To evaluate whether a web-based Intraoperative Glycemic Protocol Calculator (IGPC) improves provider compliance with intraoperative glycemic management protocols during cardiac surgery. Single-center retrospective cohort...To evaluate whether a web-based Intraoperative Glycemic Protocol Calculator (IGPC) improves provider compliance with intraoperative glycemic management protocols during cardiac surgery. Single-center retrospective cohort study conducted between August - October 2022 (pre-intervention) and April - June 2023 (post-intervention). Tertiary care academic hospital. Adult patients undergoing coronary artery bypass grafting and/or valve surgery requiring cardiopulmonary bypass. Implementation of the IGPC, a web-based clinical decision support tool designed to automate insulin dosing recommendations intraoperatively. Protocol adherence, defined as appropriate insulin administration within five minutes of glucose measurement, was compared before and after IGPC implementation. Among 143 patients, IGPC use significantly increased adherence across all intraoperative phases: Pre-CPB (65.5% to 80.2%, p = 0.017), On-CPB (53.0% to 75.1%, p < 0.001), and Post-CPB (34.8% to 58.8%, p < 0.001). Rates of severe hypoglycemia remained low and unchanged (0.1% in both groups; p = 0.772), and intraoperative hyperglycemia rates were similar (4.2% vs. 4.1%; p = 0.995). Implementation of the IGPC significantly improved real-time adherence to intraoperative glycemic control protocols without increasing adverse glycemic events. However, rates of intraoperative hyperglycemia and hypoglycemia remained unchanged between the pre- and post-intervention phases. These findings highlight the utility of clinical decision support tools in enhancing protocol compliance during high-acuity cardiac surgeries.
Gonem S, Stones L, Ward D
… +2 more, Briggs S, McKeever T
J Clin Monit Comput
· 2026 Apr · PMID 41240250
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Respiratory rate is an important early sign of clinical deterioration but the current practice of counting breaths manually is time-consuming and prone to error. We aimed to determine the concordance between manual respi...Respiratory rate is an important early sign of clinical deterioration but the current practice of counting breaths manually is time-consuming and prone to error. We aimed to determine the concordance between manual respiratory rate measurements and automated measurements recorded using a wearable device. We undertook a prospective observational study on three general respiratory wards to compare manual respiratory rate measurements collected during usual clinical care with automated readings from a wearable respiratory rate monitor (RespiraSense, PMD Solutions, Cork, Ireland). Thirty-one patients took part in the study. Manual respiratory rate readings displayed large peaks at 20 and 24 breaths/min, whereas automated readings followed a smooth bell-shaped distribution. Manual and automated respiratory rates were both higher during the day than at night, and this was more marked for automated readings. Automated readings were on average 2.5 (95% confidence interval [CI] 2.2 to 2.8) breaths/minute higher than time-matched manual readings, and the 95% limits of agreement were - 7.9 (95% CI -8.4 to -7.4) and 12.9 (95% CI 12.3 to 13.4) breaths/minute, wider than the clinically acceptable limits of ± 3 breaths/min. Trends in manual and automated respiratory rates were concordant in only 56% of cases. Automated respiratory rate measurements using RespiraSense do not display clinically acceptable agreement with manual measurements in the setting of a respiratory ward.
Elmankabadi S, Dove J, Behnke E
… +14 more, Chou YC, Ortiz L, Leeb G, Auchus I, Chen D, Feiner J, Law TJ, Bickler PE, Hashi S, Zamora RV, Negussie F, Bisegerwa R, Bernstein M, Lipnick MS
J Clin Monit Comput
· 2026 Apr · PMID 41236607
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Functional testers are designed to evaluate select pulse oximeter characteristics but are often misused to validate device accuracy, potentially providing false reassurance. This study evaluated whether the Fluke ProSim8...Functional testers are designed to evaluate select pulse oximeter characteristics but are often misused to validate device accuracy, potentially providing false reassurance. This study evaluated whether the Fluke ProSim8 (FPS8) could accurately predict oximeter performance during human controlled desaturation studies or identify performance differences under low signal conditions. 12 oximeters were tested using two FPS8 protocols: (1) an 'SpO₂ plateau' protocol which mimicked controlled desaturation studies by evaluating device performance over a range of simulated SpO (70-100%), and (2) a 'signal space' protocol designed to assess device accuracy under varying modulation and transmission conditions. Each device also underwent controlled desaturation testing in healthy adults. Six of the 12 oximeters passed (ARMS ≤ 3%) the SpO₂ plateau protocol; however, three of these failed (ARMS > 3%) human testing. At lower simulated saturations, most devices overestimated SpO₂. In the signal space protocol, oximeters performed well under high signal conditions, but many failed to produce readings or showed SpO₂ errors > 3% under low signal conditions. On average, oximeters failed to generate a reading 20.2 ± 7.2 times out of 60 attempts. Ten devices passed (ARMS < 3%) the signal space protocol, but two of these failed human testing. Oximeter performance on the FPS8 did not correlate with human performance (R² = 0.08 for the plateau protocol; R² = 0.01 for the signal space protocol). The FPS8 did not reliably predict oximeter accuracy in human desaturation studies or under low signal conditions; current functional tester protocols are limited in predicting real-world oximeter performance.
The Nociception Level (NOL) index of the PMD-200™ monitor measures intraoperative nociception-antinociception balance. Because it relies on photoplethysmography, it may be affected by pacemaker interference. We evaluated...The Nociception Level (NOL) index of the PMD-200™ monitor measures intraoperative nociception-antinociception balance. Because it relies on photoplethysmography, it may be affected by pacemaker interference. We evaluated its response to pacemaker stimulation in the absence of nociceptive input. Mechanically ventilated adults after elective cardiac surgery were studied. NOL index, bispectral index, mean arterial pressure, and heart rate were recorded every minute for 35 min across seven five-minute periods: baseline (pacemaker off), pacing at 90 beats.min, pacing at 110 beats min, pacemaker off (washout), pacing at 110 beats min (rechallenge), after PMD-200™ recalibration at 110 beats min, and continued monitoring at 110 beats min. Data were analysed with mixed-model repeated measures (random intercept for patient, time fixed; bispectral index covariate for NOL). Results are least-square adjusted means ± (standard error), comparing the last minute of each period. Twenty patients were analysed. Pacemaker-induced heart rate changes significantly affected NOL over time (F = 28.420, p < 0.001). Compared with baseline 2.1 ± (1.74), pacing at 90 beats min increased NOL to 8.4 ± (1.73) (p = 1.000) and at 110 beats min to 18.4 ± (1.73) (p < 0.001). Stopping pacing returned NOL to 1.1 ± (1.73) (p = 1.000), which rose again at 110 beats.min rechallenge to 18.0 ± (1.73) (p < 0.001). Recalibration restored baseline values 1.1 ± (1.73) (p = 1.000), with stability maintained during continued monitoring 1.5 ± (1.73) (p = 1.000). The NOL index captured the studied nociception-antinociception balance during pacemaker stimulation when recalibrated to the paced rate. ClinicalTrials.gov: NCT06696781 on 17.11.2024.
Yang Y, Li M, Yang C
… +4 more, Shi Z, Wu H, Chen G, Chen L
J Clin Monit Comput
· 2026 Apr · PMID 41160382
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BACKGROUND: Accurately identifying surgical patients who will have an increase in stroke volume following fluid administration remains challenging when utilizing noninvasive bedside methods. This study aims to compare th...BACKGROUND: Accurately identifying surgical patients who will have an increase in stroke volume following fluid administration remains challenging when utilizing noninvasive bedside methods. This study aims to compare the value of using ultrasound to measure changes in corrected carotid artery flow time (ΔFTc) with that of using invasive measurements of stroke volume variation (ΔSVV) for assessing volume responsiveness in patients under general anesthesia and mechanical ventilation. METHODS: A total of 91 patients undergoing elective abdominal surgery under general anesthesia were enrolled in this prospective observational study. Under general anesthesia and mechanical ventilation, the ΔFTc was measured using noninvasive bedside ultrasound, and the ΔSVV was measured using invasive hemodynamic monitoring, both before and after fluid administration. Fluid responders were defined as an increase in stroke volume of ≥ 10% after the fluid challenge. RESULTS: A total of 47 (54.0%) patients were fluid responders. The ΔFTc was 14.5 ± 8.3 ms for responders and 5.7 ± 4.9 ms for non-responders, while the ΔSVV was 3.3 ± 1.4% for responders and 1.7 ± 0.7% for non-responders. The areas under the receiver operating characteristic curves for ΔFTc and ΔSVV were 0.85 (95% CI 0.77-0.92; P < 0.05) and 0.84 (95% CI 0.75-0.93; P < 0.05), respectively. The optimal cutoff values were 7.03 ms for ΔFTc (sensitivity 91.5%, specificity 69.8%) and 2.85% for ΔSVV (sensitivity 95.6%, specificity 72.6%). A narrower gray zone for ΔFTc, ranging from 7 ms to 12 ms and covering 27 patients, was observed compared with that for ΔSVV, which ranged from 1% to 3% and covered 41 patients. CONCLUSIONS: Both the ΔFTc and ΔSVV reliably assessed fluid responsiveness in patients undergoing general anesthesia and mechanical ventilation. Noninvasive bedside ultrasound measurement of ΔFTc can serve as an accurate assessment parameter, reflecting the presence of volume responsiveness following rapid fluid administration and showing greater clinical applicability. TRIAL REGISTRATION: www.chictr.org.cn (ChiCTR2500101114); registered 21 April 2025.
PURPOSE: Traditional assessments using carboxyhemoglobin (COHb) levels alone often do not adequately predict clinical course of carbon monoxide (CO) poisoning cases. Perfusion index (PI) and pleth variability index (PVI)...PURPOSE: Traditional assessments using carboxyhemoglobin (COHb) levels alone often do not adequately predict clinical course of carbon monoxide (CO) poisoning cases. Perfusion index (PI) and pleth variability index (PVI) offer non-invasive, continuous monitoring of peripheral perfusion, potentially improving patient management. The objective of this study is to evaluate whether perfusion indices can assist in triage and monitoring of patients with CO poisoning. METHODS: All patients aged 18 years and older, diagnosed with CO poisoning were consecutively enrolled in this prospective observational study from January 2019 to May 2023. Perfusion indices, COHb and lactate levels were measured at diagnosis (values denoted by 1) and after 60-min hyperbaric or normobaric oxygen therapy (HBOT or NBOT) (values denoted by 2). RESULTS: PI-1 showed significant moderate negative correlation with COHb-1 levels in all patients and AUC value of PI-1 in predicting the necessity for HBOT was 0.935. Patients requiring HBOT had significantly lower PI-1 and higher COHb-1, lactate-1, and PVI-1 compared to those receiving NBOT. Following treatment, PI increased, and PVI, lactate, and COHb decreased significantly in both treatment groups (p<0.001 for all). CONCLUSIONS: Perfusion indices, especially PI, may reflect changes in COHb levels and could provide additional information to support triage and monitoring in CO poisoning.
We thank the authors for their interest in our work and their valuable comments. Our response addresses three main points. First, we clarify that the method we presented, deriving mean systemic filling pressure (MSFP) fr...We thank the authors for their interest in our work and their valuable comments. Our response addresses three main points. First, we clarify that the method we presented, deriving mean systemic filling pressure (MSFP) from cardiac power, is a simplification of the Parkin formula. This formula has been validated in both experimental and clinical studies, and we have confirmed its correlation with our approach across different populations. Second, we emphasize the advantage of our method over the Parkin approach: it does not require patient-specific variables such as age, weight, or height, nor does it rely on the assumption of a constant venous-to-arterial compliance ratio (Cv/Ca) of 25:1, which may not always apply. Finally, we identify a critical inconsistency in the authors' simulation model, which yields physiologically impossible values, with venous return resistance exceeding total systemic resistance. This issue highlights the need for further reevaluation.
Gricourt Y, Bibollet G, Perin M
… +7 more, Vialatte PB, Forget P, Alexander B, Chasseigne V, Lefrant JY, Mezzarobba M, Cuvillon P
J Clin Monit Comput
· 2026 Apr · PMID 41118122
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Reduce sevoflurane consumption during anaesthesia remains an economic and environmental challenge. This case study analyzed retrospectively a large cohort of procedures using end-tidal (ET) Control to optimize sevofluran...Reduce sevoflurane consumption during anaesthesia remains an economic and environmental challenge. This case study analyzed retrospectively a large cohort of procedures using end-tidal (ET) Control to optimize sevoflurane consumption and assess the impact of ventilator settings on it. In single center, consecutive adult procedures for noncardiac surgery under general anaesthesia were analyzed in twelve operating rooms. The anaesthesia system (Aisys CS, GE, USA) was connected to software (Carestation Insight, GE, USA) that automatically recorded sevoflurane consumption for each case. Left to the discretion of the anaesthesiologist, fresh gas flow (FGF) was set at 0.5, 0.8 or 1 L.min with an initial end-tidal sevoflurane target of 1.2-2% to reach the goal of approximately 1.0 MAC. The primary endpoint was the sevoflurane consumption (mL.min). Secondary endpoints were sevoflurane consumption and carbon footprint for the cohort (sevoflurane GWP = 702) and by anaesthesia duration, type of airway management (endotracheal intubation EI, laryngeal mask LM), FGF and initial sevoflurane settings. From May to September 2024, 3064 procedures were recorded via the app. with a median (IQR) duration of surgery of 79 (47-124) minutes. Sevoflurane consumption was. 19 528 mL. Median (IQR) sevoflurane consumption was 0.16 (0.12-0.20) mL.min with a carbon footprint (sevoflurane GWP including manufacturing = 1,468 kg/mL) of 0,23(0.17-0.29) kgCO.min.Subgroup analysis demonstrated that FGF at 0.8 or 1.0 L.min significantly increased sevoflurane consumption and CO emission when compared with 0.5 L.min (P < 0.01). Initial ET target sevoflurane levels of 1.2% vs greater than 1.2% did not change total sevoflurane consumption. Regarding airway management (EI vs LM), LM use was associated with higher consumption, specifically when duration > 120 min (P < 0.01). In this large cohort of cases, this study demonstrated that controlling ET with an FGF target of 0.5 L.min remained the best way to reduce sevoflurane consumption. Other settings did not significantly reduce gas consumption.
J Clin Monit Comput
· 2026 Apr · PMID 41099954
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Burn shock is a major early complication in the treatment of severely burned patients, and precise and timely fluid management is essential for survival. Traditional clinical indicators such as urine output, blood pressu...Burn shock is a major early complication in the treatment of severely burned patients, and precise and timely fluid management is essential for survival. Traditional clinical indicators such as urine output, blood pressure, central venous pressure (CVP), and blood lactate are commonly used, but each has significant limitations. Invasive hemodynamic monitoring technologies, such as Pulmonary Artery Catheterization (PAC) and Pulse Contour Cardiac Output (PiCCO), have improved the accuracy of fluid assessment, but carry risks of infection and procedural complications and require experienced clinical interpretation within the context of the patient's overall condition. Non-invasive ultrasound-based methods, including critical care ultrasonography and the Venous Excess Ultrasound Score (VExUS), are emerging as promising alternatives, particularly in resource-limited settings. This review summarizes current methods for fluid management in severely burned patients, with a focus on the concepts of fluid responsiveness and fluid tolerance, and provides recommendations for clinical practice.
Zitzmann A, Strübing A, Reuter DA
… +3 more, Waldmann A, Böhm SH, Müller-Graf F
J Clin Monit Comput
· 2026 Feb · PMID 41091340
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PURPOSE: Electrical impedance tomography (EIT) is a functional imaging technique to monitor regional ventilation. However, the quantification of clinically used ventilation parameters like tidal volume (VT) has not been...PURPOSE: Electrical impedance tomography (EIT) is a functional imaging technique to monitor regional ventilation. However, the quantification of clinically used ventilation parameters like tidal volume (VT) has not been possible yet since EIT measures relative and not absolute changes in impedance. Thus, the study aimed to evaluate the relationship between impedance changes (dZ) and VT in humans and to identify influencing factors. METHODS: 27 patients undergoing elective surgery under general anaesthesia were equipped with a commercially available EIT belt. Measurements were performed at four VTs (6, 8, 10 and 12 mL/BW) on each of four PEEP levels (0, 5, 10 and 15 cmHO). Linear regression analysis was performed for normalized dZ and VT per ideal bodyweight (VT_IBW). Additionally, PEEP, gender, age, height and weight were analysed as potential influencing factors. RESULTS: Regression analysis for individual patients showed good correlations between VT_IBW and normalized dZ (mean R 0.890 ± 0.15). However, for the group of patients, correlations were rather weak (R 0.485). Including additional factors improved the model (adjusted R 0.767), with VT_IBW having the biggest impact, followed by weight, height and PEEP; age did not contribute to it significantly. Higher VT_IBW, PEEP and height increased, while female gender and higher weight decreased normalized dZ. CONCLUSION: Normalized dZ correlated strongly with VT_IBW in the individual ventilated humans but more weakly when analyzing the cohort. PEEP, gender, weight and height were identified as additional influencing factors. TRIAL REGISTRATION: This study was prospectively registered at the German Register of Clinical Studies (Deutsches Register Klinischer Studien; DRKS00027226) on 3rd December 2021.
Burša F, Frelich M, Sklienka P
… +6 more, Kučerová Z, Sagan J, Oczka D, Penhaker M, Burda M, Máca J
J Clin Monit Comput
· 2026 Feb · PMID 41075121
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BACKGROUND: Despite the substantial advancements in mechanical ventilation (MV), mortality remains high. Mechanical power (MP), MV forces are associated with outcomes. Real-time monitoring of MP and the adjustment of MV...BACKGROUND: Despite the substantial advancements in mechanical ventilation (MV), mortality remains high. Mechanical power (MP), MV forces are associated with outcomes. Real-time monitoring of MP and the adjustment of MV according to MP may result in ventilation with lower MP. METHODS: Randomized controled trial conducted at the ECMO Centre Ostrava, Czech Republic, from March 2023 to March 2024 enrolled adult patients on MV (with or without extracorporeal membrane oxygenation, ECMO) with acute respiratory failure. A system for real-time MP monitoring (geometric method and simplified Becher´s formula) has been developed. In the intervention arm, the physician was able to observe the MP in real time and adjust the MV parameters accordingly. In the control group, the MP was concealed. RESULTS: A total of 494 subjects were screened and 33 patients were randomized (further 7 ECMO patients). There was no significant difference between the control and intervention groups. Median MP was 3.22 J/min (maximum 15.2 J/min) and MP of 5.94 J/min (maximum 18.4 J/min). Only a weak (but significant, p = 0.0001) correlation between MP and MP was observed. A highly significant difference was observed in MP between day and night (6 a.m. - 6 p.m.) with higher MP at night. CONCLUSION: Although real-time MP measurement is feasible, there was no significant difference in MP between the control and intervention groups with low MP in both groups. Experience physicians was capable of safe MV, even if they do not know the exact MP value. The night shift was a high-risk period for developing lung damage due to elevated MP. TRIAL REGISTRATION: ClinicalTrials NCT06035146.
Megjhani M, Weinerman B, Alalqum T
… +12 more, Li Y, Zhou Z, Lau B, Kwon SB, Ku Y, Velazquez A, Ghoshal S, Roh DJ, Agarwal S, Connolly ES, Claassen J, Park S
J Clin Monit Comput
· 2025 Dec · PMID 41066041
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Elevated intracranial pressure (ICP) contributes to poor neurological outcomes in brain injured patients but relies on invasive approaches with inherent risks. ICP dynamics are closely related to cerebral blood flow velo...Elevated intracranial pressure (ICP) contributes to poor neurological outcomes in brain injured patients but relies on invasive approaches with inherent risks. ICP dynamics are closely related to cerebral blood flow velocity (CBFV) and arterial blood pressure (ABP). Data-driven, non-invasive techniques show promise but lack clinically acceptable accuracy and require large amounts of data. We used a pre-trained transformer-based foundation model (MOMENT) to generate embeddings from ABP and CBFV in two cohorts (a) Columbia University Irving Medical Center (CUIMC) (b) Medical Information Mart for Intensive Care III (MIMIC). These embeddings were then used to train a stochastic gradient descent regressor for deriving non-invasive ICP (nICP). Model performance was evaluated using median absolute error (MAE) and Bland-Altman statistics, with leave-one-patient-out validation strategy for within-cohort testing. Further models trained in one cohort were validated on the other to assess generalizability. The CUIMC dataset included 11 patients with a median age of 56 years [IQR: 44–66], and ICP ranging from 0 to 39.8 mmHg. The MIMIC dataset included 11 patients, with a median age of 11 years [IQR: 6.7–17], and ICP ranging from 0 to 35.6 mmHg. The CUIMC-trained model achieved a median MAE of 3.4 mmHg [IQR: 2.54–5.69] on CUIMC dataset and 3.21 mmHg [IQR: 2.46–3.81] on MIMIC dataset. The MIMIC-trained model achieved a median MAE of 3.99 mmHg [IQR: 2.56–5.96] MIMIC dataset and 1.97 mmHg [IQR: 1.87–3.82] on CUIMC dataset. We present a framework for leveraging a time-series foundation model for deriving robust nICP measures across diverse patient populations.
UNLABELLED: Purpose To evaluate the effect of reducing tidal volume from 8 mL/kg predicted body weight (PBW) to 6 mL/kg PBW on dynamic arterial elastance (Eadyn) in patients scheduled for laparoscopic surgery. METHOD: Af...UNLABELLED: Purpose To evaluate the effect of reducing tidal volume from 8 mL/kg predicted body weight (PBW) to 6 mL/kg PBW on dynamic arterial elastance (Eadyn) in patients scheduled for laparoscopic surgery. METHOD: After the start of intra-abdominal insufflation, if MAP became < 65 mmHg and SVV > 10%, then the tidal volume was reduced from 8 mL/kg PBW to 6 mL/kg PBW. One min later, 250 mL of lactate Ringer's solution was administered over 10 min. MAP responsiveness was defined as a > 10% increase in MAP following a fluid challenge. RESULTS: This study included 46 patients, 11 MAP non-responders and 35 MAP responders. Both PPV and SVV decreased significantly (- 19.4 ± 11% and - 19.7 ± 9.9%, respectively) following tidal volume reduction. However, the magnitude of the decrease differed. As a result, the change in Eadyn was minimal on average, although inter-individual variability was observed. Bland-Altman analysis revealed a mean difference of - 0.004, with 95% limits of agreement ranging from - 0.285 to + 0.278. Eadyn values before and after tidal volume reduction failed to predict MAP responsiveness (at 8 mL/kg PBW: area under the ROC curve [AUC] 0.514, at 6 mL/kg PBW: AUC 0.508). CONCLUSION: The reduction in tidal volume had a clinically negligible effect on Eadyn. Neither Eadyn values at tidal volume of 8 mL/kg PBW and 6 mL/kg PBW could not predict MAP increase after a fluid challenge during laparoscopic surgery. TRIAL REGISTRATION: This study was registered in the UMIN-CTR Clinical Database (ID: UMIN000054061) on April 4th, 2024. https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi? recptno=R000061722.
Baseline cerebral regional oxygen saturation (rSO₂) measured with the INVOS 5100C near-infrared spectroscopy (NIRS) device has been reported to correlate primarily with preoperative B-type natriuretic peptide (BNP) and h...Baseline cerebral regional oxygen saturation (rSO₂) measured with the INVOS 5100C near-infrared spectroscopy (NIRS) device has been reported to correlate primarily with preoperative B-type natriuretic peptide (BNP) and hemoglobin levels. It has also been reported to be associated with postoperative mortality. This study evaluated whether similar associations exist for other NIRS-derived indicators, including tissue oxygenation index (TOI) and tissue oxygen saturation (StO₂), measured with the NIRO-200NX and FORESIGHT Elite devices, respectively. We retrospectively analyzed 510, 468, and 510 non-dialysis adult patients undergoing cardiac surgery in whom baseline rSO₂, TOI, and StO₂, respectively, were measured on the forehead before anesthesia and mixed venous oxygen saturation (SmvO₂) was measured after induction of anesthesia. Correlations between 37 preoperative blood test variables and NIRS or SmvO₂ values were evaluated using Spearman's correlation coefficient. Associations between baseline NIRS values and postoperative in-hospital mortality were assessed using logistic regression. Across all three devices, baseline NIRS values and SmvO₂ values were most significantly correlated with BNP and hemoglobin (all p < 0.00001) of the 37 preoperative blood test variables. Baseline rSO₂, TOI, and StO₂ values were each significantly associated with postoperative mortality (p = 0.00101, 0.00111, and 0.01122, respectively). For all NIRS-derived indicators examined, baseline NIRS values before anesthesia and SmvO₂ values after induction of anesthesia were primarily correlated with BNP and hemoglobin levels. In addition, baseline NIRS values showed a significant association with postoperative in-hospital mortality, suggesting their potential utility as a prognostic marker, although this requires confirmation in larger studies.
Koschmieder KC, Pinnschmidt HO, Borst LS
… +4 more, Greiwe G, Kainz E, Fischer M, Nitzschke R
J Clin Monit Comput
· 2026 Apr · PMID 41042488
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PURPOSE: This randomised controlled trial investigated the effect of Surgical Pleth Index (SPI) guided sufentanil administration on intraoperative sufentanil consumption compared to routine care in patients with a combin...PURPOSE: This randomised controlled trial investigated the effect of Surgical Pleth Index (SPI) guided sufentanil administration on intraoperative sufentanil consumption compared to routine care in patients with a combination of general anaesthesia and regional anaesthesia having trauma and orthopaedic surgery. METHODS: Eighty patients with a combination of general anaesthesia and regional anaesthesia undergoing trauma or orthopaedic surgery were randomised into two groups to receive either sufentanil guided by SPI monitoring or by routine care (Control). The primary endpoint was intraoperative sufentanil consumption. Secondary endpoints were postoperative pain level, opioid consumption, incidence of nausea, duration of time in the post-anaesthesia care unit (PACU) and quality of recovery. RESULTS: The median intraoperative sufentanil administration adjusted to bodyweight and surgery duration did not differ between the groups: SPI guided group 2.29 (interquartile range, IQR 0.29 to 6.91), Control 1.65 (IQR 0.83 to 2.63) µg·kg·min*1000 (P = 0.906). The relative risk for receiving intraoperative sufentanil was RR 0.909 (95% CI 0.723 to 1.143, P = 0.414). Median morphine equivalents administered in the 24 h after discharge from the PACU were 3.8 (IQR 0.0 to 22.5) in the SPI guided group and 19.1 (IQR 3.8 to 30.0) mg (P = 0.021) in the control group without adjustment for multiple testing. Other secondary endpoints showed no differences. CONCLUSION: SPI guided sufentanil administration did not reduce intraoperative sufentanil consumption compared to routine care in patients having trauma and orthopaedic surgery with a combination of general anaesthesia and regional anaesthesia. TRIAL REGISTRATION: Clinicaltrials.gov identifier NCT06040307 (registered September 8, 2023).