Abstract:
PURPOSE:Protective mechanical ventilation based on multiple ventilator parameters such as tidal volume, plateau pressure, and driving pressure has been widely used in acute respiratory distress syndrome (ARDS). More recently, mechanical power (MP) was found to be associated with mortality. The study aimed to investigate whether MP normalized to predicted body weight (norMP) was superior to other ventilator variables and to prove that the discrimination power cannot be further improved with a sophisticated machine learning method. METHODS:The study included individual patient data from eight randomized controlled trials conducted by the ARDSNet. The data was split 3:1 into training and testing subsamples. The discrimination of each ventilator variable was calculated in the testing subsample using the area under receiver operating characteristic curve. The gradient boosting machine was used to examine whether the discrimination could be further improved. RESULTS:A total of 5159 patients with acute onset ARDS were included for analysis. The discrimination of norMP in predicting mortality was significantly better than the absolute MP (p = 0.011 for DeLong's test). The gradient boosting machine was not able to improve the discrimination as compared to norMP (p = 0.913 for DeLong's test). The multivariable regression model showed a significant interaction between norMP and ARDS severity (p < 0.05). While the norMP was not significantly associated with mortality outcome (OR 0.99; 95% CI 0.91-1.07; p = 0.862) in patients with mild ARDS, it was associated with increased risk of mortality in moderate (OR 1.11; 95% CI 1.02-1.23; p = 0.021) and severe (OR 1.13; 95% CI 1.03-1.24; p < 0.008) ARDS. CONCLUSIONS:The study showed that norMP was a good ventilator variable associated with mortality, and its predictive discrimination cannot be further improved with a sophisticated machine learning method. Further experimental trials are needed to investigate whether adjusting ventilator variables according to norMP will significantly improve clinical outcomes.
journal_name
Intensive Care Medjournal_title
Intensive care medicineauthors
Zhang Z,Zheng B,Liu N,Ge H,Hong Ydoi
10.1007/s00134-019-05627-9subject
Has Abstractpub_date
2019-06-01 00:00:00pages
856-864issue
6eissn
0342-4642issn
1432-1238pii
10.1007/s00134-019-05627-9journal_volume
45pub_type
杂志文章abstract::This narrative review focuses on thoracic ultrasonography (lung and pleural) with the aim of outlining its utility for the critical care clinician. The article summarizes the applications of thoracic ultrasonography for the evaluation and management of pneumothorax, pleural effusion, acute dyspnea, pulmonary edema, pu...
journal_title:Intensive care medicine
pub_type: 杂志文章,评审
doi:10.1007/s00134-019-05725-8
更新日期:2019-09-01 00:00:00
abstract:: ...
journal_title:Intensive care medicine
pub_type: 信件
doi:10.1007/s00134-018-5180-2
更新日期:2018-06-01 00:00:00
abstract:PURPOSE:Limited data exist on the correlation between higher flow rates of high-flow nasal cannula (HFNC) and its physiologic effects in patients with acute hypoxemic respiratory failure (AHRF). We assessed the effects of HFNC delivered at increasing flow rate on inspiratory effort, work of breathing, minute ventilatio...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-017-4890-1
更新日期:2017-10-01 00:00:00
abstract:PURPOSE:Chronic pulmonary hypertension (PH) therapy is poorly investigated in intensive care. Our aim was to evaluate haemodynamic and neuroendocrine effects of the dual endothelin-1 (ET-1) blocker tezosentan in monocrotaline (MCT)-induced PH. METHODS:Male Wistar rats (180-200 g, n = 194) randomly received 60 mg kg(-1...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-012-2484-5
更新日期:2012-06-01 00:00:00
abstract::Neuromuscular blocking agents (NMBAs) inhibit patient-initiated active breath and the risk of high tidal volumes and consequent high transpulmonary pressure swings, and minimize patient/ ventilator asynchrony in acute respiratory distress syndrome (ARDS). Minimization of volutrauma and ventilator-induced lung injury (...
journal_title:Intensive care medicine
pub_type: 杂志文章,评审
doi:10.1007/s00134-020-06297-8
更新日期:2020-12-01 00:00:00
abstract::The goals of management of patients with respiratory failure include improving arterial oxygenation with PEEP and red cell transfusion to maintain oxygen carrying capacity, both of which contribute to improving tissue oxygen delivery. However, standard CPD-stored blood is rapidly depleted of 2,3 diphosphoglycerate (2,...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF00315364
更新日期:1986-01-01 00:00:00
abstract:PURPOSE:To assess the utility of two in situ techniques, differential time to positivity (DTP) and semiquantitative superficial cultures (SQSC) for diagnosing catheter-related bloodstream infection (CR-BSI) in critically ill adults. METHODS:This was a prospective cohort study in patients with suspected CR-BSI arising ...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-012-2689-7
更新日期:2013-01-01 00:00:00
abstract:: ...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-018-5213-x
更新日期:2019-01-01 00:00:00
abstract:OBJECTIVE:The aim of the present study was (1) to determine the prevalence of intensive care unit (ICU) admissions due to an adverse drug reaction (ADR), and (2) to compare affected patients with patients admitted to the ICU for the treatment of deliberate self-poisoning using medical drugs. DESIGN:Prospective observa...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-008-1250-1
更新日期:2009-02-01 00:00:00
abstract::Measurements of added inspiratory work (AIW) of breathing imposed by three different CPAP systems were performed in 10 patients. One system was a continuous flow system while the two others were demand flow systems separated from respirators (Ohmeda VD 101 and Draeger CPAP 800 devices). AIW was calculated from pressur...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF00292929
更新日期:1986-01-01 00:00:00
abstract::We present a patient with evidence of severe intravascular hemolysis after mitral valve repair, an established method for the surgical treatment of mitral valve disease to avoid prosthesis related complications. The coincidence of this uncommon complication with hemodynamic instability due to pre-existing myocardial d...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF01694714
更新日期:1993-01-01 00:00:00
abstract::The spread of a multi-resistant glucose-acidifying Acinetobacter calcoaceticus strain in a community hospital was studied. After admission of a colonized patient to the hospital the strain was found in clinical specimens from ICU patients and subsequently from several of these patients after transfer to medical wards....
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF01058568
更新日期:1989-01-01 00:00:00
abstract:OBJECTIVE:To examine the usefulness of preload indices obtained by transoesophageal echocardiography (TOE) for estimating stroke volume at various levels of cardiac index. DESIGN:Prospective clinical study. SETTING:Intensive care unit with surgical patients. PATIENTS:16 ventilated patients monitored via Swan-Ganz ca...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s001340050349
更新日期:1997-04-01 00:00:00
abstract:OBJECTIVE:To determine: (1) the proportion of small (<5 mm) or thrombosed internal jugular veins (IJV) and femoral veins (FV) in which catheter placement would be difficult without ultrasound guidance; (2) which position increases central vein sizes and may facilitate cannulation of these vessels. DESIGN:Prospective s...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-007-0875-9
更新日期:2008-02-01 00:00:00
abstract::The abundance of literature related to nutritional support reflects its recently recognised role in preventing metabolic complications and gut dysfunction during critical illness. However, some published studies lack relevance to critically ill patients, as a result of the selection of subjects and outcome variables, ...
journal_title:Intensive care medicine
pub_type: 杂志文章,评审
doi:10.1007/s00134-002-1581-2
更新日期:2003-02-01 00:00:00
abstract:OBJECTIVE:There is still a lack of knowledge on the age-dependent relation between a reduction in cerebral perfusion pressure (CPP) and compromised brain perfusion leading to excessive transmitter release and brain damage cascades. The hypothesis is that an age-dependent lower threshold of cerebral blood flow (CBF) aut...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-010-1846-0
更新日期:2010-06-01 00:00:00
abstract:OBJECTIVE:The Sonoclot analyser provides global measurement of haemostasis, including plasma coagulation, platelet function and fibrinolysis. Benefits of its use in cardiovascular and hepatic surgery are well-documented and it may be useful in managing obstetric complications. The aim of this study was to determine ran...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s001340050047
更新日期:2000-02-01 00:00:00
abstract:OBJECTIVE:The Pediatric Index of Mortality 2 (PIM2), one of the key mortality prediction models for children in intensive care units, has not been validated in Japan. The purpose of this study was to validate the performance of PIM2 in a population of patients admitted to one pediatric intensive care unit (PICU) in Jap...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-011-2460-5
更新日期:2012-04-01 00:00:00
abstract:OBJECTIVE:The aim of the study was to investigate the effect of lung volume changes on end-expiratory lung impedance change (ELIC) in mechanically ventilated patients, since we hypothesized that ELIC may be a suitable parameter to monitor lung volume change at the bedside. DESIGN:Clinical trial on patients requiring m...
journal_title:Intensive care medicine
pub_type: 临床试验,杂志文章
doi:10.1007/s00134-002-1555-4
更新日期:2003-01-01 00:00:00
abstract:PURPOSE:Because non-invasive mechanical ventilation (NIV) is increasingly used, new devices, both ventilators and interfaces, have been continuously proposed for clinical use in recent years. To provide the clinicians with valuable information about ventilators and interfaces for NIV, several bench studies evaluating a...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-011-2416-9
更新日期:2012-01-01 00:00:00
abstract::Two patients with severe hepatic and renal failure underwent emergency hepatic retransplantation (2nd and 6th day after transplantation). Continuous arteriovenous haemodialysis was begun before surgery and successfully performed, without any incident, during the retransplantation with a biospal (SCU/CAVH AN 69 S) devi...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF01706360
更新日期:1990-01-01 00:00:00
abstract:OBJECTIVE:Comparison of side effects (fever shivering and/or allergic reactions, collapse, symptomatic hypocalcaemia) of the different substitution fluids used during therapeutical plasmapheresis. DESIGN:Multicentric retrospective comparative study designed to explore the side effects due to the replacements fluids (a...
journal_title:Intensive care medicine
pub_type: 杂志文章,多中心研究
doi:10.1007/s001340050595
更新日期:1998-05-01 00:00:00
abstract:OBJECTIVE:To measure the effects of rapid permissive hypercapnia on hemodynamics and gas exchange in patients with acute respiratory distress syndrome (ARDS). DESIGN:Prospective study. SETTING:18-bed, medical intensive care unit, university hospital. PATIENTS:11 mechanically ventilated ARDS patients. INTERVENTION:P...
journal_title:Intensive care medicine
pub_type: 临床试验,杂志文章
doi:10.1007/BF01712235
更新日期:1996-03-01 00:00:00
abstract:OBJECTIVE:To determine the presence of tricuspid regurgitation (TR) in patients affected by acute lung injury (ALI) and the adult respiratory distress syndrome (ARDS) during mechanical ventilation with positive end-expiratory pressure (PEEP). DESIGN:A prospective clinical study. SETTING:10-bed general intensive care ...
journal_title:Intensive care medicine
pub_type: 临床试验,杂志文章
doi:10.1007/s001340050419
更新日期:1997-08-01 00:00:00
abstract:PURPOSE:The effect of advanced age per se versus severity of chronic and acute diseases on the short- and long-term survival of older patients admitted to the intensive care unit (ICU) remains unclear. METHODS:Intensive care unit admissions to the surgical ICU and medical ICU of patients older than 65 years were analy...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-012-2629-6
更新日期:2012-10-01 00:00:00
abstract::We have treated 30 patients with flail chest, with priority given to associated factors (pain, secretions retention, hemo-/pneumothorax and underlying pulmonary contusion). When this treatment was insufficient IMV + PEEP was instituted; in this group there was a 58.8% incidence of pneumonia, 47.5% of sepsis and 11.7 d...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF01687161
更新日期:1980-08-01 00:00:00
abstract:OBJECTIVE:To evaluate the nursing time required for difficult-to-wean patients in a dedicated weaning center (WC) and to examine the correlation of the nursing time with nursing workload (NW) scores and with clinical severity and dependency. SETTING:Four-bed WC of a pulmonary rehabilitation department. INTERVENTION:N...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s001340051249
更新日期:2000-06-01 00:00:00
abstract::A case of brainstem encephalitis complicated by torsade de pointes is described. The possible occurrence of ventricular arrhythmias may contribute to the mortality in this condition. We recommend the admission of patients with brainstem encephalitis to an intensive care unit, for a period of electrocardiographic monit...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF00263564
更新日期:1987-01-01 00:00:00
abstract::Arterial catheterization is the second most common invasive procedure performed in the intensive care unit. Despite the ubiquity of the procedure, complications including failure to place the catheter occur. While many clinicians are familiar with the use of ultrasound (US) guidance to decrease complication rates of c...
journal_title:Intensive care medicine
pub_type: 杂志文章,评审
doi:10.1007/s00134-009-1699-6
更新日期:2010-02-01 00:00:00
abstract::This article was originally published under a CC BY-NC 4.0 license, but has now been made available under a CC BY 4.0 license. The PDF and HTML versions of the paper have been modified accordingly. ...
journal_title:Intensive care medicine
pub_type: 杂志文章,已发布勘误
doi:10.1007/s00134-018-5254-1
更新日期:2018-05-01 00:00:00