Decoding accelerometry for classification and prediction of critically ill patients with severe brain injury

The goal of this research is to explore quantitative motor features in critically ill patients with severe brain injury (SBI). We hypothesized that computational decoding of these features would yield important information on underlying neurological states and clinical outcomes. Using wearable microsensors placed on all extremities, we recorded 1,701 hours of continuous, high-frequency accelerometry data from a prospective cohort of patients (n = 69) admitted to the ICU with SBI. Models were trained using time-, frequency-, and wavelet-domain motion features and levels of responsiveness and outcome as labels. The two primary tasks were detection of levels of responsiveness, assessed by motor sub-score of the Glasgow Coma Scale (GCSm), and prediction of functional outcome at hospital discharge, measured with the Glasgow Outcome Scale—Extended (GOSE). Detection models achieved significant (AUC: 0.70 [95% CI: 0.53—0.85]) and consistent (observation windows: 12 min — 9 hours) discrimination of SBI patients capable of purposeful movement (GCSm > 4). Prediction models accurately discriminated SBI patients of upper moderate disability or better (GOSE > 5) with 2—6 hours of observation (AUC: 0.82 [95% CI: 0.75—0.90]). Results suggest that computational analysis of time series motor activity in patients with SBI yields clinically important insights on underlying neurologic states and short-term clinical outcomes.

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Decoding accelerometry for classification and prediction of critically ill patients with severe brain injury

Scientific Reports ◽

10.1038/s41598-021-02974-w ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Shubhayu Bhattacharyay ◽

John Rattray ◽

Matthew Wang ◽

Peter H. Dziedzic ◽

Eusebia Calvillo ◽

...

Keyword(s):

Brain Injury ◽

Critically Ill ◽

Critically Ill Patients ◽

High Frequency ◽

Prediction Models ◽

Severe Brain Injury ◽

Short Term ◽

Time Frequency ◽

Yield Information ◽

Functional States

AbstractOur goal is to explore quantitative motor features in critically ill patients with severe brain injury (SBI). We hypothesized that computational decoding of these features would yield information on underlying neurological states and outcomes. Using wearable microsensors placed on all extremities, we recorded a median 24.1 (IQR: 22.8–25.1) hours of high-frequency accelerometry data per patient from a prospective cohort (n = 69) admitted to the ICU with SBI. Models were trained using time-, frequency-, and wavelet-domain features and levels of responsiveness and outcome as labels. The two primary tasks were detection of levels of responsiveness, assessed by motor sub-score of the Glasgow Coma Scale (GCSm), and prediction of functional outcome at discharge, measured with the Glasgow Outcome Scale–Extended (GOSE). Detection models achieved significant (AUC: 0.70 [95% CI: 0.53–0.85]) and consistent (observation windows: 12 min–9 h) discrimination of SBI patients capable of purposeful movement (GCSm > 4). Prediction models accurately discriminated patients of upper moderate disability or better (GOSE > 5) with 2–6 h of observation (AUC: 0.82 [95% CI: 0.75–0.90]). Results suggest that time series analysis of motor activity yields clinically relevant insights on underlying functional states and short-term outcomes in patients with SBI.

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Author Correction: Decoding accelerometry for classification and prediction of critically ill patients with severe brain injury

Scientific Reports ◽

10.1038/s41598-022-05237-4 ◽

2022 ◽

Vol 12 (1) ◽

Author(s):

Shubhayu Bhattacharyay ◽

John Rattray ◽

Matthew Wang ◽

Peter H. Dziedzic ◽

Eusebia Calvillo ◽

...

Keyword(s):

Brain Injury ◽

Critically Ill ◽

Critically Ill Patients ◽

Severe Brain Injury

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Faculty Opinions recommendation of Population pharmacokinetics and pharmacodynamics of continuous versus short-term infusion of imipenem-cilastatin in critically ill patients in a randomized, controlled trial.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1099302.555530 ◽

2008 ◽

Author(s):

Mathias Pletz

Keyword(s):

Randomized Controlled Trial ◽

Population Pharmacokinetics ◽

Critically Ill ◽

Critically Ill Patients ◽

Controlled Trial ◽

Pharmacokinetics And Pharmacodynamics ◽

Short Term ◽

Population Pharmacokinetics And Pharmacodynamics ◽

Randomized Controlled

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Faculty Opinions recommendation of Early parenteral nutrition in critically ill patients with short-term relative contraindications to early enteral nutrition: a randomized controlled trial.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718011916.793479251 ◽

2013 ◽

Author(s):

Bruce Bistrian

Keyword(s):

Randomized Controlled Trial ◽

Enteral Nutrition ◽

Parenteral Nutrition ◽

Critically Ill ◽

Critically Ill Patients ◽

Controlled Trial ◽

Early Enteral Nutrition ◽

Short Term ◽

Randomized Controlled ◽

Early Parenteral Nutrition

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Controlled normothermia in critically ill patients with traumatic brain injury

EMERGENCY MEDICINE ◽

10.22141/2224-0586.3.82.2017.102326 ◽

2017 ◽

Vol 0 (3.82) ◽

pp. 66-72

Author(s):

A.V. Tsarev

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Critically Ill ◽

Critically Ill Patients

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Effect of timing of intubation on clinical outcomes of critically ill patients with COVID-19: a systematic review and meta-analysis of non-randomized cohort studies

Critical Care ◽

10.1186/s13054-021-03540-6 ◽

2021 ◽

Vol 25 (1) ◽

Author(s):

Eleni Papoutsi ◽

Vassilis G. Giannakoulis ◽

Eleni Xourgia ◽

Christina Routsi ◽

Anastasia Kotanidou ◽

...

Keyword(s):

Systematic Review ◽

Mechanical Ventilation ◽

Clinical Outcomes ◽

Critically Ill ◽

Critically Ill Patients ◽

Meta Analysis ◽

Mortality And Morbidity ◽

Icu Admission ◽

All Cause Mortality ◽

Detectable Difference

Abstract Background Although several international guidelines recommend early over late intubation of patients with severe coronavirus disease 2019 (COVID-19), this issue is still controversial. We aimed to investigate the effect (if any) of timing of intubation on clinical outcomes of critically ill patients with COVID-19 by carrying out a systematic review and meta-analysis. Methods PubMed and Scopus were systematically searched, while references and preprint servers were explored, for relevant articles up to December 26, 2020, to identify studies which reported on mortality and/or morbidity of patients with COVID-19 undergoing early versus late intubation. “Early” was defined as intubation within 24 h from intensive care unit (ICU) admission, while “late” as intubation at any time after 24 h of ICU admission. All-cause mortality and duration of mechanical ventilation (MV) were the primary outcomes of the meta-analysis. Pooled risk ratio (RR), pooled mean difference (MD) and 95% confidence intervals (CI) were calculated using a random effects model. The meta-analysis was registered with PROSPERO (CRD42020222147). Results A total of 12 studies, involving 8944 critically ill patients with COVID-19, were included. There was no statistically detectable difference on all-cause mortality between patients undergoing early versus late intubation (3981 deaths; 45.4% versus 39.1%; RR 1.07, 95% CI 0.99–1.15, p = 0.08). This was also the case for duration of MV (1892 patients; MD − 0.58 days, 95% CI − 3.06 to 1.89 days, p = 0.65). In a sensitivity analysis using an alternate definition of early/late intubation, intubation without versus with a prior trial of high-flow nasal cannula or noninvasive mechanical ventilation was still not associated with a statistically detectable difference on all-cause mortality (1128 deaths; 48.9% versus 42.5%; RR 1.11, 95% CI 0.99–1.25, p = 0.08). Conclusions The synthesized evidence suggests that timing of intubation may have no effect on mortality and morbidity of critically ill patients with COVID-19. These results might justify a wait-and-see approach, which may lead to fewer intubations. Relevant guidelines may therefore need to be updated.

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Evaluation of Delirium in Critically Ill Patients Prescribed Melatonin or Ramelteon

Annals of Pharmacotherapy ◽

10.1177/10600280211002054 ◽

2021 ◽

pp. 106002802110020

Author(s):

Natasha Romero ◽

Kevin M. Dube ◽

Kenneth E. Lupi ◽

Jeremy R. DeGrado

Keyword(s):

Clinical Outcomes ◽

Critically Ill ◽

Critically Ill Patients ◽

Receptor Agonist ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Melatonin Receptor ◽

Observational Cohort ◽

Impaired Sleep ◽

Retrospective Observational Cohort Study

Background: An impaired sleep-wake cycle may be one factor that affects the development of delirium in critically ill patients. Several small studies suggest that exogenous melatonin or ramelteon may decrease the incidence and/or duration of delirium. Objective: To compare the effect of prophylactic administration of melatonin, ramelteon, or no melatonin receptor agonist on the development of delirium in the intensive care unit (ICU). Methods: This was a single-center, retrospective, observational cohort study of nondelirious patients in the ICU who received melatonin, ramelteon, or no melatonin receptor agonist. The primary end point was the incidence of delirium. Secondary end points included assessments of daily level of sedation and daily utilization of antipsychotic, sedative, and opioid agents. Results: No difference was observed in the incidence of delirium among the melatonin, ramelteon, and placebo cohorts (18.7% vs 14.3% vs 13.8%; P = 0.77). A difference was observed in the rate of agitation and sedation among the 3 groups, with the greatest observed in the melatonin cohort. Additionally, there was a difference in the use of propofol, dexmedetomidine, and opioids. Overall, there was no difference in clinical outcomes, including duration of mechanical ventilation and ICU or hospital length of stay. Conclusion and Relevance: Therapy with melatonin, ramelteon, and no melatonin receptor agonist resulted in similar rates of delirium in a mixed ICU population. Despite significant differences in agitation, sedation, and medication utilization, there was no differences in the clinical outcomes evaluated.

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Obesity, Inflammatory and Thrombotic Markers, and Major Clinical Outcomes in Critically Ill Patients with COVID‐19 in the US

Obesity ◽

10.1002/oby.23245 ◽

2021 ◽

Author(s):

Allon N. Friedman ◽

John Guirguis ◽

Raj Kapoor ◽

Shruti Gupta ◽

David E. Leaf ◽

...

Keyword(s):

Clinical Outcomes ◽

Critically Ill ◽

Critically Ill Patients ◽

The Us

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Full versus Trophic Feeds in Critically Ill Adults with High and Low Nutritional Risk Scores: A Randomized Controlled Trial

Nutrients ◽

10.3390/nu12113518 ◽

2020 ◽

Vol 12 (11) ◽

pp. 3518

Author(s):

Chen-Yu Wang ◽

Pin-Kuei Fu ◽

Wen-Cheng Chao ◽

Wei-Ning Wang ◽

Chao-Hsiu Chen ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Hospital Stay ◽

Clinical Outcomes ◽

Critically Ill ◽

Critically Ill Patients ◽

Controlled Trial ◽

Risk Scores ◽

Nutrition Risk ◽

Randomized Controlled ◽

Trophic Feeding

Although energy intake might be associated with clinical outcomes in critically ill patients, it remains unclear whether full or trophic feeding is suitable for critically ill patients with high or low nutrition risk. We conducted a prospective study to determine which feeding energy intakes were associated with clinical outcomes in critically ill patients with high or low nutrition risk. This was an investigator-initiated, single center, single blind, randomized controlled trial. Critically ill patients were allocated to either high or low nutrition risk based on their Nutrition Risk in the Critically Ill score, and then randomized to receive either the full or the trophic feeding. The feeding procedure was administered for six days. No significant differences were observed in hospital, 14-day and 28-day mortalities, the length of ventilator dependency, or ICU and hospital stay among the four groups. There were no associations between energy and protein intakes and hospital, 14-day and 28-day mortalities in any of the four groups. However, protein intake was positively associated with the length of hospital stay and ventilator dependency in patients with low nutrition risk receiving trophic feeding. Full or trophic feeding in critically ill patients showed no associations with clinical outcomes, regardless of nutrition risk.

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