Tests for predicting complications of pre-eclampsia: A protocol for systematic reviews

Background Pre-eclampsia is associated with several complications. Early prediction of complications and timely management is needed for clinical care of these patients to avert fetal and maternal mortality and morbidity. There is a need to identify best testing strategies in pre eclampsia to identify the women at increased risk of complications. We aim to determine the accuracy of various tests to predict complications of pre-eclampsia by systematic quantitative reviews. Method We performed extensive search in MEDLINE (1951–2004), EMBASE (1974–2004) and also will also include manual searches of bibliographies of primary and review articles. An initial search has revealed 19500 citations. Two reviewers will independently select studies and extract data on study characteristics, quality and accuracy. Accuracy data will be used to construct 2 × 2 tables. Data synthesis will involve assessment for heterogeneity and appropriately pooling of results to produce summary Receiver Operating Characteristics (ROC) curve and summary likelihood ratios. Discussion This review will generate predictive information and integrate that with therapeutic effectiveness to determine the absolute benefit and harm of available therapy in reducing complications in women with pre-eclampsia

Diagnostic and prognostic prediction models in ventilator-associated pneumonia: Systematic review and meta-analysis of prediction modelling studies

Machine learning; Mechanical ventilation; Prognostic modelAprenentatge automàtic; Ventilació mecànica; Model pronòsticAprendizaje automático; Ventilacion mecanica; Modelo pronósticoPurpose Existing expert systems have not improved the diagnostic accuracy of ventilator-associated pneumonia (VAP). The aim of this systematic literature review was to review and summarize state-of-the-art prediction models detecting or predicting VAP from exhaled breath, patient reports and demographic and clinical characteristics. Methods Both diagnostic and prognostic prediction models were searched from a representative list of multidisciplinary databases. An extensive list of validated search terms was added to the search to cover papers failing to mention predictive research in their title or abstract. Two authors independently selected studies, while three authors extracted data using predefined criteria and data extraction forms. The Prediction Model Risk of Bias Assessment Tool was used to assess both the risk of bias and the applicability of the prediction modelling studies. Technology readiness was also assessed. Results Out of 2052 identified studies, 20 were included. Fourteen (70%) studies reported the predictive performance of diagnostic models to detect VAP from exhaled human breath with a high degree of sensitivity and a moderate specificity. In addition, the majority of them were validated on a realistic dataset. The rest of the studies reported the predictive performance of diagnostic and prognostic prediction models to detect VAP from unstructured narratives [2 (10%)] as well as baseline demographics and clinical characteristics [4 (20%)]. All studies, however, had either a high or unclear risk of bias without significant improvements in applicability. Conclusions The development and deployment of prediction modelling studies are limited in VAP and related outcomes. More computational, translational, and clinical research is needed to bring these tools from the bench to the bedside.The project is supported by the Academy of Finland (project number 326291) and the University of Oulu

Improving Mechanical Ventilator Clinical Decision Support Systems with A Machine Learning Classifier for Determining Ventilator Mode

Clinical decision support systems (CDSS) will play an in-creasing role in improving the quality of medical care for critically ill patients. However, due to limitations in current informatics infrastructure, CDSS do not always have com-plete information on state of supporting physiologic monitor-ing devices, which can limit the input data available to CDSS. This is especially true in the use case of mechanical ventilation (MV), where current CDSS have no knowledge of critical ventilation settings, such as ventilation mode. To enable MV CDSS to make accurate recommendations related to ventilator mode, we developed a highly performant ma-chine learning model that is able to perform per-breath clas-sification of 5 of the most widely used ventilation modes in the USA with an average F1-score of 97.52%. We also show how our approach makes methodologic improvements over previous work and that it is highly robust to missing data caused by software/sensor error

Becoming a cyborg : experiences of undergoing mechanical ventilation in the intensive care unit

Background: In intensive care ventilator treatment is a common therapy associated with discomfort and stress. On account of the technology there is a risk that the human bering is not being seen. Aim: Describe the experience of being cared for in an intensive care unit while undergoing mechanical ventilation. Method: Systematic literature review that included 18 scientific articles. The articles were analyzed using qualitative content analysis and the term cyborg as well as Martinsons epic Aniara from 1956 is the basis for the discussion of the findings. Findings: The persons describes a linkage to the technology that eventually becomes a part of themselves. To receive mechanical ventilation is to become a cyborg. The perception of time is lost, as well as the line between reality and illusion and they are unable to communicate wishes and needs - they are stuck in a black hole. Health professionals and close ones are a great part of the experience which is described as being a part of a galaxy. Close ones creates safety while health professionals has the power to make the situation better or worse through their actions. Discussion and conclusion: Persons receiving mechanical ventilation in the intensive care unit is affected by the surrounding people, environment and technology. They are subjected to an extreme situation where the body is malfunctioning; the technology is their only hope for survival and the transformation into a cyborg is necessary. They are powerless, helpless and dejected. Their suffering can be eased by their close ones and by being well cared for by health professionals.Bakgrund: Många personer som vårdas på intensivvårdsavdelning är i behov av behandling med ventilator som förknippas med obehag och stress. Intensivvårdsavdelningen är en tekniktät miljö i vilken det föreligger en risk att människan inte blir sedd på grund av teknologin. Syfte: Beskriva upplevelsen av att vårdas på intensivvårdsavdelning under ventilatorbehandling. Metod: Litteraturstudie med systematisk metod som inkluderade 18 artiklar. Artiklarna analyserades med kvalitativ innehållsanalys och resultatet diskuteras utifrån begreppet cyborg samt Martinsons rymdepos Aniara från 1956. Resultat: Personerna beskriver en tät sammankoppling med tekniken som slutligen blir en del av dem själva. Att vårdas på en intensivvårdsavdelning med ventilatorbehandling är att bli en cyborg. Tiden är omöjlig att avgöra såväl som skiljelinjen mellan verklighet och illusion och de kan inte kommunicera sina känslor och önskningar – de är fast i ett svart hål. Vårdpersonal, närstående och andra som vårdas i närheten påverkar deras situation vilket beskrivs som att vara del i en galax. Närstående skapar trygghet medan vårdpersonal har makten att både förbättra och försämra deras situation genom sitt handlande. Diskussion och slutsats: Personer som vårdas med ventilator på intensivvårdsavdelningen påverkas av omgivande teknik, miljö och människor. De är utsatta för en extrem situation där den egna kroppen är ur funktion; tekniken blir deras enda möjlighet att överleva och förvandlingen till en cyborg är nödvändig. Personerna befinner sig i en skrämmande miljö där de inte kan skilja dröm från verklighet eller uppfatta dygnsrytmen. De är maktlösa, utsatta och uppgivna. Deras plågor kan lindras deras närståendes närvaro och god omvårdnad från vårdpersonalen

Pico de fluxo da tosse como preditor de sucesso na extubação orotraqueal: revisão sistemática com metanálise

Uma porcentagem significativa de pacientes que obtêm sucesso no teste de respiração espontânea (TRE) é reintubada devido à incapacidade de proteger as vias aéreas. Esta revisão sistemática foi realizada para analisar a capacidade do pico de fluxo da tosse (PFT) em predizer o desfecho da extubação em pacientes que passaram no TRE. Métodos: A pesquisa abrangeu as bases de dados científicos MEDLINE, EMBASE, LILACS e IBECS, Scopus, Cochrane, Web of Science, CINAHL, SciELO e literatura cinzenta. O instrumento de avaliação Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) foi utilizado para avaliar a qualidade metodológica e o risco de viés do estudo. A heterogeneidade estatística através do likelihood e odds ratio foi avaliada usando gráfico de forest plot e através da estatística Q de Cochran, e calculou-se a curva SROC (summary receiver operating characteristic) utilizando múltiplos pontos de corte. Resultados: Muitos estudos apresentaram “risco incerto” de viés nos critérios de “seleção de pacientes” e “fluxo e tempo”. Dos 12 estudos incluídos, 7 apresentaram “alto risco” e 5 “risco incerto” no item “padrão de referência”, devido à falta de critérios clínicos objetivos para reintubação, uso de terapia de resgate e não exclusão de pacientes que reintubaram por laringoespasmo. A predição diagnóstica da PFT para o resultado da extubação foi baixa a moderada, considerando os resultados de todos os estudos incluídos. Uma análise de subgrupo incluindo apenas os estudos com ponto de corte entre 55-65 L/min mostrou um desempenho um pouco melhor, porém ainda moderado. Conclusão: A avaliação do PFT considerando um ponto de corte entre 55-65 L/min pode ser útil como uma medida complementar antes da extubação. São necessários mais estudos com protocolos bem estabelecidos para elucidar o melhor método e equipamento para registrar o PFT, bem como o melhor ponto de corte.A considerable proportion of patients who succeed in the spontaneous breathing trial (SBT) are reintubated because of the incapacity to protect their airways. This systematic review was designed to assess the cough peak flow CPF usefulness to predict the extubation outcome in patients who passed an SBT. Methods: The search covered the databases MEDLINE, EMBASE, LILACS and IBECS scientific databases, CINAHL, SciELO, Cochrane, Scopus, Web of Science, and gray literature. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) was used to assess the methodological quality and risk of study bias. The statistical heterogeneity of likelihood and diagnostic odds ratios was evaluated using forest plots and the Cochran’s Q statistic, and a crosshair summary receiver operator characteristic (SROC) plot using the multiple cutoffs model was calculated. Results: Many studies presented unclear risk of bias in the “patient selection”, and “flow and time” criteria. Of the 12 included studies, 7 presented “high risk” and 5 a “unclear risk” in the item “Reference Standard”, because of lack of objective clinical criteria for reintubation, use of rescue therapy and non-exclusion of patients who reintubated for laryngospasm. The diagnostic performance of CPF for extubation outcome was low to moderate when considering the results from all included studies. A subgroup analysis including only the studies with a cutoff between 55-65L/min showed a slightly better performance, however, still moderate. Conclusion: The CPF assessment considering a cutoff between 55-65L/min may be useful as a complementary measurement prior to the extubation. More well-designed studies are needed to elucidate the best method and equipment to record CPF, as well as the best cutoff.Coordenação de Aperfeiçoamento de Pessoal de Nível Superio

“Not Being Able to Talk Was Horrid”: A Descriptive, Correlational Study of Communication During Mechanical Ventilation

Objectives: The purpose of this study was to describe the patient experience of communication during mechanical ventilation. Research methodology: This descriptive study is a secondary analysis of data collected to study the relationship between sedation and the MV patients’ recall of the ICU. Interviews, conducted after extubation, included the Intensive Care Experience Questionnaire. Data were analysed with Spearman correlation coefficients (rs) and content analysis. Setting: Participants were recruited from a medical-surgical intensive care unit in the Midwest United States. Results: Participants (n = 31) with a mean age of 65 ± 11.9 were on the ventilator a median of 5 days. Inability to communicate needs was associated with helplessness (rs = .43). While perceived lack of information received was associated with not feeling in control (rs = 41) and helplessness (rs = 41). Ineffective communication impacted negatively on satisfaction with care. Participants expressed frustration with failed communication and a lack of information received. They believed receipt of information helped them cope and desired a better system of communication during mechanical ventilation. Conclusion: Communication effectiveness impacts patients’ sense of safety and well-being during mechanical ventilation. Greater emphasis needs to be placed on the development and integration of communication strategies into critical care nursing practice

Mobilização precoce em pessoas submetidas a ventilação mecânica invasiva: Revisão Integrativa da Literatura

Introduction: Early mobilization in the intensive care unit is considered an important intervention in the prevention of complications related to immobility and mechanical ventilation, mainly in the development of generalized muscular weakness. Objective: To identify the benefits of the various therapeutic modalities used in the early mobilization of critically ill people submitted to invasive mechanical ventilation. Method: It was performed an integrative review. The following question was formulated through the PICo strategy - what is the state of knowledge about early mobilization in critically placed people submitted to invasive ventilation? The research was carried out on the EBSCOhost platform in September 2018, in the electronic databases CINAHL and MEDLINE and the period between January 2010 and September 2018 was defined. Results: Of the 397 articles identified, 9 articles were included. Early mobilization in person submitted to invasive mechanical ventilation is considered a safe practice, since the occurrence of adverse events is reduced. The main benefits are improvement of functional capacity, reduction of complications associated with immobility and invasive mechanical ventilation, reduction of the number of days under invasive mechanical ventilation and, consequently, the reduction of the days of ICU stay and hospitalization. This intervention reduces hospital morbidity and mortality. Conclusion: Early mobilization in people undergoing invasive mechanical ventilation is safe and contributes to health gains at both the person / family and organizational levels.Introducción: La movilización precoz en la unidad de cuidados intensivos se considera una intervención importante en la prevención de complicaciones relacionadas con la inmovilidad y la ventilación mecánica, principalmente en el desarrollo de debilidad muscular generalizada. Objetivo: Identificar los beneficios de las diversas modalidades terapéuticas utilizadas en la movilización precoz de las personas en situación crítica, sometidas a ventilación mecánica invasiva. Identificar los beneficios de las diversas modalidades terapéuticas utilizadas en la movilización precoz de las personas en situación crítica, sometidas a ventilación mecánica invasiva. Método: Se realizó una revisión integrativa de la literatura. Se formuló la siguiente cuestión: a través de la estrategia PICo: ¿cual el estado del conocimiento sobre la movilización precoz en personas en situación crítica sometidas a ventilación invasiva? La investigación se realizó en la plataforma EBSCOhost en septiembre de 2018, en las bases de datos electrónicas CINAHL y MEDLINE y se definió el período comprendido entre enero de 2010 y septiembre de 2018. Resultados: De los 397 artículos identificados, se incluyeron 9 artículos. La movilización precoz en persona sometida a ventilación mecánica invasiva se considera una práctica segura, ya que la aparición de eventos adversos es reducida. Los principales beneficios son la mejora de la capacidad funcional, disminución de las complicaciones asociadas a la inmovilidad y ventilación mecánica invasiva, reducción del número de días bajo ventilación mecánica invasiva y, consecuentemente, a la disminución de los días de permanencia en la UCI y de internamiento hospitalario. Esta intervención disminuye la morbilidad y mortalidad hospitalaria. Conclusión: La movilización precoz en personas sometidas a ventilación mecánica invasiva es segura y contribuye a las ganancias en salud tanto a nivel de la persona/familia, bien organizacional.Introdução: A mobilização precoce na unidade de cuidados intensivos é considerada uma intervenção importante na prevenção de complicações relacionadas com a imobilidade e a ventilação mecânica, principalmente no desenvolvimento de fraqueza muscular generalizada. Objetivo: Identificar os benefícios das várias modalidades terapêuticas utilizadas na mobilização precoce das pessoas em situação crítica, submetidas a ventilação mecânica invasiva. Método: Realizou-se uma revisão integrativa da literatura. Formulou-se a seguinte questão através da estratégia PICo - o qual o estado do conhecimento sobre a mobilização precoce em pessoas em situação critica submetidas a ventilação invasiva? A pesquisa foi realizada na plataforma EBSCOhost em setembro de 2018, nas bases de dados eletrónicas CINAHL e MEDLINE e foi definido o período compreendido entre janeiro de 2010 e setembro de 2018. Resultados: Dos 397 artigos identificados, foram incluídos 9 artigos. A mobilização precoce em pessoa submetida a ventilação mecânica invasiva é considerada uma prática segura, uma vez que a ocorrência de eventos adversos é reduzida. Os principais benefícios são melhoria da capacidade funcional, diminuição das complicações associadas à imobilidade e ventilação mecânica invasiva, redução do número de dias sob ventilação mecânica invasiva e, consequentemente, à diminuição dos dias de permanência na unidade de cuidados intensivos e de internamento hospitalar. Esta intervenção diminui a morbilidade e mortalidade hospitalar. Conclusão: A mobilização precoce em pessoas submetidas a ventilação mecânica invasiva é segura e contribui para os ganhos em saúde quer a nível da pessoa/família, quer organizacional

Alpha-2 agonists for sedation of mechanically ventilated adults in intensive care units : a systematic review

Funding The National Institute for Health Research Health Technology Assessment programme. The Health Services Research Unit is core funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorates.Peer reviewedPublisher PD

Alveolar fluid in acute respiratory distress syndrome promotes fibroblast migration: role of platelet-derived growth factor pathway

OBJECTIVES: Fibroblast migration is an initiating step in fibroproliferation; its involvement during acute lung injury and acute respiratory distress syndrome remains poorly understood. The aims of this study were: 1) to determine whether bronchoalveolar lavage fluids from patients with acute lung injury/acute respiratory distress syndrome modulate lung fibroblast migration; 2) to assess lung fibroblast migration\u27s clinical relevance; and 3) to evaluate the role of the platelet-derived growth factor pathway in this effect. DESIGN: Prospective cohort study. SETTING: Three intensive care units of a large tertiary referral center. PATIENTS: Ninety-three ventilated patients requiring bronchoalveolar lavage fluids were enrolled (48 with acute respiratory distress syndrome, 33 with acute lung injury, and 12 ventilated patients without acute lung injury/acute respiratory distress syndrome). INTERVENTIONS: After bronchoalveolar lavage fluids collection during standard care, the patients were followed up for 28 days and clinical outcomes were recorded. Migration assays were performed by using a Transwell model; bronchoalveolar lavage fluids platelet-derived growth factor and soluble platelet-derived growth factor receptor-alpha were characterized by Western blot and measured by ELISA. MEASUREMENTS AND MAIN RESULTS: Most of the bronchoalveolar lavage fluids inhibited basal fibroblast migration. Bronchoalveolar lavage fluids chemotactic index increased with severity of lung injury (28% in patients without acute lung injury/acute respiratory distress syndrome and with acute lung injury vs. 91% in acute respiratory distress syndrome patients; p = .016). In acute lung injury/acute respiratory distress syndrome patients, inhibition of basal fibroblast migration by bronchoalveolar lavage fluids below 52% was independently associated with a lower 28-day mortality (odds ratio [95% confidence interval] 0.313 [0.10-0.98], p = .046). Platelet-derived growth factor-related peptides and soluble platelet-derived growth factor-Ralpha were detected in all bronchoalveolar lavage fluids from acute lung injury/acute respiratory distress syndrome patients. The effect of bronchoalveolar lavage fluids stimulating migration was inhibited by a specific platelet-derived growth factor receptor inhibitor (AG1296). Bronchoalveolar lavage fluids inhibiting migration reversed the effect of rh-platelet-derived growth factor-BB and reduced by 40% the binding of 125I-platelet-derived growth factor-BB to fibroblast cell surface in favor of a role for platelet-derived growth factor-sRalpha. CONCLUSIONS: : Together, our results suggest that during acute lung injury, fibroblast migration is modulated by bronchoalveolar lavage fluids through a platelet-derived growth factor/platelet-derived growth factor-sRalpha balance. Migration is associated with clinical severity and patient 28-day mortality