F. Michard, T.J. Gan, H. Kehlet British Journal of Anaesthesia

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Digital innovations and emerging technologies for enhanced recovery programmes F. Michard, T.J. Gan, H. Kehlet British Journal of Anaesthesia Volume 119, Issue 1, Pages 31-39 (July 2017) DOI: 10.1093/bja/aex140 Copyright © 2017 The Author(s) Terms and Conditions

Fig 1 Examples of non-invasive haemodynamic monitoring techniques. (A) Bioimpedance tracheal tube (ECOM, San Juan Capistrano, CA, USA), (B) bioreactance electrodes (Cheetah, Newton Center, MA, USA), (C) miniaturized single-use transoesophageal echocardiography probe (Imacor, Garden City, NY, USA), (D, E) volume clamp finger cuff systems (CNSystems, Graz, Austria and Edwards, Irvine, CA, USA) and (F) applanation tonometry wrist device (Tensys, San Diego, CA, USA). British Journal of Anaesthesia 2017 119, 31-39DOI: (10.1093/bja/aex140) Copyright © 2017 The Author(s) Terms and Conditions

Fig 2 Examples of visual decision support tools. These screens are designed to help clinicians chasing haemodynamic targets in the context of individualized fluid management. Two dimensions (A from Edwards, Irvine, CA, USA and B from LiDCO, London, UK) and multidimensions (C from Pulsion, Munich, Germany and D from Tensys, San Diego, CA, USA) target screens. British Journal of Anaesthesia 2017 119, 31-39DOI: (10.1093/bja/aex140) Copyright © 2017 The Author(s) Terms and Conditions

Fig 3 Examples of monitoring solutions to detect respiratory complications. (A) Contact-free piezo electric sensor (EarlySense, Ramat Gan, Israel), to be placed below the mattress, detecting the patient’s heart rate (HR) and respiratory rate (RR). (B) Pulse oximeter (finger) and acoustic sensor (neck) to monitor HR, arterial oxygen saturation (SpO2) and RR (Masimo, Irvine, CA, USA). (C) Capnographic sensor to monitor RR (Covidien, Boulder, CO, USA). (D) Impedance thoracic sensor to monitor RR, tidal volume and minute ventilation (Respiratory motion, Waltham, MA, USA). British Journal of Anaesthesia 2017 119, 31-39DOI: (10.1093/bja/aex140) Copyright © 2017 The Author(s) Terms and Conditions

Fig 4 Examples of wearable and wireless sensors. Medical grade adhesive patches (A from VitalConnect, San Jose, CA, USA, B from Isansys, Abingdon, UK, C from Sensium, Abingdon, UK and D from Intelesens, Belfast, Northern Ireland) and necklaces (E from CloudDX, Kitchener, Canada and F from toSense, San Diego, CA, USA) designed to monitor heart rate, respiratory rate, thoracic fluid content, temperature and/or activity in ambulatory patients. British Journal of Anaesthesia 2017 119, 31-39DOI: (10.1093/bja/aex140) Copyright © 2017 The Author(s) Terms and Conditions

Fig 5 Example of data fusion system. (A) Several variables are integrated to create a single wellness index and (B) self-explanatory graphical display allowing the immediate and visual recognition of patients’ deterioration by nurses working in the wards (PhysIQ, Naperville, IL, USA). British Journal of Anaesthesia 2017 119, 31-39DOI: (10.1093/bja/aex140) Copyright © 2017 The Author(s) Terms and Conditions