Journal of Clinical Monitoring and Computing最新文献

Respiratory rate (RR) is a vital sign often unused in clinical practice due to labour-intensive manual counting or capnography limitations in spontaneously breathing patients. This study validated RespX, a novel accelerometer-based wireless sensor, for continuous respiratory rate measurement in hospitalised patients. This prospective, single-centre observational study included hospitalised adults (> 18 years) expected to remain undisturbed for one hour while measuring RR. The RespX sensor, placed on the left chest wall, was compared with continuous capnography and manual counting every 20 min for one hour. The primary endpoint was respiratory rate measured by RespX within ± 3 breaths per minute compared to capnography. Linear mixed-effects models analyzed mean differences between methods. Twenty-nine patients completed the study. The proportion of RespX measurements within ± 3 breaths per minute of capnography was 77% (95% CI: 74.8-79.0%) for raw data and 82.8% (95% CI: 80.7-84.7%) after removing outliers. The proportion of RespX measurements within ± 3 breaths per minute of manual counting was 87,5% (95% CI: 81,1%-93,8%). For the capnography the proportions for the raw data was 87,8% (95% CI: 81,8-93,8%) and 94,5% (95% CI: 90,3%-98,7%) after removing outliers. Linear mixed-effects analysis showed mean differences of -0.40 (p = 0.43) for raw data and 0.39 (p = 0.15) for filtered data between RespX and capnography, supporting their equivalence. RespX demonstrated lower measurement variability (SD: 0.75-3.05) compared to capnography (SD: 0.99-5.19). No adverse events were observed during the study. The wireless RespX accelerometer-based sensor provides a novel and accurate method for assessing the respiratory rate in awake hospitalised patients compared with capnography.Trial registration: NCT06911541.

Post-dural puncture headache (PDPH) following epidural anesthesia remains a frequent obstetric complication. While epidural blood patch (EBP) is the reference treatment, its efficacy assessment still relies on subjective pain reporting. This study explored whether changes in optic nerve sheath diameter (ONSD) measured by ultrasound could serve as an objective, real-time indicator of early EBP response. In this prospective, single-center observational study, 30 postpartum patients with PDPH undergoing EBP had ONSD measured before (H0) and 2 h after (H2) the procedure. Correlation between ΔONSD and ΔVAS pain scores was analyzed with bootstrap validation, and receiver operating characteristic (ROC) analysis identified thresholds associated with early response. Mean ΔONSD was 0.97 ± 0.55 mm, significantly correlated with pain reduction (r = - 0.64, p < 0.001; bootstrap 95% CI: -0.81 to - 0.36). ROC analysis showed good diagnostic performance (AUC = 0.96, 95% CI: 0.87-1.00), with a ΔONSD ≥ 0.40 mm threshold providing 100% sensitivity and 83% specificity for early improvement. These preliminary findings suggest that ONSD ultrasound may offer a feasible, noninvasive adjunct for assessing early EBP response in PDPH. The identified 0.40 mm change threshold appears promising but requires confirmation in larger, multicenter studies with extended follow-up to determine its reproducibility and clinical utility.

Shock is a life-threatening condition marked by inadequate tissue perfusion and oxygen supply, leading to organ failure if not rapidly addressed. Clinical management of shock involves detecting and correcting altered macro hemodynamic parameters. However, these parameters may not accurately reflect microcirculatory alterations or abnormalities in oxygenation. A resuscitation strategy focused on peripheral perfusion, which can be non-invasively monitored, may allow for earlier shock detection and treatment, potentially reducing mortality. This literature review aims to study the available technologies found in literature and in patents to non-invasively monitor peripheral perfusion. PRISMA method was employed to systematically select or exclude articles and patents, resulting in 44 studies and 21 patents included in the review. The found technologies were classified based on the sensing principle in light (reflected, transmitted, or scattered), Doppler effect, temperature, and skin mottling. Combining the monitorization of microcirculatory with macrocirculatory parameters has the potential to have an accurate prognosis value for shock and other diseases. However, the various technologies that have been developed to monitor peripheral perfusion require further research and testing in diverse conditions.

Hemodynamic monitoring is a cornerstone of perioperative care in cardiac surgery, where patients are at high risk of cardiovascular instability and organ hypoperfusion. In recent years, goal-directed therapy (GDT) protocols have increasingly incorporated advanced monitoring technologies to optimize perfusion and improve outcomes. This systematic review aims to critically appraise contemporary hemodynamic monitoring strategies and their integration into GDT protocols in adult patients undergoing cardiac surgery. A systematic review of studies published between January 2015 and May 2025 was conducted using PubMed, Embase, Scopus, and the Cochrane Library. The last search was conducted on 17 May 2025 in all databases. Eligible studies included adult cardiac surgical patients managed with perioperative hemodynamic monitoring strategies that incorporated cardiac output assessment and structured GDT protocols. A qualitative synthesis of monitoring modalities, targeted hemodynamic endpoints, and reported clinical outcomes was performed. Our analysis included 15 studies comprising 4,224 patients. Monitoring strategies ranged from pulmonary artery catheters to minimally invasive and noninvasive tools such as FloTrac/EV1000 and esophageal Doppler. Cardiac index and stroke volume variation were the most frequently targeted parameters, often in combination with perfusion markers such as mean arterial pressure or central venous oxygen saturation. GDT protocols were associated with reductions in AKI, duration of mechanical ventilation, and ICU/hospital stay. Mortality benefits were inconsistently reported and not predefined in most studies. Current evidence supports the physiological rationale for GDT guided by advanced hemodynamic monitoring in cardiac surgery. Nonetheless, substantial heterogeneity in strategies and outcomes highlights the need for standardized protocols and high-quality multicenter trials to determine the most effective, patient-centered approaches.Trial registration: PROSPERO registration number: CRD420251102582, retrospectively registered on 11 July 2025.