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Significant risk factors for intensive care unit-acquired weakness:A processing strategy based on repeated machine learning

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World Journal of Clinical Cases 2024年第7期12卷 1235-1242页

作者： Ling Wang Deng-Yan Long intensive care unit People's Hospital of Qiandongnan Miao and Dong Autonomous PrefectureKaili 556000Guizhou ProvinceChina

BACKGROUND intensive care unit-acquired weakness(ICU-AW)is a common complication that significantly impacts the patient's recovery process,even leading to adverse ***,there is a lack of effective preventive *** To identify significant risk factors for ICU-AW through iterative machine learning techniques and offer recommendations for its prevention and *** Patients were categorized into ICU-AW and non-ICU-AW groups on the 14th day post-ICU *** data from the initial 14 d of ICU stay,such as age,comorbidities,sedative dosage,vasopressor dosage,duration of mechanical ventilation,length of ICU stay,and rehabilitation therapy,were *** relationships between these variables and ICU-AW were *** iterative machine learning techniques,a multilayer perceptron neural network model was developed,and its predictive performance for ICU-AW was assessed using the receiver operating characteristic *** Within the ICU-AW group,age,duration of mechanical ventilation,lorazepam dosage,adrenaline dosage,and length of ICU stay were significantly higher than in the non-ICU-AW ***,sepsis,multiple organ dysfunction syndrome,hypoalbuminemia,acute heart failure,respiratory failure,acute kidney injury,anemia,stress-related gastrointestinal bleeding,shock,hypertension,coronary artery disease,malignant tumors,and rehabilitation therapy ratios were significantly higher in the ICU-AW group,demonstrating statistical *** most influential factors contributing to ICU-AW were identified as the length of ICU stay(100.0%)and the duration of mechanical ventilation(54.9%).The neural network model predicted ICU-AW with an area under the curve of 0.941,sensitivity of 92.2%,and specificity of 82.7%.CONCLUSION The main factors influencing ICU-AW are the length of ICU stay and the duration of mechanical ventilation.A primary preventive strategy,when feasible,involves minimizing both ICU stay and mechani

关键词： intensive care unit-acquired weakness Risk factors Machine learning Prevention Strategies

Tissue-resident macrophages exacerbate lung injury after remote sterile damage

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Cellular & Molecular Immunology 2024年第4期21卷 332-348页

作者： Hanhui Zhong Jingjing Ji Jinling Zhuang Ziying Xiong Pengyun Xie Xiaolei Liu Jundi Zheng Wangli Tian Xiaoyang Hong Jing Tang The Department of Anesthesiology Affiliated Hospital of Guangdong Medical UniversityZhanjiangGuangdongChina The Department of Critical care Medicine General Hospital of Southern Theater Command of PLAGuangzhouChina The Department of respiratory Medicine Guangdong Provincial Hospital of Integrated Chinese and Western MedicineFoshanChina Pediatric intensive care unit Senior Department of Pediatricsthe Seventh Medical Center of PLA General HospitalBeijingChina

Remote organ injury,which is a common secondary complication of sterile tissue damage,is a major cause of poor prognosis and is difficult to ***,we report the critical role of tissue-resident macrophages in lung injury after trauma or stroke through the inflammatory *** found that depleting tissue-resident macrophages rather than disrupting the recruitment of monocyte-derived macrophages attenuated lung injury after trauma or *** findings revealed that the release of circulating alarmins from sites of distant sterile tissue damage triggered an inflammatory response in lung-resident macrophages by binding to receptor for advanced glycation end products(RAGE)on the membrane,which activated epidermal growth factor receptor(EGFR).Mechanistically,ligand-activated RAGE triggered EGFR activation through an interaction,leading to Rab5-mediated RAGE internalization and EGFR phosphorylation,which subsequently recruited and activated P38;this,in turn,promoted RAGE translation and trafficking to the plasma membrane to increase the cellular response to RAGE ligands,consequently exacerbating *** study also showed that the loss of RAGE or EGFR expression by adoptive transfer of macrophages,blocking the function of RAGE with a neutralizing antibody,or pharmacological inhibition of EGFR activation in macrophages could protect against trauma-or stroke-induced remote lung ***,our study revealed that targeting the RAGE-EGFR signaling pathway in tissue-resident macrophages is a potential therapeutic approach for treating secondary complications of sterile damage.

关键词： tissue-resident macrophage RAGE remote sterile damage

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

Early diagnosis and management of neonatal sepsis:a perspective

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World Journal of Pediatrics 2024年第4期20卷 303-306页

作者： Li‑Zhong Du Neonatal intensive care unit Children’s Hospital Zhejiang University School of MedicineNational Clinical Research Center for Child Health3333 Binsheng RoadHangzhou 310052China

Neonatal sepsis is an illness caused by bloodstream bacteria or fungal infections that affect newborn infants under 28 days of *** stands as a significant contributor to morbidity and mortality in neonatal intensive care units(NICUs).With the improved survival rates of very low-birth-weight or extremely premature infants,a growing number of these vulnerable infants are receiving intensive care and undergoing invasive procedures,making nosocomial infections a persistent challenge in *** mortality rate associated with neonatal sepsis varies depending on factors such as birth weight,gestational age,and other *** can also lead to a range of long-term health consequences,including neurodevelopmental disabilities like cerebral palsy,visual or hearing impairments,and cognitive ***,neonatal sepsis is linked to various adverse outcomes,including respiratory complications,bronchopulmonary dysplasia,nutritional and growth issues,and immunological dysfunction[1].Due to its atypical clinical presentation and the low rate of specific diagnostic indicators,such as a positive blood culture,accurately diagnosing neonatal sepsis is ***,the appropriateness of antibiotic treatment is often a matter of controversy.

关键词： neonatal mortality diagnosis

Severe acute respiratory syndrome coronavirus-2-related and imputable deaths in children:results from the French pediatric national registry

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World Journal of Pediatrics 2024年第6期20卷 611-620页

作者： Marguerite Lockhart-Bouron Noemie Vanel Michael Levy Anais R.Briant Etienne Javouhey Sophie Breinig Julia Dina Marion Caseris Francois Angoulvant Stephane Leteurtre Morgan Recher David W.Brossier Univ.Lille CHU LilleULR 2694-METRICS:Evaluation Des Technologies de Sante Et Des Pratiques Medicales59000LilleFrance Pediatric intensive care unit CHU de MarseilleMarseilleFrance Pediatric intensive care unit CHU Robert-DebreAssistance Publique Hopitaux de ParisParisFrance UniversitéParis-Cite ParisFrance Biostatistics and Clinical Research unit CHU de Caen Normandie14000CaenFrance Pediatric intensive care Hospices Civils de LyonLyonFrance Neonatal andPediatric intensivecare unit Children's HospitalToulouseFrance Virology Department INSERM U1311 DynamicureUniv CAEN NormandieCHU de Caen14000 CaenFrance Medical School Universite Caen Normandie14000 CaenFrance Department of Pediatrics CHU Robert-DebréAssistance Publique Hopitaux de ParisParisFrance Department Women-Mother-Child Service of PediatricsLausanne University Hospital(CHUV)LausanneSwitzerland Pediatric intensive care unit Réanimation Et Soins Intensifs PéediatriquesCHU de CAENAvenue de La Cote de Nacre14000 CaenFrance CHU Sainte Justine Research Center MontréalCanada

Background Severe acute respiratory syndrome coronavirus-2(SARS-CoV-2)is responsible for an important mortality rate *** aimed to evaluate the actual imputability of SARS-CoV-2 on the mortality rate associated with SARS-CoV-2-related illnesses in the pediatric intensive care unit(PICU).Secondary objectives were to identify risk factors for *** This national multicenter comparative study comprised all patients under 18 years old with positive SARS-CoV-2 polymerase chain reactions(PCRs)[acute corona virus disease 2019(COVID-19)or incidental SARS-CoV-2 infection]and/or pediatric inflammatory multisystem syndrome(PIMS)recorded in the French PICU registry(PICURe)between September 1,2021,and August 31,*** patients were classified and compared according to their living status at the end of their PICU *** patients were evaluated by four experts in the field of pediatric infectiology and/or pediatric intensive *** imputability of SARS-CoV-2 as the cause of death was classified into four categories:certain,very probable,possible,or unlikely,and was defined by any of the first three *** There were 948 patients included of which 43 died(4.5%).From this,26 deaths(67%)could be attributed to SARS-CoV-2 infection,with an overall mortality rate of 2.8%.The imputability of death to SARS-CoV-2 was considered certain in only one case(O.1%).Deceased patients suffered more often from comorbidities,especially heart disease,neurological disorders,hematological disease,cancer,and *** of the deceased patients were admitted for pediatric inflam-matory multisystem syndrome(PIMS).Mortality risk factors were male gender,cardiac comorbidities,cancer,and acute respiratorydistress *** SARS-CoV-2 mortality in the French pediatric population was *** though the imputability of SARS-Cov-2 on mortality was considered in almost two-thirds of cases,this imputability was considered certain in only one case.

关键词： Death Pediatric intensive care unit SARS-CoV-2

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

Hygrometry behavior during high-flow nasal oxygen therapy and non-invasive mechanical ventilation:A narrative review of bench to clinical studies

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Journal of intensive Medicine 2024年第4期4卷 433-441页

作者： Sanjay Singhal Mohan Gurjar Jun Duan Salvatore Notaro Antonio M.Esquinas Department of Pulmonary Medicine All India Institute of Medical ScienceRajkotGujaratIndia Department of Critical care Medicine Sanjay Gandhi Post Graduate Institute of Medical Sciences(SGPGIMS)LucknowIndia Department of respiratory and Critical care Medicine The First Affiliated Hospital of Chongqing Medical UniversityChongqingChina intensive care unit and ECMO A.O.R.N.“Dei Colli”Monaldi HospitalNaplesItaly intensive care unit Hospital Morales MeseguerMurciaSpain

Recently,there has been growing interest in knowing the best hygrometry level during high-flow nasal oxygen and non-invasive ventilation(NIV)and its potential influence on the *** studies have shown that breathing cold and dry air results in excessive water loss by nasal mucosa,reduced mucociliary clearance,in-creased airway resistance,reduced epithelial cell function,increased inflammation,sloughing of tracheal epithe-lium,and submucosal *** the Coronavirus Disease 2019 pandemic,using high-flow nasal oxygen with a heated humidifier has become an emerging form of non-invasive support among ***,we cannot always assume stable ***,there are no clear guidelines for using humidification dur-ing NIV,although humidification of inspired gas during invasive ventilation is an accepted standard of *** disturbs the normal physiological system that warms and humidifies inspired *** NIV is supplied through an intensive care unit ventilator that utilizes anhydrous gases from compressed wall air and oxygen,the risk of dry-ness *** addition,patients with acute respiratory failure tend to breathe through the mouth during NIV,which is a less efficient route than nasal breathing for adding heat and moisture to the inspired *** sleep apnea syndrome is one of the most important indications for chronic use of NIV at *** data suggest that up to 60%of patients with obstructive sleep apnea syndrome who use continuous positive airway pressure therapy experience nasal congestion and dryness of the mouth and ***,humidifying the inspired gas in NIV may be essential for patient comfort and compliance with *** aimed to review the available bench and clinical studies that addressed the utility of hygrometry in NIV and nasal high-flow oxygen and discuss the technical limitations of different humidification systems for both systems.

关键词： Acute respiratory failure Hygrometry Non-invasive mechanical ventilation High flow nasal oxygen Oxygenation Heated humidifier

Child Acute Lower respiratory Tract Infection in Pediatrics intensive care unit at University Hospital of Brazzaville (Congo)

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Open Journal of Pediatrics 2018年第1期8卷 32-41页

作者： Engoba Moyen Judicael Kambourou Annie Rachelle Okoko Lori Bertrand Nguelongo Verlem Bomelefa-Bomel Kadidja Grace Nkounkou Georges Moyen Jean-Louis Nkoua Faculty of Health Sciences Marien Ngouabi University of BrazzavilleBrazzavilleCongo Pediatric intensive cares unit University Hospital of BrazzavilleBrazzavilleCongo

In order to contribute to reduction of morbidity and mortality due to low acute respiratory infections in pediatrics, the objective of this study was to determine the epidemiological profile and to identify the factors favoring and those associated with the risk of deceased. We reviewed the cases of children aged between 1 and 59 months hospitalized between January and December 2015 in the pediatric intensive care unit of the CHU of Brazzaville and retained those whose diagnosis of discharge was an ALRI. The study variables were: epidemiological, clinical, paraclinic, diagnostic, therapeutic and evolutionary. For 2012 hospitalized children, 400 (19.8%) were hospitalized for an ALRI. There were 235 boys (58.8%) and 165 girls (41.2%) of average age. Infants aged 1 to 11 months were the most affected n = 260 (65%). They were insufficiently immunized with haemophilus influenza B and pneumococcus n = 378 (94.5%);Fully immunized n = 20 (5%), the average delay for consultation after the first symptom was 5.03 ± 3.86 days;Denutrition was rated n = 180 (45%), positive retroviral serology n = 19 cases (4.8%). The main nosological varieties were: bronchiolitis n = 223 (55.7%), pneumonia n = 145 (36.2%). One death was rated n = 65 (16.3%). The mortality determinants were: prematurity, vaccination status and HIV/AIDS infection. The frequency and severity of ALRIs necessitates a strengthened program of integrated management of childhood illnesses, and public health actions targeting the factors that promote and contribute to the risk of death.

关键词： Acute respiratory Infections Child Brazzaville Bronchiolitis

A case of post traumatic mitral chordae rupture mimicking acute respiratory distress syndrome

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World Journal of Emergency Medicine 2024年第4期15卷 322-324页

作者： Hülya Deniz Misir Nalan Demir Ferit Kasimzade Cansu Yahşi intensive care Department Ankara Bilkent City HospitalAnkara 06800Turkiye intensive care Department University of Health Sciences Ankara Bilkent City HospitalAnkara 06800Turkiye Cardiovascular Surgery Department Ankara Bilkent City HospitalAnkara 06800Turkiye Pulmonary Medicine Department University of Health Sciences Ankara Bilkent City HospitalAnkara 06800Turkiye

Traumatic mitral chordae rupture is a rare and known cause of acute mitral valve regurgitation and de novo heart *** pathologies in a trauma patient may mask the findings of de novo heart failure due to mitral chordae *** patients may also have other potential pre-diagnoses that could explain symptoms related to heart failure,such as tachycardia,circulatory shock,and acute *** possibility of traumatic chordae tendinea rupture being a preventable cause of mortality should be carefully evaluated.

关键词： rupture mitral acute