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JMIR AI Nov 2023Early warning score systems are widely used for identifying patients who are at the highest risk of deterioration to assist clinical decision-making. This could...
BACKGROUND
Early warning score systems are widely used for identifying patients who are at the highest risk of deterioration to assist clinical decision-making. This could facilitate early intervention and consequently improve patient outcomes; for example, the National Early Warning Score (NEWS) system, which is recommended by the Royal College of Physicians in the United Kingdom, uses predefined alerting thresholds to assign scores to patients based on their vital signs. However, there is limited evidence of the reliability of such scores across patient cohorts in the United Arab Emirates.
OBJECTIVE
Our aim in this study was to propose a data-driven model that accurately predicts in-hospital deterioration in an inpatient cohort in the United Arab Emirates.
METHODS
We conducted a retrospective cohort study using a real-world data set that consisted of 16,901 unique patients associated with 26,073 inpatient emergency encounters and 951,591 observation sets collected between April 2015 and August 2021 at a large multispecialty hospital in Abu Dhabi, United Arab Emirates. The observation sets included routine measurements of heart rate, respiratory rate, systolic blood pressure, level of consciousness, temperature, and oxygen saturation, as well as whether the patient was receiving supplementary oxygen. We divided the data set of 16,901 unique patients into training, validation, and test sets consisting of 11,830 (70%; 18,319/26,073, 70.26% emergency encounters), 3397 (20.1%; 5206/26,073, 19.97% emergency encounters), and 1674 (9.9%; 2548/26,073, 9.77% emergency encounters) patients, respectively. We defined an adverse event as the occurrence of admission to the intensive care unit, mortality, or both if the patient was admitted to the intensive care unit first. On the basis of 7 routine vital signs measurements, we assessed the performance of the NEWS system in detecting deterioration within 24 hours using the area under the receiver operating characteristic curve (AUROC). We also developed and evaluated several machine learning models, including logistic regression, a gradient-boosting model, and a feed-forward neural network.
RESULTS
In a holdout test set of 2548 encounters with 95,755 observation sets, the NEWS system achieved an overall AUROC value of 0.682 (95% CI 0.673-0.690). In comparison, the best-performing machine learning models, which were the gradient-boosting model and the neural network, achieved AUROC values of 0.778 (95% CI 0.770-0.785) and 0.756 (95% CI 0.749-0.764), respectively. Our interpretability results highlight the importance of temperature and respiratory rate in predicting patient deterioration.
CONCLUSIONS
Although traditional early warning score systems are the dominant form of deterioration prediction models in clinical practice today, we strongly recommend the development and use of cohort-specific machine learning models as an alternative. This is especially important in external patient cohorts that were unseen during model development.
PubMed: 38875543
DOI: 10.2196/45257 -
Medicine Jun 2024Laparoscopic hepatectomy (LH) poses a high risk of carbon dioxide embolism due to extensive hepatic transection, long surgery duration, and dissection of the large...
INTRODUCTION
Laparoscopic hepatectomy (LH) poses a high risk of carbon dioxide embolism due to extensive hepatic transection, long surgery duration, and dissection of the large hepatic veins or vena cava.
PATIENT CONCERNS
A 65-year-old man was scheduled to undergo LH. Following intraperitoneal carbon dioxide (CO2) insufflation and hepatic portal occlusion, the patient developed severe hemodynamic collapse accompanied by a decrease in the pulse oxygen saturation (SpO2).
DIAGNOSIS
Although a decrease in end-tidal carbon dioxide (ETCO2) was not observed, CO2 embolism was still suspected because of the symptoms.
INTERVENTIONS AND OUTCOMES
The patient was successfully resuscitated after the immediate discontinuation of CO2 insufflation and inotrope administration. CO2 embolism must always be suspected during laparoscopic surgery whenever sudden hemodynamic collapse associated with decreased pulse oxygen saturation occurs, regardless of whether ETCO2 changes. Instant arterial blood gas analysis is imperative, and a significant difference between PaCO2 and ETCO2 is indicative of carbon dioxide embolism.
CONCLUSION
Instant arterial blood gas analysis is imperative, and a significant difference between PaCO2 and ETCO2 is indicative of carbon dioxide embolism.
Topics: Humans; Male; Aged; Laparoscopy; Hepatectomy; Embolism, Air; Carbon Dioxide; Insufflation; Blood Gas Analysis; Intraoperative Complications
PubMed: 38875434
DOI: 10.1097/MD.0000000000038468 -
European Journal of Sport Science Jun 2024This study investigates whether exercise as a strategy for improving physical fitness at sea level also offers comparable benefits in the unique context of high... (Randomized Controlled Trial)
Randomized Controlled Trial
This study investigates whether exercise as a strategy for improving physical fitness at sea level also offers comparable benefits in the unique context of high altitudes (HA), considering the physiological challenges of hypoxic conditions. Overall, 121 lowlanders who had lived on the Tibetan Plateau for >2 years and were still living at HA during the measurements were randomly classified into four groups. Each individual of the low-intensity (LI), moderate-intensity (MI), and high-intensity (HI) groups performed 20 sessions of aerobic exercise at HA (3680 m) over 4 weeks, while the control group (CG) did not undergo any intervention. Physiological responses before and after the intervention were observed. The LI and MI groups experienced significant improvement in cardiopulmonary fitness (0.27 and 0.35 L/min increases in peak oxygen uptake [ O], both p < 0.05) after exercise intervention, while the hematocrit (HCT) remained unchanged (p > 0.05). However, HI exercise was less efficient for cardiopulmonary fitness of lowlanders (0.02 L/min decrease in O, p > 0.05), whereas both the HCT (1.74 %, p < 0.001) and glomerular filtration rate (18.41 mL/min, p < 0.001) increased with HI intervention. Therefore, LI and MI aerobic exercise, rather than HI, can help lowlanders in Tibet become more acclimated to the HA by increasing cardiopulmonary function and counteracting erythrocytosis.
Topics: Humans; Tibet; Exercise; Altitude; Male; Adult; Acclimatization; Oxygen Consumption; Cardiorespiratory Fitness; Female; Hematocrit; Young Adult; Glomerular Filtration Rate; Physical Fitness; Heart Rate
PubMed: 38874991
DOI: 10.1002/ejsc.12110 -
European Journal of Sport Science Jun 2024Blood flow restriction (BFR) is increasingly being used to enhance aerobic performance in endurance athletes. This study examined physiological responses to BFR applied... (Randomized Controlled Trial)
Randomized Controlled Trial
Blood flow restriction (BFR) is increasingly being used to enhance aerobic performance in endurance athletes. This study examined physiological responses to BFR applied in recovery phases within a high-intensity interval training (HIIT) session in trained cyclists. Eleven competitive road cyclists (mean ± SD, age: 28 ± 7 years, body mass: 69 ± 6 kg, peak oxygen uptake: 65 ± 9 mL · kg · min) completed two randomised crossover conditions: HIIT with (BFR) and without (CON) BFR applied during recovery phases. HIIT consisted of six 30-s cycling bouts at an intensity equivalent to 85% of maximal 30-s power (523 ± 93 W), interspersed with 4.5-min recovery. BFR (200 mmHg, 12 cm cuff width) was applied for 2-min in the early recovery phase between each interval. Pulmonary gas exchange (V̇O, V̇CO, and V̇E), tissue oxygen saturation index (TSI), heart rate (HR), and serum vascular endothelial growth factor concentration (VEGF) were measured. Compared to CON, BFR increased V̇CO and V̇E during work bouts (both p < 0.05, dz < 0.5), but there was no effect on V̇O, TSI, or HR (p > 0.05). In early recovery, BFR decreased TSI, V̇O, V̇CO, and V̇E (all p < 0.05, dz > 0.8) versus CON, with no change in HR (p > 0.05). In late recovery, when BFR was released, V̇O, V̇CO, V̇E, and HR increased, but TSI decreased versus CON (all p < 0.05, dz > 0.8). There was a greater increase in VEGF at 3-h post-exercise in BFR compared to CON (p < 0.05, dz > 0.8). Incorporating BFR into HIIT recovery phases altered physiological responses compared to exercise alone.
Topics: Humans; Bicycling; High-Intensity Interval Training; Adult; Heart Rate; Oxygen Consumption; Cross-Over Studies; Male; Young Adult; Pulmonary Gas Exchange; Vascular Endothelial Growth Factor A; Regional Blood Flow; Athletic Performance; Oxygen Saturation
PubMed: 38874956
DOI: 10.1002/ejsc.12107 -
European Journal of Sport Science Jun 2024We examine the impact of the acute manipulation of oxygen availability during discrete phases (active and passive) of a repeated-sprint cycling protocol on performance,...
We examine the impact of the acute manipulation of oxygen availability during discrete phases (active and passive) of a repeated-sprint cycling protocol on performance, physiological, and perceptual responses. On separate days, twelve trained males completed four sets of five 5-s 'all out' cycle sprints (25-s inter-sprint recovery and 5-min interset rest) in four randomized conditions: normobaric hypoxia (inspired oxygen fraction of 12.9%) applied continuously (C-HYP), intermittently during only the sets of sprints (I-HYP) or between-sets recovery periods (I-HYP), or not at all (C-NOR). Peak and mean power output, peripheral oxygen saturation, heart rate, blood lactate concentration, exercise-related sensations, and vastus lateralis muscle oxygenation using near-infrared spectroscopy were assessed. Peak and mean power output was ∼4%-5% lower for C-HYP compared to C-NOR (P ≤ 0.050) and I-HYP (P ≤ 0.027). Peripheral oxygen saturation was lower during C-HYP and I-HYP compared with C-NOR and I-HYP during sets of sprints (∼83-85 vs. ∼95%-97%; P < 0.001), while lower values were obtained for C-HYP and I-HYP than C-NOR and I-HYP during between-sets rest period (∼84-85 vs. ∼96%; P < 0.001). Difficulty in breathing was ∼21% higher for C-HYP than C-NOR (P = 0.050). Ratings of perceived exertion (P = 0.435), limb discomfort (P = 0.416), heart rate (P = 0.605), blood lactate concentration (P = 0.976), and muscle oxygenation-derived variables (P = 0.056 to 0.605) did not differ between conditions. In conclusion, the method of hypoxic exposure application (continuous vs. intermittent) affects mechanical performance, while internal demands remained essentially comparable during repeated cycle sprints.
PubMed: 38874584
DOI: 10.1002/ejsc.12146 -
The Journal of Maternal-fetal &... Dec 2024Extracorporeal membrane oxygenation (ECMO) use in peripartum patients is rare, and there is a gap in the literature on the outcomes and guidance on using ECMO in...
BACKGROUND
Extracorporeal membrane oxygenation (ECMO) use in peripartum patients is rare, and there is a gap in the literature on the outcomes and guidance on using ECMO in peripartum patients. This study describes ECMO strategies our institution uses for peripartum patients and reports outcomes of ECMO use in peripartum patients with respiratory and/or cardiac failure.
METHODS
A case series of all peripartum patients, defined as pregnant or up to 6 weeks after delivery of an infant >20 weeks gestation, from 2018 to 2023 from a single center requiring ECMO support. Patients were included if ECMO was initiated in the setting of cardiac, pulmonary, or combined failure. Patient demographics, operative details, ECMO data, and adverse outcomes for maternal, fetus, and neonates were all collected.
RESULTS
Eighteen patients met the inclusion criteria. The cohort had a mean maternal age of 30.7 years old and was racially diverse. A majority of this cohort tested positive for COVID-19 ( = 10, 55%). ECMO was a bridge to recovery for all patients, of whom 14 (78%) were discharged out of the hospital alive. No patients received transplantation or a durable mechanical device. The most common complications were infection (25%) and postpartum hemorrhage (22%).
CONCLUSIONS
ECMO use in peripartum patients in a single tertiary center was associated with a high survival rate. Furthermore, a strong multidisciplinary team, careful reevaluation of clinical trajectory, and consideration of complications and risks associated with using ECMO in peripartum patients are possible frameworks to use when challenged with critically ill peripartum patients.
Topics: Humans; Extracorporeal Membrane Oxygenation; Female; Pregnancy; Adult; Peripartum Period; COVID-19; Retrospective Studies; Infant, Newborn; SARS-CoV-2; Respiratory Insufficiency; Heart Failure; Young Adult
PubMed: 38873894
DOI: 10.1080/14767058.2024.2355293 -
Early diagnosis of occult pulmonary embolism secondary to lower limb fractures: summary of 18 cases.Frontiers in Medicine 2024Pulmonary thromboembolism is a severe but probably underdiagnosed disorder. Patients with lower limb fractures are at high risk for pulmonary thromboembolism. This study...
OBJECTIVES
Pulmonary thromboembolism is a severe but probably underdiagnosed disorder. Patients with lower limb fractures are at high risk for pulmonary thromboembolism. This study aimed to demonstrate the early identification strategies for occult pulmonary thromboembolism.
METHODS
From January to December 2022, 18 patients diagnosed with pulmonary thromboembolism were reviewed for this study. Data on patients' demographics, laboratory test results, and radiographic findings were collected. Finally, the data was analyzed.
RESULTS
Eighteen patients with lower limb fractures were included in this study. All of them present different symptoms, including 12 cases (12/18, 66%) of unexplained decrease in oxygen saturation; 16 patients had deep vein thrombosis in the lower limbs, with nine cases involving proximal veins and seven involving distal veins. One patient had an antithrombin III level of 35%. Thirteen cases were diagnosed with pulmonary embolism using CT pulmonary angiography. Four patients had pulmonary embolisms incidentally detected during coronary CT angiography, and one patient during aortic CT angiography.
CONCLUSION
Patients with lower limb fractures showing chest tightness and unexplained decrease in finger pulse oxygen levels should be assessed for pulmonary thromboembolism. Simultaneously, selecting appropriate diagnostic tools is essential to guaranteeing quick and accurate diagnosis.
PubMed: 38873198
DOI: 10.3389/fmed.2024.1355030 -
Physiological Reports Jun 2024We aimed to determine the relative contribution of hypercapnia and hypoxia to the bradycardic response to apneas. We hypothesized that apneas with hypercapnia would...
We aimed to determine the relative contribution of hypercapnia and hypoxia to the bradycardic response to apneas. We hypothesized that apneas with hypercapnia would cause greater bradycardia than normoxia, similar to the response seen with hypoxia, and that apneas with hypercapnic hypoxia would induce greater bradycardia than hypoxia or hypercapnia alone. Twenty-six healthy participants (12 females; 23 ± 2 years; BMI 24 ± 3 kg/m) underwent three gas challenges: hypercapnia (+5 torr end tidal partial pressure of CO [PCO]), hypoxia (50 torr end tidal partial pressure of O [PO]), and hypercapnic hypoxia (combined hypercapnia and hypoxia), with each condition interspersed with normocapnic normoxia. Heart rate and rhythm, blood pressure, PCO, PO, and oxygen saturation were measured continuously. Hypercapnic hypoxic apneas induced larger bradycardia (-19 ± 16 bpm) than normocapnic normoxic apneas (-11 ± 15 bpm; p = 0.002), but had a comparable response to hypoxic (-19 ± 15 bpm; p = 0.999) and hypercapnic apneas (-14 ± 14 bpm; p = 0.059). Hypercapnic apneas were not different from normocapnic normoxic apneas (p = 0.134). After removal of the normocapnic normoxic heart rate response, the change in heart rate during hypercapnic hypoxia (-11 ± 16 bpm) was similar to the summed change during hypercapnia+hypoxia (-9 ± 10 bpm; p = 0.485). Only hypoxia contributed to this bradycardic response. Under apneic conditions, the cardiac response is driven by hypoxia.
Topics: Humans; Hypercapnia; Female; Male; Heart Rate; Hypoxia; Apnea; Adult; Bradycardia; Young Adult; Blood Pressure; Carbon Dioxide
PubMed: 38872580
DOI: 10.14814/phy2.16054 -
Journal of Medical Internet Research Jun 2024Resting heart rate (HR) and routine physical activity are associated with cardiorespiratory fitness levels. Commercial smartwatches permit remote HR monitoring and step...
BACKGROUND
Resting heart rate (HR) and routine physical activity are associated with cardiorespiratory fitness levels. Commercial smartwatches permit remote HR monitoring and step count recording in real-world settings over long periods of time, but the relationship between smartwatch-measured HR and daily steps to cardiorespiratory fitness remains incompletely characterized in the community.
OBJECTIVE
This study aimed to examine the association of nonactive HR and daily steps measured by a smartwatch with a multidimensional fitness assessment via cardiopulmonary exercise testing (CPET) among participants in the electronic Framingham Heart Study.
METHODS
Electronic Framingham Heart Study participants were enrolled in a research examination (2016-2019) and provided with a study smartwatch that collected longitudinal HR and physical activity data for up to 3 years. At the same examination, the participants underwent CPET on a cycle ergometer. Multivariable linear models were used to test the association of CPET indices with nonactive HR and daily steps from the smartwatch.
RESULTS
We included 662 participants (mean age 53, SD 9 years; n=391, 59% women, n=599, 91% White; mean nonactive HR 73, SD 6 beats per minute) with a median of 1836 (IQR 889-3559) HR records and a median of 128 (IQR 65-227) watch-wearing days for each individual. In multivariable-adjusted models, lower nonactive HR and higher daily steps were associated with higher peak oxygen uptake (VO), % predicted peak VO, and VO at the ventilatory anaerobic threshold, with false discovery rate (FDR)-adjusted P values <.001 for all. Reductions of 2.4 beats per minute in nonactive HR, or increases of nearly 1000 daily steps, corresponded to a 1.3 mL/kg/min higher peak VO. In addition, ventilatory efficiency (V/VCO; FDR-adjusted P=.009), % predicted maximum HR (FDR-adjusted P<.001), and systolic blood pressure-to-workload slope (FDR-adjusted P=.01) were associated with nonactive HR but not associated with daily steps.
CONCLUSIONS
Our findings suggest that smartwatch-based assessments are associated with a broad array of cardiorespiratory fitness responses in the community, including measures of global fitness (peak VO), ventilatory efficiency, and blood pressure response to exercise. Metrics captured by wearable devices offer a valuable opportunity to use extensive data on health factors and behaviors to provide a window into individual cardiovascular fitness levels.
Topics: Humans; Heart Rate; Female; Male; Cardiorespiratory Fitness; Middle Aged; Exercise; Cohort Studies; Adult; Exercise Test; Wearable Electronic Devices
PubMed: 38870519
DOI: 10.2196/56676 -
JMIR Research Protocols Jun 2024High-calorie-expenditure training is common among endurance athletes and is an effective strategy for weight loss. Although many training protocols include walking,... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
High-calorie-expenditure training is common among endurance athletes and is an effective strategy for weight loss. Although many training protocols include walking, running, cycling, and swimming according to a target heart rate, there is limited research on high-calorie-expenditure interventions with multimodal training programs using quantitative methods.
OBJECTIVE
The aims of this research protocol are to (1) develop a high-calorie-expenditure training program to cover target calorie expenditure according to the trainability of women classified as overweight (according to a BMI of 25-29.9 kg/m); (2) determine the effect of high-calorie-expenditure workouts on conditioning, glycemic variables, and body composition; and (3) evaluate the implementation of the intervention and results in comparison with outcomes obtained under a standard-calorie-expenditure training program.
METHODS
This is a randomized controlled trial with a pretest-posttest design. Participants include 33 women with a BMI in the overweight range (25-29.9) allocated to three groups: two intervention groups and one control group. The intervention will be conducted for 12 weeks. Participants in the first group will be assigned an exercise program with high energy expenditure of approximately 3000-3500 kilocalories/week in the form of 5 sessions per week with an intensity of 50%-75% maximum oxygen rate (VO max) and 60%-80% target heart rate. The second group will be assigned an exercise program with a standard energy expenditure of approximately 1200-1500 kilocalories/week with 3 sessions per week at an intensity of 60%-75% VO max, according to The American College of Sports Medicine guideline. The effects of the multimodal training program with daily tasks will be compared to those of the standard-calorie-expenditure and control (no exercise) conditions with respect to changes in glycemic indices and body composition. Daily calories will be calculated through the International Physical Activity Questionnaire and using Nutrition 4 software.
RESULTS
Preliminary results show significant weight loss in both the high- and standard-calorie-expenditure groups (P=.003). Significant improvements were also found in muscle percentage (P=.05) and BMI (P=.05) for the high-calorie-expenditure group. Analyses are ongoing for glycemic indices, inflammation factors, and blood parameters.
CONCLUSIONS
High-calorie-expenditure training can cause further weight loss than standard exercise, which can eventually lead to greater fat mass reduction and improvement in glycemic indices. These results demonstrate that, in some cases, it may be necessary to increase the activity of women and use multimodal exercise programs with increased volume and intensity to increase the expenditure of exercise and daily activity. We found a net effect of exercise and daily activity at the individual level, whereas the daily lifestyle and physical behaviors of the participants remained constant.
TRIAL REGISTRATION
Iranian Registry of Clinical Trials IRCT20220202053916N1; https://tinyurl.com/c8jxfw36.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)
DERR1-10.2196/51599.
Topics: Humans; Female; Overweight; Adult; Energy Metabolism; Exercise Therapy; Exercise; Middle Aged; Young Adult
PubMed: 38870518
DOI: 10.2196/51599