{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T20:13:08Z","timestamp":1783455188835,"version":"3.55.0"},"reference-count":11,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T00:00:00Z","timestamp":1776988800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T00:00:00Z","timestamp":1776988800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Anesthesia"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Hemodynamic instability during vasoactive drug infusion remains a clinical challenge. While macroscopic factors are well\u2010studied, the physical interaction between syringe residual air and vertical pump positioning is often overlooked. This study investigates how these factors synergistically disrupt flow stability using a simplified simulation model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A simulation model was constructed using a 60 mL syringe, infusion tubing, and two 3\u2010way stopcocks. The system was tested under four conditions: with or without 1\u2009mL of air in the syringe, and with the infusion terminal positioned 25\u2009cm or 50\u2009cm below the syringe level. Droplet formation at the terminal stopcock was quantified over 10 s intervals using a standardized visual scale. Each condition was repeated 30 times (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009120 trials). Data were analyzed using non\u2010parametric tests.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The presence of 1\u2009mL of air significantly increased flow instability, yielding higher droplet counts compared to the no\u2010air group at both 25\u2009cm (median: 0.75 vs. 0.25 drops,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and 50\u2009cm (median: 2.25 vs. 0.75 drops,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Increasing the height from 25\u2009cm to 50\u2009cm also significantly raised droplet output: from 0.25 to 0.75 drops without air (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), and from 0.75 to 2.50 drops with 1\u2009mL of air (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). The greatest instability occurred under the combined condition of 50\u2009cm height with 1\u2009mL of air.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Residual syringe air and infusion pump vertical position are critical, interacting factors that disrupt flow continuity during vasoactive drug delivery. Air bubbles induce transient flow variations, while height differences amplify these effects through hydrostatic pressure. Clinical protocols should emphasize meticulous air elimination and consistent pump positioning at the level of the patient's right atrium to minimize avoidable infusion\u2010related hemodynamic instability.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pan.70198","type":"journal-article","created":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T12:49:24Z","timestamp":1777034964000},"page":"923-927","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Effect of Syringe Pump Vertical Position and Residual Air on the Stability of Vasoactive Drug Infusion: A Simulation Study"],"prefix":"10.1002","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2738-4185","authenticated-orcid":false,"given":"Xiaowei","family":"Chang","sequence":"first","affiliation":[{"name":"Department of Critical Care Medicine Peking Union Medical College Hospital, Chinese Academy of Medical Sciences &amp; Peking Union Medical College  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianhua","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Intensive Care Unit Peking Union Medical College Hospital, Chinese Academy of Medical Sciences &amp; Peking Union Medical College  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zunzhu","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine Peking Union Medical College Hospital, Chinese Academy of Medical Sciences &amp; Peking Union Medical College  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Jing","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine Peking Union Medical College Hospital, Chinese Academy of Medical Sciences &amp; Peking Union Medical College  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tingting","family":"Yuan","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine Peking Union Medical College Hospital, Chinese Academy of Medical Sciences &amp; Peking Union Medical College  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haohang","family":"Guan","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine Peking Union Medical College Hospital, Chinese Academy of Medical Sciences &amp; Peking Union Medical College  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuai","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine Peking Union Medical College Hospital, Chinese Academy of Medical Sciences &amp; Peking Union Medical College  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinyi","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine Peking Union Medical College Hospital, Chinese Academy of Medical Sciences &amp; Peking Union Medical College  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tianchao","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine Peking Union Medical College Hospital, Chinese Academy of Medical Sciences &amp; Peking Union Medical College  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinbang","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine Peking Union Medical College Hospital, Chinese Academy of Medical Sciences &amp; Peking Union Medical College  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,24]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11845-024-03827-x"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/PTS.0000000000000722"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1517\/17425247.2013.785519"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2020.06.041"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/pan.14717"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.iccn.2024.103861"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/pan.14750"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1063\/5.0145415"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1017\/jfm.2024.954"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10877-024-01156-z"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1177\/1129729820909024"}],"container-title":["Pediatric Anesthesia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pan.70198","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/pan.70198","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pan.70198","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T19:09:12Z","timestamp":1783451352000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/pan.70198"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,24]]},"references-count":11,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1002\/pan.70198"],"URL":"https:\/\/doi.org\/10.1002\/pan.70198","archive":["Portico"],"relation":{},"ISSN":["1155-5645","1460-9592"],"issn-type":[{"value":"1155-5645","type":"print"},{"value":"1460-9592","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,24]]},"assertion":[{"value":"2025-12-29","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-08","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-24","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}