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Novel Methods and Devices for Monitoring and Diagnosing in Critical...
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Novel Methods and Devices for Monitoring and Diagnosing in Critical Care

A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Point-of-Care Diagnostics and Devices".

Deadline for manuscript submissions: 31 December 2025 | Viewed by 3818

Special Issue Editor

Dr. Zhongheng Zhang

E-Mail Website
Guest Editor
Department of Emergency Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
Interests: emergency and critical care medicine; AI
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Managing critically ill patients necessitates intensive monitoring, such as hemodynamic monitoring, respiratory monitoring, lab exams, etc. In recent decades, significant progress has been made in developing innovative monitoring systems and equipment for critically ill patients. In terms of hemodynamic monitoring, for instance, great progress has been made in developing non-invasive and minimally invasive monitoring of macro-hemodynamics. In critically ill patients, however, incoherence between the macro-circulation and microcirculation is prevalent. Recent innovations include video-microscopy, laser flowmetry, and near-infrared spectroscopy (NIRS) for quantification and visualization of microcirculation. In addition, each organ has unique blood flow patterns due to its unique structure or auto-regulatory capabilities. Therefore, it remains to be determined how to monitor the specific perfusion of vital organs such as the liver, brain, and kidney.

In clinical practice settings, many other novel methods and techniques are also appealing: continuous monitoring of vital signs using cameras, trans pulmonary pressure monitoring, wearable sensors, therapeutic drug monitoring, machine learning tools in prediction models, transcranial Doppler as a screening test to rule out intracranial hypertension, novel biomarkers in early disease detection, critical care ultrasound, etc.

These innovative methods have accelerated the evolution of Critical Care Medicine. This Special Issue aims to enlighten all individuals involved in the care of critically ill patients about these developments. We hope you will contribute to this Special Issue, whether your expertise lies in intensive care, emergency medicine, internal medicine, radiology, or artificial intelligence.

Dr. Zhongheng Zhang
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Diagnostics is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • hemodynamic monitoring
  • perfusion
  • heart-lung interactions
  • novel biomarkers
  • machine learning
  • ultrasound
  • therapeutic drug monitoring
  • wearable sensors

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Published Papers (5 papers)

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10 pages, 1857 KiB  
Article
The LJ System—Development and Validation of a Reliable and Simple Device for Bronchoscopic Measurement of Distances Within the Tracheobronchial Tree
by Zuzana Sestakova, Sarka Nemcova, Petr Denk, Veronika Pechkova, Pavel Michalek and Jiri Votruba
Diagnostics 2025, 15(8), 954; https://doi.org/10.3390/diagnostics15080954 - 9 Apr 2025
Viewed by 198
Abstract
Background: The accurate measurement of the distances within the airways during bronchoscopy is necessary for diagnostic purposes; however, a reliable and simple device does not exist. Methods: The LJ system, consisting of a probe, a box with a display, an encoder, and a [...] Read more.
Background: The accurate measurement of the distances within the airways during bronchoscopy is necessary for diagnostic purposes; however, a reliable and simple device does not exist. Methods: The LJ system, consisting of a probe, a box with a display, an encoder, and a microcontroller, has been developed, and its prototype has been tested in vitro and validated in clinical practice in suitable procedures of interventional bronchoscopy. Results: In vitro, the device measurements showed a good correlation with the control performed with a digital caliper. Subsequently, ten patients were included in a pilot study evaluating this novel prototype of a measurement device. The device was used on four patients with tracheal stenosis indicated for Y-stent placement, four patients indicated for open surgery, and two cases of tracheoesophageal fistula. The measurements have been validated using computed tomography imaging or by direct inspection and measurement during open surgical procedures. Conclusions: The first experience and pilot study evaluating this novel instrument for distance measurements during interventional bronchology procedures showed that the LJ device can provide precise readings of the distance from the vocal cords, the lengths of tracheal stenoses, or the size of tumorous and other lesions. Its use might be widened to other endoscopic indications. Full article
(This article belongs to the Special Issue Novel Methods and Devices for Monitoring and Diagnosing in Critical Care)
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9 pages, 990 KiB  
Communication
Utility of a Card-Type Respiratory Rate Measuring Device for Spontaneously Breathing Patients
by Yoshiaki Iwashita, Shun Takeda, Satoshi Kawashima, Shinya Sato and Satoru Nebuya
Diagnostics 2025, 15(7), 864; https://doi.org/10.3390/diagnostics15070864 - 28 Mar 2025
Viewed by 307
Abstract
Background/Objectives: Accurate measurement of respiratory rate (RR) is critical for early detection of patient deterioration. A newly developed contactless card-type device measures RR and heart rate (HR) by detecting chest impedance changes. Although previously validated in mechanically ventilated patients with 15% RR accuracy, [...] Read more.
Background/Objectives: Accurate measurement of respiratory rate (RR) is critical for early detection of patient deterioration. A newly developed contactless card-type device measures RR and heart rate (HR) by detecting chest impedance changes. Although previously validated in mechanically ventilated patients with 15% RR accuracy, its performance in spontaneously breathing patients remains uncertain. Methods: This prospective observational study was conducted at the Department of Emergency and Critical Care Medicine, Shimane University Hospital, in December 2022. Patients admitted to the emergency center without invasive mechanical ventilation were enrolled. The card-type device was subsequently placed on the left chest, while the RR and HR were simultaneously recorded with an electrocardiogram monitor. Data from both devices were collected and compared. Results: Six patients were enrolled. The RR measurements from the card-type device were within a 10% difference from those measured using the standard monitor in four out of six cases. In two cases, the card-type device recorded an RR lower than that of the standard monitor, which coincided with periods of patient speaking. For HR, the card-type device was within a 10% margin of the standard monitor in two cases, but it underestimated HR in the remaining four cases, particularly during high tidal volumes or increased thoracic thickness. Conclusions: The contactless card-type device accurately measured respiratory rates within a 10% margin compared to standard monitors in most non-intubated patients, except during activities such as speaking. Further studies with larger sample sizes are warranted to confirm these findings and improve the device’s performance. Full article
(This article belongs to the Special Issue Novel Methods and Devices for Monitoring and Diagnosing in Critical Care)
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13 pages, 221 KiB  
Article
New Predictive Diagnostic Method for Cardiac Dynamics Based on Probability Distributions
by Javier Rodríguez Velásquez, Leonardo Juan Ramírez López and Sofia García Torres
Diagnostics 2025, 15(6), 650; https://doi.org/10.3390/diagnostics15060650 - 7 Mar 2025
Viewed by 558
Abstract
Background/Objectives: Probability theory and dynamic systems have enabled the development of diagnostic support tools that simplify Holter evaluation. Method: A study was conducted on 80 Holter tests over 21 h with patients over 21 years old. Four prototypes were selected based on normal, [...] Read more.
Background/Objectives: Probability theory and dynamic systems have enabled the development of diagnostic support tools that simplify Holter evaluation. Method: A study was conducted on 80 Holter tests over 21 h with patients over 21 years old. Four prototypes were selected based on normal, chronic, acute, and pacemaker diagnoses. An induction was created using the heart rate ranges of the prototypes, from 55 to 105, as the general probability space. Probability theory was applied to the frequency repetition ranges of 1000 to 2000 and 2001 to 3000. A blinded study was conducted with the remaining Holter tests, applying the same methodology used for the prototypes. A physical/mathematical induction was performed for the prototypes, and the other Holter tests were analyzed in a blinded study. Results: The results were compared to the predictions of the prototypes, and sensitivity, specificity, and the kappa coefficient were calculated. In the 1000–2000 range, the repetition counts for normal dynamics were 14 to 11, for chronic cases 31 to 21, for acute cases 11 to 9, and for pacemaker dynamics 5 to 4. In the 2001–3000 range, the repetitions for normal dynamics were 3 to 0, for chronic cases 14 to 10, for acute cases 6 to 3, and for pacemaker dynamics 2. The cumulative probabilities loaded for the 1000–2000 range were as follows: normal dynamics, 0.46 to 0.35; chronic dynamics, 0.48 to 0.35; acute cases, 0.6 to 0.5; and pacemaker dynamics, 0.6 to 0.5. In the 2001–3000 range, the cumulative probabilities loaded for normal dynamics were 1 to 0; for chronic cases, 0.7 to 0.54; for acute cases, 0.75 to 0.46; and for pacemaker dynamics, 1. The frequencies observed in the repetition ranges for 1000–2000 were normal, 95 to 55; chronic, 105 to 65; acute, 100 to 75; and pacemaker, 75 to 60. For the 2001–3000 range, the frequencies were normal, 95 to 65; chronic, 85 to 65; acute, 100 to 80; and pacemaker, 65 to 60. The probabilities were less than 0.3 for normal dynamics and greater than 0.3 for chronic, acute, and pacemaker dynamics across different frequency ranges, differentiating the dynamics. Conclusions: The epidemiological study results for sensitivity, specificity, and kappa coefficient were all 1. To conclude, a diagnostic support tool was developed for cardiac dynamics with clinical applications based on the appearance of frequency ranges and probability theory, enabling differentiation of normal, chronic, acute, and pacemaker dynamics. Full article
(This article belongs to the Special Issue Novel Methods and Devices for Monitoring and Diagnosing in Critical Care)
11 pages, 1356 KiB  
Article
Near-Infrared Spectroscopy (NIRS) to Assess Infection Complications During the Acute Phase of Acute Pancreatitis
by Nobutaka Chiba, Tsukasa Yagi, Minori Mizuochi, Jun Sato, Takeshi Saito, Atsushi Sakurai and Kosaku Kinoshita
Diagnostics 2024, 14(23), 2647; https://doi.org/10.3390/diagnostics14232647 - 24 Nov 2024
Viewed by 719
Abstract
Background: Acute pancreatitis (AP) severity is correlated with systemic infection incidence in the acute phase, and it is important to assess inflammation during the disease course and to recognize infection at an early stage. As in sepsis, inflammation in AP impairs tissue oxygen [...] Read more.
Background: Acute pancreatitis (AP) severity is correlated with systemic infection incidence in the acute phase, and it is important to assess inflammation during the disease course and to recognize infection at an early stage. As in sepsis, inflammation in AP impairs tissue oxygen metabolism and disrupts microcirculation. We performed a vascular occlusion test (VOT) via near-infrared spectroscopy (NIRS), which noninvasively monitors local oxygen in peripheral tissues, to evaluate tissue oxygen metabolism and blood circulation during the acute AP phase. Methods: Tissue oxygen metabolism was measured via an NIRS probe attached to the thenar eminence at admission and 7 days after admission. The upper arm was wrapped with a sphygmomanometer cuff while avoiding brachial artery compression for 3 min. The minimum desaturation value was defined as the minimum tissue oxygen index (TOI), the maximum reactive hyperemia value after release was defined as the maximum TOI, and the difference was defined as the ∆TOI. The time from the minimum TOI to maximum TOI was defined as the TOI interval. Results: Fifteen healthy volunteers, 13 patients with AP, and 12 patients with sepsis were included. The TOI at baseline and ∆TOI (parameter describing tissue oxygen metabolism) decreased in a stepwise manner, and the TOI interval (measure of peripheral vasodilatory capacity) was protracted in a stepwise manner among the three groups. In a subgroup analysis, no significant differences in the NIRS-derived variables between patients with AP complicated by infection and those without infection were observed at admission; however, after 7 days, the groups significantly differed. Additionally, blood lactate concentrations were significantly correlated with the ∆TOI and TOI. Conclusions: Mild tissue oxygen metabolism impairment and tissue perfusion occurred in AP compared with sepsis, and changes similar to those in sepsis occur in AP complicated by infection. Further research is needed to evaluate whether these values can be applied to treating this group of patients. Full article
(This article belongs to the Special Issue Novel Methods and Devices for Monitoring and Diagnosing in Critical Care)
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13 pages, 3827 KiB  
Systematic Review
The Use of the Perfusion Index to Predict Post-Induction Hypotension in Patients Undergoing General Anesthesia: A Systematic Review and Meta-Analysis
by Kuo-Chuan Hung, Shu-Wei Liao, Chia-Li Kao, Yen-Ta Huang, Jheng-Yan Wu, Yao-Tsung Lin, Chien-Ming Lin, Chien-Hung Lin and I-Wen Chen
Diagnostics 2024, 14(16), 1769; https://doi.org/10.3390/diagnostics14161769 - 14 Aug 2024
Cited by 1 | Viewed by 1562
Abstract
Post-induction hypotension (PIH) is a common and potentially serious complication of general anesthesia. This meta-analysis (Prospero registration number: CRD42024566321) aimed to evaluate the predictive efficacy of the perfusion index (PI) for PIH in patients undergoing general anesthesia. A comprehensive literature search was performed [...] Read more.
Post-induction hypotension (PIH) is a common and potentially serious complication of general anesthesia. This meta-analysis (Prospero registration number: CRD42024566321) aimed to evaluate the predictive efficacy of the perfusion index (PI) for PIH in patients undergoing general anesthesia. A comprehensive literature search was performed using multiple electronic databases (Google Scholar, EMBASE, Cochrane Library, and MEDLINE). Studies involving adult patients undergoing general anesthesia, with the PI measured before anesthesia induction and reporting PIH incidence, were included. The primary outcome was the diagnostic accuracy of the PI in predicting the probability of PIH. The secondary outcome was the pooled PIH incidence. Eight studies with 678 patients were included. The pooled incidence of PIH was 44.8% (95% confidence interval [CI]: 29.9%–60.8%). The combined sensitivity and specificity of the PI for predicting PIH were 0.84 (95% CI: 0.65–0.94) and 0.82 (95% CI: 0.70–0.90), respectively. The summary receiver operating characteristic (sROC) analysis revealed an area under curve of 0.89 (95% CI: 0.86–0.92). The Deek’s funnel plot asymmetry test indicated no significant publication bias. The PI demonstrates high predictive efficacy for PIH in patients undergoing general anesthesia, indicating that it can be a valuable tool for identifying those at risk of PIH. Full article
(This article belongs to the Special Issue Novel Methods and Devices for Monitoring and Diagnosing in Critical Care)
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