Research progress in agitation early warning monitoring and new technologies for critically ill patients: a narrative review.

Agitation is a common and clinically significant problem in critically ill patients, closely associated with unplanned extubation, device removal, prolonged hospital stay, and increased mortality. Traditional assessment tools such as the richmond agitation-sedation scale (RASS) and sedation-agitation scale (SAS), despite their widespread use, are limited by intermittent assessment, subjectivity, and inability to provide continuous monitoring. In recent years, the rapid development of artificial intelligence and sensing technologies has opened new avenues for objective, continuous, and real-time agitation monitoring through vital sign-based parameters, video surveillance with computer vision, wearable devices, and multimodal fusion approaches. This narrative review systematically examines the epidemiological characteristics and clinical consequences of agitation in critically ill patients, analyzes the limitations of traditional assessment tools, and highlights emerging technologies based on physiological signals, computer vision, deep learning, and multimodal integration. The current status and challenges of agitation monitoring in various clinical settings-including intensive care units, emergency departments, prehospital environments, and inter-hospital transport-are discussed. Finally, future directions for multimodal early warning systems in complex environments are proposed, providing a theoretical foundation for constructing a comprehensive agitation monitoring system spanning prehospital, in-hospital, and transport settings based on vital signs and video-based behavioral analysis.