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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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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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Predictive performance of the variation rate of the driving pressure on the outcome of invasive mechanical ventilation in patients with acute respiratory distress syndrome

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Chinese Journal of Traumatology 2024年第2期27卷 107-113页

作者： Hui-Dan Jing Jun-Ying Tian Wei Li Bing-Ling He Hong-Chao Li Fu-Xia Jian Cui Shang Feng Shen department of intensive care Unit The Affiliated Hospital of Guizhou Medical UniversityGuiyang 550004China department of intensive care Unit Army Medical Center of PLAChongqing400042China College of Foreign Languges Chongqing Medical UniversityChongqing400016China

Purpose:To assess the value of the driving pressure variation rate(ΔP%)in predicting the outcome of weaning from invasive mechanical ventilation in patients with acute respiratory distress ***:In this case-control study,a total of 35 patients with moderate-severe acute respiratory distress syndrome were admitted to the intensive care unit between January 2022 and December 2022 and received invasive mechanical ventilation for at least 48 h were *** were divided into successful weaning group and failed weaning group depending on whether they could be removed from ventilator support within 14 *** measures including driving pressure,PaO2:FiO2,and positive end-expiratory pressure,*** assessed every 24 h from day 0 to day 14 until successful weaning was *** measurement data of non-normal distribution were presented as median(Q1,Q3),and the differences between groups were compared by Wilcoxon rank sum *** categorical data use the Chi-square test or Fisher's exact test to *** predictive value ofΔP%in predicting the outcome of weaning from the ventilator was analyzed using receiver operating characteristic ***:Of the total 35 patients included in the study,17 were successful vs.18 failed in weaning from a ventilator after 14 days of mechanical *** cut-off values of the medianΔP%measured by Operator 1 *** 2 in the first 4 days were≥4.17%and 4.55%,respectively(p<0.001),with the area under curve of 0.804(sensitivity of 88.2%,specificity of 64.7%)and 0.770(sensitivity of 88.2%,specificity of 64.7%),*** was a significant difference in mechanical ventilation duration between the successful weaning group and the failure weaning group(8(6,13)vs.12(7.5,17.3),p=0.043).The incidence of ventilator-associated pneumonia in the successful weaning group was significantly lower than in the failed weaning group(0.2‰vs.2.3‰,p=0.001).There was a significant difference noted between these

关键词： Driving pressure Driving pressure variation rate Acute respiratory distress syndrome Mechanical ventilation

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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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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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Data driven analysis reveals prognostic genes and immunological targets in human sepsis-associated acute kidney injury

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World Journal of Emergency Medicine 2024年第2期15卷 91-97页

作者： Qing Zhao Jinfu Ma Jianguo Xiao Zhe Feng Hui Liu department of Diagnosis and Treatment of Cadres the First Medical CenterChinese PLA General HospitalBeijing 100853China intensive care Unit the 305th Hospital of Chinese PLABeijing 100032China department of Critical care Medicine the First Medical CenterChinese PLA General HospitalBeijing 100853China Nephrology department the First Medical CenterChinese PLA General HospitalBeijing 100853China

BACKGROUND:The molecular mechanism of sepsis-associated acute kidney injury(SA-AKI)is *** analyzed co-differentially expressed genes(co-DEGs)to elucidate the underlying mechanism and intervention targets of ***:The microarray datasets GSE65682,GSE30718,and GSE174220 were downloaded from the Gene Expression Omnibus(GEO)*** identified the co-DEGs and constructed a gene co-expression network to screen the hub *** analyzed immune correlations and disease correlations and performed functional annotation of the hub *** also performed single-cell and microenvironment analyses and investigated the enrichment pathways and the main transcription ***,we conducted a correlation analysis to evaluate the role of the hub ***:Interleukin 32(IL32)was identified as the hub gene in SA-AKI,and the main enriched signaling pathways were associated with hemopoiesis,cellular response to cytokine stimulus,inflammatory response,and regulation of kidney ***,IL32 was significantly associated with mortality in SA-AKI ***,macrophages,T cells,and NK cells were closely related to IL32 and were involved in the immune microenvironment in SA-AKI ***32 expression increased significantly in the kidney of septic ***-like receptor 2(TLR2)was significantly and negatively correlated with ***:IL32 is the key gene involved in SA-AKI and is significantly associated with ***2 and relevant immune cells are closely related to key genes.

关键词： Sepsis Acute kidney injury Interleukin 32 Toll-like receptor 2 Bioinformatics analysis

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Lysinuric protein intolerance with novel mutations in solute carrier family 7A member 7 in a Chinese family

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Pediatric Investigation 2024年第2期8卷 149-153页

作者： Yilin Pang Feng Huo Xiao Liu Yimu Fan Zhezhe Zhang Jie Wu Quan Wang Emergency department Emergency Intensive Care UnitBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina

Introduction:Lysinuric protein intolerance(LPI)is a rare genetic disorder caused by mutations in the solute carrier family 7A member 7(SLC7A7)*** presentation:We presented two siblings with LPI,carrying novel mutations of c.776delT(p.L259Rfs*18)and c.155G>T(p.G52V)in *** younger sibling,preferring protein-rich foods,showed severe symptoms,including alveolar proteinosis,macrophage activation syndrome,severe diarrhea,and disturbance of consciousness with involuntary *** contrast,the elder sibling only had mild symptoms,likely due to aversion to protein-rich food since toddler ***:LPI is a congenital genetic metabolic disease with multisystem *** appropriate protein-restricted diet therapy as soon as possible could help prevent the progression of LPI.

关键词： Diet Lysinuric protein intolerance Pulmonary alveolar proteinosis SLC7A7

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Characteristics and Risk Factors for Pediatric Sepsis

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Current Medical Science 2024年第3期44卷 648-656页

作者： Yong-bing ZHU Tong-lin LIU Qi DAI Shu-fan LIU Peng XIONG Hao HUANG Yi YUAN Tian-nan ZHANG Yu CHEN department of Pediatric intensive care Unit Tongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan430030China

Objective Sepsis is considered a major cause of health loss in children and had high mortality and ***,there is no reliable model for predicting the prognosis of pediatric patients with *** study aimed to analyze the clinical characteristics of sepsis in children and assess the risk factors associated with poor prognosis in pediatric sepsis patients to identify timely interventions and improve their *** This study analyzed the clinical indicators and laboratory results of septic patients hospitalized in the Pediatric intensive care Unit of Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,China,from January 1,2019,to December 31,*** factors for sepsis were identified by logistic regression *** A total of 355 children with sepsis were enrolled,with 333 children(93.8%)in the good prognosis group,and 22 children(6.2%)in the poor prognosis *** them,there were 255 patients(71.8%)in the sepsis group,and 100 patients(28.2%)in the severe sepsis *** length of hospital stay in the poor prognosis group was longer than that in the good prognosis group(P0.05),and the platelet(PLT),albumin(ALB),and hemoglobin(Hb)levels were lower in the poor prognosis group(P<0.01).The IL-8 levels in the severe sepsis group were higher than those in the sepsis group(P<0.05).Multiple logistic regression analysis suggested that lower Hb levels,ALB levels,peak PLT counts,and higher IL-1βlevels were independent risk factors for poor prognosis in children with *** Lower Hb,ALB,and PLT counts and elevated IL-1βare independent risk factors for poor prognosis in children with sepsis.

关键词： pediatric sepsis inflammation severity prognosis risk factors

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Effects of strengthening prospective nursing practice on sleep quality,anxiety,and depression of awake patients in intensive care unit

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World Journal of Psychiatry 2024年第5期14卷 735-741页

作者： Fei Lin Lei Liu department of intensive care Unit Dushu Lake Hospital Affiliated to Soochow UniversitySuzhou 215000Jiangsu ProvinceChina

BACKGROUND The intensive care unit(ICU)is a specialized hospital *** patients in the ICU frequently encounter adverse psychological states,such as anxiety and fear,often accompanied by poor sleep *** situation has garnered significant attention within the medical *** To investigate the impact of prospective nursing intervention strategies on the sleep quality and negative emotional state of conscious ICU *** One hundred and twenty ICU awake patients admitted to our hospital were selected and randomly divided into control(n=60)and observation(n=60)*** in the control group were cared for using the conventional nursing model,while patients in the observation group were cared for using the prospective nursing *** improvement was assessed using the International Standardized Sleep Efficiency Formula and Pittsburgh Sleep Quality Index(PSQI).The PSQI,Generalized Anxiety Disorder 7-item(GAD-7)scale,Self-Depression Scale(SDS),and satisfaction before and after treatment were used to assess the negative emotional states of patients under the two care *** Patient satisfaction in the observation group was significantly higher than in the control *** GAD-7 and SDS scores in the observation group were significantly lower than those in the control group,and the total effective rate of sleep improvement in the observation group was significantly higher than in the control *** treatment,the PSQI scores of the two groups significantly decreased(P<0.05).The decrease in the observation group was more significan than that in the control group,and the difference between the two groups was statistically *** Prospective nursing interventions can improve sleep quality and psychological levels and significantly affect conscious patients in the ICU,which is worthy of clinical application.

关键词： Prospective nursing intensive care unit Sobriety Mental health sleep quality Anxiety and depression

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