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Optimizing artificial intelligence in sepsis management: Opportunities in the present and looking closely to the future

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Journal of intensive Medicine 2024年第1期4卷 34-45页

作者： Darragh O’Reilly Jennifer McGrath Ignacio Martin-Loeches department of intensive care Medicine Multidisciplinary Intensive Care Research Organization(MICRO)St James’HospitalDublinIreland department of Respiratory intensive care Hospital ClinicUniversitat de BarcelonaIDIBAPSCIBERESBarcelonaSpain

Sepsis remains a major challenge internationally for healthcare *** incidence is rising due to poor public awareness and delays in its recognition and subsequent *** sepsis,mortality increases with every hour left *** intelligence(AI)is transforming worldwide healthcare delivery at *** review has outlined how AI can augment strategies to address this global disease *** and machine learning(ML)algorithms can analyze vast quantities of increasingly complex clinical datasets from electronic medical records to assist clinicians in diagnosing and treating sepsis earlier than traditional *** review highlights how these models can predict the risk of sepsis and organ failure even before it *** gives providers additional time to plan and execute treatment plans,thereby avoiding increasing complications associated with delayed diagnosis of *** potential for cost savings with AI implementation is also discussed,including improving workflow efficiencies,reducing administrative costs,and improving healthcare *** these advantages,clinicians have been slow to adopt AI into clinical *** of the limitations posed by AI solutions include the lack of diverse data sets for model building so that they are widely applicable for routine clinical ***,the subsequent algorithms are often based on complex mathematics leading to clinician hesitancy to embrace such ***,we highlight the need for robust political and regulatory frameworks in this area to achieve the trust and approval of clinicians and patients to implement this transformational technology。

关键词： Artificial intelligence Data science Machine learning intensive care unit(ICU) Critical care Sepsis

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Postoperative Analgesia and Cesarean Section under General anesthesia: Multicenter Study

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Open Journal of Anesthesiology 2024年第1期14卷 1-12页

作者： Ghislain Edjo Nkilly Raphael Okoue Ondo Pascal Christian Nze Obiang Stéphane Oliveira Jean-Marcel Mandji-Lawson Romain Tchoua department of anesthesia and intensive care Omar Bongo Ondimba Army Training Hospital (HIAOBO) Libreville Gabon department of anesthesia and intensive care Jeanne Ebori Fondation Libreville Gabon department of anesthesia and intensive care Akanda Army Training Hospital Libreville Gabon

Background: Neuraxial anesthesia with intrathecal morphine is the reference technique in cesarean section anesthesia for the management of postoperative analgesia. If there is a contraindication to this, general anesthesia is required. The objective of the study was to evaluate the analgesic effectiveness of 4 analgesic techniques performed during cesarean section under general anesthesia in two centers with different anesthetic practices (North Franche Comté Hospital and Omar Bongo Ondimba Army Training Hospital). Method: This is a retrospective and descriptive study over 2 years, from January 1, 2019 to December 31, 2020. It involved evaluating the analgesic effectiveness and tolerance of morphine in the epidural catheter, wound infiltration, intravenous analgesia and Transversus Abdominous Plane block (TAP block) from the post-anesthesia care unit (PACU) until the 4th post-operative day. Results: Of the 354 cesarean sections performed, 84 (11.14%) received general anesthesia. The average age was 32.27 years. Acute fetal distress was the first indication for cesarean section (45.2%), followed by hemorrhagic placenta previa (10.7%) and prolapse of the cord (8.33%). Morphine in the epidural catheter was the most used (47.6%) followed by parietal infiltration (36.9%), intravenous analgesia (13.1%) and TAP block (2.38%). The analgesic effectiveness was comparable between the techniques from postoperative day 0 to day 4. No difference in side effects. Postoperative morphine consumption was significantly reduced (p = 0.011) in the infiltration (9 mg) and TAP block (9mg) groups compared to the epidural catheter (16 mg) and intravenous analgesia (17 mg). No difference in 02 rehabilitation criteria (ambulation, first bowel movement). No difference in the occurrence of chronic pain. Conclusion: In the event of a cesarean section under general anesthesia, there are effective and well-tolerated alternatives to neuraxial anesthesia, particularly regional anesthesia

关键词： Cesarean General anesthesia Morphine Parietal Infiltration Epidural Catheter Transversus Abdominis Plane Block Intravenous Analgesia

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Early plasma exchange and continuous renal replacement therapy improve puerperal prognosis in hepatitis B virus-related acute-on-chronic liver failure in pregnancy

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Liver Research 2024年第2期8卷 118-126页

作者： Lijuan Li Mingming Fan Mi Zhou Pinglan Lu Jianrong Liu Huimin Yi Xuxia Wei surgical intensive care Unit The Third Affiliated Hospital of Sun Yat-sen University Guangzhou Guangdong China

Background and aim Hepatitis B virus (HBV)-related gestational acute-on-chronic liver failure (ACLF) is a severe condition with limited treatment options. This study aimed to evaluate the efficacy and ideal timing of plasma exchange and continuous renal replacement therapy (CRRT) in managing pregnant women with HBV-related ACLF. Methods This study retrospectively analyzed 51 eligible patients with HBV-related gestational ACLF between 2009 and 2020. Patients admitted to the study were divided into a conventional treatment group and a new treatment group according to whether they received the new management protocol, which included more aggressive plasma exchange (PE) and CRRT strategies. All 19 pregnant women with hepatic encephalopathy (HE) were divided into an early treatment group and a non-early treatment group according to whether PE therapy was initiated within three days. Our study had two primary objectives. Firstly, we aimed to evaluate the impact of PE and CRRT on puerperal survival. Secondly, we sought to assess the effects of early PE and CRRT regimens on puerperal survival in women with HE. Results The levels of total bilirubin on the second day postpartum (D3), the third day postpartum (D4), and the fifth day postpartum (D6) were significantly lower in the new treatment group compared to the conventional treatment group ( P = 0.02, 0.01, and 0.02, respectively). The ALT of D3 was significantly elevated in the new treatment group compared to the conventional treatment group ( P = 0.02). The incidence of HE overall increased from prenatal to postpartum D4, peaked on D4, and then gradually decreased from the fourth day postpartum (D5) （ P = 0.027）. The first week after delivery revealed a significant difference in survival rate between the two groups, the conventional treatment group had statistically higher mortality rates compared to the new treatment group ( P = 0.002). Similarly, the entire puerperal period mortality rate of the conventional treatm

关键词： Acute-on-chronic liver failure (ACLF) Liver disease in pregnancy Hepatitis B virus (HBV) Plasma exchange (PE) Continuous renal replacement therapy (CRRT) Hepatic encephalopathy (HE)

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Extracorporeal membrane oxygenation as a bridging therapy for patients with thiamine deficiency-induced pulmonary arterial hypertension

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World Journal of Emergency Medicine 2024年第2期15卷 147-149页

作者： Fangfang Qiu Weixing Dai Tengyue Huang Min Li department of intensive care Unit the Fourth Affiliated Hospital of Zhejiang University School of MedicineYiwu 322000China department of intensive care Unit the Second Affiliated Hospital of Zhejiang University School of MedicineHangzhou 310009China

Thiamine deficiency is characterized by a deficiency of thiamine(vitamin B1),lactic acidosis,pulmonary arterial hypertension(PAH),right-sided heart failure,and peripheral nerve *** deficiency is easily misdiagnosed and missed during clinical practice and is associated with death in severe cases.[1,2]Here we reported a patient who was admitted to the hospital with severe metabolic acidosis and pulmonary hypertension and finally diagnosed with thiamine deficiency by detecting plasma vitamin B1 *** clinically obvious thiamine deficiency is rare,and cases of thiamine deficiency requiring extracorporeal membrane oxygenation(ECMO)treatment are rarer,we believe that our case will be helpful for emergency clinicians.

关键词： vitamin hypertension arterial

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Prediction of mechanical ventilation outcome by early abdominal-visceral-blood-flow-and-function score in critically ill patients after cardiopulmonary bypass in the ICU: A prospective observational study

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Journal of intensive Medicine 2024年第1期4卷 101-107页

作者： Chaofu Yue Longxiang Su Jun Wang Na Cui Yuankai Zhou Wei Cheng Bo Tang Xi Rui Huaiwu He Yun Long department of intensive care Unit Peking Union Medical College HospitalBeijingChina department of intensive care Unit Qujing First People’s HospitalQujingYunnanChina department of intensive care Unit Shiyan People’s Hospital of Bao’an DistrictShenzhenGuangdongChina

Background:Abdominal organs are important organs that sense and respond to ischemia and hypoxia,but there are few evaluation *** use ultrasonography to evaluate abdominal organ function and blood flow in patients with mechanical ventilation(MV)after cardiopulmonary bypass and to obtain a semiquantitative score for abdominal organ function and blood ***:Patients with cardiopulmonary bypass in the Critical care department of Peking Union Medical College Hospital in China from March to July 2021 were enrolled in this prospective observational *** correlation of the abdominal-visceral-blood-flow-and-function score(AVBFS)with the duration of MV,number of days spent in the intensive care unit(ICU),acute physiology and chronic health evaluation II(APACHE-II),sequential organ failure assessment(SOFA),lactate,epinephrine,and norepinephrine use was analyzed,and the results were used to assess the predictive value of the receiver operating characteristic curve(ROC)regression analysis score for the duration of ***:Of the 92 patients who underwent cardiopulmonary bypass,41 were finally *** AVBFS were significantly correlated with the duration of MV,number of days spent in the ICU,APACHE-II score,SOFA score,and norepinephrine use *** AVBFS in a group of patients using ventilators≥36 h were significantly higher than those obtained for a group of patients using ventilators<36 h(P<0.05).The evaluation results for the AVBFS at 0-12 h after ICU admission were as follows:area under the ROC curve(AUC)=0.876(95%confidence interval[CI]:0.767 to 0.984),cut-off value=2.5,specificity=0.842,and sensitivity=***:Abdominal visceral organ function and blood perfusion can be used to evaluate gastrointestinal *** is related to early and late extubation after cardiac surgery.

关键词： Ultrasonic evaluation Abdominal-visceral-blood-flow-and-function score(AVBFS) Gastrointestinal dysfunction Mechanical ventilation Cardiopulmonary bypass

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Regional Block anesthesia in Breast Surgery: What Do We Know So Far?

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Open Journal of Anesthesiology 2024年第9期14卷 185-195页

作者： Hao Wang Sharat Chopra Prit Anand Singh department of anesthesia & surgical intensive care Changi General Hospital Simei Singapore department of Surgery Aneurin Bevan University Health Board Newport UK

Breast cancer is the most prevalent cancer in women worldwide, and pain following mastectomy is a major post-surgical complication. This paper highlights the risk factors for chronic pain in breast surgery and evaluates various regional block techniques used to reduce post-operative pain, and minimize hospital stays in high-risk patients. Further research is needed to evaluate the effectiveness of novel regional anaesthesia techniques in an enhanced recovery context, and to assess their role in preventing or reducing chronic pain.

关键词： Chronic Pain Breast Surgery Mastectomy Regional anesthesia Nerve Blocks Ultrasound-Guided

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The 6-hour lactate clearance rate in predicting 30-day mortality in cardiogenic shock

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Journal of intensive Medicine 2024年第3期4卷 393-399页

作者： Junfeng Wang Mingxia Ji department of intensive care Unit Yiwu Central HospitalYiwuZhejiangChina

Background Early evaluation of prognosis in cardiogenic shock(CS)is crucial for tailored treatment *** lactate clearance and lactate levels are considered useful prognostic biomarkers in patients with ***,there is yet no literature comparing the 6-hour lactate clearance rate(Δ6Lac)with lactate levels measured at admission(L1)and after 6 h(L2)to predict 30-day mortality in *** In this observational cohort study,95 patients with CS were treated at department of intensive care Unit,Yiwu Central Hospital between January 2020 and December *** these,88 patients met the eligibility *** lactate levels were measured after admission(L1)as the baseline lactate value,and were measured after 6 h(L2)following *** primary endpoint of the study was survival rate at 30 days.A receiver operating characteristic curve was used for data *** and multivariate Cox regression analyses were performed based onΔ***–Meier(KM)survival curves were generated to compare the 30-day survival rates among L1,L2,andΔ*** TheΔ6Lac model showed the highest area under the curve value(0.839),followed by the L2(0.805)and L1(0.668)***Δ6Lac model showed a sensitivity of 84.2%and specificity of 75.4%.The L1 and L2 models had sensitivities of 57.9%each and specificities of 89.9%and 98.6%,*** cut-off values forΔ6Lac,L1,and L2 were 18.2%,6.7 mmol/L,and 6.1 mmol/L,*** Cox regression analysis revealed a significant association betweenΔ6Lac and 30-day *** adjusting for five models in multivariate Cox regression,Δ6Lac remained a significant risk factor for 30-day mortality in patients with *** our fifth multivariate Cox regression model,Δ6Lac remained a risk factor associated with 30-day mortality(hazard ratio[HR]=5.14,95%confidence interval[CI]:1.48 to 17.89,P=0.010)as well as L2(HR=8.42,95%CI:1.26 to 56.22,P=0.028).The KM survival curve analysis revealed that L1>6.7 mmol/L(HR=8.08,95%

关键词： Lactates The 6-h lactate clearance rate Cardiogenic shock Mortality Cox regression

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Diagnosis and management of malaria in the intensive care unit

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Journal of intensive Medicine 2024年第1期4卷 3-15页

作者： George Akafity Nicholas Kumi Joyce Ashong department of Research Monitoringand EvaluationCape Coast Teaching HospitalCape CoastGhana intensive care Unit Department of Critical Care and AnesthesiaCape Coast Teaching HospitalCape Coast department of Paediatrics and Child Health Cape Coast Teaching HospitalCape CoastGhana

Malaria is responsible for approximately three-quarters of a million deaths in humans globally each *** of the morbidity and mortality reported are from Sub-Saharan Africa and Asia,where the disease is *** non-endemic areas,malaria is the most common cause of imported infection and is associated with significant mortality despite recent advancements and investments in elimination *** malaria often requires intensive care unit admission and can be complicated by cerebral malaria,respiratory distress,acute kidney injury,bleeding complications,and *** care management includes prompt diagnosis and early initiation of effective antimalarial therapy,recognition of complications,and appropriate supportive ***,the lack of diagnostic capacities due to limited advances in equipment,personnel,and infrastructure presents a challenge to the effective diagnosis and management of *** article reviews the clinical classification,diagnosis,and management of malaria as relevant to critical care clinicians,highlighting the role of diagnostic capacity,treatment options,and supportive care.

关键词： Malaria intensive care unit Severe malaria Antimicrobial resistance Antimalarials Artemisinin-based combination therapy

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A Retrospective Analysis of Intoxicated Patients Admitted to the intensive care Unit: A Single-Institution Assessment in the Post-Pandemic Period

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Journal of Biosciences and Medicines 2024年第3期12卷 159-167页

作者： Müge Arikan Abdullah Yeşilkaya Büşra Nur Taşdelen İbrahim Özyiğit department of anesthesia and intensive care Faculty of Medicine Karabuk University Karabuk Turkey

Background: The aim of this study was to evaluate the clinical and epidemiological characteristics of patients with acute intoxication admitted to the intensive care Unit (ICU). Material and Methods: An observational retrospective study was conducted on intoxicated patients who admitted to ICU between January 2022 and January 2024. Data were collected from the patients medical records. The demographic characteristics, causes of intoxications, clinical parameters, the mean stay in the ICU, treatment modalities and prognosis were recorded. Results: A total of 2875 critically ill patients were admitted during the study period, and 109 (3.79%) of them were acute intoxications. Their mean of ages was 38.09 ± 12.29. The female-to-male ratio was 1.37/1. Drugs were found to be the primary cause (62.39%) of intoxications, and analgesics, antidepressants, and antibiotics were the most frequent agents. Suicidal attempts were present in 66 patients, most of them were female (62.13%) and between 17 - 24 years (40.91%). The other common causes of intoxications were carbon monoxide (CO) (22.02%), methyl/ethyl alcohol (8.26%) and mushroom (5.50%). The mean stay in the ICU was 2.69 ± 0.89 days. Mechanical ventilation was applied to 10 of our patients. Renal replacement therapy was required in 6 patients. Despite all treatments, 6 of our patients died, and we found the mortality rate to be 5.50%. Conclusion: Intoxications were more frequent in young female patients and drugs were the most common cause with suicidal intent. Unfortunately, CO poisoning continues to be a very important problem in our city. These findings provided significant information about the characteristics of intoxications in Karabuk.

关键词： Intoxication intensive care Unit Suicidal Mortality

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Septic shock due to Capnocytophaga canimorsus treated with IgM-enriched immunoglobulin as adjuvant therapy in an immunocompetent woman

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Journal of intensive Medicine 2024年第2期4卷 265-268页

作者： Josephine Braunsteiner Stephanie Siedler Dominik Jarczak Stefan Kluge Axel Nierhaus department of intensive care Medicine University Medical Centre Hamburg-EppendorfHamburgGermany

Background Capnocytophaga canimorsus(***)belongs to the family *** is a facultative anaerobic Gram-negative bacillus and belongs to the normal oral microbiota of some mammals,such as cats and *** to humans can occur through the skin after skin abrasion caused by a scratch or a bite.[1]Based on polymerase chain reaction(PCR)analysis,*** is present in saliva in 70%-74%of dogs and 55%-57%of cats.

关键词： belongs enriched scratch

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