larynGuide (22%) compared to C-MAC (27%), although not statistically significant (p = 0.095). The larynGuide AI-powered software improved tracheal intubation success rates compared to standard C-MAC videolaryngoscopy in this simulation-based study, highlighting the potential role of AI in enhancing airway management. Further clinical studies are needed to confirm these results and support broader integration into practice. TRIAL REGISTRATION: ClinicalTrials.gov ID NCT06657417.
Respiratory variation in carotid artery blood flow peak velocity combined with tidal volume challenge in predicting fluid responsiveness of lung-protective ventilation patients: a feasibility study.
Wang X, Zhou Q, Ma J … +2 more , Gao J, Huang T
J Clin Monit Comput · 2026 Mar · PMID 41831122 · Publisher ↗
Dynamic indices provide high predictable value in fluid management during anesthesia. However, as the emerging concept of lung protective strategy, the application spectrum of dynamic indices is limited in low tidal volu...
Dynamic indices provide high predictable value in fluid management during anesthesia. However, as the emerging concept of lung protective strategy, the application spectrum of dynamic indices is limited in low tidal volume (Vt) due to insufficient intrathoracic pressure and preload variation. Tidal volume challenge (TVC), a functional tool, has proved to help dynamic indices solve the dilemma in low Vt. This study aimed to explore the feasibility and accuracy of respiratory variation in carotid artery blood flow peak velocity (ΔVpeak-CA) combined with TVC to evaluate fluid responsiveness in patients ventilated with lung protective strategies during general anesthesia. We performed lung protective strategies after intubation, including low Vt, PEEP titration and open-lung approach when necessary. We implemented TVC after completing individual lung protective setting. Soon after, fluid challenge (FC) was conducted, and we defined fluid responsiveness as cardiac index (CI)≥15%. Hemodynamic data were collected immediately before TVC(T1), at the end-time point of TVC(T2), immediately before FC(T3) and after FC(T4). Finally，we enrolled 74 patients underwent major open abdominal surgery among whom 45 were fluid responsive. We found TVC improved the predictability of ΔVpeak-CA, with significant AUC difference between ΔVpeak-CA T2and ΔVpeak-CA T1(0.162, p = 0.0052). The ΔVpeak-CA T2exhibited more accurate and easier assessable than ΔVpeak-CA T2- T1, yielding the highest AUC of 0.897 (0.619 - 0.830) (p<0.0001). ΔVpeak-CA T2＞15% predicted fluid responsiveness with a sensitivity of 66.67% and a specificity of 100.00%. In subgroup analysis, we found PRM has limited influence on the predictability, with no significant AUC differences between ΔVpeak-CA T2and ΔVpeak-CA T2without PRM (0.0369, p=0.4355). Clinical trial registration: Chinese Clinical Trial Registry (ChiCTR2500108553). Registered on September 1, 2025.
Correction: Prediction of surgery start for automated anesthesia using draping detection from surveillance videos.
Ito A, Mitarai S, Kishimoto K … +5 more , Liu C, Yamamoto G, Mori Y, Egi M, Kuroda T
J Clin Monit Comput · 2026 Apr · PMID 41817642 · Full text
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Real-time flow-pressure coupling under pulse contour monitoring in kidney transplantation: prospective algorithm and retrospective phenotype assignment.
Cutler J, Wang L, Golfeiz H … +7 more , McDaniel E, Barnette R, Glick W, Gereboff A, Breen L, Simon B, Kariger R
J Clin Monit Comput · 2026 Mar · PMID 41806159 · Publisher ↗
To prospectively evaluate a pulse contour–guided algorithm for real-time flow–pressure coupling to direct fluid versus vasoactive therapy during kidney transplantation, and to retrospectively assign circulation phenotype...
To prospectively evaluate a pulse contour–guided algorithm for real-time flow–pressure coupling to direct fluid versus vasoactive therapy during kidney transplantation, and to retrospectively assign circulation phenotypes from intraoperative hemodynamics and assess their association with fluid responsiveness. We conducted a prospective, nonrandomized evaluation of 65 KT recipients (32 deceased donor, 33 living donor) managed with GDHM. Pulse contour monitoring (HemoSphere/Acumen IQ) provided mean arterial pressure (MAP), cardiac index (CI), systemic vascular resistance index (SVRI), arterial dP/dt, and dynamic arterial elastance (EaDyn = PPV/SVV). Standardized fluid challenges were repeated every 45–60 min. Phenotypes were assigned using CI–SVRI patterns with dP/dt as a contractility proxy. Flow-pressure coupling was predefined as ΔSV ≥ 10% with EaDyn > 1.0. Primary outcomes were circulatory phenotype (initial and averaged) and per-challenge FPC responsiveness modeled as a proportion with trial weights. Recipients received a mean 3.57 fluid challenges; phenotype shifts were infrequent. Most patients showed limited flow-pressure coupling (41.5% had 0 responsive challenges). In binomial generalized linear models (logit), modeling the proportion of positive FPC tests with the number of challenges as trial weights, phenotype predicted per-challenge flow-pressure coupling (Hyperdynamic had lower odds versus Normal); covariates were not associated. Intraoperative volume, vasoactive support and early outcomes were similar; no protocol-related adverse events. Circulatory phenotypes were associated with flow-pressure coupling and supported real-time fluid/inotrope decisions under GDHM during KT. Phenotype-guided GDHM enabled individualized MAP control while limiting unnecessary fluid/vasoactive therapy. Findings establish feasibility and motivate multicenter trials to test clinical impact and cross-platform validation.
Exploratory clinical trial on the acoustic variability index for predicting fluid responsiveness during hepatectomy.
Seo WY, Kwon HM, Moon B … +9 more , Kim HS, Kang KM, Heo CH, Park GC, Park JJ, Kim SH, Jun IG, Song JG, Hwang GS
J Clin Monit Comput · 2026 Jun · PMID 41801281 · Full text
The acoustic variability index (AVI), derived from continuous phonocardiographic analysis of heart sounds via an esophageal stethoscope, is a novel minimally invasive method for intraoperative hemodynamic monitoring. We...
The acoustic variability index (AVI), derived from continuous phonocardiographic analysis of heart sounds via an esophageal stethoscope, is a novel minimally invasive method for intraoperative hemodynamic monitoring. We evaluated the ability of AVI to predict fluid responsiveness in patients undergoing hepatectomy and compared its performance with that of the conventional indices. Forty adult patients who underwent hepatectomy were enrolled in this prospective, single-center observational study. After major surgical resection and stabilization, a 500 mL crystalloid fluid challenge was administered. Hemodynamic parameters including AVI, central venous pressure (CVP), stroke volume variation (SVV), and pulse pressure variation (PPV) were recorded before and after volume expansion. Patients with ≥ 10% increase in cardiac output (CO) were defined as responders. Thirty-seven patients were included in the final analysis, of which 12 (32.4%) were classified as responders. After fluid loading, responders showed a significant decrease in AVI (11.4% ± 2.5% to 7.8% ± 2.9%, p = 0.004), while non-responders showed no significant change (7.1% ± 3.2% to 6.3% ± 3.0%, p = 0.356). AVI demonstrated predictive performance comparable to SVV and PPV, with an optimal cutoff of > 9.8% and an area under the receiver operating characteristic curve of 0.873 (95% CI: 0.743–0.967). Real-time intraoperative monitoring of the AVI shows potential as a predictor for fluid responsiveness in patients undergoing hepatectomy. AVI offers a promising, minimally invasive approach for guiding fluid therapy. Further research is warranted to validate its utility in broader surgical populations.
Relationship between esophageal and central venous pressure variation during respiratory activity: the best choice among four different methods to measure the amplitude of central venous pressure changes.
Ogliari G, Mazzuca Mari L, Crisci S … +6 more , Pradissitto G, Fusina F, Albani F, Morandi A, Bertelli M, Natalini G
J Clin Monit Comput · 2026 Mar · PMID 41784924 · Publisher ↗
Changes in lung and pleural pressures during mechanical ventilation are transmitted to intrathoracic structures, including the venous system. As a result, respiratory swings in central venous pressure (CVP) may reflect v...
Changes in lung and pleural pressures during mechanical ventilation are transmitted to intrathoracic structures, including the venous system. As a result, respiratory swings in central venous pressure (CVP) may reflect variations in pleural pressure, typically estimated using esophageal pressure (Pes). However, the point on the CVP waveform used for measurement may influence this relationship. Our aim is to find the best association between ∆Pes and each ∆CVP considering different points in the CVP waveform to calculate ∆CVP. In this prospective study, we analysed CVP and Pes waveforms in 22 mechanically ventilated patients. For each cardiac cycle, three CVP values were identified: the minimum (CVPmin), the maximum (CVPmax), and the average (CVPavg). From these, four types of respiratory CVP variation (∆CVP) were calculated per breath: ∆CVPmin = max-min of CVPmin values; ∆CVPmax = max-min of CVPmax values; ∆CVPavg = max-min of CVPavg values; ∆CVPtot = absolute difference between the highest CVPmax and the lowest CVPmin within each respiratory cycle. The primary objective was to assess the association between ∆Pes and each ∆CVP variant using linear mixed-effects models. A total of 2,286 breaths (median 104 per patient) was analysed. All ∆CVP measures showed a statistically significant association with ∆Pes. The strongest correlation was observed for ∆CVPtot, with a marginal R² of 0.50 and a conditional R² of 0.78. The association further improved when using the median of multiple consecutive breaths. Specifically, the marginal R² increased from 0.60 (median of 3 breaths) to 0.70 (median of 23 breaths). Among the different measurement strategies, ∆CVPtot—defined as the difference between the highest and lowest CVP values within a respiratory cycle—showed the strongest association with ∆Pes. Averaging over at least three consecutive breaths further enhanced this relationship. These data are useful for understanding how ∆CVP can be used to estimate ∆Pes at the bedside.
Intermittent Pneumatic Compression as an Unrecognized Source of Neuromonitoring Oscillations.
Valero R, Medina M, Abad A … +2 more , Bellafont J, Cepero E
J Clin Monit Comput · 2026 Jun · PMID 41758459 · Full text
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Editor's note.
Flick M
J Clin Monit Comput · 2026 Feb · PMID 41746585 · Full text
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Regional tissue perfusion index (RTPI): a new optical-based metric for quantifying regional tissue perfusion.
Shadgan B, Amani Tehrani I, Khosravi S … +3 more , Askari Z, Pirhadi Rad AP, Bashashati A
J Clin Monit Comput · 2026 Feb · PMID 41733851 · Publisher ↗
Accurate, continuous assessment of regional tissue perfusion remains a significant clinical challenge, as most existing modalities are invasive, indirect, or impractical for routine monitoring. Near-infrared spectroscopy...
Accurate, continuous assessment of regional tissue perfusion remains a significant clinical challenge, as most existing modalities are invasive, indirect, or impractical for routine monitoring. Near-infrared spectroscopy (NIRS) has been widely adopted to assess tissue oxygenation; however, conventional NIRS-derived indices are insufficient surrogates for true perfusion and often fail to capture rapid hemodynamic changes. This study aimed to introduce and validate the Regional Tissue Perfusion Index (RTPI), a novel NIRS-derived metric that integrates multiple features of the NIRS signal to provide continuous, non-invasive, and physiologically relevant assessment of tissue perfusion. RTPI was developed using principal component analysis (PCA) of multiple NIRS-derived parameters, including pulse amplitude ratio, derivative, and area under the curve. Its performance was evaluated in healthy volunteers during controlled ischemia–reperfusion protocols and compared with established reference standards, including laser Doppler flowmetry (LDF) and photoplethysmography (PPG). RTPI showed acceptable correlations with LDF Flux and PPG perfusion index (PI) during dynamic perfusion changes. Unlike conventional NIRS-derived oxygenation and hemodynamic indices, which often exhibited delayed responses, RTPI demonstrated immediate and significant sensitivity to both complete and partial ischemia–reperfusion episodes in the analyzed datasets. Intraclass correlation indicated stronger session-to-session reliability for RTPI than for both Flux and PI. RTPI represents a multiparametric, physiologically meaningful, and computationally efficient metric for real-time monitoring of tissue perfusion. Its ability to detect perfusion compromise independently of oxygenation indices highlights its translational potential for bedside implementation in critical care, trauma, perioperative, and vascular medicine, where improved diagnostic accuracy could significantly impact patient outcomes.
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