From Intelligent Operating Room to Smart ICU: Digital Continuity, AI-Supported Decision-Making and CRRT as a Model of Pharmacokinetic Personalization in Critical Care.

Critically ill patients frequently move between the intensive care unit (ICU) and the operating room while remaining dependent on ventilatory, hemodynamic, antimicrobial, sedative, analgesic, and renal support. Although extensive perioperative data are generated, clinically relevant information may remain fragmented across devices and electronic systems. This narrative review synthesizes the literature published primarily between 2016 and 2026 on perioperative digital continuity, structured ICU-operating room handoff, interoperability, artificial intelligence (AI)-supported decision support, continuous renal replacement therapy (CRRT)-related pharmacokinetic personalization, and digital twin concepts. Based on this synthesis, we develop a conceptual framework in which the Intelligent Operating Room and Smart ICU function as connected clinical information nodes. The framework is organized around a minimum perioperative continuity dataset, a perioperative delta view, and the author-proposed concept of Time-to-Truth at ICU readmission. Current evidence supports structured handoff and selected AI-assisted physiological prediction, but evidence for improvement in major patient-centered outcomes remains limited and heterogeneous. CRRT illustrates the importance of preserving information on delivered therapy, interruptions, residual kidney function, and treatment-related changes when interpreting drug exposure. The proposed framework is not clinically validated and is intended as a basis for future implementation and prospective evaluation. Overall, the review suggests that improving digital continuity should precede more complex forms of automation in perioperative critical care.