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Despite this, integrating multiple data streams into coherent, physiology-guided clinical decisions remains challenging, and unified interpretive frameworks remain limited. To introduce the HOPFIT framework \u2014 a conceptual model linking continuous neuro-cardiovascular monitoring to structured, physiology-guided clinical reasoning across six interdependent domains. HOPFIT organises six therapeutic domains \u2014 Hypnotics, Opioids, Pressors, Fluids, Inotropes, and Transfusion \u2014 around the interdependence of brain function, cardiovascular physiology, and oxygen delivery. Rather than introducing new monitoring modalities, the framework provides a unifying structure for bedside interpretation of existing data, including processed electroencephalography, cerebral oximetry, dynamic indices of fluid responsiveness, non-invasive haemoglobin, and cardiac output monitoring. An original pharmacodynamic risk surface illustrates the interaction between hypnotic and analgesic agents, and a conceptual hypotension framework integrating EEG and haemodynamic data illustrates how multimodal information may support clinical reasoning. Tables summarise monitoring parameters, commonly used ranges, and potential clinical applications across patient groups. HOPFIT is intended as a conceptual and educational tool to support integration of multimodal physiological data at the bedside, rather than a prescriptive clinical protocol. Prospective studies are required to determine its impact on clinical decision-making and patient outcomes.<\/jats:p>","DOI":"10.1007\/s10877-026-01474-4","type":"journal-article","created":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T04:55:33Z","timestamp":1787720133000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["HOPFIT: A neuro-cardiovascular monitoring framework for precision sedation, anaesthesia, and resuscitation"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8832-918X","authenticated-orcid":false,"given":"Andrea","family":"Lavinio","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Romagnoli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Basil","family":"Matta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,26]]},"reference":[{"key":"1474_CR1","doi-asserted-by":"publisher","first-page":"e25","DOI":"10.1213\/ANE.0000000000007117","volume":"139","author":"S Romagnoli","year":"2024","unstructured":"Romagnoli S, Saugel B, Thomsen KK, Matta B. 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SR reports receiving research support, consultancy, and speaker fees from Masimo, Edwards Lifesciences, and Baxter. BM is Senior Vice President and Chief Medical Officer, Masimo Corporation. Masimo Corporation is the manufacturer of several technologies discussed in this framework. The academic authors (AL and SR) maintained final authority over the framework design and the decision to submit the manuscript for publication. The HOPFIT concept and its original six-domain structure were conceived by AL. The framework was subsequently developed and expanded collaboratively by AL and SR, including development of the physiology-guided hypotension approach. BM supported the work and contributed to the writing, critical revision, and final approval of the manuscript. Masimo Corporation provided financial support for manuscript preparation but had no input into the original framework concept, domain selection, or the decision to submit for publication. Final editorial authority rested with the academic authors throughout.","order":1,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors used AI-assisted tools during manuscript preparation for language editing, figure refinement, reference-management support, and independent quality checking. Figure\u00a02 was generated from original code developed by the authors, with AI-assisted coding support. AI tools were not used to generate primary data, conduct statistical analyses, or make scientific conclusions. All AI-assisted outputs were critically reviewed, edited, and approved by the authors, who take full responsibility for the content of the manuscript.","order":2,"name":"Ethics","label":"Artificial intelligence assistance statement","group":{"name":"EthicsHeading","label":"Declarations"}}]}}