Monitoring In Intensive Care Unit Research Articles

Clinical Effectiveness of Laparoscopic Fiberoptic Choledochoscopy versus Conventional Open Surgery for Gallbladder Stones Complicated with Common Bile Duct Stones.

Objective To assess the clinical effectiveness of laparoscopic fiberoptic choledochoscopy versus conventional open surgery for gallbladder stones complicated with common bile duct stones. Methods In this retrospective study, 110 patients with gallbladder stones complicated with common bile duct stones treated in our institution between May 2018 and April 2020 were recruited and assigned to receive either open surgery (conventional group) or laparoscopic fiberoptic choledochoscopy (experimental group). Outcome measures included intraoperative indices, postoperative indices, postoperative complications, and changes in postoperative blood indices. Results Laparoscopic fiberoptic choledochoscopy was associated with less intraoperative bleeding volume and a shorter surgical incision length versus open surgery (P < 0.05). All eligible patients showed similar operative time (P > 0.05). Laparoscopic fiberoptic choledochoscopy resulted in shorter postoperative exhaust time and mean length of stay and a higher mean hospitalization cost versus open surgery (P < 0.05). There was no significant difference in the number of patients with intensive care units (ICU) monitoring or primary suture of the common bile duct between the two groups (P > 0.05). The eligible patients after laparoscopic fiberoptic choledochoscopy experienced fewer complications versus those after open surgery (P < 0.05). Laparoscopic fiberoptic choledochoscopy had a milder impact on postoperative albumin decrease versus open surgery (P < 0.05). No significant difference was found in the postoperative leukocyte changes and total bilirubin decrease between the two groups (P > 0.05). Conclusion Laparoscopic fiberoptic choledochoscopy has better perioperative indices outcomes, lower incidence of postoperative complications, smaller postoperative albumin changes, and superior overall performance versus conventional open surgery for gallbladder stones complicated with common bile duct stones.

Neurological monitoring and sedation protocols in the Liver Intensive Care Unit

Patients with liver disease often have alteration of neurological status which requires admission to an intensive care unit. Patients with acute liver failure (ALF), acute-on-chronic liver failure (ACLF) and rarely cirrhosis are at risk of cerebral edema. These patients require prompt assessment of neurological status including assessment of intra-cranial pressure (ICP) and monitoring metabolic parameters like arterial/venous ammonia levels, serum creatinine and serum electrolytes so that timely specific therapy for raised ICP can be instituted to prevent permanent neurological dysfunction. The overall aims of neuromonitoring and sedation protocols in a liver intensive care unit are to identify the level of multifactorial metabolic encephalopathy, individualize sedation and analgesia requirements for patients on mechanical ventilation, institute specific therapy to correct the neurological insult in ALF and ACLF, provide clear physiological data for guided therapy of drugs like muscle relaxants, antiepileptics, and cerebral edema reducing agents, and assist with overall prognostication. In this review article we will outline the clinical scenarios related to liver disease requiring intensive care and neuromonitoring, current techniques of neurological assessment, sedation protocols and point of care tests which enable the treating physician and intensivist guide therapy for raised ICP.

Pain and sedation management and monitoring in pediatric intensive care units across Europe: an ESPNIC survey

BackgroundManagement and monitoring of pain and sedation to reduce discomfort as well as side effects, such as over- and under-sedation, withdrawal syndrome and delirium, is an integral part of pediatric intensive care practice. However, the current state of management and monitoring of analgosedation across European pediatric intensive care units (PICUs) remains unknown. The aim of this survey was to describe current practices across European PICUs regarding the management and monitoring of pain and sedation.MethodsAn online survey was distributed among 357 European PICUs assessing demographic features, drug choices and dosing, as well as usage of instruments for monitoring pain and sedation. We also compared low- and high-volume PICUs practices. Responses were collected from January to April 2021.ResultsA total of 215 (60% response rate) PICUs from 27 European countries responded. Seventy-one percent of PICUs stated to use protocols for analgosedation management, more frequently in low-volume PICUs (77% vs 63%, p = 0.028). First-choice drug combination was an opioid with a benzodiazepine, namely fentanyl (51%) and midazolam (71%) being the preferred drugs. The starting doses differed between PICUs from 0.1 to 5 mcg/kg/h for fentanyl, and 0.01 to 0.5 mg/kg/h for midazolam. Daily assessment and documentation for pain (81%) and sedation (87%) was reported by most of the PICUs, using the preferred validated FLACC scale (54%) and the COMFORT Behavioural scale (48%), respectively. Both analgesia and sedation were mainly monitored by nurses (92% and 84%, respectively). Eighty-six percent of the responding PICUs stated to use neuromuscular blocking agents in some scenarios. Monitoring of paralysed patients was preferably done by observation of vital signs with electronic devices support.ConclusionsThis survey provides an overview of current analgosedation practices among European PICUs. Drugs of choice, dosing and assessment strategies were shown to differ widely. Further research and development of evidence-based guidelines for optimal drug dosing and analgosedation assessment are needed.

Contactless radar-based breathing monitoring of premature infants in the neonatal intensive care unit

Vital sign monitoring systems are essential in the care of hospitalized neonates. Due to the immaturity of their organs and immune system, premature infants require continuous monitoring of their vital parameters and sensors need to be directly attached to their fragile skin. Besides mobility restrictions and stress, these sensors often cause skin irritation and may lead to pressure necrosis. In this work, we show that a contactless radar-based approach is viable for breathing monitoring in the Neonatal intensive care unit (NICU). For the first time, different scenarios common to the NICU daily routine are investigated, and the challenges of monitoring in a real clinical setup are addressed through different contributions in the signal processing framework. Rather than just discarding measurements under strong interference, we present a novel random body movement mitigation technique based on the time-frequency decomposition of the recovered signal. In addition, we propose a simple and accurate frequency estimator which explores the harmonic structure of the breathing signal. As a result, the proposed radar-based solution is able to provide reliable breathing frequency estimation, which is close to the reference cabled device values most of the time. Our findings shed light on the strengths and limitations of this technology and lay the foundation for future studies toward a completely contactless solution for vital signs monitoring.

Intra-arterial blood pressure measurement: sources of error and solutions.

Intra-arterial blood pressure measurement is the cornerstone of hemodynamic monitoring in intensive care units (ICU). Accuracy of the measurement is dependent on the dynamic response of the measuring system, defined by its natural frequency (fnatural) and damping coefficient (Zdamping). Gardner's plot (1981) has long been the only way to determine the accuracy of the pressure measurement. Specific objectives: (i) estimation of the amplitude of error in pressure measurement through simulations based on real-world data, (ii) a novel method to correct the error. Simulated blood pressure waveforms of various heart rates were passed through simulated measurement systems with varying fnatural and Zdamping. The numerical errors in systolic and diastolic pressures and mean error in the measured pressure were used to generate heat maps for the various recording conditions, in the same plot as that by Gardner (1981). fnatural and Zdamping from 121 patient recordings are plotted on these heat maps to demonstrate the fraction of unacceptable recordings. Performance of a tunable filter to correct the error is demonstrated. In many clinical settings, the measurement of intra-arterial pressure is prone to significant error. The proposed tunable filter is shown to improve the accuracy of intra-arterial pressure recording.

Management of a Voluminous Incisional Hernia – Case Report and Brief Review

Abstract Introduction: Massive ventral hernia repairs may lead to abdominal compartment syndrome, which is associated with increased morbidity and mortality, and is caused by an acute rise in intra-abdominal pressure, frequently leading to multi-organ failure and possibly death. This report presents a case with a voluminous incisional hernia associated with intestine obstruction and the issues surrounding emergency surgical treatment. Case report: An overweight 67-year-old patient with a medical history of diabetes and multiple cardiovascular pathologies presented to the emergency department complaining of abdominal distension, pain, nausea, vomiting, and lack of intestinal transit for 48 hours. A clinical diagnosis of bowel obstruction was established, caused by a large ventral hernia. During surgery, a tension free abdominal wall reconstruction was performed with a peritoneal flap from the hernia sac and retromuscular Prolene synthetic mesh. A Redon-type drainage of the posterior rectus compartment and subcutis was applied for 48 hours. After the operation, the patient was transferred to the intensive care unit for monitoring. During the follow-up, continuous monitoring of arterial blood pressure, oxygen saturation, renal function, daily diuresis, lactic acid values, and intraabdominal pressure was performed. On the 9th postoperative day, the patient was released in good general health, stable from a cardiorespiratory point of view, with a clean, healing surgical wound. Conclusion: The repair of large ventral hernias is technically challenging. The management of giant incisional hernias is complex, requiring thoughtful preoperative evaluation with CT imaging and volumetry calculation, which can help establish the surgical strategy.

Measuring Acuity and Pediatric Critical Care Nursing Workload by Using ICU CAMEO III.

The Intensive Care Unit Complexity Assessment and Monitoring to Ensure Optimal Outcomes (ICU CAMEO III) acuity tool measures patient acuity in terms of the complexity of nursing cognitive workload. To validate the ICU CAMEO III acuity tool in US children's hospitals. Using a convenience sample, 9 sites enrolled children admitted to pediatric intensive care units (ICUs). Descriptive statistics were used to summarize patient, nursing, and unit characteristics. Concurrent validity was evaluated by correlating the ICU CAMEO III with the Therapeutic Intervention Scoring System-Children (TISS-C) and the Pediatric Risk of Mortality III (PRISM III). Patients (N = 840) were enrolled from 15 units (7 cardiac and 8 mixed pediatric ICUs). The mean number of ICU beds was 23 (range, 12-34). Among the patients, 512 (61%) were diagnosed with cardiac and 328 (39%) with noncardiac conditions; 463 patients (55.1%) were admitted for medical reasons, and 377 patients (44.9%) were surgical. The ICU CAMEO III median score was 99 (range, 59-163). The ICU CAMEO complexity classification was determined for all 840 patients: 60 (7.1%) with level I complexity; 183 (21.8%) with level II; 201 (23.9%), level III; 267 (31.8%), level IV; and 129 (15.4%), level V. Strong correlation was found between ICU CAMEO III and both TISS-C (ρ = .822, P < .001) and PRISM III (ρ = .607, P < .001) scores, and between the CAMEO complexity classifications and the PRISM III categories (ρ = .575, P = .001). The ICU CAMEO III acuity tool and CAMEO complexity classifications are valid measures of patient acuity and nursing cognitive workload compared with PRISM III and TISS-C in academic children's hospitals.

Update on Intensive Care Unit Management of Stroke

In this review, we provide an update on the intensive care unit (ICU) management of ischemic stroke. Over the last decade, new evidence has led to rapid changes in the early management of patients admitted with acute ischemic stroke. Nevertheless, stroke remains a leading cause of disability. Consequently, a significant number of patients with acute ischemic stroke require ICU level care. The most frequent reasons for ICU admissions are large infarction with potential swelling, reduced level of consciousness, secondary hemorrhagic transformation, acute symptomatic seizures or respiratory failure and stroke-related disorders of the brain-heart interaction. Moreover, there is an increasing number of patients receiving intravenous thrombolysis or mechanical thrombectomy with a subsequent need of ICU monitoring. Several studies have shown that the implementation of specialized neuro-intensive care teams help to improve functional outcome after acute ischemic stroke. The main goal in the ICU management of stroke patients is to prevent secondary brain injury. To this end, a comprehensive approach to optimize systemic physiological homeostasis, control intracranial pressure, cerebral perfusion, hemodynamic and respiratory parameters is needed. Here, we summarize recent advances in invasive and non-invasive neuro-monitoring, decision making in decompressive neurosurgery for large supratentorial or cerebellar infarction, specific cardiorespiratory management, nutrition, temperature management and mobilization strategies in ischemic stroke.

Neurocritical Care

Neurologic critical care encompasses the management of many nervous system diseases when they present in the extremes of severity. Core conditions managed in the neuroscience intensive care unit (ICU) include stroke, cerebral hemorrhage, status epilepticus (SE), myasthenia gravis (MG), Guillain-Barré syndrome (GBS), traumatic brain and spinal cord injury, and high-risk postoperative neurosurgical patients. The skills and knowledge base required to care for patients with such conditions, and the life-threatening complications associated with them, are drawn from both traditional neurology and from critical care medicine. This chapter covers specialized monitoring in the neurologic intensive care unit and special conditions such as acute intracranial hypertension, acute ischemic stroke, intracerebral hemorrhage, venous sinus thrombosis, myasthenia gravis, GBS, seizure and status epilepticus, spinal cord injury, and traumatic brain injury. The chapter includes 8 tables and 5 figures. Tables provide common etiologies of acute intracranial hypertension; general prophylactic measures, medical interventions, surgical interventions, and stepwise treatment protocol for acute intracranial hypertension; drugs that can exacerbate weakness in myasthenia gravis, cholinergic drug dosage equivalents and duration of action, and antiseizure medications used in status epilepticus. Figures illustrate the Monro-Kellie Doctrine, intracranial pressure waveform and plateau waves, typical herniation patterns, large stroke with malignant edema, and examples of nontraumatic intracerebral hemorrhage. This chapter contains 114 references.

Related Factors of Anemia in Critically Ill Patients: A Prospective Multicenter Study.

Anemia is common in critically ill patients; almost 95% of patients admitted to intensive care units (ICUs) have hemoglobin levels below normal. Several causes may explain this phenomenon as well as the tendency to transfuse patients without adequate cause: due to a lack of adherence to protocols, lack of supervision, incomplete transfusion request forms, or a lack of knowledge about the indications, risks, and costs of transfusions. Daily sampling to monitor the coagulation parameters and the acid–base balance can aggravate anemia as the main iatrogenic factor in its production. We studied the association and importance of iatrogenic blood loss and other factors in the incidence of anemia in ICUs. We performed a prospective, observational, multicenter study in five Spanish hospitals. A total of 142 patients with a median age of 58 years (IQI: 48–69), 71.83% male and 28.17% female, were admitted to ICUs without a diagnosis of iatrogenic anemia. During their ICU stay, anemia appeared in 66.90% of the sample, 95 patients, (95% CI: 58.51–74.56%). Risk factors associated with the occurrence of iatrogenic anemia were arterial catheter insertion (72.63% vs. 46.81%, p-value = 0.003), venous catheter insertion (87.37% vs. 72.34%, p-value = 0.023), drainages (33.68% vs. 12. 77%, p-value = 0.038), and ICU stay, where the longer the stay, the higher the rate of iatrogenic anemia (p-value < 0.001). We concluded that there was a statistical significance in the production of iatrogenic anemia due to the daily sampling for laboratory monitoring and critical procedures in intensive care units. The implementation of patient blood management programs could address these issues.

Low Hospital Resource Utilization in Mechanical Thrombectomy for Pulmonary Embolism

Treatment options for pulmonary embolism (PE) are evolving to include percutaneous mechanical thrombectomy as frontline therapy. Mechanical thrombectomy has the potential to significantly reduce hospital resource utilization primarily because it avoids the direct pharmaceutical costs and intensive care unit (ICU) monitoring required after thrombolysis. The objective of this research was to characterize such resource utilization trends observed during mechanical thrombectomy for PE.

The Frequency of Clinical Seizures in Paroxysmal Events in a Neonatal Intensive Care Unit.

Background: In general clinical practice, neonatal seizures are identified visually by direct clinical observation. The study aimed to examine the frequency of clinical seizures in paroxysmal events in a neonatal intensive care unit. Methods: We conducted a prospective study of continuous video-EEG monitoring in a neonatal intensive care unit between January 2017 and December 2020. The demographic data were also reviewed. Results: Sixty-four neonates were enrolled. The median total video-EEG monitoring duration was 24.1 h (IQR 17.5–44.8 h). There were 309 clinically suspected seizure episodes, of which 181 (58.6%) were the motor type and 128 (41.4%) were the non-motor type. Only 63 (20.4%) of these events were confirmed to be clinical seizures on a simultaneous video-EEG recording. In terms of the impact of continuous video-EEG monitoring on clinical management, the anti-epileptic drugs were changed in 42 (65.6%) of the 64 neonates. Conclusion: In the identification of neonatal seizures, a clinical diagnosis by direct observation alone is not enough. The use of continuous video-EEG monitoring plays an important role in the diagnosis of neonatal seizures and in guiding clinical management decisions.

Cardiorespiratory response to early rehabilitation in critically ill adults: A secondary analysis of a randomised controlled trial.

Early rehabilitation is indicated in critically ill adults to counter functional complications. However, the physiological response to rehabilitation is poorly understood. This study aimed to determine the cardiorespiratory response to rehabilitation and to investigate the effect of explanatory variables on physiological changes during rehabilitation and recovery. In a prospectively planned, secondary analysis of a randomised controlled trial conducted in a tertiary, mixed intensive care unit (ICU), we analysed the 716 physiotherapy-led, pragmatic rehabilitation sessions (including exercise, cycling and mobilisation). Participants were previously functionally independent, mechanically ventilated, critically ill adults (n = 108). Physiological data (2-minute medians) were collected with standard ICU monitoring and indirect calorimetry, and their medians calculated for baseline (30min before), training (during physiotherapy) and recovery (15min after). We visualised physiological trajectories and investigated explanatory variables on their estimated effect with mixed-effects models. This study found a large range of variation within and across participants' sessions with clinically relevant variations (>10%) occurring in more than 1 out of 4 sessions in mean arterial pressure, minute ventilation (MV) and oxygen consumption (VO2), although early rehabilitation did not generally affect physiological values from baseline to training or recovery. Active patient participation increased MV (mean difference 0.7l/min [0.4-1.0, p<0.001]) and VO2 (23ml/min [95%CI: 13-34, p<0.001]) during training when compared to passive participation. Similarly, session type 'mobilisation' increased heart rate (6.6bpm [2.1-11.2, p = 0.006]) during recovery when compared to 'exercise'. Other modifiable explanatory variables included session duration, mobilisation level and daily medication, while non-modifiable variables were age, gender, body mass index and the daily Sequential Organ Failure Assessment. A large range of variation during rehabilitation and recovery mirrors the heterogenous interventions and patient reactions. This warrants close monitoring and individual tailoring, whereby the best option to stimulate a cardiorespiratory response seems to be active patient participation, shorter session durations and mobilisation. German Clinical Trials Register (DRKS) identification number: DRKS00004347, registered on 10 September 2012.

Integration of IoT and Fog Computing in Healthcare Based the Smart Intensive Units

Internet of Things (IoT) has enormous capability to revolutionize medical care and enhance global health indicators in the health sector. The Intensive Care Unit (ICU) is an important part of the medical sector because it treats patients who have suffered a terrible accident, have a very serious or life-threatening condition or are undergoing an effective medical treatment that necessitates 24-hour care and support. For this reason, one of the most important issues that hospitals suffer is lack of patient monitoring systems cause ICU health attendants and doctors were overburdened, which can lead to medical errors due to a huge workload that exceeded their ability. As a result, even a minor delay in recognizing a patient&#x2019;s deterioration might result in severe disability or death. Therefore, continuously patient monitoring in ICU is the most crucial process. That&#x2019;s why a way to optimize the ICU monitoring procedure in order to minimize delayed detection and reduce the workload of ICU doctors and caregivers is needed. In this study, we proposed a smart IoT-based ICU patient monitoring system to help doctors and hospitals to monitor the patients continuously and in making quick decisions. Our proposed method can measure patient&#x2019;s body parameters (temperature, SpO2, heartbeat, blood pressure, ECG, and it can also measure glucose, lactate, blood circulation, red blood cells, white blood cells, calcium, potassium from the patient fluids) in real-time and in case of anomalous values of the patient&#x2019;s body parameters, the device will send a notification to the assigned doctor and the Emergency Care Unit (ECU) of the hospital. Doctors can also monitor the patient remotely through our system.

A Low Dose Whole Lung Radiotherapy for Covid-19 Pneumonia: What have we Learned? Opinion of the International Geriatric Radiotherapy Group.

Background: Coronavirus disease 19 carry a high mortality rate among older patients and minorities such as ethnic Africans and Latinos through the induction of a cytokines storm. Many pharmacologic interventions were proposed to improve the mortality rate from normal organ damage such as pneumonia. Low dose whole lung radiotherapy has been used in the past to treat pneumonia and may improve survival through modulation of the inflammatory cytokines. However, there is a lot of controversy about the efficacy and safety of this treatment modality. Thus, a review of the clinical studies using irradiation for COVID-19 pneumonia is needed to answer those questions Methods: A literature search of PubMed and Google Scholar was conducted. Reported studies were analyzed to assess safety, efficacy, and inflammatory biomarkers response following low dose whole lung radiotherapy Results: Patients who required artificial ventilation for COVID-19 did not benefit from low dose whole lung radiotherapy, most likely due to severe lung damage. The inflammatory response may be attenuated after irradiation but it is unclear whether it is independent of the steroid effect. Conclusion: Randomized studies are required to assess the effect low dose whole lung radiotherapy for COVID-19 pneumonia and its anti-inflammatory property. Such studies are needed for emerging countries with limited resources as radiotherapy may be cost-effective to reduce hospital admission and intensive care unit monitoring.

Thoracic, Peripheral, and Cerebral Volume, Circulatory and Pressure Responses To PEEP During Simulated Hemorrhage in a Pig Model: a Case Study.

Positive end-expiratory pressure (PEEP) is a respiratory/ventilation procedure that is used to maintain or improve breathing in clinical and experimental cases that exhibit impaired lung function. Body fluid shift movement is not monitored during PEEP application in intensive care units (ICU), which would be interesting specifically in hypotensive patients. Brain injured and hypotensive patients are known to have compromised cerebral blood flow (CBF) autoregulation (AR) but currently, there is no non-invasive way to assess the risk of implementing a hypotensive resuscitation strategy and PEEP use in these patients.The advantage of electrical bioimpedance measurement is that it is noninvasive, continuous, and convenient. Since it has good time resolution, it is ideal for monitoring in intensive care units (ICU). The basis of its future use is to establish physiological correlates. In this study, we demonstrate the use of electrical bioimpedance measurement during bleeding and the use of PEEP in pig measurement.In an anesthetized pig, we performed multimodal recording on the torso and head involving electrical bioimpedance spectroscopy (EIS), fixed frequency impedance plethysmography (IPG), and bipolar (rheoencephalography – REG) measurements and processed data offline. Challenges (n=16) were PEEP, bleeding, change of SAP, and CO2 inhalation. The total measurement time was 4.12 hours.Systemic circulatory results: Bleeding caused a continuous decrease of SAP, cardiac output (CO), and increase of heart rate, temperature, shock index (SI), vegetative - Kerdo index (KI). Pulse pressure (PP) decreased only after second bleeding which coincided with loss of CBF AR. Pulmonary arterial pressure (PAP) increased during PEEP challenges as a function of time and bleeding.EIS/IPG results: Body fluid shift change was characterized by EIS-related variables. Electrical Impedance Spectroscopy was used to quantify the intravascular, interstitial, and intracellular volume changes during the application of PEEP and simulated hemorrhage. The intravascular fluid compartment was the primary source of blood during hemorrhage. PEEP produced a large fluid shift out of the intravascular compartment during the first bleeding period and continued to lose more blood following the second and third bleeding. Fixed frequency IPG was used to quantify the circulatory responses of the calf during PEEP and simulated hemorrhage. PEEP reduced the arterial blood flow into the calf and venous outflow from the calf.Head results: CBF AR was evaluated as a function of SAP change. Before bleeding, and after moderate bleeding, intracranial pressure (ICP), REG, and carotid flow pulse amplitudes (CFa) increased. This change reflected vasodilatation and active CBF AR. After additional hemorrhaging during PEEP, SAP, ICP, REG, CFa signal amplitudes decreased, indicating passive CBF AR. 1) The indicators of active AR status by modalities was the following: REG (n=9, 56 %), CFa (n=7, 44 %), and ICP (n=6, 38 %); 2) CBF reactivity was better for REG than ICP; 3) REG and ICP correlation coefficient were high (R2 = 0.81) during CBF AR active status; 4) PRx and REGx reflected active CBF AR status. CBF AR monitoring with REG offers safety for patients by preventing decreased CBF and secondary brain injury.We used different types of bioimpedance instrumentation to identify physiologic responses in the different parts of the body (that have not been discussed before) and how the peripheral responses ultimately lead to decreased cardiac output and changes in the head. These bioimpedance methods can improve ICU monitoring, increase the adequacy of therapy, and decrease mortality and morbidity.

Point-of-care Glucose Monitoring in COVID-19 Intensive Care Unit: How's It Different?

How to cite this article: Panda R, Hirolli D, Baidya DK. Point-of-care Glucose Monitoring in COVID-19 Intensive Care Unit: How's It Different? Indian J Crit Care Med 2021;25(12):1465–1466.

High CD4-to-CD8 ratio identifies an at-risk population susceptible to lethal COVID-19.

Around half of people with severe COVID‐19 requiring intensive care unit (ICU) treatment will survive, but it is unclear how the immune response to SARS‐CoV‐2 differs between ICU patients that recover and those that do not. We conducted whole‐blood immunophenotyping of COVID‐19 patients upon admission to ICU and during their treatment and uncovered marked differences in their circulating immune cell subsets. At admission, patients who later succumbed to COVID‐19 had significantly lower frequencies of all memory CD8+ T cell subsets, resulting in increased CD4‐to‐CD8 T cell and neutrophil‐to‐CD8 T cell ratios. ROC and Kaplan‐Meier analyses demonstrated that both CD4‐to‐CD8 and neutrophil‐to‐CD8 ratios at admission were strong predictors of in‐ICU mortality. Therefore, we propose the use of the CD4‐to‐CD8 T cell ratio as a marker for the early identification of those individuals likely to require enhanced monitoring and/or pro‐active intervention in ICU.

Application of Deep Learning Technology in Predicting the Risk of Inpatient Death in Intensive Care Unit.

The Intensive Care Unit (ICU) is an important unit for the rescue of critically ill patients in hospitals, and patient mortality is an important indicator to measure the level of ICU treatment. Currently, a variety of clinical scoring systems are used to evaluate the patient's condition and predict survival, but these systems require a lot of resources. However, due to the rapid development of artificial intelligence and deep learning, machine learning based methods have been used to study the survival prediction of ICU patients. Additionally, these methods have made significant progress, but there is still a distance from clinical application, and equally metric interpretability of the deep learning method is not very mature. Therefore, in this paper, we have proposed a predicting model for the life and death of ICU patients, which is primarily based on the Fuzzy ARTMAP model. With a thorough analysis of the existing ICU patient condition assessment and life and death prediction methods, we have observed that patient's ICU monitoring information performs integrated analysis and extracts features according to the clinical characteristics of physiological indicators. Finally, fuzzy ARTMAP neural network is used to predict the life and death of patients. Likewise, prediction results are combined with the clinical scoring system and logistic regression, artificial neural network, support vector machine, and AdaBoost. Experimental results of these algorithms were compared, which verifies that the proposed method has outperformed the existing model. The main purpose of the proposed mode is to design a life and death prediction method for ICU patients, which has high predictive performance and is an acceptable method for clinical medical staff, where ICU monitoring data is used. Experimental results show that the method proposed has achieved better prediction performance and accuracy ratio, which provide theoretical reference for clinical application.

Is Intensive Care Unit Monitoring Necessary After Maxillomandibular Advancement for Management of Obstructive Sleep Apnea?

Maxillomandibular advancement (MMA) is an accepted treatment modality for obstructive sleep apnea. The purpose of this study was to evaluate the incidence of complications requiring an intensive care unit (ICU) level of care and the necessity of routine overnight ICU airway monitoring after MMA. This was a retrospective cohort study of patients undergoing MMA at Massachusetts General Hospital from 2003 to 2020. The primary predictor variable was postoperative admission to the ICU versus post anesthesia care unit (PACU) or ward. The primary outcome variable was grade IV or V complications as scored using the Clavien-Dindo classification system. The secondary outcome variables included postoperative SpO2 nadir and length of hospital stay. Descriptive and bivariate statistics were computed to measure the association between complications and predictor variables. The study sample consisted of 104 patients (74.0% male, mean age 37.6±12.1years), 61 of whom were admitted to the ICU (58.7%). During the initial 24hours of airway monitoring, the mean SpO2 nadir was 93.7±2.59% for patients admitted to the ICU compared with 94.0±6.56% for patients admitted to the PACU or ward (P=.862). Patients experienced 2 grade IV complications (1.92%) and no grade V complications, with no statistical association between complications and postoperative admission location (P=1.000). Age (P=.002) and operative time (P=.046) were the only variables statistically associated with grade IV or V complications. There was no difference in length of hospital stay between patients admitted to the ICU (2.64±1.37days) versus PACU or ward (2.58±1.62days). The incidence of complications requiring ICU-level care after MMA for obstructive sleep apnea is low. Additional studies are warranted to guide development of feasible, cost-effective perioperative protocols for patients undergoing MMA.