Dardeer A, Alhammad MF, Zaza KJ
… +4 more, Shallik AN, Hammad YA, Elkarta EM, Shallik NA
J Clin Monit Comput
· 2026 Apr · PMID 41003964
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PURPOSE: Endotracheal intubation is a critical skill in anesthesia, particularly for patients with compromised airways. This randomized pilot study evaluated the feasibility and impact of the Infrared Red Intubation Syst...PURPOSE: Endotracheal intubation is a critical skill in anesthesia, particularly for patients with compromised airways. This randomized pilot study evaluated the feasibility and impact of the Infrared Red Intubation System (IRRIS) on video laryngoscopy performance, first-attempt success rate, and intubation time. METHODS: Thirty patients were randomized into two groups: one with the IRRIS device and one without (control). The primary outcome was the impact of IRRIS on first-pass success. Secondary outcomes included glottic visibility, intubation time, and adverse effects. RESULTS: Results showed that both groups demonstrated nearly identical percentages of glottic opening (POGO) and glottic entrance visibility, achieving successful intubation on the first attempt. Although the IRRIS group had a slightly longer intubation time and more instances of required external manipulation, the vocal cords were not visible without IRRIS in the most obese patient in our cohort. CONCLUSION: The IRRIS device effectively illuminated the laryngeal inlet, enhancing differentiation from surrounding structures, such as the esophagus. This study suggests that IRRIS may be a valuable adjunct for video laryngoscopy in patients with difficult airways, though further research is needed to assess its broader applicability. BACKGROUND: Endotracheal intubation in patients with compromised airways is a notoriously complex and daunting task for anesthesiologists. Throughout the years, numerous supportive techniques and innovative equipment have been developed to address this challenge. This randomized clinical study sheds light on the potential benefits of utilizing an external pre-cricoid emitting infrared light source, the 'Infrared Red Retrograde Intubation System' (IRRIS), which produces a flashing light that can be detected within the airway. By leveraging this technology, anesthesiologists may be able to identify the airway quicker and more accurately, both in terms of time and anatomical level, compared to relying solely on a video laryngoscope/ flexible bronchoscope.
This letter is a statement from the European Society for Intravenous Anaesthesia discussing the recent discovery of an incorrect implementation of a pharmacokinetic-pharmacodynamic model in a Target Controlled Infusion p...This letter is a statement from the European Society for Intravenous Anaesthesia discussing the recent discovery of an incorrect implementation of a pharmacokinetic-pharmacodynamic model in a Target Controlled Infusion pump.
J Clin Monit Comput
· 2026 Apr · PMID 40982115
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Vital sign monitoring in patients is essential for the early detection of deterioration of vital signs and timely medical intervention especially on general wards in hospitals. Traditionally performed manually and interm...Vital sign monitoring in patients is essential for the early detection of deterioration of vital signs and timely medical intervention especially on general wards in hospitals. Traditionally performed manually and intermittently, wearable monitoring devices offer a promising alternative by automatically providing real-time, continuous data. In this prospective observational study in non-cardiac surgery patients, we aim to evaluate the accuracy of respiratory rate (RR), heart rate (HR), and peripheral oxygen saturation (SpO₂) measurements obtained from a photoplethysmography (PPG)-based upper arm wearable device viQtor® (smartQare, Eindhoven, The Netherlands), by simultaneously comparing its readings with standard monitoring equipment in the Post-Anesthesia Care Unit (PACU). Capnography was included as the gold-standard reference for RR. Agreement between the wearable and reference measurements were assessed using Bland–Altman analyses. Clinical accuracy was evaluated using Clarke Error Grid analyses. Vital sign data were collected from 42 postoperative patients (age: 65.5 years [IQR 37.4–74.7]; BMI: 24.1 kg/m2 [IQR 21.7–26.9]) over a median duration of 14.0 hours. The Average Root Mean Square (ARMS) between the wearable device and the reference for RR was 2.85 BRPM, with a bias of -0.40 (95% LoA –5.85 to 5.04); for HR 2.01 BPM, with a bias of 0.08 (95% LoA -3.83 to 3.99); and for SpO2 2.08%, with a bias of –0.03 (95% LoA –4.14 to 4.09). The viQtor® device demonstrated high accuracy for RR, HR, and SpO₂ in postoperative patients. Data availability was high across all three parameters, and patient satisfaction was excellent. These findings support its potential for continuous monitoring on general wards.
Silaschi M, Kruse J, Wittmann M
… +10 more, Osawa I, Goto T, Velten M, Thudium M, Rohner M, Hamiko M, Rowlands D, Kreyer S, Coburn M, Bakhtiary F
J Clin Monit Comput
· 2026 Apr · PMID 40944783
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While cerebral near infrared spectroscopy (NIRS) is a valuable diagnostic tool to monitor brain oxygenation during cardiac surgery, its value in low cardiac output syndrome (LCOS) in adults has not been evaluated. This s...While cerebral near infrared spectroscopy (NIRS) is a valuable diagnostic tool to monitor brain oxygenation during cardiac surgery, its value in low cardiac output syndrome (LCOS) in adults has not been evaluated. This study was prospective and observational. Patients undergoing coronary artery bypass grafting (CABG) with reduced ejection fraction (LVEF < 35%) were included and received NIRS monitoring for up to 48 h after surgery with simultaneous continuous cardiac index (CI) monitoring. The primary endpoint was LCOS by a standard definition. From 2020 to 2023, 82 Patients with severely reduced LVEF undergoing CABG were included. Of these, 44 patients had sufficient NIRS and CI data for further analyses. Median age was 68 years (Interquartile range (IQR) 60-73), 91% (40/44) were male and median EuroSCORE II was 3.2% (1.7-5.4). Median LVEF was 30% (26.5-30.1) and baseline CI was 2.15 L/min/m² (2.05-2.60). CABG was combined with other procedures in 23% (10/44). LCOS rate was 11% (5/44) and in-hospital mortality was 2.2% (1/44). The performance of Lasso-regularized models increased if NIRS was included in LCOS prediction models (AUROC 0.99 [95%CI, 0.98-1.00]) showing that both relative NIRS drop rate and absolute NIRS value were significant predictors of LCOS. Risk of LCOS was high if NIRS drops by > 20% or absolute NIRS drops below < 50. In patients with LCOS, NIRS drop occurred before CI values decreased. NIRS drop was not associated with other adverse events. NIRS is an early and valid indicator of LCOS in patients after cardiac surgery. In selected patients, NIRS may be a substitute for invasive continuous CI measurements. However, we could not show an association of NIRS drop with adverse events. Future studies should compare blinded and non-blinded NIRS monitoring to investigate possible impact on clinical outcomes further.
Chaari N, Winski G, Hallbäck M
… +3 more, Lundström N, Björne H, Jacobsson M
J Clin Monit Comput
· 2026 Feb · PMID 40938328
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Intraoperative hypotension (IOH) is associated with an increased risk of heart and kidney complications. Although AI tools aim to predict IOH, their real-world reliability is often overstated due to biased data selection...Intraoperative hypotension (IOH) is associated with an increased risk of heart and kidney complications. Although AI tools aim to predict IOH, their real-world reliability is often overstated due to biased data selection. This study introduces a framework to enhance reliability by: (1) including borderline blood pressure cases (65-75 mmHg, the "Gray Zone"), (2) comparing AI model to simple blood pressure threshold, and (3) validating across diverse surgical cohorts, centers and demographics. Using datasets from Karolinska University Hospital (Sweden) and VitalDB (Korea), we found AI model performs better than MAP threshold method in more ambiguous cases. In contrast, when hypotensive and non-hypotensive cases had clearly separated MAP values, both methods performed similarly well. Cross-validation revealed asymmetric generalizability: models trained on datasets containing more borderline (Gray Zone) cases generalized better to datasets with clearer class separation, whereas the reverse struggled. To ensure fair model comparison and reduce dataset-specific bias, we standardized the MAP difference between positive (hypotension) and negative (non-hypotension) samples at the time of prediction. This virtually eliminated the class separation and demonstrated that inflated performance in some datasets can be attributed to selection bias rather than true model generalizability. Age also influenced generalization: Cross-age validation revealed models trained on older patients generalized better to younger cohorts, whereas differences in ASA classification had minimal effect. These findings highlight the need for realistic validation to bridge the gap between AI research and clinical practice.
Introna M, Carozzi C, Gentile A
… +5 more, Girasole R, Gemma M, Koomen JV, Struys MMRF, van Den Berg JP
J Clin Monit Comput
· 2026 Apr · PMID 40924277
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Target-controlled infusion (TCI) systems, originally developed for intravenous drug administration of anesthetic drugs, enable precise drug delivery based on pharmacokinetic-pharmacodynamic (PKPD) models. While widely us...Target-controlled infusion (TCI) systems, originally developed for intravenous drug administration of anesthetic drugs, enable precise drug delivery based on pharmacokinetic-pharmacodynamic (PKPD) models. While widely used in the operating room, their application in the intensive care unit (ICU) remains limited despite the complexity of drug dosing in critically ill patients. This scoping review evaluates existing evidence on the use of TCI systems in ICU settings, focusing on sedation, analgesia, and antibiotic administration. A systematic literature search was conducted in Medline and the Cochrane Library up to August 2024. Studies involving adult ICU patients receiving TCI for any drug were included. Data were extracted on study design, PKPD models, performance metrics, and clinical endpoints. A total of 281 studies were identified; 14 focused on sedatives, particularly propofol and remifentanil, using the Marsh and Minto models. TCI was associated with more stable sedation, improved titration, and fewer adverse events. Evidence on dexmedetomidine and midazolam was limited. Only three studies explored antibiotic TCI, mainly for vancomycin and cefepime, showing potential but lacking robust clinical validation. In conclusion, while current findings are promising, the evidence base supporting TCI-especially in the context of newer, generalized pharmacokinetic models and antibiotics-remains insufficient, and its broader application requires further clinical research and model validation.
Barat A, Wojtanowski A, Behal H
… +4 more, Flocteil M, Leteurtre S, De Jonckheere J, Recher M
J Clin Monit Comput
· 2026 Feb · PMID 40924276
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The Analgesia Nociception Index (ANI) has been used to assess discomfort in anesthetized adults. The COMFORT Behavior Scale (CBS) is recommended for assessing discomfort in intubated and sedated children. The primary obj...The Analgesia Nociception Index (ANI) has been used to assess discomfort in anesthetized adults. The COMFORT Behavior Scale (CBS) is recommended for assessing discomfort in intubated and sedated children. The primary objective of the present study was to assess the validity and performance of the ANI as an indicator of discomfort in intubated, ventilated children in a pediatric intensive care unit (PICU). A prospective, non-interventional, single-center pilot study was conducted between June 1st, 2021, and November 31st, 2023. Intubated, sedated, prepubescent patients aged between 2 and 10 years (for girls) or between 2 and 12 years (for boys) were included. The instantaneous ANI (ANIi) and the mean ANI (ANIm) were recorded continuously during care procedures. Data were analyzed before (period (P)1), during (P2) and after (P3) care procedures. 50 patients were included; the median (interquartile range [IQR]) age was 7 [4; 9] years. The ANIi decreased significantly between P1 and P2 (median [IQR]: 59 [45; 80] vs. 33 [26; 42], respectively; p < 0.0001) and increased significantly between P2 and P3 (33 [26; 42] vs. 51 [33; 72], respectively; p < 0.0001). The CBS score increased significantly between P2 and P3 (median [IQR]: 10 [7; 13] vs. 12 [8; 15], respectively; p < 0.0001). The ANIi was able to discriminate between over-analgosedation (defined as a CBS score < 10) and normal analgosedation (AUROC = 0.694 during P1).The ANI might be a good candidate for assessing discomfort in intubated, prepubescent patients in the PICU.Trial Registration: NCT04913038.
Massari D, Modestini M, Niezen CK
… +7 more, Yeh L, Zoutman AC, Scheeren TWL, Accord RE, van Amsterdam K, Struys MMRF, Vos JJ
J Clin Monit Comput
· 2026 Apr · PMID 40900429
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PURPOSE: Pediatric patients undergoing cardiac surgery are at risk of developing postoperative acute kidney injury (AKI). We hypothesized that a reduction in intraoperative renal (SrO) or cerebral (ScO) tissue oxygen sat...PURPOSE: Pediatric patients undergoing cardiac surgery are at risk of developing postoperative acute kidney injury (AKI). We hypothesized that a reduction in intraoperative renal (SrO) or cerebral (ScO) tissue oxygen saturation is associated with postoperative AKI. METHODS: We conducted a prospective observational study including fifty pediatric patients with non-cyanotic heart disease undergoing elective surgical repair with cardiopulmonary bypass. Intraoperative SrO and ScO were monitored using near-infrared spectroscopy (O3 Regional Oximetry). Relative decreases of 10% and 20% from baseline SrO and ScO were analysed, calculating the total time below the threshold, area under the threshold, and time-weighted average. The primary outcome was the association between intraoperative SrO and ScO decreases, and the occurrence of postoperative AKI defined with the 'Kidney Disease: Improving Global Outcomes' criteria. Secondary outcomes included the association between other known or potential risk factors for AKI and postoperative AKI. RESULTS: The incidence of postoperative AKI was 18.4%. There was no association between the duration and extent of intraoperative reductions of SrO and ScO below 10% and 20% from baseline, and postoperative AKI (e.g., area under the threshold for ScO decreases below 10%: 36.8 [11.8 to 419.9] % min in patients with AKI vs. 9.6 [0.6 to 92.8] % min in patients without AKI, P = 0.117). Preoperative serum creatinine, body mass index, intraoperative hypotension, and blood lactate were associated with postoperative AKI. CONCLUSION: A decrease in intraoperative renal or cerebral tissue oxygen saturation was not associated with postoperative AKI in pediatric patients undergoing surgery for non-cyanotic congenital heart disease.
Healthcare settings heavily rely on clinicians' abilities to interpret vital sign alarms indicating patient decompensation. Meanwhile, clinicians are bombarded with many multisensory stimuli necessary for patient care, i...Healthcare settings heavily rely on clinicians' abilities to interpret vital sign alarms indicating patient decompensation. Meanwhile, clinicians are bombarded with many multisensory stimuli necessary for patient care, including simultaneous visual and auditory displays. Here, we aim to assess how our modified auditory and visual alarm designs impact clinicians' perceived cognitive workload. This experimental study, conducted at Vanderbilt University Medical Center (VUMC) between March and September 2023, included 26 clinicians (nurse practitioners, residents, and fellows). Auditory trials involved 15 clinicians and non-clinicians (university students) to validate design intuitiveness. Clinicians participated in visual and auditory trials to identify simulated mean arterial pressure (MAP), utilizing standard and modified alarms. Visual modifications incorporated a line-graph display with a moving dot for MAP. Auditory modifications introduced harmonic overlays indicating severity and direction of MAP values. After each trial, participants completed the National Aeronautics and Space Administration Task Load Index (NASA-TLX) to assess perceived workload across 6 domains (temporal demand, physical demand, mental demand, effort, performance, frustration) on a 1-20 Likert scale with increased scores represent greater workload. For analysis, Wilcoxon signed-rank and rank-sum tests were used. Demographics for auditory alarm trials averaged an age of 26.2 and 54% identified as male. Visual display trials included 26 clinicians with an average age of 30.1 and 59% identified as male. In visual trials, clinicians reported significantly lower temporal demand with the modified monitor (median, interquartile range (IQR)) (8.0, 4.2-11.8) compared to the conventional monitor (13.0, 6.5-16.0; p = 0.022). In auditory trials, clinicians reported significantly higher perceived performance with conventional auditory alarms as compared to non-clinicians (10.0, 5.0-13.0) vs. (4.0, 2.0-9.0; p = 0.022). Non-clinicians reported higher perceived temporal demand for conventional auditory alarms when compared to clinicians (6.0, 3.0-10.0) vs. (2.5, 1.0-5.0; p = 0.024). Our findings suggest modifications to both visual and auditory alarms can reduce elements of perceived cognitive workload, especially temporal demand, while preserving clinician performance without deterioration of other measured components.
PURPOSE: Postoperative pain remains a significant adverse event after thoracic surgery, to which intraoperative nociception contributes. To measure intraoperative nociception, the Nociception Level (NOL) monitor is one o...PURPOSE: Postoperative pain remains a significant adverse event after thoracic surgery, to which intraoperative nociception contributes. To measure intraoperative nociception, the Nociception Level (NOL) monitor is one option. This study aims to assess the NOL's utility for measuring intraoperative nociception and predicting acute postoperative pain and opioid consumption. METHODS: This observational study included 114 thoracic surgery patients (37 thoracotomy, 77 minimally invasive surgery) utilizing two analgesic approaches (40 peridural anaesthesia, 74 intercostal nerve block). NOL's utility to monitor responses to incision and nerve block was assessed at population (Wilcoxon-signed-rank tests) and individual level (ROC-analyses). NOL's predictive utility for postoperative pain and opioid consumption was analysed at population (Mann-Whitney-U tests) and individual level (multivariable linear regression). RESULTS: Population NOL significantly increased after incision and decreased after nerve block (p < 0.01/ p < 0.01) and individual detection of nociception was significantly better than chance (AUCs: 0.68 [95%CI 0.61-0.75] / 0.62 [95%CI 0.53-0.72]). However, NOL did not differ significantly between thoracotomy and minimally invasive surgery (p = 0.12) or peridural anaesthesia and nerve block (p = 0.16), despite significantly different postoperative pain and opioid consumption (p < 0.01). Multivariable analyses showed no significant effect of NOL on postoperative pain or opioid consumption. CONCLUSION: NOL captures intraoperative stress with an accuracy allowing to differentiate large nociception changes at both the population and individual level after skin incision and nerve block. However, NOL was unable to differentiate between patients with plausibly different nociception levels, like patients undergoing different surgical or analgesic techniques. Consequently, while NOL can detect large nociceptive changes, its current accuracy may be insufficient to reliably guide individual analgesia in clinical practice.
J Clin Monit Comput
· 2026 Apr · PMID 40892323
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In thoracoscopic surgery, temperature monitoring is essential but traditionally relies on invasive methods such as esophageal or rectal thermometry, which risk mucosal injury and patient discomfort. This trial evaluates...In thoracoscopic surgery, temperature monitoring is essential but traditionally relies on invasive methods such as esophageal or rectal thermometry, which risk mucosal injury and patient discomfort. This trial evaluates the iThermonitor, a wireless wearable axillary thermometer, as a non-invasive alternative aiming to minimize procedural trauma while maintaining clinical accuracy. We enrolled 80 adult patients scheduled for thoracoscopic surgery under general anesthesia between December 1, 2023, to May 31, 2024. Axillary temperature (iThermonitor) and lower esophageal temperature (reference standard) were recorded every 3 minutes. The primary endpoint was the agreement between devices (± 0.5 °C). Among 3536 temperature pairs, 93.96% of iThermonitor readings were within ± 0.5 °C of lower esophageal values (95% CI: 91.94–95.85%), with strong correlation (Pearson r = 0.75, P < 0.0001). The device demonstrated high diagnostic accuracy for hypothermia (<36.0 °C; AUC = 0.876). Esophageal probes caused bloodstaining in 73.8% of cases, whereas iThermonitor-related skin redness (45%) resolved postoperatively. The iThermonitor is a reliable and accurate non-invasive alternative to traditional invasive temperature monitoring methods in thoracoscopic surgery. It effectively detects perioperative hypothermia and offers significant patient-centered benefits, including enhanced comfort and safety.
Jones TL, Glozman D, Oglesby HJA
… +1 more, Mulier JPJ
J Clin Monit Comput
· 2026 Feb · PMID 40875170
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The aim of this bench study was to assess performance between currently available sidestream capnography sampling lines claiming compatibility with a Microstream™ enabled monitor system. A series of bench tests were perf...The aim of this bench study was to assess performance between currently available sidestream capnography sampling lines claiming compatibility with a Microstream™ enabled monitor system. A series of bench tests were performed on a selection of commercially available sampling lines (oral-nasal cannulas, PetCO2 masks, and procedural bite blocks) to assess PetCO2 accuracy, filter performance and mechanical durability. For each testing procedure, three separate sampling lines were assessed for five repetitions (n = 15 for each product). A 3D printed oral-nasal model connected to a lung simulator was set to two different breathing modes to simulate “normal” and “shallow” breathing. PetCO2 accuracy measurements were completed at both breathing modes to simulate a variety of clinical scenarios, including oxygen delivery. Filter performance and mechanical durability were assessed for cannula sampling lines. When evaluating PetCO2 accuracy across all sampling line types and breathing conditions, error estimates were lowest for matched-paired sampling lines, compared to cross-paired sampling lines. For oral-nasal cannulas, the matched-paired and three cross-paired performed within the system specification for “normal” breathing conditions. Split design oral-nasal cannulas consistently fell outside specifications under conditions of nasal obstruction. Five cross-paired filters clogged prior to expected threshold, with four demonstrating a clog capacity of less than half the expected value. Almost all sampling lines passed mechanical durability testing. Across all testing conditions, cross-paired sampling lines were observed to fall outside system specifications, suggesting that using sampling lines outside the Microstream™ family may disrupt accuracy of readings when using a Microstream™ enabled capnography monitor.
Calculating the effect site concentration of remimazolam intraoperatively facilitates the prediction of the time from the end of remimazolam administration until the effect site concentration returns to the level at loss...Calculating the effect site concentration of remimazolam intraoperatively facilitates the prediction of the time from the end of remimazolam administration until the effect site concentration returns to the level at loss of consciousness (LOC). We hypothesised that the effect site concentration of remimazolam at LOC could be an indicator of arousal. This prospective, observational, single-centre study enrolled 107 patients who underwent laparoscopic surgery under remimazolam general anaesthesia. Sedative [bispectral index (BIS®) and SedLine®], non-invasive cardiac output (estimated continuous cardiac output®), and effect site concentration of remimazolam monitoring were assessed simultaneously. The intraoperative remimazolam dose was adjusted to obtain the spectral edge frequency 95 (SEF) < 16 on SedLine®. The primary endpoint was the relationship between the time for the effect site concentration of remimazolam to return to its level at LOC and recovery of consciousness (ROC). The median time from recovery of the effect site concentration of remimazolam to its level at LOC until ROC was 4.0 min. In the multivariate-adjusted general linear model, maintenance administration time and the effect site concentration of remimazolam ratio were significantly associated with the interval between effect site concentration of remimazolam recovery to LOC levels until ROC. This interval was significantly longer in patients whose effect site concentration of remimazolam ratio was lower. The effect site concentration of remimazolam at LOC could be useful for determining arousal time. The effect site concentration ratio and surgery duration could affect the time from recovery of effect site concentration of remimazolam to LOC levels until ROC.
In response to the recent proposal by Monares-Zepeda et al. to estimate mean systemic filling pressure (MSFP) using cardiac power (CP) as a surrogate for the venous return pressure gradient (VRg), we raise concerns regar...In response to the recent proposal by Monares-Zepeda et al. to estimate mean systemic filling pressure (MSFP) using cardiac power (CP) as a surrogate for the venous return pressure gradient (VRg), we raise concerns regarding the physiological validity and generalizability of the reported correlation. We demonstrate through simulation that the relationship between CP and VRg arises from structural mathematical coupling due to shared dependence on cardiac output (CO), and that this correlation weakens significantly (r = 0.54) when realistic physiological variability is introduced. We further argue that CP and VRg reflect distinct hemodynamic domains, and caution against interpreting their empirical correlation as evidence of physiological interchangeability. We call for broader validation of the model across diverse circulatory conditions. Comment on: 'Presentation of a novel method to estimate analog mean systemic filling pressure based on cardiac power' -on Correlation, Coupling, and Physiological Meaning.
Albrecht F, Schirra C, Scheffler K
… +2 more, Volk T, Meiser A
J Clin Monit Comput
· 2026 Feb · PMID 40848215
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The Mirus™ system (Technologie Institut Medizin GmbH, Germany) enables target-controlled delivery of volatile anaesthetics with open system ventilators. Its interface, positioned between Y-piece and the patient, injects...The Mirus™ system (Technologie Institut Medizin GmbH, Germany) enables target-controlled delivery of volatile anaesthetics with open system ventilators. Its interface, positioned between Y-piece and the patient, injects anaesthetic vapor during inspiration, while adsorbing anaesthetic and resupplying it during the next inspiration. A newly introduced interface (Lisa-44) was evaluated under body temperature pressure saturated and normocapnic conditions using a test lung. Volume-controlled ventilation was applied with a 500 mL tidal volume, 10 bpm respiratory rate, and inspiratory flow (IF) times of 2.5 s and 0.5 s. Isoflurane (sevoflurane) target concentrations were stepwise increased to 1.5 MAC and then decreased. An external gas monitor recorded real-time anaesthetic concentrations. End-tidal concentrations (EC) and area under the curve (AUC) were analyzed for each breath. Accuracy and precision were assessed using Bland-Altman plots. Consumption was calculated and compared to historical controls. Mirus EC measurements correlated well with external gas monitor readings. ECs fluctuated around targets, with higher targets requiring more frequent injections and larger AUCs. Anaesthetic consumption was lower than historical controls and comparable to the Sedaconda ACD. At 0.3-0.5 MAC, hourly isoflurane consumption ranged from 1.0 to 1.7 mL (sevoflurane: 3.8-6.1 mL). However, very short IF times significantly increased consumption, reaching 43 mL sevoflurane at an EC of 2.6 vol%, with prolonged injections extending into the expiration phase. The new system demonstrates high accuracy, precision, and improved efficiency, suggesting reduced anaesthetic consumption in clinical use. However, high concentrations combined with very short IF times substantially increase consumption, indicating potential limitations.
Rosalba D, Shi R, Bruscagnin C
… +6 more, Lai C, Fouque G, Hagry J, Vaschetto R, Teboul JL, Monnet X
J Clin Monit Comput
· 2025 Oct · PMID 40848214
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Whether the thoracic fluid content (TFC) estimated by bioimpedance actually reflects the thoracic water content and tracks its changes has not been tested yet. We compared TFC changes induced by volume expansion with tho...Whether the thoracic fluid content (TFC) estimated by bioimpedance actually reflects the thoracic water content and tracks its changes has not been tested yet. We compared TFC changes induced by volume expansion with those of well-established markers of cardiac preload including the global end-diastolic volume indexed (GEDVI) estimated by transpulmonary thermodilution (TPTD) and central venous pressure (CVP). We assessed the relationship between TFC and extravascular lung water indexed (EVLWI) estimated by TPTD in patients with acute respiratory distress syndrome (ARDS). In 42 patients with a TPTD device (PiCCO2), we measured GEDVI, EVLWI and CVP before and after a 500-mL fluid bolus (Fluid group). In 23 different patients with ARDS, we measured the day-to-day changes in TFC and EVLWI (ARDS group). In the Fluid group (42 measurements), TFC increased significantly during fluid infusion. There was no correlation between the fluid-induced changes in GEDVI or CVP and the fluid-induced changes in TFC (p = 0.71 and p = 0.09, respectively). In the ARDS group, 124 measurements were performed, representing 101 changes between timepoints. There was no correlation between the percent changes in GEDVI, EVLWI, the sum of GEDVI + EVLWI and the percent changes in TFC (p = 0.52, 0.40 and 0.55, respectively). Considering all 208 measurements performed, absolute values of EVLWI were correlated with absolute values of TFC (r = 0.21, p = 0.04). There was no correlation between the absolute values of GEDVI and the sum of GEDVI + EVLWI and those of TFC (p = 0.33 and 0.39, respectively). Still considering all measurements performed, the percentage of error of cardiac index measured by bioreactance compared to TPTD was 131%. In critically ill patients, TFC measured by bioimpedance does not follow the changes induced by a fluid bolus of well-known markers of cardiac preload. It also does not follow the changes in EVLWI observed in patients with ARDS. While absolute values of TFC are weakly correlated with those of EVLWI, it is determined neither by GEDVI, nor by the sum of both.
Tenge T, Reekers S, Maier O
… +12 more, Schallenburger M, Batzler YN, Stefaniak M, Schwartz J, Stroda A, M Pembele R, Roth S, Bahners BH, Chen G, Schaefer MS, Jung C, Neukirchen M
J Clin Monit Comput
· 2026 Apr · PMID 40828438
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Vital sign monitoring in palliative care could support symptom management and prediction, though its utility at the end-of-life remains critically discussed. This study aims to test a wireless device for continuous vital...Vital sign monitoring in palliative care could support symptom management and prediction, though its utility at the end-of-life remains critically discussed. This study aims to test a wireless device for continuous vital sign monitoring at the end-of-life. This prospective observational study included adult terminal care patients in the palliative care unit at a tertiary-care hospital (05/2023-03/2024). Continuous monitoring of heart rate (HR in beats/minute, bpm), respiratory rate, and temperature was conducted using VitalPatches (MediBioSense). Patient demographics, medications, and symptoms were further recorded. Linear mixed-effects models were applied for analyses. 30 patients (median age 70, 53.3% female, 90% with cancer) were included. Median patch duration was 88 h (IQR 35-153). Symptom load increased until death (p = 0.004), with weakness and impaired vigilance being prominent. From patch start to end, opioid use rose from 80 to 100% (p = 0.010), and benzodiazepine use from 50 to 80% (p = 0.015). All vital signs increased in daily and hourly intervals. Compared to three days prior, the HR increased as death approached: 3.70 bpm (-2 days, p < 0.001), 7.64 bpm (-1 day, p < 0.001), and 12.26 bpm (day of death, p < 0.001). Pain correlated with HR (r = 0.32, p < 0.001), and a 5 bpm HR increase over the previous 24 h was associated with imminent death within the following 24 h. Continuous vital sign monitoring in palliative care using VitalPatches is feasible and depicts vital sign changes at the end-of-life. A positive correlation of HR with pain was detected. These observations provide a rationale for larger studies investigating their relevance for life time prediction as well as symptom detection and management.