J Clin Monit Comput [JOURNAL]
Sun
200 papers
Feasibility of estimating cardiac indices using cardiac surgery anesthesia records in a multicenter cohort.
Balczewski EA, Mentz G, Singh K … +1 more , Mathis MR
J Clin Monit Comput · 2026 Jun · PMID 41442096 · Full text
Cardiac index (CI) is a key physiologic indicator correlated with end-organ perfusion in cardiac surgical patients, yet it is not routinely measured in all cases. This study evaluated the accuracy of estimating CI using...
Cardiac index (CI) is a key physiologic indicator correlated with end-organ perfusion in cardiac surgical patients, yet it is not routinely measured in all cases. This study evaluated the accuracy of estimating CI using routinely available physiologic monitor data, adjusted for relevant patient, physiologic, and procedural factors documented in perioperative anesthesia records. We analyzed anesthesia records from adult cardiac surgical patients with thermodilution-based CI measurements across seven US hospitals from 2014 to 2022. Four published formulas-based on intraoperative blood pressure and heart rate-were used to estimate CI in generalized linear models, with adjustment for perioperative patient and procedure characteristics. Bland-Altman analysis compared adjusted CI estimates to reference thermodilution CI values. The ability of each estimator to classify patients with low CI (< 2.2 L/min/m²) was assessed for concordance. In a cohort of 5,989 patients, the median (IQR = interquartile range) thermodilution-based CIs were 2.1 (1.8-2.6) and 2.4 (2.0-2.9) L/min/m² before and after cardiopulmonary bypass, respectively. The best-performing formula, Liljestrand and Zander, achieved mean absolute errors of 0.45 and 0.47 L/min/m² before and after bypass, respectively. However, its reliability in classifying low CI was limited (Cohen's kappa = 0.26 pre-bypass, 0.20 post-bypass). Routinely collected physiologic and patient data can be used to generate population-level cardiac index estimates in adult cardiac surgery patients when appropriately adjusted, though individual-level discrimination of low CI is limited. These findings inform future large-scale perioperative hemodynamic research.
A pre-trained language model approach for triaging surgical patients for preoperative anesthesia clinics.
Xu NY, Litake O, Tully JL … +4 more , Meineke MN, Sinha A, Meyer M, Gabriel RA
J Clin Monit Comput · 2026 Apr · PMID 41442095 · Full text
PURPOSE: Preoperative anesthesia evaluation is a crucial step in ensuring patient safety and optimizing perioperative care. A heterogenous patient population requiring varying levels of assessment often leads to ineffici...
PURPOSE: Preoperative anesthesia evaluation is a crucial step in ensuring patient safety and optimizing perioperative care. A heterogenous patient population requiring varying levels of assessment often leads to inefficiencies and additional resource allocation. This study proposes using pre-trained language models to assist in triaging the appropriate degree of preoperative anesthesia evaluation for surgical patients. METHODS: Retrospective institutional data were obtained from surgical patients evaluated at a single center preoperative anesthesia care clinic. The performance of four pre-trained language models (RoBERTa, BERT, ClinicalBERT, and PubMedBERT) in the classification of which patients would be appropriate for a nursing preoperative phone call versus in-person clinician evaluation was assessed using F1-score, area under the receiver operating characteristics curve (AUC), specificity, sensitivity, and average precision. For each pre-trained language model, three different data input combinations were assessed: (1) diagnosis codes (D); (2) clinical text data (N); and (3) diagnosis codes and clinical text (D + N). The data were split into training (75%) and test set (25%). RESULTS: There were 1,761 unique patients, with an average of 12 notes per patient and a total of 46,922 clinical documents, included in the analysis. The AUC range between the four language models was highest in the D + N analyses (0.70 - 0.74), lower in the N analyses (0.58 - 0.73) and lowest in the D analyses (0.57 - 0.62). RoBERTa had the highest score compared to the other language models for all data types. CONCLUSIONS: Automating integrated analysis using pre-trained language models to aid in preoperative triaging could enhance accuracy and efficiency at scale, reducing manual review and provider burden.
The effect of personalized perioperative blood pressure management on intraoperative cerebral oxygen saturation, burst suppression ratio and postoperative neurological outcomes in patients having major non-cardiac surgery: an observational substudy of the IMPROVE-pilot randomized controlled trial.
Khader W, Hein M, Kouz K … +7 more , Bergholz A, Saugel B, Wallqvist J, Goldmann S, Gräfe K, Larmann J, Grüßer L
J Clin Monit Comput · 2026 Apr · PMID 41428250 · Full text
It is not clear whether adopting personalized intraoperative blood pressure management could lead to better intraoperative regional cerebral saturation (rSO2), lower burst suppression ratio (BSR) or better neurological o...
It is not clear whether adopting personalized intraoperative blood pressure management could lead to better intraoperative regional cerebral saturation (rSO2), lower burst suppression ratio (BSR) or better neurological outcomes. Therefore, we performed this prespecified exploratory substudy of the IMPROVE-pilot trial to investigate the effects of personalized compared to routine intraoperative blood pressure management on the intraoperative rSO2. We also explored the effect of personalized intraoperative blood pressure management on BSR and the incidence of postoperative delirium (POD) and delayed neurocognitive recovery (dNCR). We included patients aged ≥ 45 years with American Society of Anesthesiologists (ASA) physical status II-IV who were scheduled for elective major surgery. Preoperative automated nighttime blood pressure measurements were performed. Patients were randomized to personalized blood pressure management maintaining intraoperative mean arterial pressure (MAP) at least at the preoperative mean nighttime MAP or to routine blood pressure management with a lower MAP intervention threshold of 65 mmHg. Intraoperative measurements of MAP, rSO2 on both hemispheres, and BSR were performed. POD was assessed daily on the first 3 postoperative days using the 3D-confusion assessment method or the confusion assessment method for the intensive care unit. We screened for dNCR using the telephone-Montreal Cognitive Assessment on postoperative days 3, 7, and 30. We enrolled 55 patients and randomized 50 patients. 49 patients were included in the final analysis. The median areas under the baseline rSO2 and BSR were similar between the two groups. One patient assigned to personalized blood pressure management and none of the patients assigned to routine blood pressure management had POD. There was no meaningful difference in the incidence of dNCR between the groups. In this substudy of the IMPROVE-pilot trial, we observed no evidence of difference in intraoperative area under baseline rSO2 between patients who received personalized compared to routine perioperative blood pressure management. TRIAL REGISTRATION: This substudy was registered at the German Clinical Trials Register (Deutsches Register Klinischer Studien DRKS00025762, on December 3, 2021).
Effects of sustained Trendelenburg position on the spectral signatures of the EEG: implications for the consistency of the level of anesthesia, an observational study.
Rubio-Baines I, Martinez-Simon A, Valencia M … +6 more , Panadero A, Cacho-Asenjo E, Manzanilla O, Alegre M, Nuñez-Cordoba JM, Honorato-Cia C
J Clin Monit Comput · 2026 Apr · PMID 41428249 · Full text
Measurements from level of anesthesia monitors can be influenced by various factors. This study aimed to compare the evolution of BIS Vista™ monitor and electroencephalogram (EEG) parameters over time during steep Trende...
Measurements from level of anesthesia monitors can be influenced by various factors. This study aimed to compare the evolution of BIS Vista™ monitor and electroencephalogram (EEG) parameters over time during steep Trendelenburg positioning. In this prospective observational study, data were collected from patients undergoing robot-assisted radical prostatectomy. BIS Vista™ monitor parameters (BIS Index, SEF95, EEG-BIS) and a 4-electrode EEG setup (EEG-BrVis) were recorded at baseline, 30 min after Trendelenburg positioning, and every 60 min until procedure completion. Parameter changes from baseline and trends over time were analyzed. Eighteen patients were analyzed. The mean surgical duration was 269 ± 69 min, with Trendelenburg angles ranging from 32º to 41º. No significant changes were observed in BIS Index or SEF95 in trend over the time. Mean changes in BIS Index were 0.017 ± 0.01 (p = 0.096) and 0.016 ± 0.011 (p = 0.162); SEF95 changes were − 0.002 ± 0.002 Hz (p = 0.390) and − 0.002 ± 0.002 Hz (p = 0.326) for left and right hemispheres, respectively. However, the area under the curve of the power spectral (p < 0.001) and all frequency bands power (p < 0.001) showed a significant decrease over the time in both EEG. Minimal changes without clear pattern were observed in spectral slope during the study. BIS Index and SEF95 remained consistent during prolonged Trendelenburg positioning. The reduction in EEG singal power across 0–45 Hz caused a vertical shift in the power spectrum with minimal changes in its spectral profile. Facial tissue edema by positioning plays a primary role in the EEG signal power reduction.
On the utility of near-infrared spectroscopy-derived measures for assessing cerebrovascular autoregulation: results from an observational cohort study.
Bögli SY, Smith C, Olakorede I … +3 more , Placek MM, Bale G, Smielewski P
J Clin Monit Comput · 2026 Apr · PMID 41396350 · Full text
Cerebrovascular autoregulation maintains stable cerebral blood flow by counteracting slow changes in cerebral perfusion pressure (termed "slow waves"). Conventional assessment involves invasive techniques using intracran...
Cerebrovascular autoregulation maintains stable cerebral blood flow by counteracting slow changes in cerebral perfusion pressure (termed "slow waves"). Conventional assessment involves invasive techniques using intracranial pressure (ICP) or technically challenging cerebral blood flow velocity (FV) measurements. Near-infrared spectroscopy (NIRS) has emerged as a non-invasive alternative; however, its ability to accurately capture the slow-wave oscillations fundamental to cerebrovascular autoregulation remains uncertain. 412 h of simultaneous ICP, FV, NIRS, and arterial blood pressure (ABP) monitoring from 35 traumatic brain injury patients were explored. Coherence, gain, and Granger causality analyses were employed to assess whether NIRS adequately reflects slow waves in ABP, FV, or ICP to investigate whether NIRS is a suitable alternative for assessing the state of cerebrovascular autoregulation In this single-centre observational cohort study, 89 recordings from 35 moderate to severe traumatic brain injury (TBI) patients (totalling 412 h of artefact-free data) were analysed. Simultaneous high-resolution recordings of NIRS, ICP, FV, and arterial blood pressure (ABP) were acquired. Coherence and gain were computed across defined frequency bands (0.001-0.5 Hz), with a focus on the range most relevant to cerebrovascular autoregulation (0.005-0.05 Hz). Granger causality was used to explore directional relationships between physiological inputs (ABP, FV, ICP) and NIRS outputs (rSO2 and haemoglobin metrics). Haemoglobin-based NIRS metrics (total, oxy-, deoxy-, and delta haemoglobin) demonstrated significantly higher coherence and Granger causality with FV and ICP compared to rSO2 (p < 0.001, large effect sizes) capturing the slow-wave oscillations central to cerebrovascular autoregulation. In contrast, rSO₂ exhibited poor coherence and low causality, especially with ABP, likely due to device-specific post-processing and resolution limitations. NIRS derived haemoglobin metrics reliably capture slow-wave dynamics reflective of cerebrovascular autoregulation and reactivity, offering a non-invasive alternative to traditional methods. Conversely, rSO2 lacks sufficient temporal fidelity to detect these fluctuations under routine clinical conditions, limiting its utility for cerebrovascular autoregulation assessment.
Predicting difficult videolaryngoscopic intubation in patients with obesity using ultrasound: an observational, prospective study.
Li J, Meng Z, Li D … +3 more , Bian C, Cai J, Wang Y
J Clin Monit Comput · 2026 Feb · PMID 41385007 · Publisher ↗
This study aimed to assess the effectiveness and validity of ultrasonographic measurements in predicting difficult videolaryngoscopic intubation in patients with obesity. This observational prospective study included 140...
This study aimed to assess the effectiveness and validity of ultrasonographic measurements in predicting difficult videolaryngoscopic intubation in patients with obesity. This observational prospective study included 140 patients with obesity who were scheduled for elective laparoscopic bariatric surgery under general anesthesia. Following tracheal intubation during anesthesia induction, patients were classified into either the non-difficult or difficult intubation group based on the Videolaryngoscopic Intubation and Difficult Airway Classification scale. Clinical and ultrasonographic airway parameters were recorded during the pre-anesthetic evaluation. Receiver operating characteristic curves were generated to assess the diagnostic performance of the airway measurements. Of the 140 enrolled patients, 128 were analysed, with 101 classified as non-difficult and 27 as difficult intubations. Skin-to-tongue thickness and the distance from the skin to the epiglottis (DSE) were the two most reliable predictors of difficult intubation, with area under the curve (AUC) values of 0.776 [95% confidence interval (CI): 0.672–0.879] and 0.774 (95% CI: 0.678–0.869), respectively. The LEMON (Look-Evaluate-Mallampati-Obstruction-Neck mobility) score, skin-to-tongue thickness, and DSE were identified as independent risk factors for predicting difficult intubation. When these three parameters were combined, predictive performance improved, with an AUC of 0.845 (95% CI: 0.760–0.929). The combination of the LEMON score, skin-to-tongue thickness, and DSE demonstrated superior predictive accuracy compared to any single parameter for identifying difficult videolaryngoscopic intubation in obese patients.
Program of quality improvement for extracorporeal blood purification therapies in the intensive care unit.
Cecchi M, Pomarè Montin D, Fioccola A … +8 more , Bocciero V, Scirè Calabrisotto C, Autieri F, Benelli M, Geppetti A, Ricci Z, Romagnoli S, Villa G
J Clin Monit Comput · 2026 Jun · PMID 41385006 · Full text
Critically ill patients often require complex extracorporeal treatments, such as extracorporeal blood purification (EBP). At the bedside, there can be reluctance or uncertainty about when to initiate EBP, and there is no...
Critically ill patients often require complex extracorporeal treatments, such as extracorporeal blood purification (EBP). At the bedside, there can be reluctance or uncertainty about when to initiate EBP, and there is no standard agreement on which goals to pursue, what prescriptions to use to achieve those goals, or which recommendations to follow to prevent complications. Furthermore, an accurate analysis of why clinical goals are not achieved or how often the patient should be reassessed to readjust the EBP prescription is not currently standardized. This narrative review describes the main actions characterizing a quality improvement program for EBP in the ICU, which took place at the University of Florence and was subsequently adopted at the national level. The pillars of this program were: (1) definition, implementation, and dissemination of information and communication technology tools aimed at objectively measuring results at the bedside, supporting dynamic prescribing and precision medicine, and promoting advances in knowledge in this field; (2) creation of a national multi-professional network of clinical users and researchers in EBP; (3) promotion and maintenance of technical and non-technical skills in EBP based on the reformulation of advanced academic training in this field.
Transcranial doppler assessment of preoperative cerebral blood flow velocity in cardiac surgery patients.
Saller T, Almaghrabi M, Thudium M … +3 more , Saqqa MNA, Kilger E, Juchem G
J Clin Monit Comput · 2026 Apr · PMID 41385005 · Full text
Postoperative delirium (POD) is a common and multifactorial complication following cardiac surgery, with cardiopulmonary bypass (CPB) playing a significant contributory role. Impaired cerebral autoregulation (CA) during...
Postoperative delirium (POD) is a common and multifactorial complication following cardiac surgery, with cardiopulmonary bypass (CPB) playing a significant contributory role. Impaired cerebral autoregulation (CA) during CPB, particularly in older patients, may lead to cerebral hypo- or hyperperfusion. While several methods exist to assess CA and cerebral blood flow, many require specialized equipment not widely available. This prospective observational study aimed to investigate whether altered cerebral artery flow velocity, measured preoperatively by transcranial Doppler (TCD), is associated with the development of POD. We enrolled 41 patients undergoing elective cardiac surgery with CPB. Bilateral peak flow velocities of the middle cerebral arteries were measured preoperatively using TCD. The mean middle cerebral artery velocity (mMCAv) was calculated for each patient. POD occurred in 21 patients (51%). A lower mMCAv was significantly associated with an increased risk of POD. Specifically, each 1 cm/s decrease in mMCAv increased the likelihood of POD by 9.2% (odds ratio 0.908; 95% confidence interval: 0.840-0.981; p = 0.015). Reduced cerebral blood flow velocity during CPB, as measured by TCD, is associated with a higher risk of POD. These findings highlight the potential utility of intraoperative TCD monitoring for early identification of at-risk patients and support further research into TCD-guided preventive strategies in cardiac surgery.
The evolution and future of point of care ultrasound in the perioperative period: narrative review.
Dabo-Trubelja A, Perioperative D
J Clin Monit Comput · 2026 Feb · PMID 41379285 · Full text
Clinical ultrasound in the hands of physicians is rich with experiences from various medical specialties. As point of care ultrasound has revolutionized patient care in the perioperative period, it is important to reflec...
Clinical ultrasound in the hands of physicians is rich with experiences from various medical specialties. As point of care ultrasound has revolutionized patient care in the perioperative period, it is important to reflect on the beginnings, and the path taken to modern day portable devices. As anesthesiologists, point of care ultrasound has become embedded into all aspects of perioperative care to improve patient outcomes. Advancements in technology continue to extend the boundaries for use by anesthesiologists and redefine the standard of care in the perioperative period. This article reflects on the path of point-of-care ultrasound from its beginning to the present day and discusses future directions. A summary of key findings is shown.
Cerebral monitoring responses to bedside physiological challenges in comatose post-cardiac arrest patients.
Kishna YS, Baars S, van der Horst ICC … +4 more , Mess WH, Hendrix R, Delnoij TSR, Aries M
J Clin Monit Comput · 2026 Feb · PMID 41369879 · Publisher ↗
To evaluate the effects of three simple bedside challenges on cerebral oxygenation and brain activity, measured non-invasively using near-infrared spectroscopy (NIRS) and frontal single-channel electroencephalography (EE...
To evaluate the effects of three simple bedside challenges on cerebral oxygenation and brain activity, measured non-invasively using near-infrared spectroscopy (NIRS) and frontal single-channel electroencephalography (EEG), in comatose post-cardiac arrest patients, and to examine whether these responses differ according to cerebral autoregulation status and intensive care unit (ICU) outcome and could aid early prognostication. Three bedside physiological challenges were conducted: (1) increasing the fraction of inspired oxygen (FiO₂) to 100%, (2) lowering the head-of-bed (HOB) to 0°, and (3) elevating end-tidal carbon dioxide (etCO₂) by 1.0 kPa. Tissue oxygen saturation (StO₂) and EEG amplitude were hypothesized to increase, by enhancing oxygen delivery (FiO₂), augmenting cerebral perfusion pressure (HOB), and inducing cerebral vasodilation (etCO₂). Furthermore, we examined the associations between signal responses, cerebral autoregulation status, and ICU outcome. Of the 48 monitored patients, FiO, HOB, and etCO₂ challenges were successfully completed in 41 (85%), 33 (69%), and 32 (67%) patients, respectively. The StO₂ increased on average by 0.3% (95%-CI 0.2-0.5, p < 0.001) for every 10% rise in FiO, and 1.94% (95%-CI 0.9-3.0, p < 0.001) for each 15º lowering of the HOB. The etCO₂ challenge did not affect the StO₂. EEG amplitude remained unchanged during all three challenges. No significant differences were found in the responses between patients with intact versus impaired autoregulation or between the ICU outcome groups. Brief physiological challenges simulating common ICU scenarios elicited only modest increases in StO₂, and no measurable response in EEG amplitude. Response patterns were not associated with cerebral autoregulation status or ICU outcome.
Comparing signal concordance of needle electrodes and conventional bispectral index sensors in anesthesia monitoring: a prospective pilot study.
Xu J, Wu W, Zhou N … +10 more , Zhu L, Zhao L, Li T, Hu S, Wei Q, Chen Y, Yao Y, Yan M, Liu J, Zhang F
J Clin Monit Comput · 2026 Feb · PMID 41364191 · Publisher ↗
Processed EEG is commonly used for evaluating depth of anesthesia. Conventionally, the adhesive electrodes are applied to the patient’s frontal region. However, it may be unsuitable for certain neurosurgeries. The goal o...
Processed EEG is commonly used for evaluating depth of anesthesia. Conventionally, the adhesive electrodes are applied to the patient’s frontal region. However, it may be unsuitable for certain neurosurgeries. The goal of this study is to assess and compare the performance of needle electrodes and conventional electrodes for intraoperative anesthesia depth monitoring. We developed an in-house interface for connecting needle electrodes to a BIS monitoring system, and simultaneously monitored BIS using needle electrodes and conventional sensor in patients under general anesthesia for elective surgery. Agreement in BIS values between the electrode and sensor was assessed using Bland-Altman analysis, and correlation between the two measurements was assessed using a generalized linear model. We also compared the beta ratio, alpha ratio, 95% spectral edge frequency, and SynchFastSlow index between the needle electrodes and conventional sensor. We analyzed 3,447 pairs of BIS index of 23 patients. Values from the needle electrodes and conventional sensor correlated strongly (r = 0.912 [95% confidence interval, 0.9057 to 0.9170] ) and showed a mean difference (± SD, 95% limits of agreement) of 1.735 (± 5.469, − 8.983 to 12.454). The raw EEG signal obtained with needle electrodes for processed EEG monitoring is comparable to that of conventional electrodes. Therefore, needle electrodes can be an alternative to conventional electrodes.
Impact of rapid-eye-movement sleep behavior disorder on propofol anesthesia depth monitoring in parkinson's disease.
Ling Y, Liu L, Xiao Q … +13 more , Huang L, Guo Q, Wang S, Qu B, Wen Z, Wu B, Zhang C, Xie B, Zhu N, Chu J, Chen L, Liu J, Jiang N
J Clin Monit Comput · 2026 Feb · PMID 41364190 · Publisher ↗
Depth-of-anesthesia monitoring, particularly in functional neurosurgical procedures such as asleep deep brain stimulation, is critical for balancing individualized neurophysiological needs with perioperative safety. Park...
Depth-of-anesthesia monitoring, particularly in functional neurosurgical procedures such as asleep deep brain stimulation, is critical for balancing individualized neurophysiological needs with perioperative safety. Parkinson's disease (PD) patients with rapid-eye-movement sleep behavior disorder (RBD) demonstrate wakefulness electroencephalographic (EEG) abnormalities that may confound monitoring. Whether these RBD-associated EEG patterns persist under propofol anesthesia and distort monitoring indices remains to be elucidated. This study therefore aimed to determine if propofol anesthesia in PD-RBD patients disrupts coherence between anesthesia depth indices and true neurophysiological states. We retrospectively analyzed SedLine-monitored prefrontal EEG data from 43 PD patients undergoing subthalamic nucleus deep brain stimulation, divided into non-RBD (n = 23) and RBD (n = 20) groups. Evaluations were conducted across awake, propofol anesthesia, and propofol light anesthesia states during microelectrode recording, including power spectral density analysis, derived parameter comparisons, and postoperative outcomes. Results showed RBD patients had lower patient state index values during wakefulness (p = 0.034) but displayed comparable patient state index, spectral edge frequency, and suppression ratio under anesthesia; notably stronger gamma suppression occurred in RBD patients during propofol anesthesia (p = 0.027) and light anesthesia states (p = 0.011), along with higher postoperative delirium incidence (65.00%). Logistic regression identified associations between postoperative delirium risk and RBD status, Mini-Mental State Examination scores, and propofol-induced theta power, with theta power emerging as a protective factor. Collectively, PD-RBD patients exhibit abnormal EEG under propofol anesthesia but maintain reliable depth-of-anesthesia indices, necessitating customized anesthesia care and delirium prevention. Clinical Trial Number: ChiCTR2400082770, 2024-04-07, ClinicalTrials.gov).
Mean flow index (Mxa) algorithm option can influence cerebral autoregulation classification in critically ill septic patients.
Vitali E, Salvagno M, Crippa IA … +5 more , Caldas J, Cornejo AQ, Njim H, Panerai RB, Taccone FS
J Clin Monit Comput · 2026 Feb · PMID 41359245 · Publisher ↗
The Mean flow index (Mxa) is widely used to assess dynamic cerebral autoregulation in different clinical populations. This calculation is based on defined characteristics, including blocks, overlap periods, and epochs of...
The Mean flow index (Mxa) is widely used to assess dynamic cerebral autoregulation in different clinical populations. This calculation is based on defined characteristics, including blocks, overlap periods, and epochs of the whole recordings. This study aimed to investigate the reproducibility of different Mxa calculations, using variable blocks, overlap periods, and epochs. We retrospectively analyzed 50 transcranial Doppler recordings from septic shock patients, acquired within 48 h of ICU admission. Mxa was computed using eight signal-processing strategies that varied by block duration (5-10 s), overlap percentage (20%, 50%, 80%), and epoch length (3-5 min), as well as a continuous approach without epochs. Each configuration was labeled using the format epoch-block-overlap. Mxa values were compared using repeated measures analyses, intraclass correlation coefficients (ICC), Bland-Altman plots, and polychoric correlation heatmaps. Median Mxa values ranged from 0.36 to 0.45 across configurations, with no statistically significant differences in within-patient comparisons (p > 0.05). ICCs demonstrated excellent agreement (ICC > 0.90) between approaches using the same epoch duration. Agreement declined modestly when comparing configurations with different epoch lengths (e.g., ICC = 0.782 between 3-10-50 and 5-10-50). Fixed-effects analysis did not identify any individual segmentation parameter as a significant source of variability. Mxa values calculated using different combinations of block, overlap, and epoch duration were consistent within patients, particularly when epoch length was maintained. These findings support the reproducibility of Mxa and suggest flexibility in processing strategies, provided methodological consistency is maintained. Further validation is warranted.
Early detection of postoperative infections using continuous temperature monitoring: A prospective clinical trial.
Schäfer L, Dickel F, Strohmayer K … +4 more , Koele W, Leber B, Sucher R, Stiegler P
J Clin Monit Comput · 2026 Jun · PMID 41348412 · Full text
This study aimed to evaluate whether continuous axillary temperature monitoring using a wearable patch enables earlier detection of postoperative infections compared to conventional intermittent infrared thermometry. 103...
This study aimed to evaluate whether continuous axillary temperature monitoring using a wearable patch enables earlier detection of postoperative infections compared to conventional intermittent infrared thermometry. 103 surgical patients were included in this prospective, single-center study and monitored over an 11-month period. Continuous axillary temperature monitoring using the SteadyTemp patch was compared to routine infrared measurements performed as part of clinical routine. The primary outcome was fever detection rate (≥ 38.0 °C). Secondary outcomes included the correlation between fever detection and laboratory values as well as the frequency of clinical interventions. Out of 103 included patients, fever was detected in 33 cases. Continuous monitoring identified fever in 31 of these 33 patients (93.9%), whereas infrared thermometry detected fever in only 12 cases (36.4%). In 16 cases where antibiotic therapy was initiated or adjusted due to newly detected fever, the patch detected fever in 15 patients, compared to only 7 detections by infrared thermometry. Surgical interventions due to suspected infections were performed in 5 patients, and fever was detected by the patch in all cases, while infrared thermometry detected fever in only 2 of these patients. Due to the frequent failure of infrared thermometry to detect fever, a scoring system was developed to assess the clinical relevance of fever detection. Continuous temperature monitoring with the SteadyTemp patch demonstrated superior fever detection compared to infrared thermometry, leading to earlier identification of febrile events. This study suggests that continuous temperature monitoring may enhance infection surveillance in surgical patients, allowing for more timely clinical interventions.
Ultrasound strain elastography for peripheral nerves localization for regional anesthesia A prospective observational pilot study.
Parvais M, Lecucq A, Estruch-Pons I … +4 more , Coesens L, Engelman E, Tuna T, Pandin P
J Clin Monit Comput · 2026 Feb · PMID 41348411 · Publisher ↗
Ultrasound Elastography (UE) tends to improve the ultrasound diagnosis accuracy. The Strain Elastography (SE) depicts the pathological tissue loss of elasticity in response to an external pressure applied by the operator...
Ultrasound Elastography (UE) tends to improve the ultrasound diagnosis accuracy. The Strain Elastography (SE) depicts the pathological tissue loss of elasticity in response to an external pressure applied by the operator. It is now recommended for benign/malignant parenchymal process differentiation and for muscle and nervous rigidness assessment and follow-up. The SE was able to differentiate the normal nerves from their muscular-vascular environment based on their own elasticity using a colorimetric scale (CS)0.30 healthy adult patients were included into this prospective observational study. The femoral nerve (FN) and the popliteal sciatic nerve (PSN) were studied using 2D black and white sonography (S) and SE. About the SE, firstly, CS goes from red (stiffer) to blue (softer) differentiating 6 main colors at the visual assessment. Secondly, the CS was transformed into a 3 points tissues classification related to FN and PSN elasticity for easier reading. Results are presented as percentages.FN and PSN in sonography were normal in all patients confirming the different morphology of each kind of nerve with a high level of patient-to-patient reproducibility. SE detected as "stiff" the FN and PSN in respectively 87 and 83% of the patients. Finally, a superposition between sonogram and elastogram greater than 50% was observed in 54 and 70% of the patients.SE represents a promising technique that may complement S to try to improve the quality of nerve localization. Further and larger studies are needed for a better understanding the subject in real clinical conditions.
Profiling cerebral hemodynamics in sepsis and septic shock patients with transcranial doppler: a systematic review and meta-analysis.
Cury P, Passos T, Alves F … +4 more , Taccone FS, Bogossian EG, Panerai RB, Caldas J
J Clin Monit Comput · 2026 Feb · PMID 41348410 · Publisher ↗
Neurological dysfunction is an early marker of sepsis. Cerebral hemodynamic disturbances are frequent in septic and septic shock and may play a key role in the development of sepsis-associated brain dysfunction. Our aim...
Neurological dysfunction is an early marker of sepsis. Cerebral hemodynamic disturbances are frequent in septic and septic shock and may play a key role in the development of sepsis-associated brain dysfunction. Our aim was to assess the existing evidence on the assessment of cerebral hemodynamics in sepsis with the use of transcranial Doppler (TCD). A systematic search of PubMed/Medline, EMBASE and Web of Science was conducted for eligible studies. We included studies published in English up to January 2025 observational and interventional articles using TCD were included. We analyzed data provided by TCD, including middle cerebral artery velocity (MCAv), pulsatility index, cerebral autoregulation indices, cerebral vaso-reactivity, estimated intracranial pressure (eICP), critical closing pressure, and their relationship with clinical outcomes, such as cerebral dysfunction and mortality. This systematic review was recorded in PROSPERO with the ID CRD42023449660. After screening 371 articles, 62 were reviewed in full text, and 29 met the inclusion criteria. A total of 1,087 patients were included, 558 of whom had confirmed septic shock. Mean MCA-v remained within normal limits, cerebral perfusion pressure was relatively low, without an increase in eICP. While cerebral autoregulation was often impaired in septic patients, assessment of cerebral vasoreactivity showed divergent results. The pulsatility index and impaired autoregulation were associated with the occurrence of neurological dysfunction. Cerebral hemodynamics are often altered in sepsis and septic shock and may contribute to neurological alterations observed in such patients. Further randomized trials are needed to identify effective interventions.
The ANI monitor's "Energy" variable detects autonomic state modification during general anesthesia, sedation and spinal anesthesia: a retrospective cohort study.
Bourgeois A, Ferran C, Morin L … +3 more , Leroy M, Tavernier B, Jeanne M
J Clin Monit Comput · 2026 Feb · PMID 41317209 · Publisher ↗
The Analgesia Nociception Index (ANI) is based on respiratory sinus arrhythmia and is a validated surrogate marker of the nociception-antinociception balance. Along with the ANI, the monitor provides a measure of overall...
The Analgesia Nociception Index (ANI) is based on respiratory sinus arrhythmia and is a validated surrogate marker of the nociception-antinociception balance. Along with the ANI, the monitor provides a measure of overall heart rate variability modulation named "Energy" and which is closely related to the standard deviation of normal R-R intervals. The objective of the present study was to evaluate variations in "Energy" during general anesthesia, sedation, and spinal anesthesia. We retrospectively analyzed data stored in the anesthesia data warehouse at Lille University Medical Center (Lille, France). Eligible cases involved general anesthesia, spinal anesthesia, or sedation over the period 2012-2024. Patients with arrhythmia or missing baseline data were excluded. Three periods were defined: pre-induction (P1), post-induction (P2), and intraoperative (P3). Linear mixed models were adjusted for age, the American Society of Anesthesiologists score, norepinephrine use, and sex. 2226 procedures were included. The decrease in "Energy" after induction was significantly greater for general anesthesia after adjustment between P1 and P2 (Mean (SD) -0.306 (-0.321; -0.292), p < 0.001) and between P1 and P3 (-0.334 (-0.348; -0.319), p < 0.001). Same results were found for sedation (P1-P2: -0.120 (-0.176; -0.064), p < 0.001; P1-P3: -0.113 (-0.168; -0.056), p < 0.001) and spinal anesthesia (P1-P2: 0.082 (0.017; 0.146), p = 0.012; P1-P3: 0.089 (0.025; 0.153), p = 0.006) after adjustment. Changes during sedation and spinal anesthesia were not clinically relevant. "Energy" decreases after the induction of general anesthesia and sedation and thus reflects a lower degree of autonomic modulation.
Continuous autonomic system monitoring during neurosurgical procedures -proof of concept.
Zipfel J, Stoyanov D, Czosnyka M … +2 more , Drexler B, Schuhmann MU
J Clin Monit Comput · 2026 Jun · PMID 41317208 · Full text
Vegetative reactions are common during neurosurgical procedures. Known effects are mainly cardiovascular, including tachy- and bradyarrhythmia, hyper- and hypotonia as well as cardiac arrest. Computer-assisted real-time...
Vegetative reactions are common during neurosurgical procedures. Known effects are mainly cardiovascular, including tachy- and bradyarrhythmia, hyper- and hypotonia as well as cardiac arrest. Computer-assisted real-time analysis of heart rate variability (HRV), baroreflex-sensitivity (BRS) allows for continuous evaluation of the autonomic nervous system (ANS). We analyzed ANS parameters during intracranial neurosurgical procedures. In this pilot study, we aim to provide proof-of-concept that ANS monitoring during surgery is feasible and yields stable results.We included 129 consecutive patients undergoing neurosurgery for intracranial pathologies over a period of four months. Heart rate (HR) and mean arterial pressure (MAP) were continuously monitored during routine anesthesiology care. Data were recorded via ICM + software. HRV, BRS and other vegetative parameters were calculated continuously. Intraoperative events such as hypo-/hypertonia or brady-/tachycardia were monitored.Mean age was 47.2 ± 17.7 years. Of all patients, 54.3% were male (n = 70). For every patient, four intraoperative episodes were defined: start of anesthesia until incision - start of incision until craniotomy - craniotomy until end of resection or intracranial manipulation - end phase until skin closure. BRS continuously decreased during cranial surgery, indicating stabilized autonomic function. Furthermore, blood pressure variability was increased during semi-sitting surgery.Autonomic system monitoring during neurosurgical procedures is safe and feasible. Intraoperatively, an increasing sympathetic activity has been observed without clear disctinction between surgical or anesthesiological events as underlying cause. Monitoring results are reproducible and may be of importance for the detection and prevention of intraoperative cardiovascular events.
Early prognosis prediction in mechanically ventilated patients using machine learning for tertiary care hospital settings.
Mendiratta S, Mukkelli VG, Baidya Kayal E … +2 more , Khanna P, Mehndiratta A
J Clin Monit Comput · 2026 Feb · PMID 41307642 · Publisher ↗
PURPOSE: Intensive care units (ICUs) handle mechanically ventilated patients with life-threatening conditions, who require intensive monitoring and treatment. In a low physician-patient ratio setting, providing consisten...
PURPOSE: Intensive care units (ICUs) handle mechanically ventilated patients with life-threatening conditions, who require intensive monitoring and treatment. In a low physician-patient ratio setting, providing consistent care to all patients is challenging. A survival prediction model using machine-learning can potentially improve prognosis evaluation and resource allocation. This study aims to develop a machine-learning model to predict survival/mortality in mechanically ventilated patients using clinical features recorded at the time of ICU admission and compare its performance with the Sequential Organ Failure Assessment (SOFA) score as a standalone predictor. METHODS: A dataset consisting of 660 mechanically ventilated patients and 98 clinical parameters (n = 660, Male: Female = 365:295, Age = 44.45 ± 19.36 years) from three ICUs at AIIMS, Delhi, was retrospectively evaluated after institutional ethical approval. Binary classification models were trained using 10-fold cross-validation with 70% data and 30% reserved for testing. The outcome was based on the survival/death of the patient during their ICU stay. RESULTS: A total of 39 features were selected using Shapley-Additive-Explanations (SHAP) and Random Forest model. The top three features were SOFA score, International normalized ratio (INR) and respiratory rate with feature importance values of 7.3%, 4.5% and 3.4% respectively. The K-nearest-neighbour (KNN) model using SHAP-selected features achieved the best test performance with an accuracy = 0.80, area-under-receiver-operating-characteristics-curve (AUROC) = 0.84, sensitivity = 0.82, specificity = 0.77, positive-predictive-value (PPV) = 0.78 and negative-predictive-value (NPV) = 0.82, compared to the SOFA-only model showing accuracy = 0.73, AUROC = 0.73, sensitivity = 0.82, specificity = 0.63, PPV = 0.69 and NPV = 0.78. CONCLUSION: The automated machine-learning method for prognosis prediction may assist clinicians in the early triage of patients. These models may offer valuable support to ICU physicians for timely alerts and informed clinical judgment. The study also highlights the continued utility of the SOFA score used by clinicians as the first assessment tool in ICUs, while suggesting that carefully developed machine-learning models may offer complementary support in high-risk ICU settings.
Reliability of bioreactance and arterial waveform analyses in monitoring stroke volume variation during cardiac surgery.
Paaso STM, Tuukkanen PA, Niemi SE … +7 more , Ohtonen PP, Piirainen PT, Ylikauma LA, Lanning KM, Pohjola MJ, Erkinaro TM, Kaakinen TI
J Clin Monit Comput · 2026 Feb · PMID 41284164 · Publisher ↗
PURPOSE: Stroke volume variation (SVV) is a dynamic parameter used to assess fluid responsiveness in mechanically ventilated patients. This study aimed to evaluate the agreement and trending ability of SVV measurements o...
PURPOSE: Stroke volume variation (SVV) is a dynamic parameter used to assess fluid responsiveness in mechanically ventilated patients. This study aimed to evaluate the agreement and trending ability of SVV measurements obtained from bioreactance (Starling SV) and arterial waveform analysis devices (FloTrac and LiDCOrapid) during cardiac surgery. METHODS: This prospective observational method comparison study was conducted in a single university hospital. 18 patients undergoing off-pump coronary artery bypass grafting (OPCAB) were monitored with Starling SV and FloTrac. 20 patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) were monitored with Starling SV and LiDCOrapid. SVV measurements were collected intraoperatively and postoperatively. Agreement and trending ability between devices were assessed using Bland-Altman analysis and four-quadrant plots with error grids and concordance analysis. RESULTS: A total of 2055 paired SVV measurements were obtained in the OPCAB group and 367 in the CPB group. The mean bias between Starling SV and FloTrac was 2.3%pt (95% CI 2.1 to 2.6) with wide limits of agreement (-14.3 to 20.5%pt). For Starling SV and LiDCOrapid, the bias was 1.5%pt (95% CI 0.9 to 2.2) with very wide limits of agreement (-38.3 to 38.4%pt). Trending ability was poor in all comparisons. CONCLUSION: Despite acceptable mean biases, the variability between devices was considerable, and trending analyses indicated only limited concordance. The studied SVV monitors, therefore, cannot be considered interchangeable in the context of cardiac surgery. These findings highlight the limitations and uncertainty of SVV monitoring in this setting.
About
- Frequency
- Sun
- Papers found
- 200
- RSS feed
- Subscribe