Journal of Clinical Monitoring and Computing最新文献

Purpose To evaluate the effect of reducing tidal volume from 8 mL/kg predicted body weight (PBW) to 6 mL/kg PBW on dynamic arterial elastance (Eadyn) in patients scheduled for laparoscopic surgery.

Method: After the start of intra-abdominal insufflation, if MAP became < 65 mmHg and SVV > 10%, then the tidal volume was reduced from 8 mL/kg PBW to 6 mL/kg PBW. One min later, 250 mL of lactate Ringer's solution was administered over 10 min. MAP responsiveness was defined as a > 10% increase in MAP following a fluid challenge.

Results: This study included 46 patients, 11 MAP non-responders and 35 MAP responders. Both PPV and SVV decreased significantly (- 19.4 ± 11% and - 19.7 ± 9.9%, respectively) following tidal volume reduction. However, the magnitude of the decrease differed. As a result, the change in Eadyn was minimal on average, although inter-individual variability was observed. Bland-Altman analysis revealed a mean difference of - 0.004, with 95% limits of agreement ranging from - 0.285 to + 0.278. Eadyn values before and after tidal volume reduction failed to predict MAP responsiveness (at 8 mL/kg PBW: area under the ROC curve [AUC] 0.514, at 6 mL/kg PBW: AUC 0.508).

Conclusion: The reduction in tidal volume had a clinically negligible effect on Eadyn. Neither Eadyn values at tidal volume of 8 mL/kg PBW and 6 mL/kg PBW could not predict MAP increase after a fluid challenge during laparoscopic surgery.

Trial registration: This study was registered in the UMIN-CTR Clinical Database (ID: UMIN000054061) on April 4th, 2024. https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi? recptno=R000061722.

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.

To evaluate whether a web-based Intraoperative Glycemic Protocol Calculator (IGPC) improves provider compliance with intraoperative glycemic management protocols during cardiac surgery. Single-center retrospective cohort study conducted between August - October 2022 (pre-intervention) and April - June 2023 (post-intervention). Tertiary care academic hospital. Adult patients undergoing coronary artery bypass grafting and/or valve surgery requiring cardiopulmonary bypass. Implementation of the IGPC, a web-based clinical decision support tool designed to automate insulin dosing recommendations intraoperatively. Protocol adherence, defined as appropriate insulin administration within five minutes of glucose measurement, was compared before and after IGPC implementation. Among 143 patients, IGPC use significantly increased adherence across all intraoperative phases: Pre-CPB (65.5% to 80.2%, p = 0.017), On-CPB (53.0% to 75.1%, p < 0.001), and Post-CPB (34.8% to 58.8%, p < 0.001). Rates of severe hypoglycemia remained low and unchanged (0.1% in both groups; p = 0.772), and intraoperative hyperglycemia rates were similar (4.2% vs. 4.1%; p = 0.995). Implementation of the IGPC significantly improved real-time adherence to intraoperative glycemic control protocols without increasing adverse glycemic events. However, rates of intraoperative hyperglycemia and hypoglycemia remained unchanged between the pre- and post-intervention phases. These findings highlight the utility of clinical decision support tools in enhancing protocol compliance during high-acuity cardiac surgeries.

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.

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.

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.