Background The incidence of diastolic heart failure has increased over time.The evaluation of left-ventricular diastolic func-tion is complex,ongoing,and remains poorly performed in pediatric intensive-care patients.T...Background The incidence of diastolic heart failure has increased over time.The evaluation of left-ventricular diastolic func-tion is complex,ongoing,and remains poorly performed in pediatric intensive-care patients.This study aimed to review the literature and to provide an update on the evaluation of left-ventricular diastolic function in adults and children in intensive care.Data sources We searched data from PubMed/Medline.Thirty-two studies were included.Four pragmatic questions were identified:(1)What is the physiopathology of diastolic dysfunction?(2)Which tools are required to evaluate diastolic func-tion?(3)What are the echocardiographic criteria needed to evaluate diastolic function?(4)When should diastolic function be evaluated in pediatric intensive care?Results Early diastole allows characterization of relaxation,whereas compliance assessments and filling pressures are evalu-ated during late diastole.The evolution of diastolic function differs between adults and children.Unlike in adults,decreased compliance occurs at the same time as delayed relaxation in children.Diastolic function can be evaluated by Doppler echo-cardiography.The echocardiographic criteria for ventricular relaxation include the E wave,E/A wave ratio,and isovolumic relaxation time.Ventricular compliance can be assessed by the E/e'wave ratio,atrial volume,and Ap wave duration during pulmonary vein flow.In adult intensive-care patients,the E/e'ratio can be used as an index of tolerance for volume expan-sion in septic patients and to adjust the inotropic support.Conclusion Clinical studies would allow some of these parameters to be validated for use in children in intensive care.展开更多
BACKGROUND The rising prevalence of carbapenem-resistant Acinetobacter baumannii(CRAB)in neonatal intensive care units(NICUs)represents an escalating challenge in healthcare settings,particularly in managing hospital-...BACKGROUND The rising prevalence of carbapenem-resistant Acinetobacter baumannii(CRAB)in neonatal intensive care units(NICUs)represents an escalating challenge in healthcare settings,particularly in managing hospital-acquired infections(HAIs).Studies across various World Health Organization regions have documented a significant incidence of CRAB-related HAIs,with rates as high as 41.7 cases per 1000 patients in ICUs,accounting for 13.6%of all HAIs.These infections pose a doubled mortality risk compared to infections with carbapenem-susceptible Acinetobacter baumannii.A particularly concerning aspect of CRAB colonization is its asymptomatic nature,enabling its transmission through healthcare workers(HCWs)or the NICU environment to vulnerable neonates with developing immune systems.AIM To explore the prevalence of CRAB colonization in NICUs,focusing on neonates,healthcare workers,and the environmental samples,to enhance epidemiological understanding and inform targeted interventions.METHODS We conducted according to PRISMA 2020 checklist guidelines,a comprehensive literature search across multiple databases including MEDLINE(Ovid),EMBASE(Ovid),Global Health(Ovid),Web of Science,and Global Index Me-dicus.Studies were selected based on predetermined criteria,primarily involving neonates,HCWs,and environmental swabs,using culture or molecular methods to detect CRAB colonization.We excluded studies that did not specifically focus on NICUs,were duplicates,or lacked necessary data.The study selection and quality assessment were conducted independently by two reviewers.Data extraction involved collecting comprehensive details about each study.Our statistical analysis used a random-effects model to calculate the pooled prevalence and confidence intervals,stratifying results by regional location.We assessed study heterogeneity using Cochran's Q statistic and I²statistic,with regression tests employed to evaluate potential publication bias.RESULTS We analyzed 737 records from five databases,ultimately including 13 studies from ten countries.For neonates,the pooled prevalence was 4.8%(95%CI:1.1%to 10.5%)with the highest rates observed in South-East Asia(10.5%;95%CI:2.4%to 23.3%).Among HCWs,a single Indian study reported a 3.3%prevalence.Environmental samples showed a prevalence of 2.3%(95%CI:0%to 9.3%),with the highest rates in South-East Asia(10%;95%CI:4.2%to 17.7%).Significant heterogeneity was found across studies,and no publication bias was detected.CONCLUSION This systematic review highlights a significant prevalence of CRAB colonization in neonates across various regions,particularly in South-East Asia,contrasting with lower rates in high-income countries.The study reveals a gap in research on HCWs colonization,with only a single study from India reporting moderate prevalence.Environmental samples indicate moderate levels of CRAB contamination,again higher in South-East Asia.These findings underscore the need for more extensive and focused research on CRAB colonization in NICUs,including exploring the roles of HCWs and the environment in transmission,understanding antimicrobial resistance patterns,and developing effective prevention measures.展开更多
In this paper, we propose a new architecture that combines prediction and decision-making in the form of a hybrid framework aimed at providing clinicians with transparent and accurate maps, or charts, to guide and to ...In this paper, we propose a new architecture that combines prediction and decision-making in the form of a hybrid framework aimed at providing clinicians with transparent and accurate maps, or charts, to guide and to support treatment decisions, and to interrogate the clinical patients’ course as it develops. These maps should be patient-specific, with options displayed of possible treatment pathways. They would suggest the optimal care pathways, and the shortest routes to the most efficient care, by predicting clinical progress, testing the ensuing suggestions against the developing clinical state and patient condition, and suggesting new options as necessary. These maps should also mine an extensive database of accumulated patient data, modelled diseases, and modelled patient-responses based on expert-derived rules. These individualized hierarchical targets, which are implemented in order to prevent life-threatening illnesses, will also have to “adapt” to the patient’s altering clinical condition. Therapies that support one system can destabilize others and selecting which specific support to prioritize is an uncertain process, the prioritization of which can vary between clinical experts. Whilst clinical therapeutic decisions can be made with some degree of anticipation of the “likely” outcome (based on the experts’ opinion and judgment), treatment is essentially rooted in the present, and is dependent on analyzing the current clinical condition and available data. The recursive learning approach presented in this paper, allows decision rules to predict the possible future course, and reflects back derived information from such projections to the present time and thus support proactive clinical care rather than reactive clinical care. The proposed framework for such a patient map supports and enables an optimized choice from available options and also ensures that decisions are based on both the available evidence and a database of best clinical practice. Preliminary results are encouraging and it is hoped to validate the approach clinically in the near future.展开更多
文摘Background The incidence of diastolic heart failure has increased over time.The evaluation of left-ventricular diastolic func-tion is complex,ongoing,and remains poorly performed in pediatric intensive-care patients.This study aimed to review the literature and to provide an update on the evaluation of left-ventricular diastolic function in adults and children in intensive care.Data sources We searched data from PubMed/Medline.Thirty-two studies were included.Four pragmatic questions were identified:(1)What is the physiopathology of diastolic dysfunction?(2)Which tools are required to evaluate diastolic func-tion?(3)What are the echocardiographic criteria needed to evaluate diastolic function?(4)When should diastolic function be evaluated in pediatric intensive care?Results Early diastole allows characterization of relaxation,whereas compliance assessments and filling pressures are evalu-ated during late diastole.The evolution of diastolic function differs between adults and children.Unlike in adults,decreased compliance occurs at the same time as delayed relaxation in children.Diastolic function can be evaluated by Doppler echo-cardiography.The echocardiographic criteria for ventricular relaxation include the E wave,E/A wave ratio,and isovolumic relaxation time.Ventricular compliance can be assessed by the E/e'wave ratio,atrial volume,and Ap wave duration during pulmonary vein flow.In adult intensive-care patients,the E/e'ratio can be used as an index of tolerance for volume expan-sion in septic patients and to adjust the inotropic support.Conclusion Clinical studies would allow some of these parameters to be validated for use in children in intensive care.
文摘BACKGROUND The rising prevalence of carbapenem-resistant Acinetobacter baumannii(CRAB)in neonatal intensive care units(NICUs)represents an escalating challenge in healthcare settings,particularly in managing hospital-acquired infections(HAIs).Studies across various World Health Organization regions have documented a significant incidence of CRAB-related HAIs,with rates as high as 41.7 cases per 1000 patients in ICUs,accounting for 13.6%of all HAIs.These infections pose a doubled mortality risk compared to infections with carbapenem-susceptible Acinetobacter baumannii.A particularly concerning aspect of CRAB colonization is its asymptomatic nature,enabling its transmission through healthcare workers(HCWs)or the NICU environment to vulnerable neonates with developing immune systems.AIM To explore the prevalence of CRAB colonization in NICUs,focusing on neonates,healthcare workers,and the environmental samples,to enhance epidemiological understanding and inform targeted interventions.METHODS We conducted according to PRISMA 2020 checklist guidelines,a comprehensive literature search across multiple databases including MEDLINE(Ovid),EMBASE(Ovid),Global Health(Ovid),Web of Science,and Global Index Me-dicus.Studies were selected based on predetermined criteria,primarily involving neonates,HCWs,and environmental swabs,using culture or molecular methods to detect CRAB colonization.We excluded studies that did not specifically focus on NICUs,were duplicates,or lacked necessary data.The study selection and quality assessment were conducted independently by two reviewers.Data extraction involved collecting comprehensive details about each study.Our statistical analysis used a random-effects model to calculate the pooled prevalence and confidence intervals,stratifying results by regional location.We assessed study heterogeneity using Cochran's Q statistic and I²statistic,with regression tests employed to evaluate potential publication bias.RESULTS We analyzed 737 records from five databases,ultimately including 13 studies from ten countries.For neonates,the pooled prevalence was 4.8%(95%CI:1.1%to 10.5%)with the highest rates observed in South-East Asia(10.5%;95%CI:2.4%to 23.3%).Among HCWs,a single Indian study reported a 3.3%prevalence.Environmental samples showed a prevalence of 2.3%(95%CI:0%to 9.3%),with the highest rates in South-East Asia(10%;95%CI:4.2%to 17.7%).Significant heterogeneity was found across studies,and no publication bias was detected.CONCLUSION This systematic review highlights a significant prevalence of CRAB colonization in neonates across various regions,particularly in South-East Asia,contrasting with lower rates in high-income countries.The study reveals a gap in research on HCWs colonization,with only a single study from India reporting moderate prevalence.Environmental samples indicate moderate levels of CRAB contamination,again higher in South-East Asia.These findings underscore the need for more extensive and focused research on CRAB colonization in NICUs,including exploring the roles of HCWs and the environment in transmission,understanding antimicrobial resistance patterns,and developing effective prevention measures.
文摘In this paper, we propose a new architecture that combines prediction and decision-making in the form of a hybrid framework aimed at providing clinicians with transparent and accurate maps, or charts, to guide and to support treatment decisions, and to interrogate the clinical patients’ course as it develops. These maps should be patient-specific, with options displayed of possible treatment pathways. They would suggest the optimal care pathways, and the shortest routes to the most efficient care, by predicting clinical progress, testing the ensuing suggestions against the developing clinical state and patient condition, and suggesting new options as necessary. These maps should also mine an extensive database of accumulated patient data, modelled diseases, and modelled patient-responses based on expert-derived rules. These individualized hierarchical targets, which are implemented in order to prevent life-threatening illnesses, will also have to “adapt” to the patient’s altering clinical condition. Therapies that support one system can destabilize others and selecting which specific support to prioritize is an uncertain process, the prioritization of which can vary between clinical experts. Whilst clinical therapeutic decisions can be made with some degree of anticipation of the “likely” outcome (based on the experts’ opinion and judgment), treatment is essentially rooted in the present, and is dependent on analyzing the current clinical condition and available data. The recursive learning approach presented in this paper, allows decision rules to predict the possible future course, and reflects back derived information from such projections to the present time and thus support proactive clinical care rather than reactive clinical care. The proposed framework for such a patient map supports and enables an optimized choice from available options and also ensures that decisions are based on both the available evidence and a database of best clinical practice. Preliminary results are encouraging and it is hoped to validate the approach clinically in the near future.
