Assessing Automated Extraction of Prognostic Information for Intensive Care Unit Patients

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): Horizon 2020 European Commission Project H2020-MSCA-ITN-2016 Background Although the cardiac burden of COVID-19 has been demonstrated, follow-up imaging studies are scarce. The aim was to use speckle-tracking deformation imaging (STE) to prospectively assess cardiac function during intensive care unit (ICU) hospitalisation, comparing ventricular and atrial function of COVID-10 patients that died and those that were discharged. Methods In a single-centre, COVID-19 patients (n = 41) (71% male, aged 65 ± 11 years) were prospectively followed with echocardiography as part of ICU treatment. The left and right ventricles (LV, RV, respectively) were studied with STE in the 4-chamber cardiac view. The endpoint was defined as death or ICU discharge. Average values of the strain parameters from the first and final scans in the ICU, respectively, were calculated for the two outcome groups. Results Endpoint was not reached in 15% (n = 6) at the time of analysis. The remaining patients (n = 32) were 69% male, aged 66 (interquartile range (IQR) 60-72) years, and with an ICU mortality 26% (n = 9). The median spent in ICU was 24 (IQR 15-43) days. On average, echocardiography was performed three times during ICU hospitalisation, amounting to 103 examinations. The changes in cardiac strain are shown in Table 1. The change in LV longitudinal strain during ICU hospitalisation is shown in Figure 1. Conclusion Worsening of LV strain and lack of improvement of RV strain is linked to higher mortality in the ICU. The assessment of cardiac function might contain prognostic information in COVID-19 patients that are admitted to the ICU. Patients discharged from thee OCU (n = 23) Patients that died in the ICU (n = 9) P value Initial echo in the ICU LV strain, % (IQR) 18.00 (15.6-19.95) 14.4 (10.56-20.42) 0.158 RV strain, % (IQR) 16.00 (14.70-20.05) 15.50 (10.38-23.70) 0.712 Final echo before discharge LV strain, % (IQR) 17.35 (15.13-18.98) 13.20 (10.75-15.40) 0.007 RV strain, % (IQR) 17.65 (16.83-19.60) 15.75 (10.68-20.43) 0.438 ICU - intensive care unit; IQR-inter-quartile range Abstract Figure 1

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Prognostic information provided during family meetings in the intensive care unit*

Critical Care Medicine ◽

10.1097/01.ccm.0000255163.16683.14 ◽

2007 ◽

Vol 35 (2) ◽

pp. 646-647 ◽

Cited By ~ 1

Author(s):

Judith Gedney Baggs

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Prognostic Information ◽

Family Meetings

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Palliative Care in the Intensive Care Unit

Hospice and Palliative Medicine and Supportive Care Flashcards ◽

10.1093/med/9780190633066.003.0040 ◽

2018 ◽

Author(s):

Margaret L. Isaac ◽

J. Randall Curtis

Keyword(s):

Intensive Care Unit ◽

Palliative Care ◽

Intensive Care ◽

Information Quality ◽

Life Support ◽

Symptom Assessment ◽

Care Needs ◽

Prognostic Information ◽

Screening Criteria ◽

Palliative Care Needs

Palliative care is increasingly recognized as an important component of care for all critically ill patients and should include both improving the primary palliative care skills of all clinicians working in the intensive care unit (ICU) as well as incorporating palliative care specialists for patients and families with unmet palliative care needs. This chapter highlights the key issues related to palliative care in ICU and evidence-based strategies to manage these issues. Topics covered include screening criteria to help identify patients with a high likelihood of unmet palliative care needs, withdrawal of life support (checklist and communication), providing prognostic information, quality indicators for end-of-life care in the ICU, and symptom assessment and management in the ICU.

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Deep RNA Sequencing of Intensive Care Unit Patients with COVID-19

10.1101/2021.01.11.21249276 ◽

2021 ◽

Author(s):

Sean F. Monaghan ◽

Alger M. Fredericks ◽

Maximilian S. Jentzsch ◽

William G. Cioffi ◽

Maya Cohen ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Computational Biology ◽

Rna Sequencing ◽

Critically Ill ◽

Rna Splicing ◽

Sampling Site ◽

Molecular Testing ◽

Upper Respiratory Tract ◽

Prognostic Information

PurposeCOVID-19 has impacted millions of patients across the world. Molecular testing occurring now identifies the presence of the virus at the sampling site: nasopharynx, nares, or oral cavity. RNA sequencing has the potential to establish both the presence of the virus and define the host’s response in COVID-19.MethodsSingle center, prospective study of patients with COVID-19 admitted to the intensive care unit where deep RNA sequencing (>100 million reads) of peripheral blood with computational biology analysis was done. All patients had positive SARS-CoV-2 PCR. Clinical data was prospectively collected.ResultsWe enrolled fifteen patients at a single hospital. Patients were critically ill with a mortality of 47% and 67% were on a ventilator. All the patients had the SARS-CoV-2 RNA identified in the blood in addition to RNA from other viruses, bacteria, and archaea. The expression of many immune modulating genes, including PD-L1 and PD-L2, were significantly different in patients who died from COVID-19. Some proteins were influenced by alternative transcription and splicing events, as seen in HLA-C, HLA-E, NRP1 and NRP2. Entropy calculated from alternative RNA splicing and transcription start/end predicted mortality in these patients.ConclusionsCurrent upper respiratory tract testing for COVID-19 only determines if the virus is present. Deep RNA sequencing with appropriate computational biology may provide important prognostic information and point to therapeutic foci to be precisely targeted in future studies.Take Home MessageDeep RNA sequencing provides a novel diagnostic tool for critically ill patients. Among ICU patients with COVID-19, RNA sequencings can identify gene expression, pathogens (including SARS-CoV-2), and can predict mortality.TweetDeep RNA sequencing is a novel technology that can assist in the care of critically ill COVID-19 patients & can be applied to other disease

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The Psychosocial Aspects of Feeding in the Neonatal Intensive Care Unit and Beyond

Perspectives of the ASHA Special Interest Groups ◽

10.1044/2019_persp-19-00097 ◽

2019 ◽

Vol 4 (6) ◽

pp. 1507-1515

Author(s):

Lauren L. Madhoun ◽

Robert Dempster

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Neonatal Intensive Care Unit ◽

Hospital Discharge ◽

Neonatal Intensive Care ◽

Oral Feeding ◽

Medical Attention ◽

Primary Role ◽

Speech Language Pathologists ◽

The Family

Purpose Feeding challenges are common for infants in the neonatal intensive care unit (NICU). While sufficient oral feeding is typically a goal during NICU admission, this can be a long and complicated process for both the infant and the family. Many of the stressors related to feeding persist long after hospital discharge, which results in the parents taking the primary role of navigating the infant's course to ensure continued feeding success. This is in addition to dealing with the psychological impact of having a child requiring increased medical attention and the need to continue to fulfill the demands at home. In this clinical focus article, we examine 3 main areas that impact psychosocial stress among parents with infants in the NICU and following discharge: parenting, feeding, and supports. Implications for speech-language pathologists working with these infants and their families are discussed. A case example is also included to describe the treatment course of an infant and her parents in the NICU and after graduation to demonstrate these points further. Conclusion Speech-language pathologists working with infants in the NICU and following hospital discharge must realize the family context and psychosocial considerations that impact feeding progression. Understanding these factors may improve parental engagement to more effectively tailor treatment approaches to meet the needs of the child and family.

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