Acute and Critical Care最新文献_第4页

Red blood cell transfusion for critically ill patients admitted through the emergency department in South Korea. 韩国急诊科收治的危重病人的红细胞输注。

IF 1.7

Acute and Critical Care Pub Date : 2024-11-01 Epub Date: 2024-11-05 DOI: 10.4266/acc.2024.00577

Tae Sung Kim, Yongil Cho, Hyuk Joong Choi, Joonbum Park, Wonhee Kim, Chiwon Ahn, Joon Young Kim

{"title":"Red blood cell transfusion for critically ill patients admitted through the emergency department in South Korea.","authors":"Tae Sung Kim, Yongil Cho, Hyuk Joong Choi, Joonbum Park, Wonhee Kim, Chiwon Ahn, Joon Young Kim","doi":"10.4266/acc.2024.00577","DOIUrl":"10.4266/acc.2024.00577","url":null,"abstract":"Background: Red blood cells (RBCs) are a limited resource, and the adverse effects of transfusion must be considered. Multiple randomized controlled trials on transfusion thresholds have been conducted, leading to the establishment of a restrictive transfusion strategy. This study aimed to investigate the status of RBC transfusions in critically ill patients.Methods: This cohort study was conducted at five university hospitals in South Korea. From December 18, 2022, to November 30, 2023, 307 nontraumatic, anemic patients admitted to intensive care units through the emergency departments were enrolled. We determined whether patients received RBC transfusion, transfusion triggers, and the clinical results.Results: Of the 154 patients who received RBC transfusions, 71 (46.1%) had a hemoglobin level of 7 or higher. Triggers other than hemoglobin level included increased lactate levels in 75 patients (48.7%), tachycardia in 47 patients (30.5%), and hypotension in 46 patients (29.9%). The 28-day mortality rate was not significantly reduced in the group that received transfusions compared to the non-transfusion group (21.4% vs. 26.8%, P=0.288). There was no difference in the intensive care unit and hospital length of stay or the proportion of survival to discharge between the two groups. The prognosis showed the same pattern in various subgroups.Conclusions: Despite the large number of RBC transfusions used in contradiction to the restrictive strategy, there was no notable difference in the prognosis of critically ill patients. To minimize unnecessary RBC transfusions, the promotion of transfusion guidelines and research on transfusion criteria that reflect individual patient conditions are required.","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":"517-525"},"PeriodicalIF":1.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11617848/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142669625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Isolated reversible mydriasis was associated with the use of nebulized ipratropium bromide: a case series using quantitative pupilometer in Korea. 与使用雾化异丙托溴铵有关的孤立性可逆性瞳孔散大：韩国使用定量瞳孔计的病例系列。

IF 1.7

Acute and Critical Care Pub Date : 2024-11-01 Epub Date: 2024-11-20 DOI: 10.4266/acc.2024.00983

Soo-Hyun Park, Tae Jung Kim, Sang-Bae Ko

{"title":"Isolated reversible mydriasis was associated with the use of nebulized ipratropium bromide: a case series using quantitative pupilometer in Korea.","authors":"Soo-Hyun Park, Tae Jung Kim, Sang-Bae Ko","doi":"10.4266/acc.2024.00983","DOIUrl":"10.4266/acc.2024.00983","url":null,"abstract":"Background: Abnormal pupillary reactivity is a neurological emergency requiring prompt evaluation to identify its underlying causes. Although isolated unilateral mydriasis without accompanying neurological abnormalities is rare, it has occasionally been associated with nebulizer use. We aimed to quantitatively assess pupillary changes using a pupillometer in cases of isolated mydriasis, which has not been described in previous studies.Methods: We retrospectively analyzed patients who developed unilateral mydriasis after using an ipratropium bromide nebulizer using a prospectively collected database in the intensive care unit (ICU) between April 2019 and August 2020. An automated pupillometer (NPi-100 or NPi-200) was used for quantitative pupillary assessment. The Neurological Pupil index (NPi) value at the time of unilateral mydriasis was assessed, and the latency before and after the application of the ipratropium bromide nebulizer was measured.Results: Five patients with isolated mydriasis were identified (mean age, 68 years; male, 60.0%), none of whom had neurological abnormalities other than pupillary light reflex abnormalities. A quantitative pupillometer examination revealed that the affected pupil was larger (5.67 mm vs. 3.20 mm) and had lower NPi values (0.60 vs. 3.40) than the unaffected side. These abnormalities resolved spontaneously without treatment (pupil size, 3.40 mm; NPi, 3.90). The affected pupil had a prolonged latency of 0.38 seconds (vs. 0.28 seconds), which improved to 0.30 seconds with the resolution of the anisocoria.Conclusions: In the ICU setting, it is important to keep in mind the ipratropium bromide nebulizer as the benign cause of unilateral mydriasis. Further, an automated pupilometer may be a useful tool for evaluating unilateral mydriasis.","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":"593-599"},"PeriodicalIF":1.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11617845/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142716426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Challenges of implementing the hour-1 sepsis bundle: a qualitative study from a secondary hospital in Indonesia. 实施 1 小时败血症束的挑战：印度尼西亚一家二级医院的定性研究。

IF 1.7

Acute and Critical Care Pub Date : 2024-11-01 Epub Date: 2024-11-27 DOI: 10.4266/acc.2023.01473

Priyo Sasmito, Satriya Pranata, Rian Adi Pamungkas, Etika Emaliyawati, Nisa Arifani

{"title":"Challenges of implementing the hour-1 sepsis bundle: a qualitative study from a secondary hospital in Indonesia.","authors":"Priyo Sasmito, Satriya Pranata, Rian Adi Pamungkas, Etika Emaliyawati, Nisa Arifani","doi":"10.4266/acc.2023.01473","DOIUrl":"10.4266/acc.2023.01473","url":null,"abstract":"Background: Good sepsis management is key to successful sepsis therapy and optimal patient outcomes. Objectives: This study aimed to determine obstacles among nurses and doctors to implementing the hour-1 sepsis bundle in a secondary hospital in Indonesia.Methods: This was a qualitative study with a phenomenological approach. Data were obtained from one-on-one in-depth interviews with 13 doctors and nurses in the intensive care unit and emergency department who were purposively sampled. Data were analyzed using content analysis.Results: Five main themes were revealed in the analysis: incomplete implementation of the hour-1 sepsis bundle, lack of knowledge about the hour-1 sepsis bundle, cost issues, lack of supporting facilities, and lack of coordination among health workers.Conclusions: Optimizing regional health laboratories, optimizing the use of quick Sequential Organ Failure Assessment (qSOFA) and SOFA, and creating a series of sepsis protocols within the hospital are some solutions that secondary hospitals can implement to ensure appropriate management of sepsis cases. Involvement of health policyholders and hospital management is needed to address these challenges.","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":"545-553"},"PeriodicalIF":1.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11617843/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142733335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Incidence of hypoglycemia in hyperkalemia patients after treatment with insulin and dextrose in the emergency department of a tertiary care hospital in India: a prospective observational study. 印度一家三级医院急诊科高钾血症患者接受胰岛素和葡萄糖治疗后的低血糖发生率：一项前瞻性观察研究。

IF 1.7

Acute and Critical Care Pub Date : 2024-11-01 Epub Date: 2024-11-22 DOI: 10.4266/acc.2024.00661

Vivek Chaurasia, Nayer Jamshed, Praveen Aggrawal, Sanjeev Bhoi, Meera Ekka, Tej Prakash Sinha, Akshay Kumar, Prakash Ranjan Mishra, Anand Kumar Das

{"title":"Incidence of hypoglycemia in hyperkalemia patients after treatment with insulin and dextrose in the emergency department of a tertiary care hospital in India: a prospective observational study.","authors":"Vivek Chaurasia, Nayer Jamshed, Praveen Aggrawal, Sanjeev Bhoi, Meera Ekka, Tej Prakash Sinha, Akshay Kumar, Prakash Ranjan Mishra, Anand Kumar Das","doi":"10.4266/acc.2024.00661","DOIUrl":"10.4266/acc.2024.00661","url":null,"abstract":"Background: Hypoglycemia is a serious, often overlooked complication of treating hyperkalemia with insulin and dextrose. If not recognized and managed, it can increase morbidity and mortality. This study aimed to estimate the incidence of hypoglycemia in hyperkalemic patients treated with 10 units of intravenous insulin, 50 ml of 50% dextrose, 10 ml of 10% calcium gluconate, and salbutamol nebulization. Additionally, the timing of hypoglycemia onset and its associated factors were studied.Methods: This prospective observational study included hyperkalemic patients (serum potassium >5.5 mmol/L) who visited the emergency department between January 26, 2020, and August 26, 2021. The primary outcome was hypoglycemia (blood glucose <70 mg/dl) within 3 hours of receiving the standard treatment. Glucose levels were measured hourly for 3 hours. Univariate and multivariate logistic regression identified factors associated with hypoglycemia.Results: Of 100 patients, 69% were male, and the median age was 46 years (IQR, 30-60 years). Hypoglycemia occurred in 44%, and 10% developed severe hypoglycemia (blood glucose <54 mg/dl). The median time for hypoglycemia onset was 2 hours (IQR, 1-2 hours). Low pretreatment blood glucose (<100 mg/dl) was significantly associated with hypoglycemia, according to both univariate and multivariate analyses.Conclusions: The study found a higher incidence of hypoglycemia in hyperkalemia treatment than reported in retrospective studies, suggesting the need for standardized management protocols with integrated glucose monitoring.","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":"499-506"},"PeriodicalIF":1.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11617841/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142733341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The efficacy of intensivist-led closed-system intensive care units in improving outcomes for cancer patients requiring emergent surgical intervention. 重症监护医师主导的封闭式重症监护病房在改善需要紧急手术干预的癌症患者预后方面的疗效。

IF 1.7

Acute and Critical Care Pub Date : 2024-11-01 Epub Date: 2024-11-28 DOI: 10.4266/acc.2024.01256

Eun Young Kim

引用次数: 0

Striving for excellence in ventilator bundle compliance through continuous quality improvement initiative in the intensive care unit of a tertiary care hospital in India. 印度一家三甲医院重症监护室通过持续质量改进措施，在遵守呼吸机捆绑规定方面精益求精。

IF 1.7

Acute and Critical Care Pub Date : 2024-11-01 Epub Date: 2024-11-12 DOI: 10.4266/acc.2024.00101

Naveen Paliwal, Pooja Bihani, Rishabh Jaju, Sadik Mohammed, Prabhu Prakash, Vidya Tharu

{"title":"Striving for excellence in ventilator bundle compliance through continuous quality improvement initiative in the intensive care unit of a tertiary care hospital in India.","authors":"Naveen Paliwal, Pooja Bihani, Rishabh Jaju, Sadik Mohammed, Prabhu Prakash, Vidya Tharu","doi":"10.4266/acc.2024.00101","DOIUrl":"10.4266/acc.2024.00101","url":null,"abstract":"Background: Ventilator-associated pneumonia (VAP) is a significant nosocomial infection in intensive care units (ICUs). Ventilator bundle (VB) implementation has been shown to decrease the incidence of VAP. This study presents a 1-year quality improvement (QI) project conducted in the ICU of a tertiary care hospital with the goal of increasing VB compliance to greater than 90% and evaluating its impact on VAP incidence and ICU length of stay.Methods: A series of Plan-Do-Study-Act (PDSA) cycles, including educational boot camps, checklist implementation, and simulation-based training, was implemented. Emphasis on standardization and documentation for each VB component further improved compliance. Data were compared using a chi-square test, unpaired t-test, or Mann-Whitney U-Test, as appropriate. A P-value <0.05 was considered statistically significant.Results: The initial observed compliance was 40.7%, with a significant difference between knowledge and implementation. The compliance increased to 90% after the second PDSA cycle. In the third PDSA cycle, uniformity and standardization of all components of VAP were ensured. After increasing the VB compliance at greater than 90%, there was a significant decline in the incidence of VAP, from 62.4/1,000 ventilatory days to 25.7/1,000 ventilatory days, with a 2.34 times risk reduction in the VAP rate (P= 0.004).Conclusions: The study highlights the effectiveness of a structured QI approach in enhancing VB compliance and reducing VAP incidence. There is a need for continued education, protocol standardization, and continuous monitoring to ensure the sustainability of this implementation.","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":"535-544"},"PeriodicalIF":1.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11617846/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142669626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Effects of closed- versus open-system intensive care units on mortality rates in patients with cancer requiring emergent surgical intervention for acute abdominal complications: a single-center retrospective study in Korea. 封闭式与开放式重症监护病房对因急性腹部并发症需要紧急手术治疗的癌症患者死亡率的影响：韩国一项单中心回顾性研究。

IF 1.7

Acute and Critical Care Pub Date : 2024-11-01 Epub Date: 2024-11-25 DOI: 10.4266/acc.2024.00808

Jae Hoon Lee, Jee Hee Kim, Ki Ho You, Won Ho Han

{"title":"Effects of closed- versus open-system intensive care units on mortality rates in patients with cancer requiring emergent surgical intervention for acute abdominal complications: a single-center retrospective study in Korea.","authors":"Jae Hoon Lee, Jee Hee Kim, Ki Ho You, Won Ho Han","doi":"10.4266/acc.2024.00808","DOIUrl":"10.4266/acc.2024.00808","url":null,"abstract":"Background: In this study, we aimed to compare the in-hospital mortality of patients with cancer who experienced acute abdominal complications that required emergent surgery in open (treatment decisions made by the primary attending physician of the patient's admission department) versus closed (treatment decisions made by intensive care unit [ICU] intensivists) ICUs.Methods: This retrospective, single-center study enrolled patients with cancer admitted to the ICU before or after emergency surgery between November 2020 and September 2023. Univariate and logistic regression analyses were conducted to explore the associations between patient characteristics in the open and closed ICUs and in-hospital mortality.Results: Among the 100 patients (open ICU, 49; closed ICU, 51), 23 died during hospitalization. The closed ICU group had higher Acute Physiology and Chronic Health Evaluation (APACHE) II scores, vasopressor use, mechanical ventilation, and preoperative lactate levels and a shorter duration from diagnosis to ICU admission, surgery, and antibiotic administration than the open ICU group. Univariate analysis linked in-hospital mortality and APACHE II score, postoperative lactate levels, continuous renal replacement therapy (CRRT), and mechanical ventilation. Multivariate analysis revealed that in-hospital mortality rate increased with CRRT use and was lower in the closed ICU.Conclusions: Compared to an open ICU, a closed ICU was an independent factor in reducing in-hospital mortality through prompt and appropriate treatment.","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":"554-564"},"PeriodicalIF":1.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11617842/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142733336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Left ventricle unloading during veno-arterial extracorporeal membrane oxygenation: review with updated evidence. 静脉-动脉体外膜氧合过程中的左心室卸荷：最新证据综述。

IF 1.7

Acute and Critical Care Pub Date : 2024-11-01 Epub Date: 2024-11-18 DOI: 10.4266/acc.2024.00801

Yongwhan Lim, Min Chul Kim, In-Seok Jeong

{"title":"Left ventricle unloading during veno-arterial extracorporeal membrane oxygenation: review with updated evidence.","authors":"Yongwhan Lim, Min Chul Kim, In-Seok Jeong","doi":"10.4266/acc.2024.00801","DOIUrl":"10.4266/acc.2024.00801","url":null,"abstract":"Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is widely used to treat medically refractory cardiogenic shock and cardiac arrest, and its usage has increased exponentially over time. Although VA-ECMO has many advantages over other mechanical circulatory supports, it has the unavoidable disadvantage of increasing retrograde arterial flow in the afterload, which causes left ventricular (LV) overload and can lead to undesirable consequences during VA-ECMO treatment. Weak or no antegrade flow without sufficient opening of the aortic valve increases the LV end-diastolic pressure, and that can cause refractory pulmonary edema, blood stagnation, thrombosis, and refractory ventricular arrhythmia. This hemodynamic change is also related to an increase in myocardial energy consumption and poor recovery, making LV unloading an essential management issue during VA-ECMO treatment. The principal factors in effective LV unloading are its timing, indications, and modalities. In this article, we review why LV unloading is required, when it is indicated, and how it can be achieved.","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":"473-487"},"PeriodicalIF":1.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11617839/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142716642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Increased red cell distribution width predicts mortality in COVID-19 patients admitted to a Dutch intensive care unit. 红细胞分布宽度增加可预测入住荷兰重症监护病房的 COVID-19 患者的死亡率。

IF 1.7

Acute and Critical Care Pub Date : 2024-08-01 Epub Date: 2024-08-22 DOI: 10.4266/acc.2023.01137

Anthony D Mompiere, Jos L M L le Noble, Manon Fleuren-Janssen, Kelly Broen, Frits van Osch, Norbert Foudraine

{"title":"Increased red cell distribution width predicts mortality in COVID-19 patients admitted to a Dutch intensive care unit.","authors":"Anthony D Mompiere, Jos L M L le Noble, Manon Fleuren-Janssen, Kelly Broen, Frits van Osch, Norbert Foudraine","doi":"10.4266/acc.2023.01137","DOIUrl":"https://doi.org/10.4266/acc.2023.01137","url":null,"abstract":"Background: Abnormal red blood cell distribution width (RDW) is associated with poor cardiovascular, respiratory, and coronavirus disease 2019 (COVID-19) outcomes. However, whether RDW provides prognostic insights regarding COVID-19 patients admitted to the intensive care unit (ICU) was unknown. Here, we retrospectively investigated the association of RDW with 30-day and 90- day mortalities, duration of mechanical ventilation, and length of ICU and hospital stay in patients with COVID-19.Methods: This study included 321 patients with COVID-19 aged >18 years who were admitted to the ICU between March 2020 and July 2022. The outcomes were mortality, duration of mechanical ventilation, and length of stay. RDW >14.5% was assessed in blood samples within 24 hours of admission.Results: The mortality rate was 30.5%. Multivariable Cox regression analysis showed an association between increased RDW and 30-day mortality (hazard ratio [HR], 3.64; 95% CI, 1.54-8.65), 90-day mortality (HR, 3.66; 95% CI, 1.59-8.40), and shorter duration of invasive ventilation (2.7 ventilator-free days, P=0.033).Conclusions: Increased RDW in COVID-19 patients at ICU admission was associated with increased 30-day and 90-day mortalities, and shorter duration of invasive ventilation. Thus, RDW can be used as a surrogate biomarker for clinical outcomes in COVID-19 patients admitted to the ICU.","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":"39 3","pages":"359-368"},"PeriodicalIF":1.7,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11392698/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142298001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Pediatric septic shock estimation using deep learning and electronic medical records. 利用深度学习和电子病历估算小儿脓毒性休克。

IF 1.7

Acute and Critical Care Pub Date : 2024-08-01 DOI: 10.4266/acc.2024.00031

Ji Weon Lee, Bongjin Lee, June Dong Park

{"title":"Pediatric septic shock estimation using deep learning and electronic medical records.","authors":"Ji Weon Lee, Bongjin Lee, June Dong Park","doi":"10.4266/acc.2024.00031","DOIUrl":"https://doi.org/10.4266/acc.2024.00031","url":null,"abstract":"Background: Diagnosing pediatric septic shock is difficult due to the complex and often impractical traditional criteria, such as systemic inflammatory response syndrome (SIRS), which result in delays and higher risks. This study aims to develop a deep learning-based model using SIRS data for early diagnosis in pediatric septic shock cases.Methods: The study analyzed data from pediatric patients (<18 years old) admitted to a tertiary hospital from January 2010 to July 2023. Vital signs, lab tests, and clinical information were collected. Septic shock cases were identified using SIRS criteria and inotrope use. A deep learning model was trained and evaluated using the area under the receiver operating characteristics curve (AUROC) and area under the precision-recall curve (AUPRC). Variable contributions were analyzed using the Shapley additive explanation value.Results: The analysis, involving 9,616,115 measurements, identified 34,696 septic shock cases (0.4%). Oxygen supply was crucial for 41.5% of the control group and 20.8% of the septic shock group. The final model showed strong performance, with an AUROC of 0.927 and AUPRC of 0.879. Key influencers were age, oxygen supply, sex, and partial pressure of carbon dioxide, while body temperature had minimal impact on estimation.Conclusions: The proposed deep learning model simplifies early septic shock diagnosis in pediatric patients, reducing the diagnostic workload. Its high accuracy allows timely treatment, but external validation through prospective studies is needed.","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":"39 3","pages":"400-407"},"PeriodicalIF":1.7,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11392703/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142298003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0