Abstract:
OBJECTIVE:To explore the potential value of heart rate variability features for automated monitoring of sedation levels in mechanically ventilated ICU patients. DESIGN:Multicenter, pilot study. SETTING:Several ICUs at Massachusetts General Hospital, Boston, MA. PATIENTS:Electrocardiogram recordings from 40 mechanically ventilated adult patients receiving sedatives in an ICU setting were used to develop and test the proposed automated system. MEASUREMENTS AND MAIN RESULTS:Richmond Agitation-Sedation Scale scores were acquired prospectively to assess patient sedation levels and were used as ground truth. Richmond Agitation-Sedation Scale scores were grouped into four levels, denoted "unarousable" (Richmond Agitation- Sedation Scale = -5, -4), "sedated" (-3, -2, -1), "awake" (0), "agitated" (+1, +2, +3, +4). A multiclass support vector machine algorithm was used for classification. Classifier training and performance evaluations were carried out using leave-oneout cross validation. An overall accuracy of 69% was achieved for discriminating between the four levels of sedation. The proposed system was able to reliably discriminate (accuracy = 79%) between sedated (Richmond Agitation-Sedation Scale < 0) and nonsedated states (Richmond Agitation-Sedation Scale > 0). CONCLUSIONS:With further refinement, the methodology reported herein could lead to a fully automated system for depth of sedation monitoring. By enabling monitoring to be continuous, such technology may help clinical staff to monitor sedation levels more effectively and to reduce complications related to over- and undersedation.
journal_name
Crit Care Medjournal_title
Critical care medicineauthors
Nagaraj SB,McClain LM,Zhou DW,Biswal S,Rosenthal ES,Purdon PL,Westover MBdoi
10.1097/CCM.0000000000001708subject
Has Abstractpub_date
2016-09-01 00:00:00pages
e782-9issue
9eissn
0090-3493issn
1530-0293journal_volume
44pub_type
杂志文章,多中心研究abstract:OBJECTIVES:Light chains κ and λ are immunoglobulin constituents but also circulate independently in blood as free light chains. We investigated whether a concomitant abnormality in free light chain and immunoglobulin levels could identify a high risk of death sepsis subpopulation to inform future IV immunoglobulin tria...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000002627
更新日期:2017-11-01 00:00:00
abstract:OBJECTIVE:To assess the influence of private attending physician status on the withdrawal of life-sustaining interventions among patients dying within a medical intensive care unit (ICU). DESIGN:Retrospective cohort analysis. SETTING:An academic tertiary care center. PATIENTS:One hundred fifty-nine consecutive patie...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199606000-00016
更新日期:1996-06-01 00:00:00
abstract:OBJECTIVE:Information booklets have not been assessed by the families of intensive care unit (ICU) patients. This study explored the information that the relatives of adult ICU patients wanted to find in the information booklets. DESIGN:Multicenter survey. SETTING:Twenty-three French ICUs. SUBJECTS:One close relativ...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/CCM.0b013e3181a03063
更新日期:2009-07-01 00:00:00
abstract:OBJECTIVE:A comparison of federal Medicare databases to identify critical care medicine (CCM) use, cost discrepancies, and their possible causes. DESIGN:A 6-yr (1995-2000) retrospective analysis of Medicare hospital and CCM use and cost, comparing the Hospital Cost Report Information System (HCRIS) with Medicare Provi...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000257255.57899.5D
更新日期:2007-03-01 00:00:00
abstract:BACKGROUND:Endotoxin (lipopolysaccharide [LPS]) has been associated with sepsis and the high mortality rate seen in septic shock. The administration of a small amount of LPS to healthy subjects produces a mild syndrome qualitatively similar to that seen in clinical sepsis. We used this model to test the efficacy of an ...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00003246-200008000-00005
更新日期:2000-08-01 00:00:00
abstract:OBJECTIVE:To test the effects of three hemoglobin solutions on liver function and hepatic morphology after resuscitation from severe hemorrhagic shock. DESIGN:Prospective study. SETTING:Laboratory. SUBJECTS:Thirty-three beagle dogs. INTERVENTION:Hemorrhagic shock was induced in anesthetized dogs by removal of blood...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199604000-00019
更新日期:1996-04-01 00:00:00
abstract::We previously reported increased lipid peroxide and decreased alpha-tocopherol levels in the blood of critically ill septic patients. To clarify these results, we investigated lipid peroxidation in experimental septic rats and severely traumatized rats. In septic rats, both platelet count and plasma alpha-tocopherol d...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198608000-00010
更新日期:1986-08-01 00:00:00
abstract:OBJECTIVES:Survivors of critical illness in early life are at risk of long-term-memory and attention impairments. However, their neurobiologic substrates remain largely unknown. DESIGN:A prospective follow-up study. SETTING:Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands. PATIENTS:Thirty-eight scho...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000002553
更新日期:2017-10-01 00:00:00
abstract:OBJECTIVES:The emergency department is an important venue for initial sepsis recognition and care. We sought to determine contemporary estimates of the epidemiology of U.S. emergency department visits for sepsis. DESIGN:Analysis of data from the National Hospital Ambulatory Medical Care Survey. SETTING:U.S. emergency...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000002538
更新日期:2017-09-01 00:00:00
abstract:OBJECTIVE:To compare the effects of two different antibiotic regimes on the colonization and infection rates of critically ill pediatric patients. DESIGN:A prospective randomized trial. SETTING:A pediatric ICU in a university hospital. PATIENTS:Fifty critically ill pediatric patients who required intensive care for ...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00003246-199110000-00005
更新日期:1991-10-01 00:00:00
abstract:OBJECTIVE:To evaluate the physiology and pharmacokinetics of a novel hemoglobin-based oxygen carrier of bovine origin. DESIGN:Randomized, single-blind, placebo-controlled, dose-escalation study. SETTING:The Upjohn Research Clinics (Kalamazoo, MI). SUBJECTS:Normal healthy adult men between the ages of 18 and 45 yrs. ...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00003246-199605000-00006
更新日期:1996-05-01 00:00:00
abstract::Prolonged artificial ventilation may result in worsening gas exchange and pulmonary compliance in patients with otherwise normal lungs. Prolonged hyperinflations to 40 cm H2O can completely reverse deterioration of gas exchange and compliance in such patients. Similar efforts have effectively recruited atelectatic lun...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198712000-00001
更新日期:1987-12-01 00:00:00
abstract:OBJECTIVE:To simultaneously determine perceived vs. practiced adherence to recommended interventions for the treatment of severe sepsis or septic shock. DESIGN:One-day cross-sectional survey. SETTING:Representative sample of German intensive care units stratified by hospital size. PATIENTS:Adult patients with severe...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e318186b6f3
更新日期:2008-10-01 00:00:00
abstract::Although recent clinical reports have noted hypokalemia after resuscitation from cardiac arrest, extensive animal work indicates that potassium is released from cells during ischemia. This study was undertaken to define the changes that occur in serum potassium ion during cardiac arrest and resuscitation in a canine m...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198604000-00012
更新日期:1986-04-01 00:00:00
abstract:OBJECTIVE:Pulmonary air embolism, causing vessel obstruction and primary or secondary reactions of blood, can lead to acute lung injury. In addition, nitric oxide has been known to play a key role in various causes of lung injury. In this study we employed the isolated rat lung model to investigate the effects of l-arg...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.ccm.0000178175.54354.ea
更新日期:2005-09-01 00:00:00
abstract::One hundred patients were ventilated with high-frequency jet ventilation (HFJV) during the initial 24-h postoperative period in the surgical and neurosurgical ICUs. Eighty-three were successfully weaned, 2 could not be ventilated adequately with HFJV, and 15 with criteria of acute respiratory failure received HFJV for...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198409000-00022
更新日期:1984-09-01 00:00:00
abstract:OBJECTIVE:To determine the ability of somatosensory evoked potentials (SEP) compared with clinical findings to monitor and predict recovery in patients suffering from closed head injury with predominantly diffuse axonal injury (DAI). DESIGN:Prospective cohort study. SETTING:Neurologic intensive care unit (ICU) of a u...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200103000-00005
更新日期:2001-03-01 00:00:00
abstract:OBJECTIVE:To evaluate the role of amino acid profiles in septic encephalopathy. DESIGN:Retrospective analysis. SETTING:Medical wards and medical ICU of a university hospital. PATIENTS:Patients with infections and normal mental status were compared with patients with septic shock and altered sensorium. INTERVENTIONS...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199106000-00004
更新日期:1991-06-01 00:00:00
abstract::Serum ionized calcium (Ca+2), creatinine, magnesium, phosphate, and arterial pH were measured in patients on admission to the medical ICU (MICU). Patients were classified into three groups: a) hypotensive (n = 38), those who received vasopressor support for frank hypotension; b) hypertensive (n = 21), those who requir...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198806000-00002
更新日期:1988-06-01 00:00:00
abstract:OBJECTIVE:Exposure of neutrophils to low doses of bacterial lipopolysaccharides enhances their readiness to respond with inflammatory mediator generation including oxygen radical formation to a subsequently applied inflammatory stimulus ("priming"). In the present study, we investigated the role of lipid mediator synth...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200210000-00020
更新日期:2002-10-01 00:00:00
abstract:OBJECTIVE:To assess the number of adult critical care beds in Asian countries and regions in relation to population size. DESIGN:Cross-sectional observational study. SETTING:Twenty-three Asian countries and regions, covering 92.1% of the continent's population. PARTICIPANTS:Ten low-income and lower-middle-income eco...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000004222
更新日期:2020-05-01 00:00:00
abstract:OBJECTIVE:To examine the ways in which healthcare professionals work together in the ICU setting, through a consideration of the contextual, organizational, processual, and relational factors that impact their interprofessional collaboration. DESIGN:Data from over 350 hours of ethnographic observation and 35 semistruc...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000001136
更新日期:2015-09-01 00:00:00
abstract:OBJECTIVES:To evaluate the methodological quality and thematic completeness of existing clinical practice guidelines, addressing early mobilization of adults in the ICU. DATA SOURCES:Systematic review of Medline, Embase, CINAHL, Cochrane, and grey literature from January 2008 to February 2020. STUDY SELECTION:Two rev...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000004574
更新日期:2020-11-01 00:00:00
abstract:OBJECTIVE:To evaluate if the up-regulation of vascular endothelial growth factor strengthens the protective effect of amniotic fluid stem cells in a renal ischemia-reperfusion injury model. DESIGN:Randomized animal study. SETTINGS:University research laboratory. SUBJECTS:A total of 40 males 12-week-old Wistar rats w...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000002020
更新日期:2017-01-01 00:00:00
abstract:BACKGROUND:Resuscitation from hemorrhagic shock (HS) predisposes to subsequent infections. Susceptibility to infection following sepsis has been attributed to apoptosis. Interleukin (IL)-6 has been shown to have antiapoptotic properties and to decrease postresuscitation inflammation in rodent and porcine models of HS. ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.ccm.0000201901.30292.c2
更新日期:2006-03-01 00:00:00
abstract::To achieve synchronized differential pulmonary ventilation, an Ohio 560 ventilator was modified through separation of the outputs of the deep breath bellows and the tidal volume bellows and providing independent volume, flow rate, PEEP, oxygen-humidification, and alarm systems. The described ventilator modification is...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198106000-00012
更新日期:1981-06-01 00:00:00
abstract:OBJECTIVE:To evaluate the use of the selective alpha 1-adrenergic receptor agonist phenylephrine in the hemodynamic support of patients with septic shock. DESIGN:Retrospective analysis of clinical use of phenylephrine. SETTING:Surgical ICU in a university hospital. PATIENTS:Thirteen patients with septic shock (diagn...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199111000-00016
更新日期:1991-11-01 00:00:00
abstract:OBJECTIVE:To describe a case of intentional ingestion of hand sanitizer in our hospital and to review published cases and those reported to the American Association of Poison Control Centers' National Poison Data System. DESIGN:A case report, a literature review of published cases, and a query of the National Poison D...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/CCM.0b013e31822f09c0
更新日期:2012-01-01 00:00:00
abstract:OBJECTIVES:To evaluate the timing of foregoing life-sustaining treatments in patients enrolled in a sepsis trial and to determine their influence on patient outcome and trial results. DESIGN:Subset of patients in a prospective, randomized, double-blind, placebo-controlled study. SETTING:Twenty-three academic medical ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199703000-00002
更新日期:1997-03-01 00:00:00
abstract:OBJECTIVES:Granulocyte transfusions have been used to treat immune cell dysfunction in sepsis. As granulocyte transfusions can trigger tissue injury via local effects of neutrophils, we hypothesized that extracorporeal treatment of plasma using granulocytes would prove beneficial while having less side effects. DESIGN...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e318194aa77
更新日期:2009-02-01 00:00:00