EPISYNC study : Predictors of patient-ventilator asynchrony in a prospective cohort of patients under invasive mechanical ventilation - Study protocol

Funding: The Episync study is supported by Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP), grant number 2015/19122-4.Introduction: Patient-ventilator asynchrony is common during the entire period of invasive mechanical ventilation (MV) and is associated with worse clinical outcomes. However, risk factors associated with asynchrony are not completely understood. The main objectives of this study are to estimate the incidence of asynchrony during invasive MV and its association with respiratory mechanics and other baseline patient characteristics. Methods and analysis: We designed a prospective cohort study of patients admitted to the intensive care unit (ICU) of a university hospital. Inclusion criteria are adult patients under invasive MV initiated for less than 72 hours, and with expectation of remaining under MV for more than 24 hours. Exclusion criteria are high flow bronchopleural fistula, inability to measure respiratory mechanics and previous tracheostomy. Baseline assessment includes clinical characteristics of patients at ICU admission, including severity of illness, reason for initiation of MV, and measurement of static mechanics of the respiratory system. We will capture ventilator waveforms during the entire MV period that will be analysed with dedicated software (Better Care, Barcelona, Spain), which automatically identifies several types of asynchrony and calculates the asynchrony index (AI). We will use a linear regression model to identify risk factors associated with AI. To assess the relationship between survival and AI we will use Kaplan-Meier curves, log rank tests and Cox regression. The calculated sample size is 103 patients. The statistical analysis will be performed by the software R Programming (www.R-project.org) and will be considered statistically significant if the p value is less than 0.05. Ethics and dissemination: The study was approved by the Ethics Committee of Instituto do Coração, School of Medicine, University of São Paulo, Brazil, and informed consent was waived due to the observational nature of the study. We aim to disseminate the study findings through peer-reviewed publications and national and international conference presentations. Trial registration number: NCT02687802; Pre-results

Detrended fluctuation analysis of heart rate by means of symbolic series

Detrended fluctuation analysis (DFA) has been shown to be a useful tool for diagnosis of patients with cardiac diseases. The scaling exponents obtained with DFA are an indicator of power-law correlations in signal fluctuation, independently of signal amplitude and external trends. In this work, an approach based on DFA was proposed for analyzing heart rate variability (HRV) by means of RR series. The proposal consisted on transforming consecutive RR increments to symbols, according to an adapted symbolic-quantization. Three scaling exponents were calculated, αHF, αLF and αVLF, which correspond to the well known VLF, LF and HF frequency bands in the power spectral of the HRV. This DFA approach better characterized high and low risk of cardiac mortality in ischemic cardiomyiopathy patients than DFA applied to RR time series or RR increment series.Peer ReviewedPostprint (published version

The CMS Event Builder

The data acquisition system of the CMS experiment at the Large Hadron Collider will employ an event builder which will combine data from about 500 data sources into full events at an aggregate throughput of 100 GByte/s. Several architectures and switch technologies have been evaluated for the DAQ Technical Design Report by measurements with test benches and by simulation. This paper describes studies of an EVB test-bench based on 64 PCs acting as data sources and data consumers and employing both Gigabit Ethernet and Myrinet technologies as the interconnect. In the case of Ethernet, protocols based on Layer-2 frames and on TCP/IP are evaluated. Results from ongoing studies, including measurements on throughput and scaling are presented. The architecture of the baseline CMS event builder will be outlined. The event builder is organised into two stages with intelligent buffers in between. The first stage contains 64 switches performing a first level of data concentration by building super-fragments from fragments of 8 data sources. The second stage combines the 64 super-fragments into full events. This architecture allows installation of the second stage of the event builder in steps, with the overall throughput scaling linearly with the number of switches in the second stage. Possible implementations of the components of the event builder are discussed and the expected performance of the full event builder is outlined.Comment: Conference CHEP0

The 2 Tbps "Data to Surface" System of the CMS Data Acquisition

The Data Acquisition system of the CMS experiment, at the CERN LHC collider, is designed to build 1~MB events at a sustained rate of 100 kHz and to provide sufficient computing power to filter the events by a factor of 1000. The Data to Surface (D2S) system is the first layer of the Data Acquisition interfacing the underground subdetector readout electronics to the surface Event Builder. It collects the 100~GB/s input data from a large number of front-end cards (650) , implements a first stage event building by combining multiple sources into lar ger-size data fragments, and transports them to the surface for the full event building. The Data to Surface system can operate at the maximum rate of 2 Tbps. This paper describes the layout, reconfigurability and production validation of the D2S system which is to be installed by December 2005

Transverse Beam Envelope Measurements and the Limitations of the 3-Screen Emittance Method for Space-Charge Dominated Beams

In its normal mode of operation the Argonne Wakefield Accelerator Facility uses a high charge (10-100 nC), short pulse (3-5 psec) drive bunch to excite high-gradient accelerating fields in various slow-wave structures. To generate this bunch, we designed a 1.5 cell, L-band, rf photocathode gun with an emittance compensating solenoid to give optimal performance at high-charge; it has recently completed commissioning. More recently, we have begun to investigate the possibility of using this gun in a high-brightness, low-charge operating mode, with charge equal to approximately 1 nC, for high-precision measurements of wakefields. Two related measurements are reported on in this paper: (1) measurements of the transverse beam envelope are compared to predictions from the beam dynamics code PARMELA; and (2) investigations into the use of a modified 3-screen emittance measurement method that uses a beam envelope model that includes both space-charge and emittance effects. Both measurements were made for the 1 nC, 8 MeV beam in the drift region directly following the rf photocathode gun.Comment: 19 pages, 7 figure

La capacidad del barorreflejo como índice de identificación de los pacientes de UCI preparados para el destete

Actualmente, la Prueba de Respiración Espontánea (SBT), indica si un paciente está listo para el destete de la ventilación mecánica. Sin embargo, en torno al 20% de los pacientes “preparados” para ser desintubados, realmente no lo estaban. En este trabajo, se ha estudiado la Capacidad del Barorreflejo durante la hora anterior a la SBT, y se ha visto que existen diferencias significativas entre los pacientes listos para el destete y los que realmente no lo estaban, sugiriendo que la predicción del éxito del destete puede ser mejorada con este nuevo índice

Run Control and Monitor System for the CMS Experiment

The Run Control and Monitor System (RCMS) of the CMS experiment is the set of hardware and software components responsible for controlling and monitoring the experiment during data-taking. It provides users with a "virtual counting room", enabling them to operate the experiment and to monitor detector status and data quality from any point in the world. This paper describes the architecture of the RCMS with particular emphasis on its scalability through a distributed collection of nodes arranged in a tree-based hierarchy. The current implementation of the architecture in a prototype RCMS used in test beam setups, detector validations and DAQ demonstrators is documented. A discussion of the key technologies used, including Web Services, and the results of tests performed with a 128-node system are presented.Comment: Talk from the 2003 Computing in High Energy and Nuclear Physics (CHEP03), La Jolla, Ca, USA, March 2003, 8 pages, PSN THGT00

Performance and Operation of the CMS Electromagnetic Calorimeter

The operation and general performance of the CMS electromagnetic calorimeter using cosmic-ray muons are described. These muons were recorded after the closure of the CMS detector in late 2008. The calorimeter is made of lead tungstate crystals and the overall status of the 75848 channels corresponding to the barrel and endcap detectors is reported. The stability of crucial operational parameters, such as high voltage, temperature and electronic noise, is summarised and the performance of the light monitoring system is presented

Calibration of the CMS Drift Tube Chambers and Measurement of the Drift Velocity with Cosmic Rays

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