Artificial intelligence and cardiac surgery during COVID-19 era

The coronavirus disease 2019 (COVID-19) pandemic has increased the burden on hospital staff world-wide. Through the redistribution of scarce resources to these high-priority cases, the cardiac sector has fallen behind. In efforts to reduce transmission, reduction in direct patient-physician contact has led to a backlog of cardiac cases. However, this accumulation of postponed or cancelled nonurgent cardiac care seems to be resolvable with the assistance of technology. From telemedicine to artificial intelligence (AI), technology has transformed healthcare systems nationwide. Telemedicine enables patient monitoring from a distance, while AI unveils a whole new realm of possibilities in clinical practice, examples include: traditional systems replacement with more efficient and accurate processing machines; automation of clerical process; and triage assistance through risk predictions. These possibilities are driven by deep and machine learning. The two subsets of AI are explored and limitations regarding "big data" are discussed. The aims of this review are to explore AI: the advancements in methodology; current integration in cardiac surgery or other clinical scenarios; and potential future roles, which are innately nearing as the COVID-19 era urges alternative approaches for care

Applicability of Clinical Decision Support in Management among Patients Undergoing Cardiac Surgery in Intensive Care Unit: A Systematic Review

[Abstract] The advances achieved in recent decades regarding cardiac surgery have led to a new risk that goes beyond surgeons’ dexterity; postoperative hours are crucial for cardiac surgery patients and are usually spent in intensive care units (ICUs), where the patients need to be continuously monitored to adjust their treatment. Clinical decision support systems (CDSSs) have been developed to take this real-time information and provide clinical suggestions to physicians in order to reduce medical errors and to improve patient recovery. In this review, an initial total of 499 papers were considered after identification using PubMed, Web of Science, and CINAHL. Twenty-two studies were included after filtering, which included the deletion of duplications and the exclusion of titles or abstracts that were not of real interest. A review of these papers concluded the applicability and advances that CDSSs offer for both doctors and patients. Better prognosis and recovery rates are achieved by using this technology, which has also received high acceptance among most physicians. However, despite the evidence that well-designed CDSSs are effective, they still need to be refined to offer the best assistance possible, which may still take time, despite the promising models that have already been applied in real ICUs.Xunta de Galicia; ED431C 2018/4

Multicenter prospective clinical study to evaluate children short-term neurodevelopmental outcome in congenital heart disease (children NEURO-HEART) : study protocol

Altres ajuts: RETICS funded by the PN 2018-2021 (Spain).Congenital heart disease (CHD) is the most prevalent congenital malformation affecting 1 in 100 newborns. While advances in early diagnosis and postnatal management have increased survival in CHD children, worrying long-term outcomes, particularly neurodevelopmental disability, have emerged as a key prognostic factor in the counseling of these pregnancies. Eligible participants are women presenting at 20 to < 37 weeks of gestation carrying a fetus with CHD. Maternal/neonatal recordings are performed at regular intervals, from the fetal period to 24 months of age, and include: placental and fetal hemodynamics, fetal brain magnetic resonance imaging (MRI), functional echocardiography, cerebral oxymetry, electroencephalography and serum neurological and cardiac biomarkers. Neurodevelopmental assessment is planned at 12 months of age using the ages and stages questionnaire (ASQ) and at 24 months of age with the Bayley-III test. Target recruitment is at least 150 cases classified in three groups according to three main severe CHD groups: transposition of great arteries (TGA), Tetralogy of Fallot (TOF) and Left Ventricular Outflow Tract Obstruction (LVOTO). The results of NEURO-HEART study will provide the most comprehensive knowledge until date of children's neurologic prognosis in CHD and will have the potential for developing future clinical decisive tools and improving preventive strategies in CHD. , on 4th December 2016 (retrospectively registered)

Multicenter prospective clinical study to evaluate children short-term neurodevelopmental outcome in congenital heart disease (children NEURO-HEART): study protocol

Congenital heart disease; Neurodevelopment; Predictive markersCardiopatía congénita; Desarrollo neurológico; Marcadores predictivosCardiopaties congènites; Neurodesenvolupament; Marcadors predictiusBackground: Congenital heart disease (CHD) is the most prevalent congenital malformation affecting 1 in 100 newborns. While advances in early diagnosis and postnatal management have increased survival in CHD children, worrying long-term outcomes, particularly neurodevelopmental disability, have emerged as a key prognostic factor in the counseling of these pregnancies. Methods: Eligible participants are women presenting at 20 to < 37 weeks of gestation carrying a fetus with CHD. Maternal/neonatal recordings are performed at regular intervals, from the fetal period to 24 months of age, and include: placental and fetal hemodynamics, fetal brain magnetic resonance imaging (MRI), functional echocardiography, cerebral oxymetry, electroencephalography and serum neurological and cardiac biomarkers. Neurodevelopmental assessment is planned at 12 months of age using the ages and stages questionnaire (ASQ) and at 24months of age with the Bayley-III test. Target recruitment is at least 150 cases classified in three groups according to three main severe CHD groups: transposition of great arteries (TGA), Tetralogy of Fallot (TOF) and Left Ventricular Outflow Tract Obstruction (LVOTO). Discussion: The results of NEURO-HEART study will provide themost comprehensive knowledge until date of children’s neurologic prognosis in CHD and will have the potential for developing future clinical decisive tools and improving preventive strategies in CHD.RETICS funded by the PN 2018-2021 (Spain), ISCIII- Sub-Directorate General for Research Assessment and Promotion and the European Regional Development Fund (FEDER), reference RD16/002

Cerebral Hemodynamics in High-Risk Neonates Probed by Diffuse Optical Spectroscopies

Advances in medical and surgical care of the critically ill neonates have decreasedmortality, yet a significant number of these neonates suffer from neurodevelopmentaldelays and failure in school. Thus, clinicians are now focusing on prevention ofneurologic injury and improvement of neurocognitive outcome in these high-risk infants. Assessment of cerebral oxygenation, cerebral blood volume, and the regulation of cerebral blood flow (CBF) during the neonatal period is vital for evaluating brain health. Traditional CBF imaging methods fail, however, for both ethical and logistical reasons. In this dissertation, I demonstrate the use of non-invasive optical modalities, i.e., diffuse optical spectroscopy and diffuse correlation spectroscopy, to study cerebral oxygenation and cerebral blood flow in the critically ill neonatal population. The optical techniques utilize near-infrared (NIR) light to probe the static and dynamic physiological properties of deep tissues. Diffuse correlation spectroscopy (DCS) employs the transport of temporal correlation functions of diffusing light to extract relative changes in blood flow in biological tissues. Diffuse optical spectroscopy (DOS) employs the wavelength-dependent attenuation of NIR light to assess the concentrations of the primary chromophores in the tissue, namely oxy- and deoxy-hemoglobin. This dissertation presents both validation and clinical applications of novel diffuse optical spectroscopies in two specific critically ill neonatal populations: very-low birth weight preterm infants,and infants born with complex congenital heart defects. For validation of DCS in neonates, the blood flow index quantified by DCS is shown to correlate well with velocity measurements in the middle cerebral artery acquired by transcranial Doppler ultrasound. In patients with congenital heart defects DCS-measured relative changes in CBF due to hypercapnia agree strongly with relative changes in blood flow in the jugular veins as measured by phase-encoded velocity mapping magnetic resonance. For applications in the clinic, CO2 reactivity in patients with congenital heart defects prior to various stages of reconstructive surgery was quantified; our initial results suggest that CO2 reactivity is not systematically related to brain injury in this population. Additionally, the cerebral effects of various interventions, such as blood transfusion and sodium bicarbonate infusion, were investigated. In preterm infants, monitoring with DCS reveals a resilience of these patients to maintain constant CBF during a small postural manipulation

Význam změn tkáňové oxygenace u monochoriálních dvojčat v predikci závažné neonatální morbidity

Despite improvements in perinatal outcome in recent decades, multiple pregnancies are associated with increased risk of complications including preterm birth, fetal growth restriction (FGR) and twin-twin transfusion syndrome (TTTS). Fetal circulatory disturbances and immature cerebral vasculature increase the risk for serious perinatal injury and adverse neurodevelopmental outcome in multiple births. Cerebral oxygenation (crSO2) monitoring using near-infrared spectroscopy (NIRS) is increasingly used in high-risk infants. However, limited data are available in twin preterm infants with respect to cerebral tissue perfusion. The aim of this project was to measure crSO2 using NIRS in preterm monochorionic and dichorionic twins during the first 72 hours of life and find out correlation between underlying fetal conditions and crSO2 development. We divided the study population into 4 subgroups based on major fetal pathology: donor (1) and recipient (2) monochorionic twins (with TTTS), selective FGR infants (3) and twins without fetal compromise (4). We observed significant variation in crSO2 among the subgroups using mixed model analysis. The recipient twins exhibited the lowest crSO2 throughout the study period, whereas the FGR and donor twins presented with the highest values. Nevertheless, we found no...Přestože došlo ke zlepšení perinatální péče v posledních desetiletích, jsou vícečetná těhotenství asociovaná se zvýšeným rizikem komplikací, jako např. předčasný porod, fetální růstová restrikce (fetal growth restriction - FGR) a transfuzní syndrom (twin-twin transfusion syndrome - TTTS). Intrauterinní cirkulační nestabilita a nezralá mozková vaskulatura významně přispívají k riziku vážného perinatálního poškození a zhoršeného neurologického vývoje dětí z vícečetných gravidit. Měření cerebrální oxygenace (crSO2) pomocí metody Near-Infrared Specotroscopy (NIRS) se používá stále častěji u rizikových novorozenců. I přes rozšířenost metody však existují omezená data s ohledem na nezralá dvojčata a jejich cerebrální tkáňovou perfuzi. Cílem práce bylo analyzovat crSO2 pomocí metody NIRS u nezralých monochoriálních a bichoriálních dvojčat v prvních 72 hodinách života a objasnit korelaci mezi fetálními komplikacemi a postnatálním vývojem crSO2. Na základě dominantních fetálních komplikací jsme rozdělili studijní populaci na 4 skupiny: donoři (1) a recipienti (2) z monochoriální gravidity s TTTS, novorozenci s FGR (3) a novorozenci bez významné fetální komplikace (4). Použitím analýzy smíšeného modelu jsme zjistili signifikantní rozdíly v crSO2 mezi jednotlivými skupinami. Ve skupině recipientů byly...Ústav pro péči o matku a dítě v Praze PodolíDepartment of Mother and Child Care in Prague PodoliThird Faculty of Medicine3. lékařská fakult

STDMn+p0: a multidimensional patient oriented data mining framework for critical care research

In the neonatal intensive care unit (NICU) environment, critical care and treatment directly correlate to the multidimensional development of an infant and are influenced by attributes such as gender and gestational age (GA). Recent literature on guidelines developed for neonatal intensive care; do not take the gender or the GA of the infant into account. The exponential activity of a growing neonate in its early stages of life needs to be captured and embedded into algorithms designed to extract patterns of predictive temperament within the NICU domain. The STDMn+p0 framework presents an extended multidimensional approach with the ability to create patient characteristic clinical rules. Further defining NICU algorithms, through the extended use of attributes to include gender and GA, and using these new algorithms in clinical decision support systems increases the accuracy and thereby minimizes the risk of adverse events

Pressure support ventilation or synchronised intermittent mandatory ventilation for weaning premature babies on mechanical ventilation : a multi centre randomised controlled trial

PhD ThesisMechanical ventilation is life saving as a respiratory support for preterm infants with respiratory distress syndrome. There is good evidence now that any form of volume-targeted modality of mechanical ventilation is superior over pressure-targeted modality to reduce chronic lung disease and death. It is perceived by minimising the duration of mechanical ventilation would reduce the exposure to positive pressure breaths and thereby could reduce long term morbidities such as chronic lung disease. An area of lacunae is defining what is weaning on mechanical ventilation. Whilst most clinicians will agree when to commence mechanical ventilation there is paucity of consensus on when to commence weaning on mechanical ventilation and the best way for weaning to prevent extubation failure. Pressure support ventilation (PSV) is pressure-targeted modality of ventilation designed to support spontaneous breathing. It was designed as a weaning mode to facilitate extubation. Pure PSV has no back up rate. Currently, PSV is used in combination with other modes such as SIMV to provide some back up respiratory rate for the unreliable respiratory drive due to apnoea in preterm infants. However, there is inadequate understanding of the appropriate PSV level for weaning preterm infants on mechanical ventilation. Clinicians routinely use 50%-70% of peak inflation pressures used prior to commencing the weaning mode. Use of Pressure support ventilation (PSV) could be variable- with one extreme utilising minimal pressure to just overcome the tube resistance (PSmin) with the aim to prevent fatigue and avoid extubation failure. The other extreme is augmenting spontaneous breathing effort to provide a full tidal volume breath (PSmax). Features of flow triggering and flow cycling aid synchrony at inspiration and expiration and this allows greater autonomy to the infant to control all aspects of its breathing cycle. Addition of some PSV to aid spontaneous breaths has shown to reduce the duration of weaning. A randomised controlled study was designed to compare duration of weaning using PSmax and SIMV. Infants less than 32 weeks gestation at birth with respiratory distress syndrome from surfactant deficiency were eligible to participate. 93 infants stratified in three groups based on their gestation at birth were randomised over 30-month period. Weaning was commenced in the randomised mode when infants reached a set priori of MAP<10 cm H2O, FiO2 <40% and had a reliable respiratory drive for at least 2 consecutive hours. In the control arm (SIMV with PSmin)– clinicians reduced the back up rate to wean. In the intervention arm (PSmax with ten SIMV breaths)- clinicians reduced the PSVmax to PSVmin for weaning. A minute ventilation test was performed to assess readiness to extubation when both arms reached PSmin with ten back up SIMV breaths. Primary outcome for the study was duration of weaning on mechanical ventilation. Our study suggests there is no difference between the two groups but there is a trend towards faster extubation in the PSV arm (the median time to extubate in the SIMV arm was 42 (95%CI, 28.23 to 55.76) hours and the median time to achieve the primary outcome in the PSV arm was 31 (95% CI, 12.59 to 49.40) hours). The survival distribution between the interventions was statistically not significant, Chi-square 0.768, p 0.381. This effect was more evident in bigger infants weighing at least 1500 grams. There was no difference in the secondary outcomes between the two groups and common preterm morbidities were equally balanced. There were no adverse events during the study period to report. Contrary to the general belief, infants are not disadvantaged by weaning on PSVmax. Clinical outcomes were comparable with the traditional SIMV method of weaning on mechanical ventilation

Quantitative Analysis of Ultrasound Images of the Preterm Brain

In this PhD new algorithms are proposed to better understand and diagnose white matter damage in the preterm Brain. Since Ultrasound imaging is the most suited modality for the inspection of brain pathologies in very low birth weight infants we propose multiple techniques to assist in what is called Computer-Aided Diagnosis. As a main result we are able to increase the qualitative diagnosis from a 70% detectability to a 98% quantitative detectability