Data Sheet 1_4D-Micro: a tiered, testable framework for hemodynamic-tissue perfusion mismatch in cardiac surgery.docx

It is not a substitute for established cardiac surgical monitoring or a claim that all four domains can be measured directly at the bedside. A tiered implementation distinguishes a core mode based on routine variables, an enhanced mode using regional and congestion signals, and a research mode using direct microvascular or biomarker measurements. Insufficient or conflicting data remain indeterminate rather than being forced into a phenotype.

We specify a staged validation pathway: content and feasibility testing, prospective assessment of classification reliability and construct validity, and only then a pragmatic comparison with protocolized usual hemodynamic care. The framework should be narrowed or rejected if it cannot be applied reliably, its predicted responses are not observed, or it fails to improve decision processes without added harm.</p>