C48. MECHANICAL VENTILATION最新文献

{"title":"Static and Dynamic Measures of Respiratory System Mechanics","authors":"P.N.F. Tawfik, M. K. Hayat Syed, F. Elmufdi, M. Evans, D. Dries, J. Marini","doi":"10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a4302","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a4302","url":null,"abstract":"","PeriodicalId":360031,"journal":{"name":"C48. MECHANICAL VENTILATION","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114796649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ICU Clinician Perspectives on Machine Learning and the Implementation of a Mechanical Ventilation Prediction Tool: A Single Center Survey Study","authors":"E. Mlodzinski, G. Wardi, S. Nemati, L. C. Crotty Alexander, A. Malhotra","doi":"10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a4304","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a4304","url":null,"abstract":"Rationale Although there is considerable interest in machine learning (ML) algorithms to improve patient care, implementation of these algorithms into practice has been limited. Our team developed and validated a deep learning algorithm to predict respiratory failure requiring mechanical ventilation in patients in the intensive care unit (ICU), including those with COVID-19. To help optimize implementation of this tool, we developed and disseminated a survey assessing ICU physician perspectives on the acceptability and feasibility of this tool at our institution. Methods We distributed an 8-item survey to 99 critical care trainees and faculty at our institution via email. The survey consisted of 6 multiple choice and 2 free response questions, with an ordinal scale of 1-5 used in perception-based questions. The survey was designed in accordance with international recommendations for web-based surveys. Our survey was reviewed for completeness by a team of critical care, machine learning, and implementation science experts. Data were collected over a 2- week period in May of 2021. This survey was anonymous and exempt from IRB review. Results Fifty-three critical care physicians (53.5% of providers contacted) started the survey, and of these, 88.7% (47/53) completed the survey. Fifty-nine percent (n=31) of respondents were attendings, 36% (n=19) fellows, and 3.7% (n=2) residents. Baseline knowledge of ML was low (mean= 2.40/5), with only 7.5% (n=4) of respondents rating their knowledge as a 4 or 5. Fifteen percent (n=8) had knowingly used an ML-based tool in their clinical practice. Confidence in predicting the need for mechanical ventilation due to COVID-19 (mean=3.57/5) was slightly lower than for respiratory failure due to all other causes (mean=3.89/5). Overall willingness to utilize an ML-based algorithm was favorable (mean=3.32/5). Factors most likely to increase likelihood of utilization were “high quality evidence that it outperformed trained clinicians” (mean=4.28/5), “transparency of the data utilized” (mean= 4.13/5), and “limited workflow interruption” (mean=4.09/5). Shared concerns from participants included “alarm fatigue” and “workflow interruption.” Conclusion The results suggest that ICU physicians have had limited exposure to ML-based tools, but feel such a tool would be beneficial in the context of predicting need for mechanical ventilation in ICU patients and those with COVID-19. Evidence of the tool's efficacy and data transparency were high priorities for respondents, and there was concern over workflow interruptions. This survey provided a baseline assessment of physician acceptance of a novel ML-based tool, which will be crucial in optimizing its implementation into clinical practice at our institution.","PeriodicalId":360031,"journal":{"name":"C48. MECHANICAL VENTILATION","volume":"60 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126011964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes Associated with Asthma Exacerbations with Respiratory Failure Treated with Extracorporeal Membrane Oxygenation","authors":"J. Zakrajsek, A. Kannappan, P. Sottile, T. Kiser, R. Allen, Shenxiao Min, M. Althoff, M. Ho, P. Reynolds, E. Burnham, M. Moss, R. Vandivier","doi":"10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a5818","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a5818","url":null,"abstract":"Rationale: Asthma affects 20 million adults in the United States resulting in up to 500,000 hospitalizations each year. Patients admitted to the intensive care unit (ICU) for asthma exacerbations requiring invasive ventilation have a mortality of ∼7%. Extracorporeal membrane oxygenation (ECMO) is a salvage technique used in patients with respiratory failure to increase delivery of oxygen, remove CO2 and allow time for recovery. Case series and uncontrolled registry studies have examined benefits of ECMO for asthma exacerbations with respiratory failure, but no studies have examined outcomes associated with use of ECMO for asthma exacerbations compared to standard care. Objective: To assess outcomes associated with use of ECMO during asthma exacerbations requiring invasive ventilation compared to standard care. Methods: Patients were extracted from the Premier Database from 2010-2020 if they had a primary diagnosis of asthma, or a primary diagnosis of respiratory failure with a secondary diagnosis of asthma, and were treated with invasive ventilation. Patients were excluded for age < 18y, no ICU admission, chronic lung disease other than asthma, COVID-19, or if they were not treated with corticosteroids. Hospital mortality was the primary study outcome. Key secondary outcomes included ICU length of stay (LOS), hospital LOS, length of invasive ventilation and hospital costs. Differences in outcomes were assessed using propensity score matching at a 1:2 ratio of ECMO versus no ECMO, and by covariate adjustment of the entire study group. Results: A total of 20,494 patients with asthma exacerbations requiring invasive ventilation were included in the study, of which 130 were treated with ECMO and 20,364 were not. After propensity matching, ECMO (N=103) versus no ECMO (N=206) was associated with reduced mortality (11.4% vs. 23.3%, p = 0.017) and increased hospital costs, but no difference in ICU LOS, hospital LOS or length of mechanical ventilation (Table). The covariate-adjusted model replicated these findings (Table). When individual patients were assigned a probability of being treated with ECMO equal to the hospital rate where they were admitted, each 10% increase in the hospital rate of ECMO was associated with no change in the odds of mortality (OR, 1.12: 95% CI, 0.82-1.52), p=0.48). ECMO was also associated with increased renal replacement therapy (P = 0.02), shock (P=0.02) and 30-day all-cause readmission (P = 0.01). Conclusion: ECMO was associated with reduced mortality at the cost of increased morbidity in asthmatics requiring invasive ventilation, indicating that ECMO has the potential to save thousands of lives.","PeriodicalId":360031,"journal":{"name":"C48. MECHANICAL VENTILATION","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127696715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Utility of Respiratory Rate-Oxygenation (ROX) Index at Admission in Acute Hypoxic Respiratory Failure Patients","authors":"M. Anil Kumar, P. Addanki, D. Grover, D. Datta","doi":"10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a4301","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a4301","url":null,"abstract":"","PeriodicalId":360031,"journal":{"name":"C48. MECHANICAL VENTILATION","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127829937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does the ROX Index Correlate with the Rapid Shallow Breathing Index as a Predictor of Successful Extubation?","authors":"D. Grover, M. Anilkumar, P. Addanki, D. Datta","doi":"10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a4311","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a4311","url":null,"abstract":"","PeriodicalId":360031,"journal":{"name":"C48. MECHANICAL VENTILATION","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130663078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Novel Active Airway Humidification Technology Device (RespirAq®) for Ventilated Patients: A Feasibility Study","authors":"M. Moylan, R. Martynoga, D. McCormack, H. Cunningham, S. Grau Bartual","doi":"10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a4310","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a4310","url":null,"abstract":"","PeriodicalId":360031,"journal":{"name":"C48. MECHANICAL VENTILATION","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128826403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lung Ultrasound for Diagnosis of Acute Respiratory Distress Syndrome - A Prospective Observational Study","authors":"M. Smit, L. Hagens, N. Heijnen, L. Pisani, F. Paulus, R. Schnabel, M. Schultz, D. Bergmans, L. Bos, DARTS Consortium","doi":"10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a5733","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a5733","url":null,"abstract":"","PeriodicalId":360031,"journal":{"name":"C48. MECHANICAL VENTILATION","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130554699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tracheostomy in Patients on VV-ECMO for Acute Respiratory Failure with High Body Mass Index and High Positive End-Expiratory Pressure","authors":"C. Zheng, C. Rackley","doi":"10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a4312","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a4312","url":null,"abstract":"","PeriodicalId":360031,"journal":{"name":"C48. MECHANICAL VENTILATION","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116426171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic Critical Illness: Continuous Improvement at a Regional Weaning Center","authors":"M. Hassenpflug, D. R. Nelson, J. Steckart","doi":"10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a4303","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a4303","url":null,"abstract":"","PeriodicalId":360031,"journal":{"name":"C48. MECHANICAL VENTILATION","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133515530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adequate Pressure Setting of Mechanical In-Exsufflation in ALS Patients with Tracheostomy","authors":"W. Choi, H. Cho, D.H. Kim, S. Yoon, S. Kang","doi":"10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a4306","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a4306","url":null,"abstract":"","PeriodicalId":360031,"journal":{"name":"C48. MECHANICAL VENTILATION","volume":"49 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116484743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}