scholarly journals Evaluation of CT severity index, Ranson and APACHE II and Ranson scores for clinical course and mortality in mechanically ventilated patients depend to severe pancreatitis

2017 ◽  
Vol 24 (4) ◽  
pp. 238-243
Author(s):  
Gürhan Adam ◽  
Erdem Koçak ◽  
Celal Çınar ◽  
Füsun Adam ◽  
Canan Bor ◽  
...  
2021 ◽  
Vol 10 (10) ◽  
pp. 2172
Author(s):  
Jong Ho Kim ◽  
Young Suk Kwon ◽  
Moon Seong Baek

Previous scoring models, such as the Acute Physiologic Assessment and Chronic Health Evaluation II (APACHE II) score, do not adequately predict the mortality of patients receiving mechanical ventilation in the intensive care unit. Therefore, this study aimed to apply machine learning algorithms to improve the prediction accuracy for 30-day mortality of mechanically ventilated patients. The data of 16,940 mechanically ventilated patients were divided into the training-validation (83%, n = 13,988) and test (17%, n = 2952) sets. Machine learning algorithms including balanced random forest, light gradient boosting machine, extreme gradient boost, multilayer perceptron, and logistic regression were used. We compared the area under the receiver operating characteristic curves (AUCs) of machine learning algorithms with those of the APACHE II and ProVent score results. The extreme gradient boost model showed the highest AUC (0.79 (0.77–0.80)) for the 30-day mortality prediction, followed by the balanced random forest model (0.78 (0.76–0.80)). The AUCs of these machine learning models as achieved by APACHE II and ProVent scores were higher than 0.67 (0.65–0.69), and 0.69 (0.67–0.71)), respectively. The most important variables in developing each machine learning model were APACHE II score, Charlson comorbidity index, and norepinephrine. The machine learning models have a higher AUC than conventional scoring systems, and can thus better predict the 30-day mortality of mechanically ventilated patients.


2020 ◽  
Author(s):  
Hitoshi Yamamura ◽  
Hiroshi Matsuura ◽  
Junichiro Nakagawa ◽  
Hiroshi Fukuoka ◽  
Hisaya Domi ◽  
...  

Abstract We attempted the cocktail treatment of favipiravir, steroid, and heparin for COVID-19. This study aimed to evaluate the effect of cocktail therapy for severe COVID-19.The treatment protocol was as follows: oral favipiravir (3600 mg on Day 1, 1600 mg from day 2 to day 14), methylprednisolone (1000 mg for 3 days), and low molecular weight (2000 IU every 12 h) or unfractionated heparin (10,000-12,000 IU/day). Thirteen patients with COVID-19 requiring mechanical ventilation were admitted during the study period. Mean patient age was 63 (range, 46-80) years, and 69.0% were men. Only one patient required extracorporeal membrane oxygenation. Time from first symptom appearance to favipiravir administration was 8.7 (range, 4-13) days. The P/F ratio changed very little over the first 6 days and then gradually recovered. The Interleukin-6 peaked on Day 4 and decreased thereafter. Presepsin also peaked on Day 3, remained about the same until Day 6, and then decreased. The clinical course of SARS-CoV-2 treatment with the cocktail in mechanically ventilated patients with COVID-19 indicated that favipiravir could partially control inflammatory mediators but could not completely control them or respiratory status.


2021 ◽  
Author(s):  
Yohei Migiyama ◽  
Shinya Sakata ◽  
Shinji Iyama ◽  
Kentaro Tokunaga ◽  
Koichi Saruwatari ◽  
...  

Abstract Background: The bacterial density of Pseudomonas aeruginosa (PA) is closely related to its pathogenicity. We evaluated the effect of airway PA density on the clinical course of mechanically ventilated patients and the therapeutic efficacy of antibiotics.Methods: We retrospectively analyzed data of intensive care unit (ICU) mechanically ventilated patients with PA isolated from endotracheal aspirates. Patients were divided into three groups according to the peak PA density during ICU stay: low-PA (≤ 104 colony-forming units [cfu]/mL), moderate-PA (105‒106 cfu/mL), and high-PA (≥ 107 cfu/mL) groups. The relationship between PA density and weaning from mechanical ventilation, risk factors for high-PA isolation, and antibiotic efficacy were investigated using multivariate and propensity score-matched analyses.Results: A total of 461 patients were enrolled. Patients with high-PA had higher inflammation marker levels and developed more severe respiratory infections. High PA was independently associated with fewer ventilator-free days on day 28 (P < 0.01) and increased ICU mortality (P = 0.047). Risk factors for high PA were prolonged mechanical ventilation (odds ratio [OR] 3.07, 95% confidence interval [CI] 1.35‒6.97), non-antipseudomonal cephalosporins (OR 2.17, 95% CI 1.35‒3.49), hyperglycemia (OR 2.01, 95% CI 1.26‒3.22) during ICU stay, and respiratory diseases (OR 1.9, 95% CI 1.12‒3.23). Isolation of commensal colonizers was associated with lower risks of high PA (OR 0.43, 95% CI 0.26‒0.73). Propensity score-matched analyses revealed that antibiotic therapy for patients with ventilator-associated tracheobronchitis improved weaning from mechanical ventilation only in the high-PA group.Conclusions: High PA significantly affected the clinical course of mechanically ventilated patients and could be a good therapeutic indicator for ventilator-associated tracheobronchitis treatment.


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