Articles: sepsis.
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Critical care medicine · Nov 2024
Multicenter Study Observational StudyThe Impact of Multi-Institution Datasets on the Generalizability of Machine Learning Prediction Models in the ICU.
To evaluate the transferability of deep learning (DL) models for the early detection of adverse events to previously unseen hospitals. ⋯ Our results emphasize the importance of diverse training data for DL-based risk prediction. They suggest that as data from more hospitals become available for training, models may become increasingly generalizable. Even so, good performance at a new hospital still depended on the inclusion of compatible hospitals during training.
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J. Cardiothorac. Vasc. Anesth. · Nov 2024
Multicenter StudyPerioperative Albumin Among Adults Undergoing Thoracic Surgery in the United States: Utilization, Associations With Clinical Outcomes, and Contribution to Hospital Costs.
To estimate the use of albumin among adults undergoing thoracic surgery in the United States, compare baseline characteristics, clinical and cost outcomes of recipients versus nonrecipients, and determine albumin's contribution to total hospital costs. ⋯ Albumin use varies widely across hospitals, and 9% of patients receive it (median 500 mL). Use was not associated with in-hospital mortality and was associated with more morbidity and cost. The cost of albumin accounted for a trivial portion of hospital costs. Clinical trials must examine the effects of albumin on complications and costs after thoracic surgery.
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Critical care medicine · Nov 2024
The Impact of Delayed Transition From Noninvasive to Invasive Mechanical Ventilation on Hospital Mortality in Immunocompromised Patients With Sepsis.
To determine whether mortality differed between initial invasive mechanical ventilation (IMV) or noninvasive ventilation (NIV) followed by delayed IMV in immunocompromised patients with sepsis. ⋯ Prolonged NIV trial before delayed IMV transition is associated with higher mortality in immunocompromised sepsis patients ultimately intubated.
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Critical care medicine · Nov 2024
Healthcare Use and Expenditures in Rural Survivors of Hospitalization for Sepsis.
Sepsis survivors have greater healthcare use than those surviving hospitalizations for other reasons, yet factors associated with greater healthcare use in this population remain ill-defined. Rural Americans are older, have more chronic illnesses, and face unique barriers to healthcare access, which could affect postsepsis healthcare use. Therefore, we compared healthcare use and expenditures among rural and urban sepsis survivors. We hypothesized that rural survivors would have greater healthcare use and expenditures. ⋯ In this large cohort study, we report important differences in healthcare use and expenditures between rural and urban sepsis survivors. Future research and policy work is needed to understand how best to optimize sepsis survivorship across the urban-rural continuum.
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Critical care medicine · Nov 2024
Moderate IV Fluid Resuscitation Is Associated With Decreased Sepsis Mortality.
Significant practice variation exists in the amount of resuscitative IV fluid given to patients with sepsis. Current research suggests equipoise between a tightly restrictive or more liberal strategy but data is lacking on a wider range of resuscitation practices. We sought to examine the relationship between a wide range of fluid resuscitation practices and sepsis mortality and then identify the primary driver of this practice variation. ⋯ Individual physician practice drives excess variation in the amount of IV fluid given to patients with sepsis. A moderate approach to IV fluid resuscitation is associated with decreased sepsis mortality and should be tested in future randomized controlled trials.