44 research outputs found

    Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies

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    Background: Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods: In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings: Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42\ub74% vs 44\ub72%; absolute difference \u20131\ub769 [\u20139\ub758 to 6\ub711] p=0\ub767; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5\u20138] vs 6 [5\u20138] cm H2O; p=0\ub70011). ICU mortality was higher in MICs than in HICs (30\ub75% vs 19\ub79%; p=0\ub70004; adjusted effect 16\ub741% [95% CI 9\ub752\u201323\ub752]; p<0\ub70001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0\ub780 [95% CI 0\ub775\u20130\ub786]; p<0\ub70001). Interpretation: Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status. Funding: No funding

    Methodology of high accuracy, sensitivity and specificity in the counts of erythrocytes and leukocytes in blood smear images

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    The evaluation of human blood is an important diagnostic method for the detection of diseases. The analysis of the erythrocytes contained in the blood contributes to the detection of anemia and leukemia, whereas the leukocyte analysis allows the diagnosis of inflammation and/or infections. The blood is analyzed through of the complete blood count test (CBC), which is dependent on automated and/or manual methodologies. The dependence of medical areas on new technologies leads the present study to the goal of developing an image segmentation algorithm that meets the criteria of efficiency and reliability for detection and counting of blood cells. The algorithm was developed through the Matlab software, being the image processing methodology based on the union of the Watershed transform and Morphological Operations, originating the WT-MO methodology. For the simulations, 30 blood smear images containing erythrocytes and leukocytes were used in a non-pathological state. The results showed that the WT-MO methodology presents high sensitivity (99%), specificity (96%) and accuracy (98,3%) when compared with the manual methodology. Therefore, the WT-MO methodology is an accurate, reliable and low-cost technique and can be applied as a third more accessible methodology to perform of the complete blood count test (CBC) in populations of underdeveloped and developing countries1407990BTSym 2018 : Proceedings of the 4th Brazilian Technology Symposium (BTSym'18)2018Blood cells Watershed transform Morphological operations Blood smear Image processing Algorith
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