scholarly journals Impact of Lactate Clearance on Early Outcomes in Pediatric ECMO Patients

Medicina ◽  
2021 ◽  
Vol 57 (3) ◽  
pp. 284
Author(s):  
Julia Merkle-Storms ◽  
Ilija Djordjevic ◽  
Carolyn Weber ◽  
Soi Avgeridou ◽  
Ihor Krasivskyi ◽  
...  
Keyword(s):  
Roc Analysis ◽  
Operating Characteristic ◽  
Pediatric Patients ◽  
Heart Defects ◽  
Lactate Clearance ◽  
Ecmo Support ◽  
Peak Lactate ◽  
Lactate Levels ◽  
The Impact ◽  
Ecmo Therapy

Background and Objectives: Pediatric extracorporeal membrane oxygenation (ECMO) support is often the ultimate therapy for neonatal and pediatric patients with congenital heart defects after cardiac surgery. The impact of lactate clearance in pediatric patients during ECMO therapy on outcomes has been analyzed. Materials andMethods: We retrospectively analyzed data from 41 pediatric vaECMO patients between January 2006 and December 2016. Blood lactate and lactate clearance have been recorded prior to ECMO implantation and 3, 6, 9 and 12 h after ECMO start. Receiver operating characteristic (ROC) analysis was used to identify cut-off levels for lactate clearance. Results: Lactate levels prior to ECMO therapy (9.8 mmol/L vs. 13.5 mmol/L; p = 0.07) and peak lactate levels during ECMO support (10.4 mmol/L vs. 14.7 mmol/L; p = 0.07) were similar between survivors and nonsurvivors. Areas under the curve (AUC) of lactate clearance at 3, 9 h and 12 h after ECMO start were significantly predictive for mortality (p = 0.017, p = 0.049 and p = 0.006, respectively). Cut-off values of lactate clearance were 3.8%, 51% and 56%. Duration of ECMO support and respiratory ventilation was significantly longer in survivors than in nonsurvivors (p = 0.01 and p < 0.001, respectively). Conclusions: Dynamic recording of lactate clearance after ECMO start is a valuable tool to assess outcomes and effectiveness of ECMO application. Poor lactate clearance during ECMO therapy in pediatric patients is a significant marker for higher mortality.

scholarly journals The impact of lactate clearance on outcomes according to infection sites in patients with sepsis: a retrospective observational study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Momoko Sugimoto ◽  
Wataru Takayama ◽  
Kiyoshi Murata ◽  
Yasuhiro Otomo
Keyword(s):  
Hospital Mortality ◽  
Patient Outcomes ◽  
Operating Characteristic ◽  
Multivariate Analyses ◽  
Characteristic Curve ◽  
Treatment Strategies ◽  
Lactate Clearance ◽  
Infection Site ◽  
Medical Centers ◽  
The Impact

AbstractWhether lactate clearance (LC) influences outcomes differently depending on the infection site in sepsis cases is not fully elucidated. Herein, we analyzed LC’s clinical utility as a predictor of patient outcomes according to infection site. This retrospective study, conducted at two tertiary emergency critical care medical centers in Japan, included patients with sepsis or septic shock. The associations between infection site (lungs vs. other organs) and in-hospital mortality and ventilator-free days (VFDs) were evaluated using univariable and multivariate analyses. We assessed LC’s ability to predict in-hospital mortality using the area under the receiver operating characteristic curve. Among 369 patients with sepsis, infection sites were as follows: lungs, 186 (50.4%); urinary tract, 45 (12.2%); abdomen, 102 (27.6%); and other, 36 (9.8%). Patients were divided into a pneumonia group or non-pneumonia group depending on their infection site. The pneumonia group displayed a higher in-hospital mortality than the non-pneumonia group (24.2% vs. 15.8%, p = 0.051). In the multivariate analysis, lower LC was associated with higher in-hospital mortality [adjusted odds ratio (AOR), 0.97; 95% confidence interval (CI) 0.96–0.98; p < 0.001] and fewer VFD [adjusted difference p value (AD), − 1.23; 95% CI − 2.42 to − 0.09; p = 0.025] in the non-pneumonia group. Conversely, LC did not affect in-hospital mortality (AOR 0.99; 95% CI 0.99–1.00; p = 0.134) and VFD (AD − 0.08; 95% CI − 2.06 to 1.91; p = 0.854) in the pneumonia group. Given the differences in the impact of LC on outcomes between the pneumonia and non-pneumonia groups, this study suggests that optimal treatment strategies might improve outcomes. Further studies are warranted to validate our results and develop optimal therapeutic strategies for sepsis patients.

Receiver Operating Characteristic (ROC) Analysis for Characterizing Synaptic Efficacy

2007 ◽  
Vol 97 (2) ◽  
pp. 1799-1808 ◽  
Author(s):  
Frances S. Chance
Keyword(s):  
Receiver Operating Characteristic ◽  
Synaptic Input ◽  
Roc Analysis ◽  
Operating Characteristic ◽  
Synaptic Activity ◽  
Synaptic Efficacy ◽  
Input Noise ◽  
Noisy Background ◽  
The Impact ◽  
Receiver Operating

The role of background synaptic activity in cortical processing has recently received much attention. How do individual neurons extract information when embedded in a noisy background? When examining the impact of a synaptic input on postsynaptic firing, it is important to distinguish a change in overall firing probability from a true change in neuronal sensitivity to a particular input (synaptic efficacy) that corresponds to a change in detection performance. Here we study the impact of background synaptic input on neuronal sensitivity to individual synaptic inputs using receiver operating characteristic (ROC) analysis. We use the area under the ROC curve as a measure of synaptic efficacy, here defined as the ability of a postsynaptic action potential to identify a particular synaptic input event. An advantage of using ROC analysis to measure synaptic efficacy is that it provides a measure that is independent of postsynaptic firing rate. Furthermore, changes in mean excitation or inhibition, although affecting overall firing probability, do not modulate synaptic efficacy when measured in this way. Changes in overall conductance also affect firing probability but not this form of synaptic efficacy. Input noise, here defined as the variance of the input current, does modulate synaptic efficacy, however. This effect persists when the change in input variance is coupled with a change in conductance (as would result from changing background activity).

scholarly journals Pupillary unrest, opioid intensity, and the impact of environmental stimulation on respiratory depression

2021 ◽  
Author(s):  
Rachel Eshima McKay ◽  
Michael A. Kohn ◽  
Merlin D. Larson
Keyword(s):  
Respiratory Depression ◽  
Roc Analysis ◽  
Operating Characteristic ◽  
Clinical Manifestations ◽  
Clinical Trial Registration ◽  
Conversational Interaction ◽  
Remifentanil Infusion ◽  
Environmental Stimulation ◽  
The Subject ◽  
The Impact

Abstract Opioid-induced respiratory depression (OIRD) confers significant morbidity, but its onset can be challenging to recognize. Pain or stimulation effects of conversation may mask or attenuate common clinical manifestations of OIRD. We asked whether pupillary unrest could provide an objective signal of opioid exposure, and whether this signal would be independent from the confounding influence of extrinsic stimulation. We conducted a cross-over trial of healthy volunteers using identical remifentanil infusions separated by a washout period; in both, pupillary unrest in ambient light (PUAL) was measured at 2.5-min intervals. During one infusion, investigators continuously engaged the subject in conversation, while in the other, a quiet environment was maintained; measures of respiratory depression were compared under each condition. We tested PUAL’s relationship to estimated opioid concentration under quiet conditions, measured PUAL’s discrimination of lower versus higher opioid exposure using receiver operating characteristic (ROC) analysis, and assessed the effect of stimulation on PUAL versus opioid using mixed effects regression. Respiratory depression occurred more frequently under quiet conditions (p < 0.0001). Under both conditions, PUAL declined significantly over the course of the remifentanil infusion and rose during recovery (p < 0.0001). PUAL showed excellent discrimination in distinguishing higher versus absent-moderate opioid exposure (AUROC = 0.957 [0.929 to 0.985]), but was unaffected by interactive versus quiet conditions (mean difference, interactive – quiet = − 0.007, 95% CI − 0.016 to 0.002). PUAL is a consistent indicator of opioid effect, and distinguishes higher opioid concentrations independently of the stimulating effects of conversational interaction. Under equivalent opioid exposure, conversational interaction delayed the onset and minimized the severity of OIRD.Clinical trial registration: NCT 04301895

Value of Lactate Levels during ECMO Support for Refractory Cardiogenic Shock

2016 ◽  
Vol 64 (S 01) ◽  
Author(s):  
I. Slottosch ◽  
O. Liakopoulos ◽  
E. Kuhn ◽  
A. Deppe ◽  
M. Scherner ◽  
...  
Keyword(s):  
Cardiogenic Shock ◽  
Ecmo Support ◽  
Refractory Cardiogenic Shock ◽  
Lactate Levels

The impact of subway operation on urban traffic: A GRA-BNs based study

2021 ◽  
pp. 1-16
Author(s):  
Lixin Yan ◽  
Tao Zeng ◽  
Yubing Xiong ◽  
Zhenyun Li ◽  
Qingmei Liu
Keyword(s):  
Bayesian Networks ◽  
Operating Characteristic ◽  
Urban Traffic ◽  
Relational Analysis ◽  
Traffic Security ◽  
Structural Network ◽  
Random Decision Forest ◽  
Roc Area ◽  
Grey Relational ◽  
The Impact

With the development of urbanization, urban traffic has exposed many problems. To study the subway’s influence on urban traffic, this paper collects data on traffic indicators in Nanchang from 2008 to 2018. The research is carried out from three aspects: traffic accessibility, green traffic, and traffic security. First, Grey Relational Analysis is used to select 18 traffic indicators correlated with the subway from 22 traffic indicators. Second, the data is discretized and learned based on Bayesian Networks to construct the structural network of the subway’s influence. Third, to verify the reliability of using GRA and the effectiveness of Bayesian Networks (GRA-BNs), Bayesian Networks with full indicators analysis and other four algorithms (Naive Bayes, Random Decision Forest, Logistic and regression) are employed for comparison. Moreover, the receiver operating characteristic (ROC) area, true positive (TP) rate, false positive (FP) rate, precision, recall, F-measure, and accuracy are utilized for comparing each situation. The result shows that GRA-BNs is the most effective model to study the impact of the subway’s operation on urban traffic. Then, the dependence relations between the subway and each index are analyzed by the conditional probability tables (CPTs). Finally, according to the analysis, some suggestions are put forward.

Using an App to monitor postoperative pain at home in pediatric patients

2021 ◽  
pp. 136749352091931
Author(s):  
Emanuela Tiozzo ◽  
Valentina Biagioli ◽  
Matilde Brancaccio ◽  
Riccardo Ricci ◽  
Anna Marchetti ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Pain Intensity ◽  
Health Professionals ◽  
Pediatric Patients ◽  
Pain Scale ◽  
Factors Associated ◽  
Prospective Comparative Study ◽  
Paper And Pencil ◽  
The Impact ◽  
At Home

A prospective comparative study was conducted in 487 pediatric patients (69% male, mean age = 6.4 ± 4.0) to evaluate (a) the incidence, intensity, and characteristics of pain in pediatric patients at home during the first 24 hours and 5 days after surgery and (b) the factors associated with higher pain intensity, including the impact of an application (App) compared to the paper-and-pencil approach. Postoperative pain was assessed by patients or their parents at home using the ‘Bambino Gesù’ Children’s Hospital (Ospedale Pediatrico Bambino Gesù, OPBG) tool for participants aged 4–17 years or the Faces, Legs, Arms, Cry, and Consolability scale for participants less than four years old. Participants were assigned to two groups: those who used the paper-and-pencil version of the pain scale and those who used the App. Overall, 209 of the 472 (44%) participants reported pain during the first 24 hours, and 92 of the 420 (22%) reported pain between one and five days after surgery. Higher pain intensity scores were associated with being in the App group, directly assessing own pain, and using the OPBG tool. The App was effective in facilitating pain assessment. Health professionals could empower pediatric patients and their parents in assessing pain at home through a dedicated App.

scholarly journals Fully Automated Colorimetric Analysis of the Optic Nerve Aided by Deep Learning and Its Association with Perimetry and OCT for the Study of Glaucoma

2021 ◽  
Vol 10 (15) ◽  
pp. 3231
Author(s):  
Marta Gonzalez-Hernandez ◽  
Daniel Gonzalez-Hernandez ◽  
Daniel Perez-Barbudo ◽  
Paloma Rodriguez-Esteve ◽  
Nisamar Betancor-Caro ◽  
...  
Keyword(s):  
Distribution Function ◽  
Deep Learning ◽  
Optic Nerve ◽  
Roc Analysis ◽  
Operating Characteristic ◽  
Learning Models ◽  
Colorimetric Analysis ◽  
Cirrus Oct ◽  
And Function ◽  
Usual Pattern

Background: Laguna-ONhE is an application for the colorimetric analysis of optic nerve images, which topographically assesses the cup and the presence of haemoglobin. Its latest version has been fully automated with five deep learning models. In this paper, perimetry in combination with Laguna-ONhE or Cirrus-OCT was evaluated. Methods: The morphology and perfusion estimated by Laguna ONhE were compiled into a “Globin Distribution Function” (GDF). Visual field irregularity was measured with the usual pattern standard deviation (PSD) and the threshold coefficient of variation (TCV), which analyses its harmony without taking into account age-corrected values. In total, 477 normal eyes, 235 confirmed, and 98 suspected glaucoma cases were examined with Cirrus-OCT and different fundus cameras and perimeters. Results: The best Receiver Operating Characteristic (ROC) analysis results for confirmed and suspected glaucoma were obtained with the combination of GDF and TCV (AUC: 0.995 and 0.935, respectively. Sensitivities: 94.5% and 45.9%, respectively, for 99% specificity). The best combination of OCT and perimetry was obtained with the vertical cup/disc ratio and PSD (AUC: 0.988 and 0.847, respectively. Sensitivities: 84.7% and 18.4%, respectively, for 99% specificity). Conclusion: Using Laguna ONhE, morphology, perfusion, and function can be mutually enhanced with the methods described for the purpose of glaucoma assessment, providing early sensitivity.

scholarly journals ECMO in COVID-19—prolonged therapy needed? A retrospective analysis of outcome and prognostic factors

Perfusion ◽  
2021 ◽  
pp. 026765912199599
Author(s):  
Esther Dreier ◽  
Maximilian Valentin Malfertheiner ◽  
Thomas Dienemann ◽  
Christoph Fisser ◽  
Maik Foltan ◽  
...  
Keyword(s):  
Lung Compliance ◽  
Ecmo Support ◽  
Short Term ◽  
Single Center Study ◽  
Venovenous Extracorporeal Membrane Oxygenation ◽  
Baseline Characteristics ◽  
Ecmo Therapy ◽  
Vv Ecmo

Background: The role of venovenous extracorporeal membrane oxygenation (VV ECMO) in patients with COVID-19-induced acute respiratory distress syndrome (ARDS) still remains unclear. Our aim was to investigate the clinical course and outcome of those patients and to identify factors associated with the need for prolonged ECMO therapy. Methods: A retrospective single-center study on patients with VV ECMO for COVID-19-associated ARDS was performed. Baseline characteristics, ventilatory and ECMO parameters, and laboratory and virological results were evaluated over time. Six months follow-up was assessed. Results: Eleven of 16 patients (68.8%) survived to 6 months follow-up with four patients requiring short-term (<28 days) and seven requiring prolonged (⩾28 days) ECMO support. Lung compliance before ECMO was higher in the prolonged than in the short-term group (28.1 (28.8–32.1) ml/cmH2O vs 18.7 (17.7–25.0) ml/cmH2O, p = 0.030). Mechanical ventilation before ECMO was longer (19 (16–23) days vs 5 (5–9) days, p = 0.002) and SOFA score was higher (12.0 (10.5–17.0) vs 10.0 (9.0–10.0), p = 0.002) in non-survivors compared to survivors. Low viral load during the first days on ECMO tended to indicate worse outcomes. Seroconversion against SARS-CoV-2 occurred in all patients, but did not affect outcome. Conclusions: VV ECMO support for COVID-19-induced ARDS is justified if initiated early and at an experienced ECMO center. Prolonged ECMO therapy might be required in those patients. Although no relevant predictive factors for the duration of ECMO support were found, the decision to stop therapy should not be made dependent of the length of ECMO treatment.

scholarly journals Quantitative Assessment of the Echogenicity of a Breast Tumor Predicts the Response to Neoadjuvant Chemotherapy

Cancers ◽  
2021 ◽  
Vol 13 (14) ◽  
pp. 3546
Author(s):  
Katarzyna Sylwia Dobruch-Sobczak ◽  
Hanna Piotrzkowska-Wróblewska ◽  
Piotr Karwat ◽  
Ziemowit Klimonda ◽  
Ewa Markiewicz-Grodzicka ◽  
...  
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Treatment Response ◽  
Roc Analysis ◽  
Operating Characteristic ◽  
Characteristic Curve ◽  
Quantitative Measure ◽  
Malignant Cell ◽  
Breast Cancer Patients ◽  
The Third ◽  
Leibler Divergence

The aim of the study was to improve monitoring the treatment response in breast cancer patients undergoing neoadjuvant chemotherapy (NAC). The IRB approved this prospective study. Ultrasound examinations were performed prior to treatment and 7 days after four consecutive NAC cycles. Residual malignant cell (RMC) measurement at surgery was the standard of reference. Alteration in B-mode ultrasound (tumor echogenicity and volume) and the Kullback-Leibler divergence (kld), as a quantitative measure of amplitude difference, were used. Correlations of these parameters with RMC were assessed and Receiver Operating Characteristic curve (ROC) analysis was performed. Thirty-nine patients (mean age 57 y.) with 50 tumors were included. There was a significant correlation between RMC and changes in quantitative parameters (KLD) after the second, third and fourth course of NAC, and alteration in echogenicity after the third and fourth course. Multivariate analysis of the echogenicity and KLD after the third NAC course revealed a sensitivity of 91%, specificity of 92%, PPV = 77%, NPV = 97%, accuracy = 91%, and AUC of 0.92 for non-responding tumors (RMC ≥ 70%). In conclusion, monitoring the echogenicity and KLD parameters made it possible to accurately predict the treatment response from the second course of NAC.

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