Articles: cations.
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Critical care medicine · Feb 2023
Predicting Readmission or Death After Discharge From the ICU: External Validation and Retraining of a Machine Learning Model.
Many machine learning (ML) models have been developed for application in the ICU, but few models have been subjected to external validation. The performance of these models in new settings therefore remains unknown. The objective of this study was to assess the performance of an existing decision support tool based on a ML model predicting readmission or death within 7 days after ICU discharge before, during, and after retraining and recalibration. ⋯ In this era of expanding availability of ML models, external validation and retraining are key steps to consider before applying ML models to new settings. Clinicians and decision-makers should take this into account when considering applying new ML models to their local settings.
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Very small anterior communicating artery aneurysms (vsACoA) of <5 mm in size are detected in a considerable number of patients with aneurysmal subarachnoid hemorrhage (aSAH). Single-center studies report that vsACoA harbor particular risks when treated. ⋯ Very small ruptured ACoA have a higher in-hospital rebleeding rate but are not associated with worse morbidity or mortality.
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Recent data indicated a high incidence of inappropriate management of neuromuscular block, with a high rate of residual paralysis and relaxant-associated postoperative complications. These data are alarming in that the available neuromuscular monitoring, as well as myorelaxants and their antagonists basically allow well tolerated management of neuromuscular blockade. In this first European Society of Anaesthesiology and Intensive Care (ESAIC) guideline on peri-operative management of neuromuscular block, we aim to present aggregated and evidence-based recommendations to assist clinicians provide best medical care and ensure patient safety. ⋯ R7 We recommend using sugammadex to antagonise deep, moderate and shallow neuromuscular blockade induced by aminosteroidal agents (rocuronium, vecuronium) (1A). R8 We recommend advanced spontaneous recovery (i.e. TOF ratio >0.2) before starting neostigmine-based reversal and to continue quantitative monitoring of neuromuscular blockade until a TOF ratio of more than 0.9 has been attained. (1C).
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To understand the effectiveness of Rescue Improvement Conference, a forum that addresses FTR. ⋯ Rescue Improvement Conference has the potential to support other surgical departments in developing system-level strategies to recognize and manage postoperative complications by providing stakeholders a forum to identify and discuss factors that contribute to FTR.
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Anesthesia and analgesia · Feb 2023
Always Assess the Raw Electroencephalogram: Why Automated Burst Suppression Detection May Not Detect All Episodes.
Electroencephalogram (EEG)-based monitors of anesthesia are used to assess patients' level of sedation and hypnosis as well as to detect burst suppression during surgery. One of these monitors, the Entropy module, uses an algorithm to calculate the burst suppression ratio (BSR) that reflects the percentage of suppressed EEG. Automated burst suppression detection monitors may not reliably detect this EEG pattern. Hence, we evaluated the detection accuracy of BSR and investigated the EEG features leading to errors in the identification of burst suppression. ⋯ Our results complement previous results regarding the underestimation of burst suppression by other automated detection modules and highlight the importance of not relying solely on the processed index, but to assess the native EEG during anesthesia.