J Clin Monit Comput [JOURNAL]
Sun
200 papers
Machine learning-enhanced prediction of operating room occupation time and length of stay: a retrospective cohort study on emergency surgery care pathways.
Dupre A, Jouini O, Lame G … +9 more , Xie X, Jemai Z, Legros B, Jebali A, Amor YB, Bouasker H, Constantin JM, Raux M, Botrel T
J Clin Monit Comput · 2025 Dec · PMID 40824572 · Publisher ↗
Emergency surgeries are resource-intensive procedures with high variability in operating room occupation time (OT) and hospital length of stay (LOS), complicating scheduling and capacity planning. Manual estimates by sur...
Emergency surgeries are resource-intensive procedures with high variability in operating room occupation time (OT) and hospital length of stay (LOS), complicating scheduling and capacity planning. Manual estimates by surgeons are frequently inaccurate, especially in emergency settings. Machine learning models (MLMs) have shown good predictive performance in elective surgery, but their applicability to emergency contexts remains underexplored. We conducted a retrospective, single-center study on 3,117 emergency procedures performed at the Pitié-Salpêtrière hospital, a major trauma center, between 2015 and 2018. Preoperative data available at the time of surgical scheduling were used to train four regression models for OT and LOS prediction: Ridge Regression, Random Forest, XGBoost, and a Multi-Layer Perceptron. Model performance was evaluated using Mean Absolute Error, Root Mean Square Error, Mean Absolute Percentage Error, and operational metrics: proportion of OT predictions within 20% of actual value (Within20) and LOS within fixed-day thresholds. RF and XGB outperformed manual estimates for OT, with RF achieving a MAE of 32 min and Within20 of 60%, improving surgeon estimates by 13%. For LOS, XGB was the best performing model with a MAE of 5 days and RMSE of 12 days. As measured through MAPE, prediction performance varied across specialties, with better accuracy in digestive and maxillofacial procedures. As for elective cases, MLMs can improve OT and LOS predictions in emergency surgery, though predictive performance remains moderate. Future work should refine models through enriched data, clinically relevant thresholds, and integration into decision-support tools to enhance emergency surgical care coordination.
Impact of age on PUAL as an indicator of opioid effect in adult subjects.
McKay RE, Kohn MA, Larson MD
J Clin Monit Comput · 2026 Apr · PMID 40824571 · Full text
Opioid-induced respiratory depression (OIRD) remains a critical safety concern, particularly in older adults, yet timely, reliable detection methods are limited. Decline of pupillary unrest in ambient light (PUAL) has de...
Opioid-induced respiratory depression (OIRD) remains a critical safety concern, particularly in older adults, yet timely, reliable detection methods are limited. Decline of pupillary unrest in ambient light (PUAL) has demonstrated potential as a marker of opioid effect in young adult subjects. We evaluated whether previously observed PUAL thresholds for high-risk opioid exposure in younger adults remain valid in 40-60-year-old subjects. Ten healthy volunteers 40-60 years of age underwent PUAL measurement at baseline and every 2.5 min during a 10-minute remifentanil infusion (0.2-0.3 µg/kg/min) and 25-minute recovery period. High-risk opioid exposure was defined primarily by modeled remifentanil effect-site concentration (CEREMI) threshold during infusion. Findings were then combined with previously collected data from 20 younger subjects (aged 20-39 years) undergoing an identical infusion protocol. PUAL declined consistently during infusion and increased toward baseline during recovery (p < 0.001). During infusion no significant difference in slope over time or CEREMI was observed between age groups, but during recovery a flatter slope was observed in older subjects (p = 0.016). PUAL reliably distinguished between high-versus low-risk opioid exposure during infusion (AUROC = 0.9833 [95% CI: 0.8935, 0.9995]), with interval likelihood ratio (iLR) for high-toxic opioid effect 27.98 (95% CI: 1.79, 438.33) for PUAL < 0.04, 0.75 (95% CI: 0.38, 1.50) for PUAL 0.04-< 0.14, and 0.030 (95% CI: 0.002, 0.477) for PUAL ≥ 0.14. Comparison of discriminatory performance to that of younger subjects showed no significant difference (chi2 = 1.02, p = 0.3129). PUAL thresholds for high-risk opioid exposure are consistent between younger and older adults and do not require age-specific adjustment up to age 60. PUAL offers a reliable, real-time marker of opioid effect with potential to enhance early OIRD detection in adults.
Analysis of SEF95 derived from two processed EEG devices during pediatric anesthesia for non-cardiac surgery.
Ricci Z, Gobbi L, Rosa E … +5 more , Filippini E, Lui M, Fischer M, Colosimo D, Romagnoli S
J Clin Monit Comput · 2026 Apr · PMID 40802216 · Full text
This study aimed to compare the values of spectral edge frequency at the 95th percentile (SEF95) obtained simultaneously by two different processed electroencephalography monitors (BIS and SedLine) in pediatric patients...
This study aimed to compare the values of spectral edge frequency at the 95th percentile (SEF95) obtained simultaneously by two different processed electroencephalography monitors (BIS and SedLine) in pediatric patients of varying ages undergoing non cardiac surgery to determine whether they remain reproducible regardless of the equipment used. Tertiary Pediatric Hospital. We conducted a prospective observational study involving pediatric patients aged 12 months to 18 years. Patients were excluded if the sensor fit was inadequate or if artifacts interfered with the data collection. Anesthesia was administered by anesthesiologists according to their preferences. A total of 51 children were enrolled, yielding 402 paired BIS/SedLine SEF95 values. These values showed an r² of 0.73 at linear regression analysis (p < 0.0001), with a bias of 0.62 (2.4) Hz and 95% limits of agreement (LoA) ranging from - 4.08 to 5.32 Hz in Bland-Altman analysis. Median SEF95 deltas (i.e., differences of paired BIS/SedLine SEF95 values) across the analyzed time points showed significant differences (p = 0.0017) between values at 15 min and 60 min after skin incision compared to extubation. A delta SEF95 within the ± 2 Hz range was observed in 267 cases (66%), within ± 3 Hz occurred in other 67 measurements (17%) and within ± 4 Hz in further 48 (12%). The remaining 20 measurements showed a higher delta. SedLine SEF95 was higher than BIS in 40 cases, while BIS was higher than SedLine in 96 cases. SEF95 monitored by BIS or SedLine pediatric patients showed some differences, with deltas up to ± 4 Hz. Values appeared to be closer during the anesthesia maintenance phase. The clinical relevance of these findings should be further confirmed.
Association of renal regional tissue oxygen saturation and post-procedural acute kidney injury following transcatheter aortic valve implantation.
Lee HS, Cho YJ, Yoo S … +4 more , Lee S, Ju JW, Nam K, Jeon Y
J Clin Monit Comput · 2025 Dec · PMID 40802215 · Publisher ↗
PURPOSE: Acute kidney injury (AKI) is a common complication and a strong risk factor for adverse outcomes after transcatheter aortic valve implantation (TAVI). Renal regional tissue oxygen saturation (rSO) reflects tissu...
PURPOSE: Acute kidney injury (AKI) is a common complication and a strong risk factor for adverse outcomes after transcatheter aortic valve implantation (TAVI). Renal regional tissue oxygen saturation (rSO) reflects tissue perfusion and can be measured using near-infrared spectroscopy. We hypothesized that decrease in renal rSO during TAVI would predict post-procedural AKI. METHODS: Patients with severe aortic stenosis who scheduled for transfemoral TAVI were enrolled. Patients undergoing emergent procedures, those with severe renal impairment, those with a distance from skin to renal capsule > 4 cm, those on mechanical ventilation, or those who refused to participate were excluded. The primary outcome was the relationship between changes in renal rSO during TAVI and post-procedural AKI. AKI was determined according to the Valve Academic Research Consortium-2 criteria. RESULTS: Sixty-four patients were included and analyzed. The mean (standard deviation [SD]) age of patients was 82 (4) years, and the median [interquartile range] procedure time was 75 [65-90] min. The incidence of post-procedural AKI was 33% (21/64). There was no difference in the mean (SD) time-weighted renal rSO (70% [13%] and 73% [11%]), changes in renal rSO (-14% [10%] and - 15% [13%]), or nadir rSO (55% [17%] and 60% [17%]) during TAVI between patients who developed post-TAVI AKI and those who did not (p = 0.227, 0.157, and 0.333, respectively). In multivariable regression analysis, renal rSO variables were not predictors of post-TAVI AKI. CONCLUSION: Procedural changes in renal rSO measured using near-infrared spectroscopy did not predict the development of post-TAVI AKI. Further studies are needed to investigate more effective strategies to predict and prevent AKI following TAVI. TRIAL REGISTRATION: This study was registered on cinicaltrials.gov (identifier, NCT04921475, registered on June 10, 2021).
Quantitative pupillometry and ambient light. Response to letters to the editor.
Kesti J, Pansell J
J Clin Monit Comput · 2025 Dec · PMID 40802214 · Publisher ↗
Abstract loading — click title to view on PubMed.
The transition to fully open access: a new era for the Journal of Clinical Monitoring and Computing.
Flick M, Lobo FA
J Clin Monit Comput · 2025 Oct · PMID 40794382 · Full text
Abstract loading — click title to view on PubMed.
Non-invasive goal-directed fluid therapy with the pleth variability index (PVI): a systematic review and meta-analysis.
Felippe VA, Codeceira R, Irigaray M … +8 more , Sckaff M, Wegner B, Nascimento T, Darcy C, Dutra L, Santiago B, Buchmann J, Lessa MA
J Clin Monit Comput · 2025 Oct · PMID 40778974 · Full text
Optimal intraoperative fluid management is essential to improve surgical outcomes and reduce complications. The Pleth Variability Index (PVI), a dynamic and non-invasive indicator of fluid responsiveness, has been propos...
Optimal intraoperative fluid management is essential to improve surgical outcomes and reduce complications. The Pleth Variability Index (PVI), a dynamic and non-invasive indicator of fluid responsiveness, has been proposed as a tool for goal-directed fluid management. This systematic review and meta-analysis aimed to evaluate the effectiveness of PVI-guided fluid therapy compared to conventional fluid management (CFM) in non-cardiac surgeries. A comprehensive search of PubMed, Embase, and Cochrane databases up to January 2024 identified eligible studies. Primary outcomes included total intraoperative fluid volume and crystalloid administration. Secondary outcomes included hemodynamic parameters, renal function markers, acid-base balance, and hospital length of stay (LOS). Random-effects models were applied, and subgroup and sensitivity analyses were performed. Nine studies comprising 1,105 patients were included. Compared to conventional fluid management, PVI-guided therapy significantly reduced total fluid volume (mean difference [MD] - 761.23 mL; 95% CI - 1267.42 to - 255.03) and crystalloid administration (MD - 655.05 mL; 95% CI - 1096.48 to - 213.62), without significant differences in colloid use, urine output, norepinephrine requirement, arterial pressure, acid-base balance, or LOS. Subgroup analysis of abdominal surgeries confirmed the observed reduction in fluid volumes. PVI-guided fluid management allows for a more restrictive and individualized approach without compromising hemodynamic or metabolic stability. While the heterogeneity across studies limits generalizability, these findings support the clinical value of PVI as a non-invasive tool for perioperative fluid optimization, especially in settings where invasive monitoring is not feasible. Further trials are needed to evaluate its impact on long-term outcomes.
Non-invasive vs biological blood determination of haemoglobinemia for perioperative management: a systematic review with meta-analysis.
Moreira L, Engelman E, Estruch-Pons I … +4 more , Parvais M, Lecucq A, Martens B, Pandin P
J Clin Monit Comput · 2025 Dec · PMID 40739388 · Publisher ↗
INTRODUCTION: Haemoglobin measurement is an essential parameter for quantifying anaemia and often used for guiding transfusion decisions. Conventional methods require blood sampling and are invasive. Results are intermit...
INTRODUCTION: Haemoglobin measurement is an essential parameter for quantifying anaemia and often used for guiding transfusion decisions. Conventional methods require blood sampling and are invasive. Results are intermittent, discontinuous and obtained after a reasonable acquisition time. Hemoglobinemia by pulsed co-oximetry is non-invasive, immediate and offers the advantage of continuous monitoring. The aim of this systematic review is to assess the diagnostic accuracy of pulsed co-oximetry compared with reference biological determinations in perioperative management. METHODS: The review was registered in PROSPERO and performed according to the PRISMA statement. Searches in Pubmed, Cochrane Library and Scopus databases were performed from January 2000 to February 2024 for studies comparing non-invasive haemoglobin measurement with invasive methods. The QUADAS-2 scale was used to assess the risk of bias. For data analysis, Review Manager 5.4.1 software was employed, using the inverse variance method and a random-effects model to calculate the mean difference (MD) and 95% confidence intervals. Sensitivity analysis were performed in order to assess the influence of site of blood sampling (arterial or venous), revision model reference of the Masimo finger sensor, the geographical location of the study centre, the risk of bias classification, the population type and the type of study. RESULTS: The meta-analysis included 36 studies involving 1888 patients. Meta-analysis revealed a mean difference between the non-invasive and invasive methods of 0.13 g.dL-1 (95% confidence interval [CI]: 0.10- 0.36) (P-value > 0.05). Sensitivity analyses showed no statistically significant difference between the two methods. There was a very good homogeneity among the studies (I = 0%). Trending analysis was considered acceptable in a majority of the studies. CONCLUSION: The results obtained support the reliability of pulsed co-oximetry. Considering the potential benefits of this parameter, it seems rational to integrate this technology perioperatively to guide standard clinical practices for optimizing the management of surgical patients.
Identification of an error in the implementation of the Eleveld model in a commercial TCI pump.
Milliet N
J Clin Monit Comput · 2026 Apr · PMID 40728768 · Full text
Abstract loading — click title to view on PubMed.
Balancing sensitivity and specificity: investigating the effect of age delay and critical illness events on the number of threshold alarms.
Chiziwa C, Kamndaya M, Phepa P … +4 more , IMPALA Study Team, Vweza AO, Calis J, Bierling B
J Clin Monit Comput · 2026 Feb · PMID 40728767 · Full text
In critical care settings, continuous vital sign monitoring is crucial to ensure patient safety and timely intervention. While traditional patient monitor threshold alarm systems have been life-saving, they often generat...
In critical care settings, continuous vital sign monitoring is crucial to ensure patient safety and timely intervention. While traditional patient monitor threshold alarm systems have been life-saving, they often generate numerous non-actionable alarms, which can overwhelm caregivers and lead to ineffective patient monitoring. We still have these numerous false alarms because we have a gap in understanding the importance of age-specific threshold settings, delay, and critical illness events inclusion in understanding the specificity and sensitivity of the threshold alarms. This study investigated the effect of age-specific thresholds, delay, and critical illness events on the number of threshold alarms to balance their specificity and sensitivity. Secondary data from 772 pediatric patients was extracted from the IMPALA Project conducted in the High Dependency Unit (HDU) at Queen Elizabeth and Zomba Central Hospitals in Malawi. Threshold crossing detector algorithms and age-defining functions were used to generate alarms and impute age-specific thresholds. Z-test was used to determine differences between normal threshold alarms and age-specific threshold alarms. Threshold alarms were categorized into different delays based on their durations to identify an adaptive delay that would minimize the threshold alarms to manageable alarms. Time series analysis was leveraged to extract and compare threshold alarms around patients with and without critical illness events per hour. Additionally, we investigated the variability of threshold alarms during the hour time windows before and after each critical illness event, considering factors such as delay and age. A multi-regression model was used to determine the effects of critical illness events on the number of threshold alarms, with a significance level set at p < 0.05, indicating statistical significance. The age-specific threshold had a positive influence on the threshold alarms by reducing the total number of threshold alarms [31.14% for ECGHR, 17.54% ECGRR and 54.79% for SPO2]. There was a greater significant difference between normal and age-specific threshold alarms (p < 0.00001). A 15-s delay reduced the total number of threshold alarms by 45%. We had more threshold alarms being generated 1 h before critical illness events occurrence, and applying delay and age-specific threshold had more impact on threshold alarms 3 h after the occurrence of critical illness events [Respiratory support (Total threshold alarms (232), 15 s delay (77), 15 s and age-specific threshold (17)] and most threshold alarms 1 h before critical illness events had longer durations. Critical illness [Convulsion (p < 0.0001), Malaria treatment (p < 0.0001), Death (p = 0.053), Respiratory support (p = 0.046), and Sepsis (p = 0.051)] had positive effects on the threshold alarm. There was a drop and increase in the vital sign values during the occurrence of these critical illness events [Bronchodilator support (β = - 0.0030), Death (β = - 0.0374), Malaria treatment (β = - 0.0056), and Inotropic support (β = - 0.0063)] indicating that more threshold alarms were produced during the occurrence of these critical illness events. Age-specific threshold, delay, and critical illness events can be used to strike a balance between the sensitivity and specificity of threshold alarms. In this way, we can reduce the number of non-actionable (false alarms) alarms and increase the number of actionable alarms around critical illness events. It is necessary to look into critical illness event alarm forecasting further.
Presentation of a novel method to estimate analog mean systemic filling pressure based on cardiac power.
Monares-Zepeda E, Barrera-Hoffmann C, Cerón-Díaz UW … +1 more , Martínez-Baltazar YI
J Clin Monit Comput · 2025 Dec · PMID 40719949 · Publisher ↗
Mean systemic filling pressure (MSFP) is a critical hemodynamic parameter for managing critically ill patients. Existing estimation methods either require invasive procedures or assume constant vascular resistances, limi...
Mean systemic filling pressure (MSFP) is a critical hemodynamic parameter for managing critically ill patients. Existing estimation methods either require invasive procedures or assume constant vascular resistances, limiting their applicability in clinical settings. We propose a novel method to estimate MSFP using cardiac power (CP), this method was developed in a cohort of 50 patients, validated in a different cohort of 50 patients, and tested in a historical cohort of 21 patients, showing a high correlation (r = 0.95 - 0.90) and agreement with Parkin analog Mean Systemic Filling Pressure (MSFPa) method. In brief MSFPe = (3.3*CP) + 2.2 + CVP. Our method provides an accurate, non-invasive bedside approach for estimating MSFP, facilitating hemodynamic assessment in critically ill patients and opening new research avenues on vascular resistance dynamics.
Assessment of intraoperative high frequency variability index as a predictor of postoperative pain after open liver or pancreatic surgery under combined general and epidural anesthesia: a prospective observational study.
Yoshida K, Hakozaki T, Hasegawa T … +4 more , Yakushiji T, Fukuhara Y, Obara S, Inoue S
J Clin Monit Comput · 2025 Dec · PMID 40702392 · Publisher ↗
The aim of the present study was to investigate the utility of the intraoperative high frequency variability index (HFVI) / Analgesia Nociception Index (ANI) for predicting postoperative pain in patients undergoing open...
The aim of the present study was to investigate the utility of the intraoperative high frequency variability index (HFVI) / Analgesia Nociception Index (ANI) for predicting postoperative pain in patients undergoing open liver or pancreatic surgery under combined general and epidural anesthesia, with a particular focus on HFVI/ANI measured immediately before extubation. We investigated whether maximum postoperative pain at rest and postoperative morphine consumption were associated with intraoperative HFVI/ANI values, including those measured immediately before extubation, the mean intraoperative values, the difference between values immediately before and 5 min after the first administration of local anesthetics via epidural catheter, and the difference between values immediately before and 5 min after the start of surgery. We analyzed the data obtained from 52 patients and found that HFVI/ANI measured immediately before extubation showed a limited but statistically significant association with postoperative pain at rest. However, receiver operating characteristic curve analysis failed to demonstrate clinically useful predictive performance of HFVI/ANI for postoperative pain defined as Numerical Rating Scale > 3 or > 7. In addition, no association was observed between intraoperative HFVI/ANI measured at any time point and postoperative morphine consumption. The present study demonstrated that intraoperative HFVI/ANI may reflect postoperative pain levels to a limited extent, particularly when measured immediately before extubation, but lacks sufficient accuracy to be used as a standalone predictor of postoperative pain.
Evaluating the efficacy of intraoperative NIRS cutoff values in detecting spinal cord ischemia during surgery.
Zinn S, Joseph N, CreveCoeur TS … +2 more , Sniecinski RM, García PS
J Clin Monit Comput · 2026 Apr · PMID 40694312 · Full text
PURPOSE: Paralysis is a serious complication of surgeries that interferes with the blood supply of the anterior spinal cord, with rates of spinal cord injury (SCI) from approximately 1% in general spine surgeries to 4-40...
PURPOSE: Paralysis is a serious complication of surgeries that interferes with the blood supply of the anterior spinal cord, with rates of spinal cord injury (SCI) from approximately 1% in general spine surgeries to 4-40% following thoracoabdominal aortic aneurysm (TAAA) repair. Near-infrared spectroscopy (NIRS) provides a non-invasive, real-time method for monitoring tissue oxygenation, largely unaffected by anesthetics. Given the heightened risk of neurologic injury during TAAA repair, this procedure is used to evaluate the effectiveness of standard regional spinal oxygen saturation (rSpO₂) cutoff values in predicting neurological outcomes. METHODS: This retrospective study analyzed 25 patients undergoing open TAAA repair. NIRS data were recorded at the ischemic site and a reference location throughout surgery. Neurological outcomes were assessed postoperatively based on paralysis, hemiparesis, or extremity weakness. After excluding eight patients due to poor signal quality, 17 patients were included. NIRS values at six key time points were compared between outcome groups. Bayesian statistics assessed the relationship between significant NIRS "drops" (< 80% of baseline) and neurological outcomes. RESULTS: Seven patients exhibited new neurological deficits (4 temporary). No credible association was found between intraoperative NIRS drops and postoperative neurological outcomes at any analyzed time point. A moderate effect was observed at the end of surgery (Hedges' g = - 1.21), suggesting a potential difference between groups, although the Bayesian credible interval included zero (posterior mean = - 0.82, 94% HDI [- 1.8, 0.18]). CONCLUSIONS: In this limited cohort, intraoperative NIRS cutoff values did not significantly correlate with postoperative neurological deficits following TAAA repair. Postoperative NIRS monitoring may be more informative for detecting spinal cord ischemia and preventing paralysis.
Change in pulse wave transit time measured using ear plethysmography is a useful substitute for finger plethysmography.
Nakano R, Higashi M, Shirozu K … +4 more , Ozasa S, Sumie M, Fujiyoshi T, Yamaura K
J Clin Monit Comput · 2026 Feb · PMID 40682725 · Full text
PURPOSE: Plethysmography using the finger is affected by various clinical conditions, including sympathetic tone. This study aimed to evaluate whether pulse wave transit time (PWTT) calculated using ear plethysmography c...
PURPOSE: Plethysmography using the finger is affected by various clinical conditions, including sympathetic tone. This study aimed to evaluate whether pulse wave transit time (PWTT) calculated using ear plethysmography could be used as a substitute for finger PWTT. METHODS: In this prospective observational study, 50 patients underwent elective hepatectomy between December 2021 and April 2022. PWTT was simultaneously measured using finger and ear plethysmography. The primary outcome was the global agreement of all PWTT measurements. The secondary outcome was trending ability during hemodynamic changes. RESULTS: In total, 311 paired readings from 50 patients were collected. PWTT-ear was shorter than PWTT (68.1 ± 15.1 ms). For the percent change in PWTT from baseline (%ΔPWTT), linear regression analyses showed a strong correlation between %ΔPWTT-ear and %ΔPWTT (r = 0.85, P < 0.001). In Bland-Altman analyses, the bias between %ΔPWTT-ear and %ΔPWTT was - 0.04% and limits of agreement from - 0.17 to 0.17%, with a percentage error (2 standard deviation/mean %ΔPWTT) of 4.2%. The conductance rate of the two methods was 95.9% based on a four-quadrant plot analysis. The angular conductance rate was 98.9% with a radial limit of ± 25.3 based on a polar plot analysis. CONCLUSION: PWTT-ear was shorter than PWTT, but the % change in PWTT-ear was similar to that in PWTT. PWTT measured using ear plethysmography can be used as a substitute for measuring changes in PWTT. TRIAL REGISTRATION: This study was registered in the UMIN-CTR Clinical Database (ID: UMIN000045950), https://center6.umin.ac.jp/cgi-open-bin/icdr_e/ctr_view.cgi?recptno=R000052326 on December 08, 2021.
Refining oxygen management through rigorous Oxygen Reserve Index (ORi) monitoring in patients undergoing general anesthesia: a randomized controlled trial : ORi to avoid excessive hyperoxia.
Kim TK, Ko SH, Sohn HM
J Clin Monit Comput · 2025 Aug · PMID 40682724 · Publisher ↗
Optimizing oxygenation for patients necessitates a delicate balance between sufficient oxygen delivery and mitigating the potential hazards of hyperoxemia. We hypothesized that integrating Oxygen Reserve Index (ORi) moni...
Optimizing oxygenation for patients necessitates a delicate balance between sufficient oxygen delivery and mitigating the potential hazards of hyperoxemia. We hypothesized that integrating Oxygen Reserve Index (ORi) monitoring would effectively reduce intraoperative hyperoxemia compared to reliance solely on pulse oximetry. This single-center randomized controlled trial included multiple trauma patients with ASA class 3 or higher undergoing general anesthesia. FiO adjustments to 0.5 started at T0 with arterial blood gas analysis (ABGA) every 30-minutes. Patients were randomized into Group O (ORi monitoring) and Group N (pulse oximetry). In Group O, FiO was reduced if ORi > 0.05; unchanged if ORi was 0-0.05. Group N decreased FiO if SpO was 100%, unchanged if SpO was < 99%, and increased FiO by 0.05 until SpO reached 95% or above. 54 participants were randomized, and 51 analyzed. Group O demonstrated a significantly higher percentage of normoxemia (80 ≤ PaO < 120 mmHg) (64.4% vs. 40.4%, P = 0.002) across 181 ABGAs. Although baseline PaO (T1) values were comparable within moderate hyperoxemia, at T2, only Group O achieved normoxemia, with consistently lower PaO values at T2, T3, and T4 compared to Group N. ORi values in Group O consistently trended lower from T1 to T4. The positive correlation between PaO and ORi was reaffirmed, establishing cut-off values for PaO ≥ 120mmHg and ≥ 150mmHg at 0.06 and 0.22, respectively. Simultaneous ORi and pulse oximetry reduce intraoperative hyperoxemia through safe and meticulous protocol adherence in patients.
Association of intraoperative hypotension and acute kidney injury in noncardiac surgery patients: a post hoc secondary analysis of the EU HYPROTECT registry.
Runge J, Grundmann CD, Mucha C … +18 more , Denz R, Kouz K, García MIM, Cerutti E, Frassanito L, Sander M, Davies SJ, Donati A, Ripolles-Melchor J, García-Lopez D, Vojnar B, Gayat E, Nol E, van den Boom T, Bramlage P, Saugel B, Scheeren TWL, Frey UH
J Clin Monit Comput · 2026 Feb · PMID 40676457 · Full text
PURPOSE: Previous cohort studies suggest that intraoperative hypotension is associated with acute kidney injury (AKI) in noncardiac surgical patients. We sought to ascertain that intraoperative hypotension is independent...
PURPOSE: Previous cohort studies suggest that intraoperative hypotension is associated with acute kidney injury (AKI) in noncardiac surgical patients. We sought to ascertain that intraoperative hypotension is independently associated with AKI within the first 3 days after surgery in a contemporary cohort of noncardiac surgery patients in whom clinicians strove to avoid profound intraoperative hypotension. METHODS: This was a post hoc secondary analysis of the multicentre EU HYPROTECT registry, which includes patients undergoing major noncardiac surgery who underwent predictive blood pressure monitoring. The primary outcome of this secondary analysis was AKI within the first 3 days after surgery. To quantify the duration and severity of intraoperative hypotension we calculated the area under a mean arterial pressure (MAP) of 65 mmHg. We used logistic regression analysis to identify factors independently associated with AKI. RESULTS: We analysed 697 patients. 62 of these 697 patients (9%) developed AKI within the first 3 days after surgery. In multivariable binary logistic regression analysis adjusted for confounding variables, the area under a MAP of 65 mmHg was independently associated with AKI within the first 3 days after surgery (OR 1.03 [95% CI 1.01-1.05] per 10 mmHg*min; P < 0.001). CONCLUSION: Our secondary analysis of the EU HYPROTECT registry shows that, in a contemporary population of noncardiac surgery patients in whom clinicians strove to avoid profound intraoperative hypotension, intraoperative hypotension is independently associated with AKI within the first 3 days after surgery.
Monitoring systemic ventriculoarterial coupling after cardiac surgery using continuous transoesophageal echocardiography and deep learning.
Yu J, Tannvik TD, Taskén AA … +7 more , Berg EAR, Slagsvold KH, Kirkeby-Garstad I, Skogvoll E, Kiss G, Grenne B, Aakhus S
J Clin Monit Comput · 2026 Apr · PMID 40676456 · Full text
Deterioration of ventriculoarterial coupling is detrimental to cardiovascular and left ventricular function. To enable continuous monitoring of left ventricular function, we have developed autoMAPSE, a new tool that comb...
Deterioration of ventriculoarterial coupling is detrimental to cardiovascular and left ventricular function. To enable continuous monitoring of left ventricular function, we have developed autoMAPSE, a new tool that combines transoesophageal echocardiography with deep learning for automatic measurement of mitral annular plane systolic excursion. We hypothesised that autoMAPSE could be used to monitor systemic ventriculoarterial coupling and detect alterations in postoperative cardiac biomarkers. To test this hypothesis, we monitored 50 patients for 120 min immediately after cardiac surgery by measuring autoMAPSE and mean arterial pressure (MAP) every 5 min. Postoperative N-terminal pro B-type natriuretic peptide (ProBNP) and high-sensitivity troponin-T (TnT) were measured twice daily until the evening of postoperative day 1. Ventriculoarterial coupling was assessed non-invasively by calculating arterial elastance and end-systolic elastance (Ea/Ees-ratio). The relationship between autoMAPSE and ventriculoarterial coupling was assessed by 1) correlating Ea/Ees-ratio with one simultaneous autoMAPSE measurement, and 2) relating the measurements of autoMAPSE with corresponding MAP within each patient using a linear mixed model with random slopes. We found that autoMAPSE correlated negatively with Ea/Ees-ratio (rho = - 0.61, P < 0.05). Furthermore, the individual slopes relating autoMAPSE to MAP were highly significant (P < 0.001) and markedly heterogeneous (both positive and negative), suggesting that ventriculoarterial coupling differs substantially in different individual patients. Finally, continuous autoMAPSE measurements were negatively correlated with both peak postoperative ProBNP (rho = - 0.46, P < 0.001) and TnT (rho = - 0.29, P < 0.05). In conclusion, continuous monitoring using autoMAPSE in the first two postoperative hours reflected ventriculoarterial coupling as well as peak ProBNP and TnT during the subsequent 24 h.
Validity of neuromuscular monitoring: beyond the technology's precision.
Fuchs-Buder T
J Clin Monit Comput · 2025 Oct · PMID 40673934 · Full text
Abstract loading — click title to view on PubMed.
Intraoperative analgesia management by monitoring the analgesia nociception index in gynecological surgeries involving erector spinae plane block: a randomized controlled study.
Koç Z, Baytar Ç, Bollucuoğlu K … +4 more , Köksal BG, Okyay RD, Pişkin Ö, Ayoğlu H
J Clin Monit Comput · 2025 Dec · PMID 40663304 · Publisher ↗
To determine the effect of monitoring the Analgesia Nociception Index (ANI) on intraoperative opioid use, postoperative recovery, and analgesia in patients receiving preoperative bilateral erector spinae plane block (ESP...
To determine the effect of monitoring the Analgesia Nociception Index (ANI) on intraoperative opioid use, postoperative recovery, and analgesia in patients receiving preoperative bilateral erector spinae plane block (ESPB) for gynecological surgery under general anesthesia. Eighty patients classified in the American Society of Anesthesiologists physical status I-III scheduled for hysterectomy under general anesthesia were included in the study. After ultrasound-guided ESPB, patients were divided into 2 groups: control and ANI. In the control group, the intraoperative remifentanil infusion dose was adjusted using conventional methods; in the ANI group, the dose was adjusted according to ANI values of 50-70. Intraoperative remifentanil consumption, postoperative pain scores, additional analgesic requirements, and complications were recorded. Intraoperative remifentanil consumption was lower in the ANI group than in the control group (p < 0.001). Numerical rating scale (NRS) scores and requirements for additional analgesics in the postoperative recovery unit were both lower in the ANI group (p < 0.05). There were no significant differences between the groups in terms of nausea or vomiting in the recovery unit. ANI monitoring in patients undergoing gynecological surgery under general anesthesia with ESPB reduced opioid consumption during the intraoperative period. Intraoperative ANI monitoring enabled individualized opioid administration and guided determination of the required dose of analgesic agent.
Effectiveness of diaphragmatic ultrasound as a predictor of successful weaning from mechanical ventilation.
Elfeky HM, Omaran J, Shaban NS … +3 more , Elmohamady A, Doha N, Afify N
J Clin Monit Comput · 2025 Oct · PMID 40658353 · Full text
Purpose: Weaning from mechanical ventilation (MV) is the transition from ventilator dependence to independent breathing. Optimal timing reduces complications. Traditional predictors like the Rapid Shallow Breathing Index...
Purpose: Weaning from mechanical ventilation (MV) is the transition from ventilator dependence to independent breathing. Optimal timing reduces complications. Traditional predictors like the Rapid Shallow Breathing Index (RSBI), diaphragmatic excursion (DE), and diaphragm thickening fraction (DTF) have limitations. This study evaluates the clinical utility of diaphragmatic excursion RSBI (DE-RSBI) and diaphragm thickening fraction RSBI (DTF-RSBI) alongside conventional RSBI in predicting weaning success. Methods: An observational study was conducted in the ICU of Menoufia University Hospitals on 50 adult patients mechanically ventilated for over 48 hours who underwent spontaneous breathing trials (SBT). Diaphragmatic ultrasound measured DE and DTF, from which DE-RSBI and DTF-RSBI were calculated and compared with RSBI. Weaning success was defined as maintaining spontaneous breathing for more than 48 hours post-extubation. Results: DE-RSBI (≥1.685) showed the highest predictive accuracy (AUC=0.851, sensitivity=80%, specificity=85%). Both DE-RSBI and DTF-RSBI correlated with ICU mortality (p<0.001) and MV duration (p≤0.001). Weaning failure odds were significantly higher for DE-RSBI >1.56 (OR=12, p=0.004) and DTF-RSBI >62.33 (OR=8.04, p=0.008) compared to RSBI alone (OR=4.84, p=0.04). Conclusions: DE-RSBI and DTF-RSBI are reliable predictors of MV weaning, outperforming RSBI alone. Their use can enhance weaning decisions, reducing failure rates and improving patient outcomes.
About
- Frequency
- Sun
- Papers found
- 200
- RSS feed
- Subscribe