Capillary refill time (CRT) is a vaso-occlusive test that allows the non-invasive assessment of skin perfusion. A vascular occlusive test (VOT) induces transient ischemia similar to that used in preconditioning ischemia....Capillary refill time (CRT) is a vaso-occlusive test that allows the non-invasive assessment of skin perfusion. A vascular occlusive test (VOT) induces transient ischemia similar to that used in preconditioning ischemia. We hypothesized that CRT could be influenced by local tissue compression mimicking ischemic preconditioning when repeated measurements are performed. In healthy volunteers (n = 30), CRTs were performed twice on the index and middle fingers of the dominant hand and the index finger of the non-dominant hand at 15-minute intervals on the first day. On the second day, two CRT measurements were taken at 30-minute intervals. No significant differences were observed in CRT measurements repeated at 15- and 30-minute intervals. Additionally, baseline CRT values did not significantly differ between the fingers of the dominant and non-dominant hands on either study day. Repeated CRT measurements are not influenced by local ischemic preconditioning in the finger over short intervals.
J Clin Monit Comput
· 2026 Feb · PMID 40637989
·
Full text
AIM: We have developed a non-contact ("touchless") system based on depth-sensing camera technology for continuous monitoring of respiratory activity. Previous work from our group has demonstrated high accuracy of the sys...AIM: We have developed a non-contact ("touchless") system based on depth-sensing camera technology for continuous monitoring of respiratory activity. Previous work from our group has demonstrated high accuracy of the system in monitoring a wide range of respiratory rates and signal morphologies across diverse conditions, including variations in lighting, posture, and coverings. Here, we report on the system's performance in a significantly more challenging anesthesia environment which included a wide range of respiratory rates and respiratory patterns, spontaneous and hand ventilated breathing, patient motion and caregiver interactions in the scene, and, in some cases, the presence of warming blankets covering the torso. METHODS: Data was collected opportunistically from 34 healthy volunteers from two separate studies, both of which had the primary objective of investigating the relationship between depth of anesthesia monitoring and anesthetic agents (inhaled and intravenous) across a wide range of anesthetic concentrations and hypnotic states. Depth-sensing information was acquired using an Intel D415 RealSense™ camera and processed to extract frame-by-frame depth changes within the subject's torso region corresponding to respiratory activity. A respiratory rate (RR) was calculated and output once-per-second from the device. This was compared to a combined reference (RR) derived from both a capnograph and an impedance-based respiratory monitor. Three time periods were evaluated: pre-anesthesia, intra-anesthesia and post-anesthesia. RESULTS: The overall RMSD accuracy [bias] obtained for the combined data set was 1.92 [0.30] breaths/min. The performance results stratified according to pre-, intra-, and post-anesthesia stages were 1.71 [0.15], 1.95 [0.39] and 2.13 [0.08] breaths/min, respectively. CONCLUSIONS: We have demonstrated the ability to continuously track respiratory rate during challenging conditions within an anesthesia setting using our non-contact, touchless, monitoring technology. We believe that our findings support the potential utility for continuous non-contact monitoring of respiration in clinical areas, such as the post-anesthesia care environment.
PURPOSE: To evaluate the inter- and intraobserver reproducibility of sublingual microcirculatory indices measured using the GlycoCheck system, including the perfused boundary region (PBR), vascular density (VD), and red...PURPOSE: To evaluate the inter- and intraobserver reproducibility of sublingual microcirculatory indices measured using the GlycoCheck system, including the perfused boundary region (PBR), vascular density (VD), and red blood cell filling (RBCF), in patients under general anesthesia without any motion artifacts. METHODS: Fifty patients who received general anesthesia for laparoscopic gastrointestinal surgery were included in this study. After the induction of general anesthesia, the leading observer and one of the five subobservers took two and one measurements of sublingual microcirculation with the GlycoCheck system, respectively. Inter- and intraobserver reproducibility was assessed using intraclass correlation coefficients (ICC). Interobserver reproducibility was calculated using the first measurements of the leading observer and subobservers, and intraobserver reproducibility was calculated using two consecutive measurements of the leading observer. RESULTS: The interobserver reproducibility of a single measurement was poor for all three parameters. The interobserver ICCs for PBR were 0.13 [95% CI: -0.15, 0.39], for VD was - 0.01 [95%CI: -0.29, 0.27], and for RBCF were 0.31 [95%CI: -0.45, 0.78]. The intraobserver ICCs for PBR was 0.32 [95% CI: 0.05, 0.55] for all 50 cases, 0.17 [95% CI: -0.25, 0.53] for the first 25 cases, and 0.46 [95% CI: 0.09, 0.72] for the second 25 cases. The Bland-Altman plots indicated that the measurement errors were random. CONCLUSION: In patients under general anesthesia, single PBR, VD, and RBCF measurements using the GlycoCheck system showed poor interobserver reproducibility. Although the intraobserver reproducibility of PBR measurements was poor, improving measurement proficiency might improve reproducibility. Further research is required to establish measurement methods that achieve better reproducibility and adequate observer training.
BACKGROUND: Assessing fluid responsiveness is crucial in managing critically ill patients. Echocardiography, particularly passive leg raising (PLR)-induced changes in the velocity-time integral of the left ventricular ou...BACKGROUND: Assessing fluid responsiveness is crucial in managing critically ill patients. Echocardiography, particularly passive leg raising (PLR)-induced changes in the velocity-time integral of the left ventricular outflow tract (VTI), is widely used for this purpose. We hypothesized that PLR-induced changes in the mitral valve velocity-time integral (VTI) could serve as a reliable alternative. METHODS: This prospective single-center study included septic ICU patients requiring fluid responsiveness assessment. VTI and VTI were measured at baseline and after PLR. Fluid responsiveness was defined as a PLR-induced increase in VTI ≥10%. The ability of PLR-induced VTI changes to predict fluid responsiveness was assessed via ROC curve and gray zone analyses. RESULTS: Fifty consecutive patients were included (median age 65 years [IQR: 57-73], APACHE II score 22 [IQR: 18-27]). Septic shock was present in 27 (54%), 21 (42%) were mechanically ventilated, and 23 (46%) were classified as responders. PLR-induced changes in VTI and VTI were significantly correlated (ρ = 0.656, p < 0.001). The area under the ROC curve for VTI was 0.927 (95% CI: 0.849-1, p < 0.001). A 10% increase in VTI predicted fluid responsiveness with a sensitivity of 83% (95% CI: 61-95) and specificity of 96% (95% CI: 83-99). The gray zone ranged between 5% and 8%, encompassing 16% of the cohort. CONCLUSION: PLR-induced changes in VTI reliably predict fluid responsiveness in critically ill patients. VTI represents a viable alternative to VTI for fluid responsiveness assessment, contributing to individualized hemodynamic management. TRIAL REGISTRATION: NCT05538637.
PURPOSE: We aimed to test a new method to determine the positive-end expiratory pressure (PEEP) that maintains the lungs open after a recruitment maneuver (RM). METHODS: In eleven anesthetized patients, we compared the s...PURPOSE: We aimed to test a new method to determine the positive-end expiratory pressure (PEEP) that maintains the lungs open after a recruitment maneuver (RM). METHODS: In eleven anesthetized patients, we compared the standard RM searching for the optimal PEEP based on the highest respiratory compliance (PEEP), with a new method. This method performs a RM during a slow pressure-volume curve and detects the optimal PEEP using the novel barometric capnography curve (BCap); i.e. the plot of expired carbon dioxide versus airway pressure. The lungs' closing pressure was detected when the slope of phase III of the BCap changed along this slow expiration (PEEP). The main objective was to compare PEEP with the reference PEEP. As a secondary objective, we explored the association between PEEP and the polarity change in end-expiratory transpulmonary pressure (PEEP) during the deflation phase of a slow flow PV curve. RESULTS: We found a PEEP of 8.5(3.3) cmHO that was no statistically different from the PEEP of 10.0(4.0) cmHO (p = 0.72). Both methods correlated well with a Rho of 0.84 (p < 0.001). The Bland-Altman plot showed a bias of 0.19 and LOA of 1.92 cmHO (95%CI -0.39 to 0.77 cmHO). During the PV slow deflation limb, PEEP was 9.3(4.3), which was statistically similar to PEEP (p = 0.61). Both pressures were strongly correlated (Rho = 0.93, p < 0.001) with a bias of -0.3 cmHO and LOA of 1.52 (95%CI -0.76 to 0.16 cmHO). CONCLUSIONS: We concluded that BCap is feasible to detect lungs collapse using a constant flow PV curve.
PURPOSE: To evaluate the accuracy and trending ability of the non-invasive esCCO (Estimated Continuous Cardiac Output, Nihon Kohden) in mechanically ventilated children. METHODS: This prospective observational study comp...PURPOSE: To evaluate the accuracy and trending ability of the non-invasive esCCO (Estimated Continuous Cardiac Output, Nihon Kohden) in mechanically ventilated children. METHODS: This prospective observational study compared Ci measurements obtained using esCCO and transthoracic echocardiography (TTE). At baseline (T0), esCCO was initially calibrated using demographic data (sex, age, weight, and height) and then recalibrated based on Ci values measured by TTE. Follow-up measurements were conducted at 2 h (T1) and 18 h (T2) post-recalibration. Agreement was assessed using Bland-Altman analysis and Lin’s concordance correlation coefficient; trending ability was evaluated with a four-quadrant plot. RESULTS: Fifty patients were included, with a median age of 7.5 months (IQR: 3–54 months). At T0, esCCO showed poor agreement with TTE, with a bias of + 5.9 L·min⁻¹·m⁻² and wide limits of agreement (− 1.2 to + 13.1 L·min⁻¹·m⁻²), resulting in a percentage error of 106.9%. After calibration with TTE, agreement improved significantly: at T1, the bias was + 0.1 L·min⁻¹·m⁻² with limits of agreement from − 1.0 to + 1.3 and a percentage error of 12.7%; at T2, the bias was + 0.2 (− 1.7 to + 2.0) with a percentage error of 20.7%. Trend analysis showed a concordance rate of 79%, indicating moderate trending ability. CONCLUSION: While esCCO demonstrated improved agreement with TTE following recalibration, its accuracy declined over time, highlighting the need for periodic recalibration to maintain reliability. Importantly, the agreement between esCCO and TTE without calibration was not clinically acceptable, limiting its use in clinical decision-making in the absence of recalibration.
Williams E, Ascherl R, Gaertner VD
… +7 more, Sibrecht G, Kurul S, Herrmann ML, Szakmar E, Raffaeli G, Bresesti I, Jost K
J Clin Monit Comput
· 2025 Oct · PMID 40576940
·
Full text
PURPOSE: Vital sign monitoring plays a pivotal role in assessing and managing the clinical condition of vulnerable newborn infants in the delivery room and in the neonatal intensive care unit (NICU), with advancements in...PURPOSE: Vital sign monitoring plays a pivotal role in assessing and managing the clinical condition of vulnerable newborn infants in the delivery room and in the neonatal intensive care unit (NICU), with advancements in technology over the last years paving the way for newer and less invasive monitoring techniques. METHODS: We conducted a narrative review of the literature in PubMed, Embase, GoogleScholar, and ClinicalTrials.gov. to describe newer technologies in neonatal monitoring of heart rate and oxygen saturation including secondary data-use, focusing also on promising studies which are currently underway. RESULTS: Innovations such as photoplethysmography, wireless skin sensors, spectroscopy and tremolo sonification can provide a continuous and comprehensive assessment of neonatal vital sign monitoring, including heart rate and oxygen saturations, allowing for the enhancement of early detection of potential complications. Moreover advanced mathematical models, such as heart rate characteristic variability and closed loop automated systems, have shown promise in processing and storing vast amounts of data, aiding in the early prediction of adverse clinical outcomes, supporting decision-making and guiding the development of future studies. CONCLUSION: As the field of vital sign monitoring in the NICU continues to evolve, it is essential to address challenges related to novel modalities, data privacy, algorithm accuracy, and seamless integration into existing healthcare systems. By harnessing the potential of innovative technologies, the future of vital sign monitoring in the NICU promises improved neonatal outcomes, enhanced healthcare delivery and facilitation of individualisation of care.
OBJECTIVE: To evaluate the feasibility and safety of distal radial artery (DRA) catheterization compared to conventional radial artery (CRA) catheterization for invasive arterial pressure monitoring in intensive care uni...OBJECTIVE: To evaluate the feasibility and safety of distal radial artery (DRA) catheterization compared to conventional radial artery (CRA) catheterization for invasive arterial pressure monitoring in intensive care unit (ICU) patients. METHODS: This single-center, prospective, randomized controlled study enrolled 197 ICU patients requiring invasive arterial pressure monitoring between May 2024 and March 2025. Patients were randomly assigned to either the DRA group (n = 99) or CRA group (n = 98). Primary outcome was first-attempt puncture success rate. Secondary outcomes included final success rate, catheterization time, compression time for hemostasis, abnormal waveform frequency, unplanned removal rate, and complications. RESULTS: The DRA group demonstrated significantly lower first-attempt puncture success rates compared to the CRA group (68.69% vs. 82.65%, P = 0.022). With ultrasound assistance, final success rates were comparable between groups (98.99% vs. 97.96%, P = 0.993). Total catheterization time (133.61 ± 35.82s vs. 126.50 ± 36.99s, P = 0.175) and abnormal waveform frequency were similar between groups. The DRA group exhibited significantly shorter hemostasis times (224.45 ± 55.25s vs. 417.56 ± 71.32s, P < 0.001). Both groups had low complication rates with no statistically significant differences (1.01% vs. 3.06%, P = 0.621). CONCLUSION: Despite lower first-attempt success rates, DRA catheterization provides equivalent monitoring stability to CRA with significantly reduced hemostasis time and comparable safety profiles. DRA represents a viable alternative for invasive arterial pressure monitoring in ICU patients, particularly those requiring rapid hemostasis, preservation of forearm radial artery integrity, and patients in special positioning.
Ito A, Mitarai S, Kishimoto K
… +5 more, Liu C, Yamamoto G, Mori Y, Egi M, Kuroda T
J Clin Monit Comput
· 2026 Feb · PMID 40540170
·
Full text
One of the primary goals of automated anesthesia is to reduce human intervention and reduce the workload of anesthesiologists. However, switching modes before the start of surgery still requires manual operation. The pre...One of the primary goals of automated anesthesia is to reduce human intervention and reduce the workload of anesthesiologists. However, switching modes before the start of surgery still requires manual operation. The present study aims to develop a system that predicts the start of surgery by analyzing the actions of medical staff in the operating room using surveillance camera footage, thereby enabling automated mode transitions in anesthesia systems. We analyzed 110 surveillance videos of elective laparoscopic surgeries at Kyoto University Hospital. Key medical staff actions to predict the start of surgery were identified, and the time intervals between each action and skin incision were recorded. We then developed a detection system to identify draping, the best key action, and evaluated it by comparing system-detected draping times with manually annotated times in 96 videos. Five key actions were identified: hand washing, sterilization, light activation, bed cradle set-up, and draping. The start of draping had the shortest median time interval to the skin incision (7.71 min, interquartile range: 5.89-9.72), which was significantly shorter than that of the other actions (p < 0.05), and also had the shortest interquartile range. In the system evaluation, the median time error for detecting draping was 19.0 s (interquartile range: 16.0-50.0). The start of draping is a reliable predictor of the start of surgery, and the draping detection system demonstrated high accuracy. These results support advances in anticipatory automated anesthesia systems, enhancing workflow efficiency and patient safety in the operating room.
A recent study introduced a patient-specific algorithm designed to reduce the acquisition time required for obtaining somatosensory evoked potentials during spinal surgery. While the approach is promising, its reliance o...A recent study introduced a patient-specific algorithm designed to reduce the acquisition time required for obtaining somatosensory evoked potentials during spinal surgery. While the approach is promising, its reliance on amplitude and latency thresholds may overlook subtle waveform features that are crucial in high-risk patients. Broader validation, integration of waveform morphology, and cautious application in clinically compromised populations are warranted. Optimizing intraoperative neurophysiological monitoring requires not only speed but also diagnostic fidelity.
Renal Doppler ultrasonography may have an important role in the detection of acute kidney injury (AKI) in early stages. This study was aimed to determine whether renal Doppler parameters at day 1 can predict the developm...Renal Doppler ultrasonography may have an important role in the detection of acute kidney injury (AKI) in early stages. This study was aimed to determine whether renal Doppler parameters at day 1 can predict the development of AKI at day 5 in acute circulatory failure (ACF). After ethics committee approval and informed written consent from patients or legally acceptable representatives, we recruited n = 80 critically ill adult patients with ACF in this single-center, prospective observational study. Baseline demographic, clinical, and laboratory parameters were noted. Renal resistive index (RRI), power Doppler ultrasound (PDU) score, and their ratio (RRI/PDU) were measured at baseline and three consecutive days. The primary outcome was the development of AKI at day five, and the secondary outcomes were 28-day mortality, length of ICU stay, duration of ventilation, and vasopressor-free days. Out of 80 patients, n = 32 (40%) developed AKI. At baseline, fluid balance (ml/kg) and APACHE II score were higher and pH was lower in AKI group. RRI and RRI/PDU values were significantly higher, and PDU was significantly lower in the AKI group compared to the non-AKI group from day 1 to day 3. Moreover, changes in these parameters (ΔPDU and ΔRRI/PDU at day 2 and day 3) were significantly more in the AKI group. On regression analysis, all three Doppler parameters from day 1 to day 3 demonstrated very good to excellent accuracy in predicting the development of AKI. To conclude, renal Doppler parameters (RRI, PDU, and RRI/PDU) on day 1 through day 3 can predict the development of AKI by day 5 in critically ill adults with acute circulatory failure.
Shirahata W, Takada R, Watanabe N
… +5 more, Miyatake K, Sato A, Minegishi K, Yoshii T, Koga H
J Clin Monit Comput
· 2025 Oct · PMID 40493109
·
Full text
The influence of intraoperative position on femoral nerve palsy after total hip arthroplasty (THA) remains unclear. Therefore, we evaluated the effect of intraoperative position on quadricep motor-evoked potential monito...The influence of intraoperative position on femoral nerve palsy after total hip arthroplasty (THA) remains unclear. Therefore, we evaluated the effect of intraoperative position on quadricep motor-evoked potential monitoring in patients undergoing THA using an anterolateral approach. We included patients who underwent primary THA using the anterolateral approach at our hospital between June 2021 and January 2024 with available data on intraoperative quadricep using transcranial electrical stimulation motor-evoked potential. Patient characteristics were compared between the supine and lateral position groups. Intraoperative quadricep MEP were evaluated at the beginning of surgery, after anterior acetabular retractor placement, after acetabular retractor placement, and before wound closure. The MEP amplitude at surgery start was set to 100%, and the change in amplitude at each time point was compared between positions. Ten patients were placed in the supine and lateral positions. Patient background did not differ significantly between the groups, and no postoperative paralysis was observed. The residual rates of quadriceps MEP were significantly lower in the supine position than the lateral position at all three time points (p < 0.05). Intraoperative quadricep motor-evoked potential monitoring in primary THA using the anterolateral approach showed significantly lower MEP amplitude in the supine position than in the lateral position at all three time points. Therefore, the lateral position may decrease femoral nerve palsy risk after THA.
Preservation of facial nerve function is extremely important in vestibular schwannoma surgery. Intraoperative transcranial facial motor evoked potential (Tc-fMEP) monitoring was used, and its accuracy and the correlation...Preservation of facial nerve function is extremely important in vestibular schwannoma surgery. Intraoperative transcranial facial motor evoked potential (Tc-fMEP) monitoring was used, and its accuracy and the correlations of Tc-fMEP results with postoperative facial nerve function at various time points were investigated. Factors associated with postoperative deterioration of facial nerve function were also examined. Forty-five consecutive cases of vestibular schwannoma that underwent surgery at our hospital from January 2013 to July 2022 were retrospectively reviewed. The correlation between intraoperative Tc-fMEP results and postoperative facial nerve function was investigated in each period from immediately after surgery to one year later. The warning criterion for Tc-fMEP was a decrease of 50% or more compared to the baseline amplitude. The relationships of age, sex, side, tumor size, and tumor nature with postoperative facial nerve function were also examined. Intraoperative Tc-fMEP monitoring was successfully performed in all 45 cases. Intraoperative Tc-fMEP results were significantly correlated with facial nerve function one week (P < 0.01) and one month after surgery (P < 0.01). The negative predictive value was 89% one month after surgery (P < 0.01). One year after surgery, the facial nerve function preservation rate (House and Brackmann: grade I-II) was 88%. In addition, facial nerve function one year after surgery was significantly worse with cystic tumors than with solid tumors (P = 0.04). Intraoperative Tc-fMEP monitoring may reflect facial nerve function one week to one month after surgery. In addition, in our study cystic tumors had significantly higher deterioration in postoperative facial nerve function than for solid tumors.
Scheffenbichler FT, Ulm B, Borgstedt L
… +8 more, Scholze A, Kretsch N, Zia N, Friedrich V, Marb M, Schaller SJ, Jungwirth B, Blobner M
J Clin Monit Comput
· 2025 Oct · PMID 40437152
·
Full text
PURPOSE: Anaesthesia providers often complain that quantitative neuromuscular monitoring does not accurately assess neuromuscular function, a problem that can be mitigated by appropriate calibration. However, there are o...PURPOSE: Anaesthesia providers often complain that quantitative neuromuscular monitoring does not accurately assess neuromuscular function, a problem that can be mitigated by appropriate calibration. However, there are only very limited recommendations for the calibration of quantitative neuromuscular monitoring in clinical routine. Therefore, this multicentre prospective agreement study compared the precision of electromyography using three different calibration approaches. METHODS: Sixty patients were assigned to one of three investigational calibration approaches: calibration before anaesthesia induction, calibration during anaesthesia induction, i.e., at loss of consciousness and state entropy < 85, or uncalibrated. All patients received electromyography calibration under deep anaesthesia on the second arm (control as recommended for research). The primary endpoint was the repeatability coefficient, which describes the fluctuation of the following train-of-four (TOF) reading. It therefore provides an estimate of the precision of a measurement method. Secondary endpoints included agreement with control calibration and pain at induction. RESULTS: The repeatability coefficient at TOF ratios ≥ 0.8 indicated that electromyography monitoring was less precise when TOF readings were uncalibrated (0.124 ± 0.130) or with calibration during induction (0.087 ± 0.104) but was acceptable after calibration before induction (0.075 ± 0.036) compared to those measured after calibration on the contralateral arm (control: 0.072 ± 0.027, 0.061 ± 0.021, and 0.083 ± 0.063, respectively). Recall of pain at anaesthesia induction did not differ between investigational groups. CONCLUSION: The findings underline the importance of thoroughly performed calibration for precise TOF readings to reliably exclude residual neuromuscular blockade. Electromyography was most precise when calibration was performed under deep anaesthesia (control). If that approach is not possible in the clinical setting, our data suggest that calibration before anaesthesia induction can be considered if previously discussed with the patient. CLINICAL TRIAL REGISTRATION: Clinical Trials NCT04911088, registered January 6, 2021.
This study aimed to determine whether the use of capnography reduces the incidence of respiratory and cardiovascular adverse events during procedural sedation and analgesia (PSA) for gastrointestinal endoscopic procedure...This study aimed to determine whether the use of capnography reduces the incidence of respiratory and cardiovascular adverse events during procedural sedation and analgesia (PSA) for gastrointestinal endoscopic procedures (GEP) provided by experienced anaesthesiologists. A prospective cohort study was conducted, including patients undergoing GEP under PSA. Patients were divided in two groups: Group A (pulse oximetry) and Group B (capnography with Capnostream monitor plus pulse oximetry). Interventions undertaken to resolve hypoxaemia, airway obstruction, or apnoea were recorded. Age, comorbidities, ASA Classification, sedative drugs, respiratory and cardiovascular adverse events, recovery Aldrete Scale value, and patient satisfaction were also recorded. Both parametric and non-parametric tests were applied. A total of 1,146 patients were included: Group A, n = 538, and Group B, n = 608. Diagnostic colonoscopy was the most frecuent procedure (49.7%), followed by diagnostic gastroscopy (22.5%) and therapeutic colonoscopy (22.2%). Apnoea < 60 s was detected only in patients monitored with capnography (35.4% vs. 0%, p < 0.000). The use of capnography significantly reduced the incidence of moderate hypoxaemia (3% vs. 6.5%, p = 0.004). Severe hypoxaemia was significantly reduced with capnography only in patients with cardio-respiratory comorbidities (2.2% vs. 4.4%, p = 0.032). The capnography group showed a lower incidence of cardiovascular events. Respiratory adverse events, such as desaturation and airway obstruction, increased with age and ASA classification, as did the need for airway maneuvers. Prolonged apnoea and intubation were rare in both groups. Mandibular traction manoeuvres were significantly more frequent in Group B (9.9% vs. 3%, p < 0.000), reducing the need for other interventions. Patient satisfaction at discharge was higher when capnography was used (p < 0,000). Moderate-deep sedation for GEP performed by experienced anaesthesiologists, combined with capnography, enhances safety, with extremely rare major complications. Capnography monitoring allowed the timely identification and resolution of apnoea and airway obstruction, avoiding severe desaturation and cardiovascular adverse events.
Pilakouta Depaskouale MA, Archonta SA, Moutafidou SΚ
… +3 more, Paidakakos NA, Dimakopoulou AN, Matsota PK
J Clin Monit Comput
· 2025 Oct · PMID 40410627
·
Full text
Intraoperative hypotension (IOH) is associated with morbidity and mortality. The Hypotension Prediction Index (HPI), a machine learning-based tool, offers the opportunity for a proactive approach by predicting hypotensiv...Intraoperative hypotension (IOH) is associated with morbidity and mortality. The Hypotension Prediction Index (HPI), a machine learning-based tool, offers the opportunity for a proactive approach by predicting hypotensive events. This single center, single blind randomized clinical trial aimed to evaluate the hypothesis that an HPI software-guided approach to IOH management during prone position spine surgery could reduce its incidence compared to our standard care practices. 85 adult patients undergoing spine fusion surgery in the prone position were enrolled. Patients were randomized with a 1:1 allocation ratio. Participants were blinded to their group allocation. In the intervention group, the HPI software was actively used to guide IOH management. In the control group, HPI software readings were blinded, and standard care was administered. The primary outcome was the comparison of time-weighted average (TWA) of IOH between the two groups. Secondary outcomes included a comparison of the incidence of postoperative in-hospital events related to IOH between groups. 77 patients were included in the final analysis (39 in the intervention group), as 8 patients were excluded due to technical issues. No statistically significant difference was found between the intervention and control groups in the TWA of IOH (0.10 mmHg [0.05, 0.23] vs. 0.15 mmHg [0.09, 0.37], p-value 0.088). However, the total duration of hypotensive events per patient was significantly lower in the intervention group (4 min [0.5, 12.2] vs. 11.2 min [2.6, 20.1]; p-value 0.019). Postoperative complication rates did not differ significantly between the two groups. HPI-guided management did not significantly reduce the TWA of IOH compared to standard care in patients undergoing prone-position spine surgery. Complication rates were similar between the two groups.Clinical Trial Registration: This trial was registered with ClinicalTrials.gov (registration number: NCT05341167).