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Development of a deep learning model for predicting critical events in a pediatric intensive care unit. 开发用于预测儿科重症监护室危急事件的深度学习模型。
IF 1.8 Q3 CRITICAL CARE MEDICINE Pub Date : 2024-02-01 Epub Date: 2024-02-20 DOI: 10.4266/acc.2023.01424
In Kyung Lee, Bongjin Lee, June Dong Park

Background: Identifying critically ill patients at risk of cardiac arrest is important because it offers the opportunity for early intervention and increased survival. The aim of this study was to develop a deep learning model to predict critical events, such as cardiopulmonary resuscitation or mortality.

Methods: This retrospective observational study was conducted at a tertiary university hospital. All patients younger than 18 years who were admitted to the pediatric intensive care unit from January 2010 to May 2023 were included. The main outcome was prediction performance of the deep learning model at forecasting critical events. Long short-term memory was used as a deep learning algorithm. The five-fold cross validation method was employed for model learning and testing.

Results: Among the vital sign measurements collected during the study period, 11,660 measurements were used to develop the model after preprocessing; 1,060 of these data points were measurements that corresponded to critical events. The prediction performance of the model was the area under the receiver operating characteristic curve (95% confidence interval) of 0.988 (0.9751.000), and the area under the precision-recall curve was 0.862 (0.700-1.000).

Conclusions: The performance of the developed model at predicting critical events was excellent. However, follow-up research is needed for external validation.

背景:识别有心脏骤停风险的危重病人非常重要,因为这为早期干预和提高存活率提供了机会。本研究旨在开发一种深度学习模型,用于预测心肺复苏或死亡率等危急事件:这项回顾性观察研究在一家三级大学医院进行。研究纳入了 2010 年 1 月至 2023 年 5 月期间入住儿科重症监护室的所有 18 岁以下患者。主要结果是深度学习模型对危急事件的预测性能。深度学习算法使用的是长短期记忆。采用五倍交叉验证法进行模型学习和测试:在研究期间收集的生命体征测量数据中,有 11,660 个测量数据经过预处理后用于开发模型;其中 1,060 个数据点与危急事件相对应。该模型的预测性能为接收者操作特征曲线下面积(95% 置信区间)为 0.988(0.9751.000),精确度-召回曲线下面积为 0.862(0.700-1.000):结论:开发的模型在预测危急事件方面表现出色。结论:所开发的模型在预测危急事件方面表现出色,但还需要后续研究进行外部验证。
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引用次数: 0
The impact of ketamine on outcomes in critically ill patients: a systematic review with meta-analysis and trial sequential analysis of randomized controlled trials. 氯胺酮对重症患者预后的影响:随机对照试验的荟萃分析和试验序列分析系统综述。
IF 1.8 Q3 CRITICAL CARE MEDICINE Pub Date : 2024-02-01 Epub Date: 2024-02-28 DOI: 10.4266/acc.2023.00829
Yerkin Abdildin, Karina Tapinova, Assel Nemerenova, Dmitriy Viderman

Background: This meta-analysis aims to evaluate the effects of ketamine in critically ill intensive care unit (ICU) patients.

Methods: We searched for randomized controlled trials (RCTs) in PubMed, Scopus, and the Cochrane Library; the search was performed initially in January but was repeated in December of 2023. We focused on ICU patients of any age. We included studies that compared ketamine with other traditional agents used in the ICU. We synthesized evidence using RevMan v5.4 and presented the results as forest plots. We also used trial sequential analysis (TSA) software v. 0.9.5.10 Beta and presented results as TSA plots. For synthesizing results, we used a random-effects model and reported differences in outcomes of two groups in terms of mean difference (MD), standardized MD, and risk ratio with 95% confidence interval. We assessed the risk of bias using the Cochrane RoB tool for RCTs. Our outcomes were mortality, pain, opioid and midazolam requirements, delirium rates, and ICU length of stay.

Results: Twelve RCTs involving 805 ICU patients (ketamine group, n=398; control group, n=407) were included in the meta-analysis. The ketamine group was not superior to the control group in terms of mortality (in five studies with 318 patients), pain (two studies with 129 patients), mean and cumulative opioid consumption (six studies with 494 patients), midazolam consumption (six studies with 304 patients), and ICU length of stay (three studies with 270 patients). However, the model favored the ketamine group over the control group in delirium rate (four studies with 358 patients). This result is significant in terms of conventional boundaries (alpha=5%) but is not robust in sequential analysis. The applicability of the findings is limited by the small number of patients pooled for each outcome.

Conclusions: Our meta-analysis did not demonstrate differences between ketamine and control groups regarding any outcome except delirium rate, where the model favored the ketamine group over the control group. However, this result is not robust as sensitivity analysis and trial sequential analysis suggest that more RCTs should be conducted in the future.

背景:这是一项荟萃分析:本荟萃分析旨在评估氯胺酮对重症监护病房(ICU)重症患者的影响:我们在 PubMed、Scopus 和 Cochrane 图书馆中搜索了随机对照试验 (RCT);搜索最初在 2023 年 1 月进行,但在 12 月又重复了一次。我们的研究对象是任何年龄段的重症监护室患者。我们纳入了将氯胺酮与 ICU 使用的其他传统药物进行比较的研究。我们使用 RevMan v5.4 对证据进行了综合,并以森林图的形式展示了结果。我们还使用了试验序列分析(TSA)软件 v.0.9.5.10 Beta 版,并以 TSA 图的形式展示结果。在综合结果时,我们使用了随机效应模型,并以平均差(MD)、标准化 MD 和风险比(含 95% 置信区间)来报告两组结果的差异。我们使用针对 RCT 的 Cochrane RoB 工具评估了偏倚风险。我们的研究结果包括死亡率、疼痛、阿片类药物和咪达唑仑的需求量、谵妄率和重症监护室的住院时间:荟萃分析纳入了涉及 805 名 ICU 患者的 12 项 RCT(氯胺酮组,n=398;对照组,n=407)。氯胺酮组在死亡率(5 项研究,318 名患者)、疼痛(2 项研究,129 名患者)、阿片类药物平均和累计用量(6 项研究,494 名患者)、咪达唑仑用量(6 项研究,304 名患者)和重症监护室住院时间(3 项研究,270 名患者)方面均不优于对照组。然而,在谵妄率方面,氯胺酮组优于对照组(四项研究,共 358 名患者)。这一结果在常规边界(α=5%)上是显著的,但在序列分析中并不稳健。由于每项结果汇集的患者人数较少,因此研究结果的适用性受到了限制:我们的荟萃分析未显示氯胺酮组和对照组在任何结果上存在差异,但谵妄率除外,模型显示氯胺酮组优于对照组。然而,这一结果并不可靠,因为敏感性分析和试验顺序分析表明,今后应进行更多的研究性临床试验。
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引用次数: 0
Liberation from mechanical ventilation in critically ill patients: Korean Society of Critical Care Medicine Clinical Practice Guidelines. 重症患者摆脱机械通气:韩国重症医学会临床实践指南》。
IF 1.8 Q3 CRITICAL CARE MEDICINE Pub Date : 2024-02-01 Epub Date: 2024-02-28 DOI: 10.4266/acc.2024.00052
Tae Sun Ha, Dong Kyu Oh, Hak-Jae Lee, Youjin Chang, In Seok Jeong, Yun Su Sim, Suk-Kyung Hong, Sunghoon Park, Gee Young Suh, So Young Park

Background: Successful liberation from mechanical ventilation is one of the most crucial processes in critical care because it is the first step by which a respiratory failure patient begins to transition out of the intensive care unit and return to their own life. Therefore, when devising appropriate strategies for removing mechanical ventilation, it is essential to consider not only the individual experiences of healthcare professionals, but also scientific and systematic approaches. Recently, numerous studies have investigated methods and tools for identifying when mechanically ventilated patients are ready to breathe on their own. The Korean Society of Critical Care Medicine therefore provides these recommendations to clinicians about liberation from the ventilator.

Methods: Meta-analyses and comprehensive syntheses were used to thoroughly review, compile, and summarize the complete body of relevant evidence. All studies were meticulously assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) method, and the outcomes were presented succinctly as evidence profiles. Those evidence syntheses were discussed by a multidisciplinary committee of experts in mechanical ventilation, who then developed and approved recommendations.

Results: Recommendations for nine PICO (population, intervention, comparator, and outcome) questions about ventilator liberation are presented in this document. This guideline includes seven conditional recommendations, one expert consensus recommendation, and one conditional deferred recommendation.

Conclusions: We developed these clinical guidelines for mechanical ventilation liberation to provide meaningful recommendations. These guidelines reflect the best treatment for patients seeking liberation from mechanical ventilation.

背景:成功脱离机械通气是重症监护中最关键的过程之一,因为这是呼吸衰竭患者开始走出重症监护室、回归自我生活的第一步。因此,在制定去除机械通气的适当策略时,不仅要考虑医护人员的个人经验,还要考虑科学和系统的方法。最近,许多研究都对识别机械通气患者何时可以自主呼吸的方法和工具进行了调查。因此,韩国重症医学会向临床医生提出了这些关于脱离呼吸机的建议:方法:采用荟萃分析和全面综合的方法对所有相关证据进行了彻底的回顾、汇编和总结。所有研究均采用 "建议、评估、发展和评价分级"(GRADE)方法进行了细致评估,并以证据简介的形式简明扼要地介绍了评估结果。机械通气领域的多学科专家委员会对这些证据综述进行了讨论,然后制定并批准了相关建议:本文件针对有关呼吸机解放的九个 PICO(人群、干预、比较者和结果)问题提出了建议。该指南包括 7 项有条件建议、1 项专家共识建议和 1 项有条件延迟建议:我们制定了这些机械通气解放临床指南,以提供有意义的建议。这些指南反映了对寻求从机械通气中解放出来的患者的最佳治疗方法。
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引用次数: 0
Brain-computer interface in critical care and rehabilitation. 重症监护和康复中的脑机接口。
IF 1.8 Q3 CRITICAL CARE MEDICINE Pub Date : 2024-02-01 Epub Date: 2024-01-12 DOI: 10.4266/acc.2023.01382
Eunseo Oh, Seyoung Shin, Sung-Phil Kim

This comprehensive review explores the broad landscape of brain-computer interface (BCI) technology and its potential use in intensive care units (ICUs), particularly for patients with motor impairments such as quadriplegia or severe brain injury. By employing brain signals from various sensing techniques, BCIs offer enhanced communication and motor rehabilitation strategies for patients. This review underscores the concept and efficacy of noninvasive, electroencephalogram-based BCIs in facilitating both communicative interactions and motor function recovery. Additionally, it highlights the current research gap in intuitive "stop" mechanisms within motor rehabilitation protocols, emphasizing the need for advancements that prioritize patient safety and individualized responsiveness. Furthermore, it advocates for more focused research that considers the unique requirements of ICU environments to address the challenges arising from patient variability, fatigue, and limited applicability of current BCI systems outside of experimental settings.

这篇综合评论探讨了脑机接口(BCI)技术的广泛前景及其在重症监护病房(ICU)中的潜在应用,尤其是对四肢瘫痪或严重脑损伤等运动障碍患者的应用。通过采用来自各种传感技术的大脑信号,BCI 为患者提供了增强的交流和运动康复策略。本综述强调了基于脑电图的无创生物识别技术在促进交流互动和运动功能恢复方面的概念和功效。此外,它还强调了目前在运动康复方案中直观 "停止 "机制方面的研究空白,强调了优先考虑患者安全和个性化响应的进步需求。此外,该研究还提倡进行更有针对性的研究,考虑重症监护室环境的独特要求,以解决因患者的可变性、疲劳以及当前 BCI 系统在实验环境之外的有限适用性而带来的挑战。
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引用次数: 0
Comparison of preoxygenation with a high-flow nasal cannula and a simple face mask before intubation in Korean patients with head and neck cancer. 头颈部癌症患者插管前使用高流量鼻插管和简单面罩进行预吸氧的比较。
IF 1.8 Q3 CRITICAL CARE MEDICINE Pub Date : 2024-02-01 Epub Date: 2024-01-26 DOI: 10.4266/acc.2022.01543
Jun-Young Jo, Jungpil Yoon, Heeyoon Jang, Wook-Jong Kim, Seungwoo Ku, Seong-Soo Choi

Background: Although preoxygenation is an essential procedure for safe endotracheal intubation, in some cases securing sufficient time for tracheal intubation may not be possible. Patients with head and neck cancer might have a difficult airway and need a longer time for endotracheal intubation. We hypothesized that the extended apneic period with preoxygenation via a high-flow nasal cannula (HFNC) is beneficial to patients who undergo head and neck surgery compared with preoxygenation with a simple mask.

Methods: The study was conducted as a single-center, single-blinded, prospective, randomized controlled trial. Patients were divided into groups based on one of the two preoxygenation.

Methods: HFNC group or simple facemask (mask group). Preoxygenation was performed for 5 minutes with each method, and endotracheal intubation for all patients was performed using a video laryngoscope. Oxygen partial pressures of the arterial blood were compared at the predefined time points.

Results: For the primary outcome, the mean arterial oxygen partial pressure (PaO2 ) immediately after intubation was 454.2 mm Hg (95% confidence interval [CI], 416.9-491.5 mm Hg) in the HFNC group and 370.7 mm Hg (95% CI, 333.7-407.4 mm Hg) in the mask group (P=0.002). The peak PaO2 at 5 minutes after preoxygenation was not statistically different between the groups (P=0.355).

Conclusions: Preoxygenation with a HFNC extending to the apneic period before endotracheal intubation may be beneficial in patients with head and neck cancer.

背景:尽管预吸氧是安全进行气管插管的必要程序,但在某些情况下,可能无法确保有足够的时间进行气管插管。头颈部癌症患者可能气道困难,需要更长时间进行气管插管。我们假设,通过高流量鼻插管(HFNC)延长呼吸暂停时间进行预吸氧与使用简单面罩进行预吸氧相比,对接受头颈部手术的患者有益:该研究是一项单中心、单盲、前瞻性随机对照试验。根据两种预吸氧方法之一将患者分为两组:HFNC 组或简单面罩组(面罩组)。每种方法的预吸氧时间均为 5 分钟,所有患者均使用视频喉镜进行气管插管。在预定的时间点比较动脉血氧分压:就主要结果而言,插管后即刻的平均动脉血氧分压(PaO2)在 HFNC 组为 454.2 mmHg(95% 置信区间 [CI],416.9-491.5 mmHg),在面罩组为 370.7 mmHg(95% 置信区间 [CI],333.7-407.4)(P=0.002)。T2时的峰值PaO2在组间无统计学差异(P=0.355):结论:在气管插管前延长至呼吸暂停期使用高频数控系统进行预吸氧可能对头颈部癌症患者有益。
{"title":"Comparison of preoxygenation with a high-flow nasal cannula and a simple face mask before intubation in Korean patients with head and neck cancer.","authors":"Jun-Young Jo, Jungpil Yoon, Heeyoon Jang, Wook-Jong Kim, Seungwoo Ku, Seong-Soo Choi","doi":"10.4266/acc.2022.01543","DOIUrl":"10.4266/acc.2022.01543","url":null,"abstract":"<p><strong>Background: </strong>Although preoxygenation is an essential procedure for safe endotracheal intubation, in some cases securing sufficient time for tracheal intubation may not be possible. Patients with head and neck cancer might have a difficult airway and need a longer time for endotracheal intubation. We hypothesized that the extended apneic period with preoxygenation via a high-flow nasal cannula (HFNC) is beneficial to patients who undergo head and neck surgery compared with preoxygenation with a simple mask.</p><p><strong>Methods: </strong>The study was conducted as a single-center, single-blinded, prospective, randomized controlled trial. Patients were divided into groups based on one of the two preoxygenation.</p><p><strong>Methods: </strong>HFNC group or simple facemask (mask group). Preoxygenation was performed for 5 minutes with each method, and endotracheal intubation for all patients was performed using a video laryngoscope. Oxygen partial pressures of the arterial blood were compared at the predefined time points.</p><p><strong>Results: </strong>For the primary outcome, the mean arterial oxygen partial pressure (PaO2 ) immediately after intubation was 454.2 mm Hg (95% confidence interval [CI], 416.9-491.5 mm Hg) in the HFNC group and 370.7 mm Hg (95% CI, 333.7-407.4 mm Hg) in the mask group (P=0.002). The peak PaO2 at 5 minutes after preoxygenation was not statistically different between the groups (P=0.355).</p><p><strong>Conclusions: </strong>Preoxygenation with a HFNC extending to the apneic period before endotracheal intubation may be beneficial in patients with head and neck cancer.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":"61-69"},"PeriodicalIF":1.8,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11002622/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139673235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Transjugular central venous catheter guidewire embolism to venoarterial extracorporeal membrane oxygenation cannula. 经颈静脉中心静脉导管导丝栓塞至静脉动脉体外膜肺氧合插管。
IF 1.8 Q3 CRITICAL CARE MEDICINE Pub Date : 2024-02-01 Epub Date: 2023-12-26 DOI: 10.4266/acc.2023.01270
Nilesh Anand Devanand, Sophie Dohnt, Michael Farquharson
{"title":"Transjugular central venous catheter guidewire embolism to venoarterial extracorporeal membrane oxygenation cannula.","authors":"Nilesh Anand Devanand, Sophie Dohnt, Michael Farquharson","doi":"10.4266/acc.2023.01270","DOIUrl":"10.4266/acc.2023.01270","url":null,"abstract":"","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":"199-200"},"PeriodicalIF":1.8,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11002620/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139040694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Nuances of pleural effusion after left ventricular assist devices implantation: insights from therapeutic drainage and preoperative predictors. 左心室辅助装置植入术后胸腔积液的细微差别:从治疗引流和术前预测因素中获得的启示。
IF 1.8 Q3 CRITICAL CARE MEDICINE Pub Date : 2024-02-01 Epub Date: 2024-02-23 DOI: 10.4266/acc.2024.00157
Huijin Lee, Jeehoon Kang
{"title":"Nuances of pleural effusion after left ventricular assist devices implantation: insights from therapeutic drainage and preoperative predictors.","authors":"Huijin Lee, Jeehoon Kang","doi":"10.4266/acc.2024.00157","DOIUrl":"10.4266/acc.2024.00157","url":null,"abstract":"","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":"39 1","pages":"192-193"},"PeriodicalIF":1.8,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11002616/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140111792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The correlation between carotid artery Doppler and stroke volume during central blood volume loss and resuscitation. 中枢性血容量丢失和复苏期间颈动脉多普勒与每搏容量之间的相关性。
IF 1.8 Q3 CRITICAL CARE MEDICINE Pub Date : 2024-02-01 Epub Date: 2024-02-23 DOI: 10.4266/acc.2023.01095
Isabel Kerrebijn, Sarah Atwi, Mai Elfarnawany, Andrew M Eibl, Joseph K Eibl, Jenna L Taylor, Chul Ho Kim, Bruce D Johnson, Jon-Émile S Kenny

Background: Using peripheral arteries to infer central hemodynamics is common among hemodynamic monitors. Doppler ultrasound of the common carotid artery has been used in this manner with conflicting results. We investigated the relationship between changing common carotid artery Doppler measures and stroke volume (SV), hypothesizing that more consecutively-averaged cardiac cycles would improve SV-carotid Doppler correlation.

Methods: Twenty-seven healthy volunteers were recruited and studied in a physiology laboratory. Carotid artery Doppler pulse was measured with a wearable, wireless ultrasound during central hypovolemia and resuscitation induced by a stepped lower body negative pressure protocol. The change in maximum velocity time integral (VTI) and corrected flow time of the carotid artery (ccFT) were compared with changing SV using repeated measures correlation.

Results: In total, 73,431 cardiac cycles were compared across 27 subjects. There was a strong linear correlation between changing SV and carotid Doppler measures during simulated hemorrhage (repeated-measures linear correlation [Rrm ]=0.91 for VTI; 0.88 for ccFT). This relationship improved with larger numbers of consecutively-averaged cardiac cycles. For ccFT, beyond four consecutively-averaged cardiac cycles the correlation coefficient remained strong (i.e., Rrm of at least 0.80). For VTI, the correlation coefficient with SV was strong for any number of averaged cardiac cycles. For both ccFT and VTI, Rrm remained stable around 25 consecutively-averaged cardiac cycles.

Conclusions: There was a strong linear correlation between changing SV and carotid Doppler measures during central blood volume loss. The strength of this relationship was dependent upon the number of consecutively-averaged cardiac cycles.

背景:使用外周动脉推断中心血流动力学在血流动力学监护仪中很常见。颈总动脉多普勒超声已被用于这种方式,但结果却相互矛盾。我们研究了不断变化的颈总动脉多普勒测量值与每搏容量(SV)之间的关系,假设更多的连续平均心动周期将改善 SV 与颈动脉多普勒的相关性:方法:招募 27 名健康志愿者,在生理学实验室进行研究。方法:招募了 27 名健康志愿者,在生理学实验室进行了研究。在中心低血容量和阶梯式下半身负压方案诱导的复苏过程中,使用可穿戴无线超声波测量了颈动脉多普勒脉搏。使用重复测量相关性比较了颈动脉最大速度时间积分(VTI)和校正血流时间(ccFT)的变化与 SV 变化的关系:结果:总共对 27 名受试者的 73431 个心动周期进行了比较。在模拟出血过程中,SV 变化与颈动脉多普勒测量之间存在很强的线性相关(重复测量线性相关 [Rrm ]=0.91 (VTI;0.88 (ccFT))。这种关系随着连续平均心动周期的增加而改善。对于 ccFT,超过四个连续平均心动周期后,相关系数仍然很强(即 Rrm 至少为 0.80)。对于 VTI,在任何平均心动周期数下,其与 SV 的相关系数都很强。对于 ccFT 和 VTI,Rrm 在 25 个连续平均心动周期左右保持稳定:结论:在中心血容量丢失期间,SV 的变化与颈动脉多普勒测量之间存在很强的线性相关。这种关系的强度取决于连续平均心动周期的数量。
{"title":"The correlation between carotid artery Doppler and stroke volume during central blood volume loss and resuscitation.","authors":"Isabel Kerrebijn, Sarah Atwi, Mai Elfarnawany, Andrew M Eibl, Joseph K Eibl, Jenna L Taylor, Chul Ho Kim, Bruce D Johnson, Jon-Émile S Kenny","doi":"10.4266/acc.2023.01095","DOIUrl":"10.4266/acc.2023.01095","url":null,"abstract":"<p><strong>Background: </strong>Using peripheral arteries to infer central hemodynamics is common among hemodynamic monitors. Doppler ultrasound of the common carotid artery has been used in this manner with conflicting results. We investigated the relationship between changing common carotid artery Doppler measures and stroke volume (SV), hypothesizing that more consecutively-averaged cardiac cycles would improve SV-carotid Doppler correlation.</p><p><strong>Methods: </strong>Twenty-seven healthy volunteers were recruited and studied in a physiology laboratory. Carotid artery Doppler pulse was measured with a wearable, wireless ultrasound during central hypovolemia and resuscitation induced by a stepped lower body negative pressure protocol. The change in maximum velocity time integral (VTI) and corrected flow time of the carotid artery (ccFT) were compared with changing SV using repeated measures correlation.</p><p><strong>Results: </strong>In total, 73,431 cardiac cycles were compared across 27 subjects. There was a strong linear correlation between changing SV and carotid Doppler measures during simulated hemorrhage (repeated-measures linear correlation [Rrm ]=0.91 for VTI; 0.88 for ccFT). This relationship improved with larger numbers of consecutively-averaged cardiac cycles. For ccFT, beyond four consecutively-averaged cardiac cycles the correlation coefficient remained strong (i.e., Rrm of at least 0.80). For VTI, the correlation coefficient with SV was strong for any number of averaged cardiac cycles. For both ccFT and VTI, Rrm remained stable around 25 consecutively-averaged cardiac cycles.</p><p><strong>Conclusions: </strong>There was a strong linear correlation between changing SV and carotid Doppler measures during central blood volume loss. The strength of this relationship was dependent upon the number of consecutively-averaged cardiac cycles.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":"39 1","pages":"162-168"},"PeriodicalIF":1.8,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11002613/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140111793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Association of malnutrition status with 30-day mortality in patients with sepsis using objective nutritional indices: a multicenter retrospective study in South Korea. 利用客观营养指数分析败血症患者营养不良状况与 30 天死亡率的关系:韩国一项多中心回顾性研究。
IF 1.8 Q3 CRITICAL CARE MEDICINE Pub Date : 2024-02-01 Epub Date: 2024-02-20 DOI: 10.4266/acc.2023.01613
Moon Seong Baek, Young Suk Kwon, Sang Soo Kang, Daechul Shim, Youngsang Yoon, Jong Ho Kim

Background: The Controlling Nutritional Status (CONUT) score and the prognostic nutritional index (PNI) have emerged as important nutritional indices because they provide an objective assessment based on data. We aimed to investigate how these nutritional indices relate to outcomes in patients with sepsis.

Methods: Data were collected retrospectively at five hospitals for patients aged ≥18 years receiving treatment for sepsis between January 1, 2017, and December 31, 2021. Serum albumin and total cholesterol concentrations, and peripheral lymphocytes were used to calculate the CONUT score and PNI. To identify predictors correlated with 30-day mortality, analyses were conducted using univariate and multivariate Cox proportional hazards models.

Results: The 30-day mortality rate among 9,763 patients was 15.8% (n=1,546). The median CONUT score was 5 (interquartile range [IQR], 3-7) and the median PNI score was 39.6 (IQR, 33.846.4). Higher 30-day mortality rates were associated with individuals with moderate (CONUT score: 5-8; PNI: 35-38) or severe (CONUT: 9-12; PNI: <35) malnutrition compared with those with no malnutrition (CONUT: 0-1; PNI: >38). With CONUT scores, the hazard ratio (HR) associated with moderate malnutrition was 1.52 (95% confidence interval [CI], 1.24-1.87; P<0.001); for severe, HR=2.42 (95% CI, 1.95-3.02; P<0.001). With PNI scores, the HR for moderate malnutrition was 1.29 (95% CI, 1.09-1.53; P=0.003); for severe, HR=1.88 (95% CI, 1.67-2.12; P<0.001).

Conclusions: The nutritional indices CONUT score and PNI showed significant associations with mortality of sepsis patients within 30 days.

背景:控制营养状况(CONUT)评分和预后营养指数(PNI)提供了基于数据的客观评估,因此已成为重要的营养指数。我们旨在研究这些营养指数与脓毒症患者预后的关系:我们在五家医院回顾性收集了 2017 年 1 月 1 日至 2021 年 12 月 31 日期间接受脓毒症治疗的年龄≥18 岁患者的数据。血清白蛋白和总胆固醇浓度以及外周淋巴细胞用于计算 CONUT 评分和 PNI。为了确定与 30 天死亡率相关的预测因素,使用单变量和多变量 Cox 比例危险模型进行了分析:结果:9763 名患者的 30 天死亡率为 15.8%(n=1546)。CONUT评分中位数为5(四分位数间距[IQR],3-7),PNI评分中位数为39.6(IQR,33.846.4)。中度(CONUT 评分:5-8;PNI:35-38)或重度(CONUT:9-12;PNI:38)患者的 30 天死亡率较高。根据 CONUT 评分,与中度营养不良相关的危险比 (HR) 为 1.52(95% 置信区间 [CI],1.24-1.87;PConclusions:营养指数CONUT评分和PNI与脓毒症患者30天内的死亡率有显著关联。
{"title":"Association of malnutrition status with 30-day mortality in patients with sepsis using objective nutritional indices: a multicenter retrospective study in South Korea.","authors":"Moon Seong Baek, Young Suk Kwon, Sang Soo Kang, Daechul Shim, Youngsang Yoon, Jong Ho Kim","doi":"10.4266/acc.2023.01613","DOIUrl":"10.4266/acc.2023.01613","url":null,"abstract":"<p><strong>Background: </strong>The Controlling Nutritional Status (CONUT) score and the prognostic nutritional index (PNI) have emerged as important nutritional indices because they provide an objective assessment based on data. We aimed to investigate how these nutritional indices relate to outcomes in patients with sepsis.</p><p><strong>Methods: </strong>Data were collected retrospectively at five hospitals for patients aged ≥18 years receiving treatment for sepsis between January 1, 2017, and December 31, 2021. Serum albumin and total cholesterol concentrations, and peripheral lymphocytes were used to calculate the CONUT score and PNI. To identify predictors correlated with 30-day mortality, analyses were conducted using univariate and multivariate Cox proportional hazards models.</p><p><strong>Results: </strong>The 30-day mortality rate among 9,763 patients was 15.8% (n=1,546). The median CONUT score was 5 (interquartile range [IQR], 3-7) and the median PNI score was 39.6 (IQR, 33.846.4). Higher 30-day mortality rates were associated with individuals with moderate (CONUT score: 5-8; PNI: 35-38) or severe (CONUT: 9-12; PNI: <35) malnutrition compared with those with no malnutrition (CONUT: 0-1; PNI: >38). With CONUT scores, the hazard ratio (HR) associated with moderate malnutrition was 1.52 (95% confidence interval [CI], 1.24-1.87; P<0.001); for severe, HR=2.42 (95% CI, 1.95-3.02; P<0.001). With PNI scores, the HR for moderate malnutrition was 1.29 (95% CI, 1.09-1.53; P=0.003); for severe, HR=1.88 (95% CI, 1.67-2.12; P<0.001).</p><p><strong>Conclusions: </strong>The nutritional indices CONUT score and PNI showed significant associations with mortality of sepsis patients within 30 days.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":"39 1","pages":"127-137"},"PeriodicalIF":1.8,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11002609/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140111753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Diagnostic accuracy of left ventricular outflow tract velocity time integral versus inferior vena cava collapsibility index in predicting post-induction hypotension during general anesthesia: an observational study. 左心室流出道速度时间积分与下腔静脉塌陷指数在预测全身麻醉诱导后低血压方面的诊断准确性:一项观察性研究。
IF 1.8 Q3 CRITICAL CARE MEDICINE Pub Date : 2024-02-01 Epub Date: 2024-02-23 DOI: 10.4266/acc.2023.00913
Vibhuti Sharma, Arti Sharma, Arvind Sethi, Jyoti Pathania

Background: Point of care ultrasound (POCUS) is being explored for dynamic measurements like inferior vena cava collapsibility index (IVC-CI) and left ventricular outflow tract velocity time integral (LVOT-VTI) to guide anesthesiologists in predicting fluid responsiveness in the preoperative period and in treating post-induction hypotension (PIH) with varying accuracy.

Methods: In this prospective, observational study on included 100 adult patients undergoing elective surgery under general anesthesia, the LVOT-VTI and IVC-CI measurements were performed in the preoperative room 15 minutes prior to surgery, and PIH was measured for 20 minutes in the post-induction period.

Results: The incidence of PIH was 24%. The area under the curve, sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of the two techniques at 95% confidence interval was 0.613, 30.4%, 93.3%, 58.3%, 81.4%, 73.6% for IVC-CI and 0.853, 83.3%, 80.3%, 57.1%, 93.8%, 77.4% for LVOT-VTI, respectively. In multivariate analysis, the cutoff value for IVC-CI was >51.5 and for LVOT-VTI it was ≤17.45 for predicting PIH with odd ratio [OR] of 8.491 (P=0.025) for IVCCI and OR of 17.427 (P<0.001) for LVOT. LVOT-VTI assessment was possible in all the patients, while 10% of patients were having poor window for IVC measurements.

Conclusions: We recommend the use of POCUS using LVOT-VTI or IVC-CI to predict PIH, to decrease the morbidity of patients undergoing surgery. Out of these, we recommend LVOT-VTI measurements as it has showed a better diagnostic accuracy (77.4%) with no failure rate.

背景:目前正在探索利用护理点超声(POCUS)进行动态测量,如下腔静脉塌陷指数(IVC-CI)和左心室流出道速度时间积分(LVOT-VTI),以指导麻醉医生预测术前输液反应和治疗诱导后低血压(PIH),其准确性各不相同:在这项前瞻性观察研究中,100 名成人患者在全身麻醉下接受择期手术,术前 15 分钟在术前室进行 LVOT-VTI 和 IVC-CI 测量,诱导后 20 分钟测量 PIH:PIH发生率为24%。IVC-CI 和 LVOT-VTI 的曲线下面积、敏感性、特异性、阳性预测值、阴性预测值和诊断准确性在 95% 置信区间分别为 0.613、30.4%、93.3%、58.3%、81.4%、73.6% 和 0.853、83.3%、80.3%、57.1%、93.8%、77.4%。在多变量分析中,预测 PIH 的 IVC-CI 临界值>51.5,LVOT-VTI 临界值≤17.45,IVCCI 的奇数比[OR]为 8.491(P=0.025),PConclusions 的 OR 为 17.427:我们建议使用 LVOT-VTI 或 IVC-CI 进行 POCUS 预测 PIH,以降低手术患者的发病率。其中,我们推荐使用 LVOT-VTI 测量,因为它的诊断准确率更高(77.4%),且无失败率。
{"title":"Diagnostic accuracy of left ventricular outflow tract velocity time integral versus inferior vena cava collapsibility index in predicting post-induction hypotension during general anesthesia: an observational study.","authors":"Vibhuti Sharma, Arti Sharma, Arvind Sethi, Jyoti Pathania","doi":"10.4266/acc.2023.00913","DOIUrl":"10.4266/acc.2023.00913","url":null,"abstract":"<p><strong>Background: </strong>Point of care ultrasound (POCUS) is being explored for dynamic measurements like inferior vena cava collapsibility index (IVC-CI) and left ventricular outflow tract velocity time integral (LVOT-VTI) to guide anesthesiologists in predicting fluid responsiveness in the preoperative period and in treating post-induction hypotension (PIH) with varying accuracy.</p><p><strong>Methods: </strong>In this prospective, observational study on included 100 adult patients undergoing elective surgery under general anesthesia, the LVOT-VTI and IVC-CI measurements were performed in the preoperative room 15 minutes prior to surgery, and PIH was measured for 20 minutes in the post-induction period.</p><p><strong>Results: </strong>The incidence of PIH was 24%. The area under the curve, sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of the two techniques at 95% confidence interval was 0.613, 30.4%, 93.3%, 58.3%, 81.4%, 73.6% for IVC-CI and 0.853, 83.3%, 80.3%, 57.1%, 93.8%, 77.4% for LVOT-VTI, respectively. In multivariate analysis, the cutoff value for IVC-CI was >51.5 and for LVOT-VTI it was ≤17.45 for predicting PIH with odd ratio [OR] of 8.491 (P=0.025) for IVCCI and OR of 17.427 (P<0.001) for LVOT. LVOT-VTI assessment was possible in all the patients, while 10% of patients were having poor window for IVC measurements.</p><p><strong>Conclusions: </strong>We recommend the use of POCUS using LVOT-VTI or IVC-CI to predict PIH, to decrease the morbidity of patients undergoing surgery. Out of these, we recommend LVOT-VTI measurements as it has showed a better diagnostic accuracy (77.4%) with no failure rate.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":"39 1","pages":"117-126"},"PeriodicalIF":1.8,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11002618/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140111789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Acute and Critical Care
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