Acute and Critical Care最新文献_第5页

Resident and nurse attitudes toward a rapid response team in a tertiary hospital in South Korea. 韩国一家三级医院的住院医生和护士对快速反应小组的态度。

IF 1.7

Acute and Critical Care Pub Date : 2025-02-01 Epub Date: 2025-02-12 DOI: 10.4266/acc.004272

Sung Yoon Lim, Ho Geol Woo, Jong Sun Park, Young-Jae Cho, Jae Ho Lee, Yeon Joo Lee

{"title":"Resident and nurse attitudes toward a rapid response team in a tertiary hospital in South Korea.","authors":"Sung Yoon Lim, Ho Geol Woo, Jong Sun Park, Young-Jae Cho, Jae Ho Lee, Yeon Joo Lee","doi":"10.4266/acc.004272","DOIUrl":"10.4266/acc.004272","url":null,"abstract":"Background: Residents and nurses who activate rapid response teams (RRTs) are well positioned to offer insights on its effectiveness. Here, we assess such evaluation of RRTs and identify barriers to activation in a 1,400-bed teaching hospital.Methods: We conducted a 24-item Likert-scale survey from January to May 2017 among residents and ward nurses with RRT experience. Factor analysis was used to identify the barriers.Results: This study comprised 305 nurses and 53 residents, most of whom were satisfied with their RRT experiences. Factor analysis showed that lack of awareness of activation criteria was a major barrier, with only 21.4% and 22.2% participants, respectively, confident about their knowledge of activation protocols. Of the survey respondents, 85.7% reported first contacting the doctor before activating the RRT. Despite the protocol, 66.7% first discussed the decision with other staff, and 71.5% called the RRT when the patient's condition worsened despite management.Conclusions: Nurses and residents value RRTs but face barriers in initiation, primarily due to a lack of confidence in applying the activation criteria. Many prefer to consult a doctor or manage the patient before calling the RRT.","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":"29-37"},"PeriodicalIF":1.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11924405/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469476","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 association between defecation frequency and mortality in critically ill patients with suspected sepsis in Israel. 以色列疑似脓毒症危重患者排便频率与死亡率的关系

IF 1.7

Acute and Critical Care Pub Date : 2025-02-01 Epub Date: 2025-02-18 DOI: 10.4266/acc.000696

Michael Roimi, Anat Shrot, Roy Ilan, Avraham Tenenbaum, Danny Epstein, Yaron Bar-Lavie

{"title":"The association between defecation frequency and mortality in critically ill patients with suspected sepsis in Israel.","authors":"Michael Roimi, Anat Shrot, Roy Ilan, Avraham Tenenbaum, Danny Epstein, Yaron Bar-Lavie","doi":"10.4266/acc.000696","DOIUrl":"10.4266/acc.000696","url":null,"abstract":"Background: The pivotal role of the gastrointestinal (GI) tract in sepsis is well recognized. This study aimed to evaluate the associations between defecation frequency as a basic assessment of GI function and the clinical outcomes of intensive care unit patients with suspected sepsis.Methods: This retrospective, single-center study included patients suspected of having sepsis. The number of defecations and consecutive days without defecation during the 72 hours preceding the suspected infection were assessed. The primary outcome was 30-day all-cause mortality. Multivariate regression analysis adjusting for potential confounders was employed to establish the associations between GI function and clinical outcomes.Results: The final analysis included 1,306 patients with a median age of 56.2 years (interquartile range [IQR], 39.6-69.1); 919 (70.4%) were male, and the median Acute Physiology and Chronic Health Evaluation II score was 22.0 (IQR, 17.0-27.0). The median Sequential Organ Failure Assessment score at the time of suspected infection was 5.0 (IQR, 3.0-7.0). Mortality rates were 20.3%, 28.0%, and 34.3% for patients with 0-2, 3-5, and >5 defecations, respectively (P<0.001). There was a strong correlation between the number of defecations and mortality (r=0.7, P=0.01). In multivariate analyses, each defecation was independently associated with increased mortality (adjusted odds ratio [aOR], 1.07; 95% CI, 1.01-1.12; P=0.01), while each consecutive day without a defecation was associated with reduced mortality (aOR, 0.83; 95% CI, 0.73-0.96; P=0.01).Conclusions: A higher number of defecations in the 72 hours preceding suspected sepsis is associated with increased 30-day all-cause mortality, suggesting a potential association with GI tract dysfunction.","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":"38-45"},"PeriodicalIF":1.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11924406/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469481","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

Corrigendum to: Comparative evaluation of tocilizumab and itolizumab for treatment of severe COVID-19 in India: a retrospective cohort study. tocilizumab和itolizumab在印度治疗重症COVID-19的比较评估：一项回顾性队列研究。

IF 1.7

Acute and Critical Care Pub Date : 2024-11-01 Epub Date: 2024-11-28 DOI: 10.4266/acc.2023.00983.e1

Abhyuday Kumar, Neeraj Kumar, Arunima Pattanayak, Ajeet Kumar, Saravanan Palavesam, Pradhan Manigowdanahundi Nagaraju, Rekha Das

引用次数: 0

Development and implementation of an artificial intelligence-enhanced care model to improve patient safety in hospital wards in Spain. 开发和实施人工智能强化护理模型，改善西班牙医院病房的患者安全。

IF 1.7

Acute and Critical Care Pub Date : 2024-11-01 Epub Date: 2024-11-18 DOI: 10.4266/acc.2024.00759

Alejandro Huete-Garcia, Sara Rodriguez-Lopez

{"title":"Development and implementation of an artificial intelligence-enhanced care model to improve patient safety in hospital wards in Spain.","authors":"Alejandro Huete-Garcia, Sara Rodriguez-Lopez","doi":"10.4266/acc.2024.00759","DOIUrl":"10.4266/acc.2024.00759","url":null,"abstract":"Background: Early detection of critical events in hospitalized patients improves clinical outcomes and reduces mortality rates. Traditional early warning score systems, such as the National Early Warning Score 2 (NEWS2), effectively identify at-risk patients. Integrating artificial intelligence (AI) could enhance the predictive accuracy and operational efficiency of such systems. The study describes the development and implementation of an AI-enhanced early warning system based on a modified NEWS2 scale with laboratory parameters (mNEWS2-Lab) and evaluates its ability to improve patient safety in hospital wards.Methods: For this retrospective cohort study of 3,790 adults admitted to hospital wards, data were collected before and after implementing the mNEWS2-Lab protocol with and without AI enhancement. The study used a multivariate prediction model with statistical analyses such as Fisher's chi-square test, relative risk (RR), RR reduction, and various AI models (logistic regression, decision trees, neural networks). The economic cost of the intervention was also analyzed.Results: The mNEWS2-Lab reduced critical events from 6.15% to 2.15% (RR, 0.35; P<0.001), representing a 65% risk reduction. AI integration further reduced events to 1.59% (RR, 0.26; P<0.001) indicating a 10% additional risk reduction and enhancing early warning accuracy by 15%. The intervention was cost-effective, resulting in substantial savings by reducing critical events in hospitalized patients.Conclusions: The mNEWS2-Lab scale, particularly when integrated with AI models, is a powerful and cost-effective tool for the early detection and prevention of critical events in hospitalized patients.","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":"488-498"},"PeriodicalIF":1.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11617847/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142669580","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

Long-term mortality of adult patients with carbon monoxide poisoning presenting to the emergency department in Korea: a population-based cohort study. 韩国急诊科一氧化碳中毒成年患者的长期死亡率：一项基于人群的队列研究。

IF 1.7

Acute and Critical Care Pub Date : 2024-11-01 Epub Date: 2024-11-18 DOI: 10.4266/acc.2024.00199

Sang Hwan Lee, Soo Rack Ryu, Kyung Hun Yoo, Juncheol Lee, Yongil Cho, Tae Ho Lim, Hyunggoo Kang, Jaehoon Oh, Byuk Sung Ko

{"title":"Long-term mortality of adult patients with carbon monoxide poisoning presenting to the emergency department in Korea: a population-based cohort study.","authors":"Sang Hwan Lee, Soo Rack Ryu, Kyung Hun Yoo, Juncheol Lee, Yongil Cho, Tae Ho Lim, Hyunggoo Kang, Jaehoon Oh, Byuk Sung Ko","doi":"10.4266/acc.2024.00199","DOIUrl":"10.4266/acc.2024.00199","url":null,"abstract":"Background: Carbon monoxide (CO) poisoning can lead to significant morbidity and mortality. However, relatively few studies have investigated its long-term mortality impact. This nationwide population-based cohort study examined the association between CO poisoning and long-term mortality.Methods: This retrospective study utilized data from the National Health Insurance Service database in South Korea. We compared the patients with CO poisoning to those without CO poisoning. Inverse probability treatment weights were applied to both groups to control for potential confounding factors. Subsequently, mortality was assessed using the incidence rate and Cox proportional hazard ratios.Results: This study included 23,387 patients with CO poisoning and 359,851 without it. Over a median follow-up period of 7.6 years after CO poisoning diagnosis, the mortality risk was 2.6 times higher in patients with CO poisoning compared to that in the control group. In a long-term follow-up of patients surviving beyond 30 days, mortality remained 2.18 times higher. Additionally, a higher mortality risk was observed in the relatively younger age group (18-39 years) and the group with fewer underlying diseases, as indicated by a Charlson Comorbidity Index score of 0.Conclusions: CO poisoning is associated with an elevated long-term mortality rate particularly in a relatively young and healthy population.","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":"526-534"},"PeriodicalIF":1.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11617836/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142669590","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

Post-intensive-care morbidity among pediatric patients in Thailand: prevalence, risk factors, and the importance of the post-intensive-care clinic. 儿科病人重症监护后的发病率：泰国重症监护后门诊的发病率、风险因素和重要性。

IF 1.7

Acute and Critical Care Pub Date : 2024-11-01 Epub Date: 2024-11-18 DOI: 10.4266/acc.2024.01011

Chanapai Chaiyakulsil

{"title":"Post-intensive-care morbidity among pediatric patients in Thailand: prevalence, risk factors, and the importance of the post-intensive-care clinic.","authors":"Chanapai Chaiyakulsil","doi":"10.4266/acc.2024.01011","DOIUrl":"10.4266/acc.2024.01011","url":null,"abstract":"Background: Long-term survival data for critically ill children discharged to post-intensive care clinics are scarce, especially in Asia. The main objective of this study was to assess the prevalence of post-intensive-care morbidity among pediatric intensive care unit (PICU) survivors at 1 month and 1 year after hospital discharge and to identify the associated risk factors.Methods: We conducted a retrospective chart review of all children aged 1 month to 15 years who were admitted to the PICU for >48 hours from July 2019 to July 2022 and visited a post-intensive-care clinic 1 month and 1 year after hospital discharge. Post-intensive care morbidity was defined using the Pediatric Cerebral Performance Category (PCPC). Descriptive statistics, univariate, and multivariate analyses were conducted.Results: A total of 111 children visited the clinic at 1 month, and 100 of these children visited the clinic at 1 year. Only 39 of 111 children (35.2%) had normal PCPC assessments at 1 month, while 54 of 100 (54.0%) were normal at 1 year. Baseline developmental delays were significantly associated with any degree of disability and at least moderate disability at both time points. Mechanical ventilation for >7 days was associated with at least moderate disability at both time points, while PICU stay >7 days was significantly associated with moderate disability at 1 month and any degree of disability at 1 year.Conclusions: A substantial percentage of PICU survivors had persistent disabilities even 1 year after critical illness. A structured multidisciplinary post-intensive-care follow-up plan is warranted to provide optimal care for such children.","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":"600-610"},"PeriodicalIF":1.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11617844/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142669624","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

Higher caloric intake through enteral nutrition is associated with lower hospital mortality rates in patients with candidemia and shock in Taiwan. 在台湾，通过肠内营养摄入更多热量与念珠菌血症和休克患者住院死亡率降低有关。

IF 1.7

Acute and Critical Care Pub Date : 2024-11-01 Epub Date: 2024-11-20 DOI: 10.4266/acc.2024.00843

Chen-Yu Wang, Tsai-Jung Wang, Yu-Cheng Wu, Chiann-Yi Hsu

{"title":"Higher caloric intake through enteral nutrition is associated with lower hospital mortality rates in patients with candidemia and shock in Taiwan.","authors":"Chen-Yu Wang, Tsai-Jung Wang, Yu-Cheng Wu, Chiann-Yi Hsu","doi":"10.4266/acc.2024.00843","DOIUrl":"10.4266/acc.2024.00843","url":null,"abstract":"Background: Candidemia is associated with markedly high intensive care unit (ICU) mortality rates. Although the Impact of Early Enteral vs. Parenteral Nutrition on Mortality in Patients Requiring Mechanical Ventilation and Catecholamines (NUTRIREA-2) trial indicated that early enteral nutrition (EN) did not reduce 28-day mortality rates among critically ill patients with shock, the European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines recommend avoiding EN in cases of uncontrolled shock. Whether increased caloric intake from EN positively impacts clinical outcomes in patients with candidemia and shock remains unclear.Methods: We retrospectively collected data from a tertiary medical center between January 2015 and December 2018. We enrolled patients who developed shock within the first 7 days following ICU admission and received a diagnosis of candidemia during their ICU stay. Patients with an ICU stay shorter than 48 hours were excluded.Results: The study included 106 patients, among whom the hospital mortality rate was 77.4% (82 patients). The median age of the patients was 71 years, and the median Acute Physiology and Chronic Health Evaluation II score was 29. The Cox regression model revealed that a higher 7-day average caloric intake through EN (hazard ratio, 0.61; 95% CI, 0.44-0.83) was significantly associated with lower hospital mortality rates. Our findings suggest EN as the preferred feeding route for critically ill patients with shock.Conclusions: Increased caloric intake through EN may be associated with lower hospital mortality rates in patients with candidemia and shock.","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":"573-582"},"PeriodicalIF":1.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11617834/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717616","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

Impact of perioperative high-intensity statin treatment on the occurrence of postoperative atrial fibrillation after coronary artery bypass grafting: a meta-analysis. 围手术期高强度他汀治疗对冠状动脉旁路移植术后心房颤动发生率的影响：一项荟萃分析。

IF 1.7

Acute and Critical Care Pub Date : 2024-11-01 Epub Date: 2024-11-25 DOI: 10.4266/acc.2024.00633

Yeiwon Lee, Somin Im, Yoonjin Kang, Suk Ho Sohn, Myoung-Jin Jang, Ho Young Hwang

{"title":"Impact of perioperative high-intensity statin treatment on the occurrence of postoperative atrial fibrillation after coronary artery bypass grafting: a meta-analysis.","authors":"Yeiwon Lee, Somin Im, Yoonjin Kang, Suk Ho Sohn, Myoung-Jin Jang, Ho Young Hwang","doi":"10.4266/acc.2024.00633","DOIUrl":"10.4266/acc.2024.00633","url":null,"abstract":"Background: This meta-analysis was conducted to evaluate the impact of high-intensity statin treatment on new-onset postoperative atrial fibrillation (POAF) after coronary artery bypass grafting (CABG).Methods: Four databases were searched for studies that enrolled patients who underwent CABG and investigated the impact of perioperative use of high-intensity statins on the occurrence rate of POAF. The primary outcome was the incidence of POAF. Secondary outcomes were operative mortality and perioperative myocardial infarction (PMI). Publication bias was assessed using a funnel plot and Egger's test.Results: Nine articles (eight randomized controlled trials and one non-randomized study: n=3,072) were selected. Rosuvastatin (20 mg) was used in four studies, while atorvastatin (40-80 mg) was used in the other five studies. Reported incidences of POAF in the included studies ranged from 11% to 48.8%. Pooled analyses showed that the incidence of POAF was significantly lower in patients treated with high-intensity statins than in patients in the control group patients (odds ratio, 0.43; 95% CI, 0.27-0.68; P<0.001). Subgroup analyses showed that the impact of high-intensity statins was significant in studies using atorvastatin but not in studies using rosuvastatin. There was no significant subgroup difference in the primary endpoint between studies using a placebo and those using low-dose statins. Secondary outcomes, including operative mortality and the incidence of PMI, were not affected by high-intensity statin treatment.Conclusions: Perioperative use of high-intensity statins is associated with a 57% reduction in the occurrence of POAF among patients undergoing CABG.","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":"507-516"},"PeriodicalIF":1.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11617835/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142733338","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

Factors associated with unplanned intensive care unit readmission among trauma patients in Republic of Korea. 大韩民国重症监护室非计划再入院创伤患者的相关因素。

IF 1.7

Acute and Critical Care Pub Date : 2024-11-01 Epub Date: 2024-11-22 DOI: 10.4266/acc.2024.00584

Yongwoong Lee, Byung Hee Kang

{"title":"Factors associated with unplanned intensive care unit readmission among trauma patients in Republic of Korea.","authors":"Yongwoong Lee, Byung Hee Kang","doi":"10.4266/acc.2024.00584","DOIUrl":"10.4266/acc.2024.00584","url":null,"abstract":"Background: In trauma patients, unplanned intensive care unit (ICU) readmission (UIR) is associated with poor clinical outcomes. In this study, we aimed to analyze associated factors for UIR in trauma patients.Methods: This retrospective study was conducted on trauma patients admitted to the ICU at a trauma center from January 2016 to December 2022. Clinical information at admission, the first ICU hospitalization, first discharge from the ICU, and reasons for readmission were collected. Patients who were successfully discharge from the ICU were compared to UIR patients. Logistic regression was performed to determine the factors with a significant impact on ICU readmission.Results: Here, 5,529 patients were admitted to the ICU over 7 years, and 212 patients (3.8%) experienced UIR. Among patients who experienced UIR, 9 (4.2%) died. In the UIR patients, hospital stay (20 days [interquartile range, 13-35] vs. 45 days [28-67], P<0.001), total ICU stay (5 days [3- 11] vs. 17 days [9-35], P<0.001), and complications during the first ICU hospitalization were significantly higher. The most common reason for UIR was respiratory problem (53.8%). In multivariable analysis, cervical spine operation during the first ICU hospitalization (odds ratio, 6.56; 95% CI, 3.62-11.91; P<0.001), renal replacement therapy (RRT; 3.52, 2.06-5.99, P<0.001), and massive blood transfusion protocol (MTP; 1.74, 1.08-2.81, P=0.023) were most highly related with UIR.Conclusions: Because UIR patients had poor outcomes, trauma patients who underwent cervical spine operation, RRT, or MTP require monitoring in the general ward, especially for respiratory problems.","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":"583-592"},"PeriodicalIF":1.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11617833/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142733337","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

A deep learning model for estimating sedation levels using heart rate variability and vital signs: a retrospective cross-sectional study at a center in South Korea. 利用心率变异性和生命体征估计镇静水平的深度学习模型：韩国一家中心的回顾性横断面研究。

IF 1.7

Acute and Critical Care Pub Date : 2024-11-01 Epub Date: 2024-11-25 DOI: 10.4266/acc.2024.01200

You Sun Kim, Bongjin Lee, Wonjin Jang, Yonghyuk Jeon, June Dong Park

{"title":"A deep learning model for estimating sedation levels using heart rate variability and vital signs: a retrospective cross-sectional study at a center in South Korea.","authors":"You Sun Kim, Bongjin Lee, Wonjin Jang, Yonghyuk Jeon, June Dong Park","doi":"10.4266/acc.2024.01200","DOIUrl":"10.4266/acc.2024.01200","url":null,"abstract":"Background: Optimal sedation assessment in critically ill children remains challenging due to the subjective nature of behavioral scales and intermittent evaluation schedules. This study aimed to develop a deep learning model based on heart rate variability (HRV) parameters and vital signs to predict effective and safe sedation levels in pediatric patients.Methods: This retrospective cross-sectional study was conducted in a pediatric intensive care unit at a tertiary children's hospital. We developed deep learning models incorporating HRV parameters extracted from electrocardiogram waveforms and vital signs to predict Richmond Agitation-Sedation Scale (RASS) scores. Model performance was evaluated using the area under the receiver operating characteristic curve (AUROC) and area under the precision-recall curve (AUPRC). The data were split into training, validation, and test sets (6:2:2), and the models were developed using a 1D ResNet architecture.Results: Analysis of 4,193 feature sets from 324 patients achieved excellent discrimination ability, with AUROC values of 0.867, 0.868, 0.858, 0.851, and 0.811 for whole number RASS thresholds of -5 to -1, respectively. AUPRC values ranged from 0.928 to 0.623, showing superior performance in deeper sedation levels. The HRV metric SDANN2 showed the highest feature importance, followed by systolic blood pressure and heart rate.Conclusions: A combination of HRV parameters and vital signs can effectively predict sedation levels in pediatric patients, offering the potential for automated and continuous sedation monitoring in pediatric intensive care settings. Future multi-center validation studies are needed to establish broader applicability.","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":"621-629"},"PeriodicalIF":1.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11617840/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142733334","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