J Clin Monit Comput [JOURNAL]
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200 papers
Periodic limb movements during sedation and general anesthesia in elderly patients: a prospective observational study.
Arki K, Harte J, Frickmann F … +6 more , Hight D, Saxena S, Gisselbaek M, Absalom AR, Berger-Estilita J, Lersch F
J Clin Monit Comput · 2026 Jun · PMID 41733850 · Full text
Dexmedetomidine sedation in elderly patients is associated with cognitive benefits due to its biomimetic non-rapid eye movement (NREM) sleep–like state. However, this state may predispose patients to periodic limb moveme...
Dexmedetomidine sedation in elderly patients is associated with cognitive benefits due to its biomimetic non-rapid eye movement (NREM) sleep–like state. However, this state may predispose patients to periodic limb movements (PLMs), which can cause unintended procedural risk during sedation. We aimed to determine the incidence of PLMs during dexmedetomidine-based multimodal sedation for transcatheter aortic valve implantation (TAVI) and explore associations with the need for conversion to general anesthesia. In this prospective observational study, 35 consecutive patients (mean age 81 ± 6 years; 17 female, 18 male) undergoing TAVI over a two-month period from October 2021 to the end of November 2021 were monitored using standard anesthesia monitoring, processed electroencephalography (pEEG) monitoring using Narcotrend 3-lead frontal EEGs (Narcotrend, Hannover, Germany), and bilateral ankle actimetry (SOMNOwatch™ plus). Sedation was administered according to our institutional protocol, beginning with a dexmedetomidine loading dose (0.5 µg kg⁻¹), followed by titration of the infusion between 0.2 and 1.5 µg kg⁻¹ h⁻¹. Additional propofol or fentanyl boluses were administered as clinically indicated by the responsible anesthesiologist. Actimetry, EEG patterns, and intraoperative events were analyzed. PLMs (2–6 movements/min; most commonly 3–5 movements/min) were observed in 20 of 35 patients (57%) and all conversions to general anesthesia (5/5, 100%) occurred in the PLM-positive group, highlighting a potential clinical impact on procedural stability. In the 19 patients with complete EEG datasets, Narcotrend indices during dexmedetomidine-only sedation averaged 96.6 ± 2.6, consistent with an awake–sedate EEG pattern. Following propofol administration, the index decreased to 39.3 ± 20.0, corresponding to a very large effect size (Cohen’s d = 2.85). Five conversions to general anesthesia were necessary in patients with PLMs, because of restlessness, although the severity of PLMs did not predict conversion. No patient had a known history of restless legs syndrome (RLS); prior neurological disease showed no consistent association with PLM occurrence. PLMs are common during dexmedetomidine sedation for TAVI in elderly patients and may need conversion to general anesthesia. While dexmedetomidine offers cognitive benefits, the potential for movement-related procedural risk warrants increased monitoring and consideration during patient selection and anesthetic planning. Further studies comparing sedation-induced and natural sleep PLMs are needed.
Describing hemodynamic states: a plea for systematic terminology.
Saugel B, Lakhal K
J Clin Monit Comput · 2026 Apr · PMID 41722001 · Full text
A clear and systematic terminological framework is essential for exactly describing a patient's hemodynamic state. After assessing absolute values of hemodynamic variables and considering the specific clinical context, t...
A clear and systematic terminological framework is essential for exactly describing a patient's hemodynamic state. After assessing absolute values of hemodynamic variables and considering the specific clinical context, the absolute values should be classified as 'normal', 'higher than normal', or 'lower than normal' - or as being 'inside the target range' or 'outside the target range'. The acuity and dynamics of changes in the hemodynamic variables should be described. The alterations should then be assigned semiological names reflecting the corresponding 'clinical sign'. Finally, it should be determined whether the alteration in the hemodynamic variable results in a state of acute circulatory failure or shock.
Renal doppler ultrasound: comparison of measurements sampled in different anatomical locations.
Aagaard R, Hermansen JL, Christensen SK … +1 more , Juhl-Olsen P
J Clin Monit Comput · 2026 Jun · PMID 41718857 · Full text
Renal Doppler ultrasound can be used to predict acute kidney injury and assess venous congestion. There is no consensus on which renal vessels should be used for Doppler sampling. This study compares renal Doppler ultras...
Renal Doppler ultrasound can be used to predict acute kidney injury and assess venous congestion. There is no consensus on which renal vessels should be used for Doppler sampling. This study compares renal Doppler ultrasound measurements obtained in renal hilar and interlobar arteries and veins in patients recovering from open-heart surgery.This secondary analysis included data from 99 patients who underwent cardiac surgery. Doppler ultrasound was performed on both hilar and interlobar vessels in each kidney and renal venous flow pattern, renal venous stasis index (RVSI), and renal arterial resistive index (RI) were assessed.For renal venous flow pattern Kappa was 84% for hilar vs. interlobar measurements, 63% for hilar measurements on either side, and 77% for interlobar measurements on either side. When comparing RVSI the biases ranged from 0.2% to 4.8%, limits of agreement were consistently wide, and percentage error ranged from 96% to 133%. The comparisons of RI showed biases from 0.1% to 0.4% with limits of agreement consistently narrow. Percentage error ranged from 9.9% to 12.3%In a population of postoperative open-heart cardiac surgery patients, comparable results can be expected when sampling renal venous flow pattern from hilar and interlobar veins. Overall low bias but also low precision can be expected when sampling RVSI in hilar and interlobar veins on either side. In regard to RI, low bias and high precision can be expected when sampling from hilar and interlobar arteries on either side.
Impact of positive end-expiratory pressure on autonomic nervous system activity and its interaction with cerebrovascular reactivity - an experimental study.
Uryga A, Kasprowicz M, Czosnyka M … +3 more , Kazimierska A, Hammervold R, Frisvold SK
J Clin Monit Comput · 2026 Jun · PMID 41706415 · Full text
Mechanical ventilation requires positive end-expiratory pressure (PEEP), which has shown to improve lung recruitment and gas exchange. However, the increase in intrathoracic pressure might impact cardiac function and aut...
Mechanical ventilation requires positive end-expiratory pressure (PEEP), which has shown to improve lung recruitment and gas exchange. However, the increase in intrathoracic pressure might impact cardiac function and autonomic nervous system (ANS) activity. This post hoc analysis aimed to evaluate the impact of incremental PEEP on ANS activity and to examine its relationship with cerebrovascular reactivity in an experimental model. Twelve anesthetized, mechanically ventilated pigs were studied in both the supine and prone positions at baseline PEEP (5 cmH₂O) and at incremental PEEP levels (10, 15, 20 cmH₂O). ANS parameters included time-domain heart rate variability (HRV): the standard deviation of normal pulse intervals (SDNN), the root mean square of successive differences between normal heartbeats (RMSSD), HRV entropy measures: fuzzy entropy (FuzzyEn) and sample entropy (SampEn), heart rate asymmetry indices: Guzik's index (GI) and Porta's index (PI), and baroreflex sensitivity (BRS). Cerebrovascular reactivity was assessed using the pressure reactivity index (PRx). Relationships between ANS metrics and PRx were analyzed using univariate and multivariate linear mixed-effects models (LMEMs), adjusted for PEEP. Increasing PEEP significantly altered HRV entropy (FuzzyEn: p = 0.006; SampEn: p = 0.018) and BRS (p = 0.013) in the supine position, with similar trends observed in the prone position. In the univariate LMEM analyses, all ANS metrics significantly influenced PRx in both positions. However, in the multivariate LMEM models, only SDNN (p = 0.001), RMSSD (p = 0.001), GI (p = 0.003), and PI (p = 0.007) remained significantly associated with PRx in the prone position, whereas no ANS metrics remained significant in the supine position. Incremental PEEP modifies ANS activity, as reflected by changes in HRV entropy and BRS. Prone positioning appears to preserve the autonomic modulation of cerebrovascular reactivity under PEEP. These findings underscore the importance of considering ventilatory settings when assessing heart-brain interactions.
A Cohort, Semi-Randomized, open label quality improvement patient blood management (PBM) comparison of point of care viscoelastic coagulation monitors in cardiac surgery.
Spiess BD, Burger M, R N MJM … +4 more , R N SG, Garvan C, Pellitier P, Zumberg M
J Clin Monit Comput · 2026 Jun · PMID 41697608 · Publisher ↗
Viscoelastic testing (VET), recommended for heart surgery, lacks adoption due to data reporting times (central laboratory coagulation assay-CLCA and laboratory VET tests) and interpretation (predicate VET devices). Three...
Viscoelastic testing (VET), recommended for heart surgery, lacks adoption due to data reporting times (central laboratory coagulation assay-CLCA and laboratory VET tests) and interpretation (predicate VET devices). Three point of care (POC) -VET devices have now become available. The hypotheses of this quality initiative (QI), patient blood management program-PBM), was that: (1) Clinicians desire timely, easily interpreted coagulation data (2) Comparison of two (first available) POC-VETs would determine the technology embraced for PBM. To evaluate these hypotheses clinicians were surveyed as to need ease of use, acceptability, and support of the expanding PBM program before and after testing in operating rooms (ORs). This was not a randomized study to examine reduction in transfusion utilization or improved outcome. It was, however, a QI study to examine perception of an existing problem; with investigation of a solution the clinicians would support decision making. Cardiac team members (anesthesia, surgery, and perfusion) were informed, and their written consent was obtained prior to survey. Team members completed QI surveys before and after the use of the technologies. Anesthesiology members were trained by the manufacturers and assessed for proficiency by Laboratory Medicine (LM). The TEG-6s® and the Quantra® QPlus, evaluated in sixty-eight cardiac patients over a six-week period (May 15-June 30, 2021) gave the clinicians direct experience. The time from blood draw (arterial line) until final coagulation data reported were compared between technologies and where available to CLCA/lab testing. Algorithms for coagulation treatments with the POC-VET data were created in consultation with the manufacturers. QI survey data were reported as percentage of answers in categories. Time to data acquisition and blood usage (pilot data only) were examined with chi-square and Wilcoxon rank sum, two sided tests. Cardiac team members (anesthesia, surgery, and perfusion) were informed, and their written consent was obtained prior to survey. Team members completed QI surveys before and after the use of the technologies. Anesthesiology members were trained by the manufacturers and assessed for proficiency by Laboratory Medicine (LM). The TEG-6s® and the Quantra® QPlus, evaluated in sixty-eight cardiac patients over a six-week period (May 15 -June 30, 2021) gave the clinicians direct experience. The time from blood draw (arterial line) until final coagulation data reported were compared between technologies and where available to CLCA/lab testing. Algorithms for coagulation treatments with the POC-VET data were created in consultation with the manufacturers. QI survey data were reported as percentage of answers in categories. Time to data acquisition and blood usage (pilot data only) were examined with chi-square and Wilcoxon rank sum, two sided tests.
Clinical validation of a novel accelerometer-based respiratory rate monitor.
Steihaug OM, Sjøset TE, Stordal AS … +4 more , Sleire AD, Ødegaard-Olsen O, Tunset A, Jammer I
J Clin Monit Comput · 2026 Jun · PMID 41649789 · Full text
Respiratory rate (RR) is a vital sign often unused in clinical practice due to labour-intensive manual counting or capnography limitations in spontaneously breathing patients. This study validated RespX, a novel accelero...
Respiratory rate (RR) is a vital sign often unused in clinical practice due to labour-intensive manual counting or capnography limitations in spontaneously breathing patients. This study validated RespX, a novel accelerometer-based wireless sensor, for continuous respiratory rate measurement in hospitalised patients. This prospective, single-centre observational study included hospitalised adults (> 18 years) expected to remain undisturbed for one hour while measuring RR. The RespX sensor, placed on the left chest wall, was compared with continuous capnography and manual counting every 20 min for one hour. The primary endpoint was respiratory rate measured by RespX within ± 3 breaths per minute compared to capnography. Linear mixed-effects models analyzed mean differences between methods. Twenty-nine patients completed the study. The proportion of RespX measurements within ± 3 breaths per minute of capnography was 77% (95% CI: 74.8-79.0%) for raw data and 82.8% (95% CI: 80.7-84.7%) after removing outliers. The proportion of RespX measurements within ± 3 breaths per minute of manual counting was 87,5% (95% CI: 81,1%-93,8%). For the capnography the proportions for the raw data was 87,8% (95% CI: 81,8-93,8%) and 94,5% (95% CI: 90,3%-98,7%) after removing outliers. Linear mixed-effects analysis showed mean differences of -0.40 (p = 0.43) for raw data and 0.39 (p = 0.15) for filtered data between RespX and capnography, supporting their equivalence. RespX demonstrated lower measurement variability (SD: 0.75-3.05) compared to capnography (SD: 0.99-5.19). No adverse events were observed during the study. The wireless RespX accelerometer-based sensor provides a novel and accurate method for assessing the respiratory rate in awake hospitalised patients compared with capnography.Trial registration: NCT06911541.
Heart rate variability as a marker of multiple organ dysfunction syndrome in deeply sedated, prepubescent patients: a secondary analysis.
Wojtanowski A, Bureau C, Jeanne M … +2 more , Recher M, De Jonckheere J
J Clin Monit Comput · 2026 Jun · PMID 41642544 · Full text
Multiple organ dysfunction syndrome (MODS) is a frequent complication in critically ill patients. The objective of the present study in a pediatric intensive care unit was to determine the feasibility of using HRV to dif...
Multiple organ dysfunction syndrome (MODS) is a frequent complication in critically ill patients. The objective of the present study in a pediatric intensive care unit was to determine the feasibility of using HRV to differentiate between deeply sedated patients with medium/high MODS and those with no/low MODS. This was a secondary analysis of data from the ANI EP clinical study (NCT04913038). Various HRV indices were computed in a 10-minute time window. A patient with a pediatric Sequential Organ Failure Assessment (pSOFA) score higher than 5 was classified into the medium/high MODS group. Forty-seven patients were selected for analysis. The Energy variable (equivalent to the standard deviation of normal-to-normal intervals) was significantly correlated with the pSOFA score (r²=-0.31, p = 0.03). HFnu values were higher in the medium/high MODS group than in the no/low MODS group (0.35 vs. 0.28, respectively; p = 0.019), and HFnu discriminated between the two groups of patients with an area under the receiver operating characteristic curve of 0.75 (sensitivity = 0.78, specificity = 0.74). Energy was slightly but not significantly lower in the medium/high MODS group (0.17, vs. 0.35 in the no/mild MODS group; p = 0.086). The results of our study in a PICU showed that HRV indices can differentiate between deeply sedated patients with MODS and those without. Further investigations are needed to confirm this finding and extend it to other populations.
Optic nerve sheath diameter as a real-time biomarker for epidural blood patch efficacy after post-dural puncture headache: a preliminary report.
Sassi K, Fresquet R, Dubois ML … +2 more , Minville V, Geeraerts T
J Clin Monit Comput · 2026 Feb · PMID 41642543 · Full text
Post-dural puncture headache (PDPH) following epidural anesthesia remains a frequent obstetric complication. While epidural blood patch (EBP) is the reference treatment, its efficacy assessment still relies on subjective...
Post-dural puncture headache (PDPH) following epidural anesthesia remains a frequent obstetric complication. While epidural blood patch (EBP) is the reference treatment, its efficacy assessment still relies on subjective pain reporting. This study explored whether changes in optic nerve sheath diameter (ONSD) measured by ultrasound could serve as an objective, real-time indicator of early EBP response. In this prospective, single-center observational study, 30 postpartum patients with PDPH undergoing EBP had ONSD measured before (H0) and 2 h after (H2) the procedure. Correlation between ΔONSD and ΔVAS pain scores was analyzed with bootstrap validation, and receiver operating characteristic (ROC) analysis identified thresholds associated with early response. Mean ΔONSD was 0.97 ± 0.55 mm, significantly correlated with pain reduction (r = - 0.64, p < 0.001; bootstrap 95% CI: -0.81 to - 0.36). ROC analysis showed good diagnostic performance (AUC = 0.96, 95% CI: 0.87-1.00), with a ΔONSD ≥ 0.40 mm threshold providing 100% sensitivity and 83% specificity for early improvement. These preliminary findings suggest that ONSD ultrasound may offer a feasible, noninvasive adjunct for assessing early EBP response in PDPH. The identified 0.40 mm change threshold appears promising but requires confirmation in larger, multicenter studies with extended follow-up to determine its reproducibility and clinical utility.
From promising prototypes to "instructions for use": embedding LLMs safely in perioperative and intensive care.
Bignami EG, Russo M
J Clin Monit Comput · 2026 Apr · PMID 41636971 · Full text
Large language models (LLMs) show promise for supporting clinical decision‑making in perioperative and intensive care settings. The recent study by Xu et al. on pre‑trained language models for preoperative anesthesia tri...
Large language models (LLMs) show promise for supporting clinical decision‑making in perioperative and intensive care settings. The recent study by Xu et al. on pre‑trained language models for preoperative anesthesia triage demonstrates that such models can effectively integrate structured and unstructured clinical data to support triage decisions. However, the translation of these tools from research prototypes to routine clinical use requires more than technical validation; it demands explicit, operationalised “instructions for use” analogous to those required for pharmaceuticals and medical devices. We argue that responsible deployment of LLMs in ICU and perioperative workflows must clarify: (1) intended clinical scope and non‑indications; (2) role in the decision‑making hierarchy and when clinicians should override model recommendations; and (3) mechanisms for transparency, governance, and staff training. Drawing on Xu et al.‘s methodological rigor and Bignami et al.‘s AI policy checklist framework, we outline a concise, practice‑oriented approach to embedding LLMs safely in critical care. We emphasise that without explicit instructions for use, clear governance structures, and comprehensive training, there is a risk of introducing inscrutable systems into the heart of critical care. The time to define these safeguards is now, before ad hoc, ungoverned adoption becomes the norm.
Short-term modulations in cardiopulmonary bypass flow enhance urine output: ancillary analysis of the FLOWMAPCA trial.
Desebbe O, Djoulene M, Delmotte L … +3 more , Ngola J, Delannoy B, Joosten A
J Clin Monit Comput · 2026 Feb · PMID 41632400 · Publisher ↗
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Paired assessment of two electromyographic neuromuscular monitors: stimpod NMX450X versus Datex-Ohmeda E-NMT.
Zambre M, Janssens U, Cools W … +3 more , De Mey J, Vanhonacker D, Carvalho H
J Clin Monit Comput · 2026 Jun · PMID 41632399 · Full text
Quantitative neuromuscular monitoring (NMM) is widely recommended, yet its clinical adoption remains limited, partly due to usability issues. This study aimed to compare the clinical performance of two electromyography (...
Quantitative neuromuscular monitoring (NMM) is widely recommended, yet its clinical adoption remains limited, partly due to usability issues. This study aimed to compare the clinical performance of two electromyography (EMG)-based NMM devices—the Datex-Ohmeda E-NMT module and the Stimpod NMS450X—under real-world operating room conditions. Twenty-four adult patients undergoing elective non-cardiac surgery were monitored simultaneously with both devices, applied contralaterally. Train-of-four (TOF) counts and TOF ratios were recorded at one-minute intervals. Agreement between devices was assessed using Bland–Altman analysis, repeatability coefficients, and the concordance correlation coefficient (CCC). The Datex-Ohmeda recorded an average of 121 TOF-count and 71 TOF-ratio values per patient, compared with 56 and 39, respectively, for the Stimpod. Inter-device correspondence was low, with numerous missing or physiologically implausible values on the Stimpod stream. The repeatability coefficient was 0.81 (95% CI: 0.80–0.83), indicating poor precision. The CCC was 0.662, consistent with weak agreement. In routine clinical use, the Stimpod NMS450X and Datex-Ohmeda E-NMT demonstrated poor concordance and high variability, likelyinfluenced by device-specific artifacts, connectivity limitations and electrode sensitivity.These findings highlight the need for device-specific validation of EMG NMM, both for clinical practice and for research purposes.
Early heart-rate trajectory phenotypes predict short-term mortality in critically ill patients: a dynamic time-warping cluster analysis.
Hirano T, Ishikawa M, Nishino T … +3 more , Takiguchi T, Igarashi Y, Yokobori S
J Clin Monit Comput · 2026 Jun · PMID 41632398 · Full text
Heart rate (HR) reflects illness severity in critically ill patients, but the prognostic significance of early HR changes is unclear. We aimed to identify HR trajectory phenotypes during the first 24 h of ICU admission a...
Heart rate (HR) reflects illness severity in critically ill patients, but the prognostic significance of early HR changes is unclear. We aimed to identify HR trajectory phenotypes during the first 24 h of ICU admission and assess their association with short-term mortality. Adults admitted to the intensive care unit (ICU) between January 2018 and December 2024 with ≥ 12 h of HR data were eligible; patients with early discharge/death, mechanical support, or sustained bradycardia were excluded. Hourly HR means from the first 24 h were imputed and clustered via Dynamic Time Warping-based TimeSeriesKMeans; five trajectories were selected using internal validation. Thirty- and 90-day mortality were assessed by multivariable Cox models. A total of 4491 patients were analyzed after applying exclusion criteria. TimeSeriesKMeans identified five early HR trajectory phenotypes: Cluster A (persistently tachycardic), Cluster B (early HR normalization), Cluster C (rising HR), Cluster D (mild tachycardic-normal), and Cluster E (normal HR). Cluster A was associated with a markedly increased risk of 30-day mortality compared with the reference Cluster E (HR 3.21, 95% CI 2.32–4.45; p < 0.001). Cluster C also showed an elevated mortality risk (HR 2.09, 95% CI 1.53–2.85; p < 0.001), whereas clusters characterized by lower or early-normalizing heart-rate trajectories demonstrated more favorable survival profiles. Kaplan-Meier analyses confirmed significant differences in survival across clusters (log-rank p < 0.001). Machine learning-based phenotyping of 24-hour HR trajectories stratified short-term mortality risk and revealed time-dependent patterns potentially reflecting treatment responsiveness. Early adverse heart-rate trajectories, particularly persistent tachycardia, may serve as prognostic signals of physiological stress or poor treatment response during the initial ICU course, supporting early risk stratification and clinical reassessment.
Peripheral perfusion noninvasive monitoring technologies - a literature and patent review.
Orellana Plaza I, Dankelman J, Bakker J
J Clin Monit Comput · 2026 Jun · PMID 41627642 · Full text
Shock is a life-threatening condition marked by inadequate tissue perfusion and oxygen supply, leading to organ failure if not rapidly addressed. Clinical management of shock involves detecting and correcting altered mac...
Shock is a life-threatening condition marked by inadequate tissue perfusion and oxygen supply, leading to organ failure if not rapidly addressed. Clinical management of shock involves detecting and correcting altered macro hemodynamic parameters. However, these parameters may not accurately reflect microcirculatory alterations or abnormalities in oxygenation. A resuscitation strategy focused on peripheral perfusion, which can be non-invasively monitored, may allow for earlier shock detection and treatment, potentially reducing mortality. This literature review aims to study the available technologies found in literature and in patents to non-invasively monitor peripheral perfusion. PRISMA method was employed to systematically select or exclude articles and patents, resulting in 44 studies and 21 patents included in the review. The found technologies were classified based on the sensing principle in light (reflected, transmitted, or scattered), Doppler effect, temperature, and skin mottling. Combining the monitorization of microcirculatory with macrocirculatory parameters has the potential to have an accurate prognosis value for shock and other diseases. However, the various technologies that have been developed to monitor peripheral perfusion require further research and testing in diverse conditions.
Artificial intelligence-enabled clinical decision support systems in preadmission testing: a scoping review of risk prediction, triage, and perioperative workflows (2020-2025).
Chinn LW, Nemeh I, Chinn NR
J Clin Monit Comput · 2026 Apr · PMID 41619047 · Full text
Preadmission testing (PAT) is a critical step in perioperative care that supports risk stratification, triage, and optimization. Tools such as the American Society of Anesthesiologists Physical Status (ASA-PS) classifica...
Preadmission testing (PAT) is a critical step in perioperative care that supports risk stratification, triage, and optimization. Tools such as the American Society of Anesthesiologists Physical Status (ASA-PS) classification have limitations. This review mapped evidence on artificial intelligence–enabled clinical decision support systems (AI-enabled CDSS) and risk prediction tools in PAT and perioperative assessment, with particular attention to their implications for perioperative efficiency and patient safety. A scoping review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. PubMed, Embase, Scopus, and CINAHL were searched for English-language studies published between January 1, 2020, and August 1, 2025. Eligible studies applied artificial intelligence (AI) or machine learning (ML) to preoperative or PAT–related evaluation, risk prediction, triage, or decision support. Two reviewers independently screened all records. The review was preregistered on the Open Science Framework (DOI: https://doi.org/10.17605/OSF.IO/JKCRH ). The original registration described a broader “digital determinants of health” scope, which was refined to AI-enabled CDSS before data extraction. Fifty-six studies were included. Most were retrospective cohorts using imaging or electronic health record data. Radiomics and deep learning dominated oncologic prediction, while structured clinical and laboratory data informed models for anesthetic risk, transfusion, and postoperative complications. Natural language processing (NLP) predicted ASA-PS classification from preoperative text. Only a small number of prospective or randomized studies were identified. AI-enabled CDSS shows promise for perioperative risk prediction and PAT triage, but most applications remain at the proof-of-concept stage. When prospectively validated and embedded in perioperative workflows, these tools could streamline preoperative work-ups, reduce unnecessary testing and day-of-surgery cancellations, and support safer intra- and perioperative monitoring. Prospective, multicenter validation and real-world implementation studies are therefore needed before routine clinical use.
Hemodynamic monitoring strategies in cardiac surgery: an update systematic review.
Melo R, Galindo V, Gioli-Pereira L … +6 more , Joelsons D, Assunção M, Alves B, Souza G, Bravim B, Passos R
J Clin Monit Comput · 2026 Feb · PMID 41618062 · Full text
Hemodynamic monitoring is a cornerstone of perioperative care in cardiac surgery, where patients are at high risk of cardiovascular instability and organ hypoperfusion. In recent years, goal-directed therapy (GDT) protoc...
Hemodynamic monitoring is a cornerstone of perioperative care in cardiac surgery, where patients are at high risk of cardiovascular instability and organ hypoperfusion. In recent years, goal-directed therapy (GDT) protocols have increasingly incorporated advanced monitoring technologies to optimize perfusion and improve outcomes. This systematic review aims to critically appraise contemporary hemodynamic monitoring strategies and their integration into GDT protocols in adult patients undergoing cardiac surgery. A systematic review of studies published between January 2015 and May 2025 was conducted using PubMed, Embase, Scopus, and the Cochrane Library. The last search was conducted on 17 May 2025 in all databases. Eligible studies included adult cardiac surgical patients managed with perioperative hemodynamic monitoring strategies that incorporated cardiac output assessment and structured GDT protocols. A qualitative synthesis of monitoring modalities, targeted hemodynamic endpoints, and reported clinical outcomes was performed. Our analysis included 15 studies comprising 4,224 patients. Monitoring strategies ranged from pulmonary artery catheters to minimally invasive and noninvasive tools such as FloTrac/EV1000 and esophageal Doppler. Cardiac index and stroke volume variation were the most frequently targeted parameters, often in combination with perfusion markers such as mean arterial pressure or central venous oxygen saturation. GDT protocols were associated with reductions in AKI, duration of mechanical ventilation, and ICU/hospital stay. Mortality benefits were inconsistently reported and not predefined in most studies. Current evidence supports the physiological rationale for GDT guided by advanced hemodynamic monitoring in cardiac surgery. Nonetheless, substantial heterogeneity in strategies and outcomes highlights the need for standardized protocols and high-quality multicenter trials to determine the most effective, patient-centered approaches.Trial registration: PROSPERO registration number: CRD420251102582, retrospectively registered on 11 July 2025.
Peripheral intravenous waveform analysis for evaluating volume status in healthy volunteers and mechanically ventilated patients.
Koistinaho A, Lie SL, Landsverk SA … +4 more , Lenz H, Rehn M, Hisdal J, Høiseth LØ
J Clin Monit Comput · 2026 Jun · PMID 41609926 · Full text
Timely diagnosis of blood loss and evaluation of intravascular volume status are pivotal tasks in clinical practice. Recent studies in animals and during lower body negative pressure (LBNP) in humans indicate that periph...
Timely diagnosis of blood loss and evaluation of intravascular volume status are pivotal tasks in clinical practice. Recent studies in animals and during lower body negative pressure (LBNP) in humans indicate that peripheral intravenous pressure waveform analysis (PIVA) may detect early stages of blood loss. As PIVA only requires a peripheral venous cannula, it may have value in emergency settings. However, its clinical relevance remains uncertain. This study examined how volume changes affect the PIVA-derived fundamental frequency (PIVAF1). Two cohorts were studied. The LBNP cohort comprised 15 healthy volunteers exposed to simulated blood loss in 10 mmHg increments of LBNP every two minutes from 0 to 80 mmHg, or until hemodynamic decompensation. The general anesthesia (GA)-cohort included 20 patients undergoing laparoscopic surgery who underwent preload increase with a head-down tilt. Peripheral intravenous pressure waveforms were continuously recorded from an antecubital vein and analyzed using short-time Fourier transform to extract the amplitude at the heart-rate frequency (PIVAF1). Changes in PIVAF1 were analyzed using linear regression. In the LBNP-cohort, data were log(e) – transformed and associated with a change per LBNP level of -0.11 (95% CI -0.14 to -0.09, P < 0.001). In the GA-cohort, PIVAF1 did not reliably predict a 10% change in stroke volume with head-down tilt [AUC 0.71 (95% CI 0.47 to 0.96; P = 0.11)]. We found statistically significant reductions in PIVAF1 during simulated blood loss but PIVAF1 did not predict increasing stroke volume during head-down tilt in general anesthesia. The clinical significance of PIVA remains to be elucidated.
Beyond the equation: transparency and verification in pharmacokinetic-pharmacodynamic model implementation for target-controlled infusion.
Introna M
J Clin Monit Comput · 2026 Feb · PMID 41591700 · Full text
Recent correspondence in the Journal of Clinical Monitoring and Computing has raised concerns about the transparency of implementing the Eleveld pharmacokinetic/pharmacodynamic model for propofol in commercial target-con...
Recent correspondence in the Journal of Clinical Monitoring and Computing has raised concerns about the transparency of implementing the Eleveld pharmacokinetic/pharmacodynamic model for propofol in commercial target-controlled infusion systems. While these models are scientifically robust, limited insight into software-level implementation may hinder independent verification and clinical confidence. Addressing this requires not only improved transparency and validation but also adequate clinician training, particularly as intravenous anesthesia techniques gain prominence in response to evolving regulatory and environmental pressures.
The association between intraoperative hypotension and postoperative acute kidney injury following emergent critical cesarean delivery: a retrospective cohort study.
Li ZP, Zhang JQ, Wang HW … +1 more , Yang JJ
J Clin Monit Comput · 2026 Jun · PMID 41504823 · Full text
This retrospective cohort study aimed to investigate the association between intraoperative hypotension (IOH) and postoperative acute kidney injury (AKI) among patients who underwent emergent critical cesarean delivery....
This retrospective cohort study aimed to investigate the association between intraoperative hypotension (IOH) and postoperative acute kidney injury (AKI) among patients who underwent emergent critical cesarean delivery. We analyzed electronic health records from January 2019 to August 2024. IOH was defined as a mean arterial pressure (MAP) less than 65 mmHg. It was quantified using four metrics: hypotensive event count, cumulative duration, area under the threshold (AUC), and time-weighted average (TWA). Postoperative AKI was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) clinical practice guidelines, based on serum creatinine levels. We employed multivariable logistic regression to assess the independent association between the primary IOH metric (cumulative duration) and postoperative AKI, adjusting for clinically relevant covariates. Sensitivity analyses were conducted using alternative IOH metrics. Postoperative AKI was diagnosed in 69 of the 508 patients (13.58%). Multivariable logistic regression analysis revealed that all four measures of intraoperative hypotension were independently associated with an increased risk of AKI: hypotensive event count (adjusted OR 2.098, 95%CI [1.180-3.732]; P = 0.012), cumulative duration (adjusted OR 1.036, 95%CI [1.013-1.060]; P = 0.002), AUC (adjusted OR 1.004, 95%CI [1.001-1.007]; P = 0.009), and TWA (adjusted OR 1.557, 95%CI [1.058-2.291]; P = 0.025). Our findings demonstrate that IOH was independently associated with a higher incidence of postoperative AKI in patients who underwent an emergent critical cesarean delivery.
PVADet: fast patient-ventilator asynchrony detection on waveforms.
Su L, Li Y, Lan Y … +9 more , Sun Q, Cai F, He H, Yuan S, Zhang S, Liu X, Baedorf-Kassis E, Huang X, Long Y
J Clin Monit Comput · 2026 Feb · PMID 41493521 · Publisher ↗
Patient-ventilator asynchrony (PVA) is a common and critically import clinical problem in patients receiving mechanical ventilation. However, PVAs are often underrecognized, underestimated and delayed, and there has been...
Patient-ventilator asynchrony (PVA) is a common and critically import clinical problem in patients receiving mechanical ventilation. However, PVAs are often underrecognized, underestimated and delayed, and there has been minimal success in automating their detection. In this study, we develop an efficient and fast end-to-end model to recognize PVAs on ventilator waveforms: running the model costs 106.5ms on CPUs and 7.8ms on GPUs. We propose label striping and stripe-mask encoding for efficient multi-class multi-target detecting. The model innovatively integrates causal convolutional, depth-wise separable convolutional, and recurrent neural networks to memorize long short-term causal features. With 60s waveform segments, our model performs a cross-validation mean average precision (mAP) of 88.1% and a testing mAP of 65.7% for comprehensive PVA detection. Our approach might be implemented as a monitoring tool to automatically identify PVAs for improving bedside and remote care and prioritizing patient comfort.
Hemodynamic monitoring: basic principles in operation room and intensive care unit.
Mirus M, Saugel B, Spieth PM
J Clin Monit Comput · 2026 Apr · PMID 41493520 · Full text
To synthesize physiological principles and practical monitoring strategies for perioperative and intensive care hemodynamics, addressing two questions: which variables should be monitored, and what targets should be purs...
To synthesize physiological principles and practical monitoring strategies for perioperative and intensive care hemodynamics, addressing two questions: which variables should be monitored, and what targets should be pursued to optimize outcomes. The review is educational in scope and highlights instrumentation details and clinical applications.Narrative, physiology-anchored review of oxygen delivery, venous return (VR), and regulation of mean arterial pressure (MAP) as a derived target. Reviews for educational purposes are included, with emphasis on instrumentation principles and clinical use cases. Invasive and non-invasive modalities are compared. Evidence from goal-directed therapy (GDT) trials in operating room and intensive care contexts is summarized to link physiology with therapy.(1) adequacy of oxygen delivery cannot be judged from MAP alone; MAP reflects the interaction of cardiac output (CO), systemic vascular resistance (SVR), and right atrial pressure. (2) VR depends on effective circulating volume, venous compliance, and mean systemic filling pressure. (3) Microcirculatory assessment remains limited; macrocirculatory surrogates and biomarkers provide guidance but have constraints. (4) Device outputs labeled identically are not interchangeable; calibration strategy and physiological assumptions are decisive. (5) GDT improves processes and may benefit selected high-risk patients, but large trials show mixed effects on mortality.Effective hemodynamic management requires physiology-based reasoning: identify the limiting factor, then select monitoring tools and therapeutic targets accordingly. MAP must be interpreted with CO, SVR, and RAP. Individualized, dynamic targets and trend-based responses outperform fixed thresholds. Embedding ultrasound skills, fluid-responsiveness testing, and calibrated device interpretation are levers to translate monitoring into safer care.
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