Publications by authors named "Grooth H"

Background: Current guidelines discourage prophylactic plasma use in non-bleeding patients. This study assesses global plasma transfusion practices in the intensive care unit (ICU) and their alignment with current guidelines.

Study Design And Methods: This was a sub-study of an international, prospective, observational cohort.

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Objectives: Intubation is a common procedure in acute hypoxemic respiratory failure (AHRF), with minimal evidence to guide decision-making. We conducted a survey of when to intubate patients with AHRF to measure the influence of clinical variables on intubation decision-making and quantify variability.

Design: Factorial vignette-based survey asking "Would you recommend intubation?" Respondents selected an ordinal recommendation from a 5-point scale ranging from "Definite no" to "Definite yes" for up to ten randomly allocated vignettes.

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Introduction: Benchmarking intensive care units for audit and feedback is frequently based on comparing actual mortality versus predicted mortality. Traditionally, mortality prediction models rely on a limited number of input variables and significant manual data entry and curation. Using automatically extracted electronic health record data may be a promising alternative.

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Background: Acute respiratory distress syndrome (ARDS) is a frequent cause of hypoxemic respiratory failure with a mortality rate of approximately 30%. Identifying ARDS subphenotypes based on "focal" or "non-focal" lung morphology has the potential to better target mechanical ventilation strategies of individual patients. However, classifying morphology through chest radiography or computed tomography is either inaccurate or impractical.

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Article Synopsis
  • Reinforcement learning (RL) has potential in intensive care medicine due to the wealth of data and real-time decision-making needs, but trust and safety issues hinder its implementation for clinical support, particularly in optimizing ventilator settings for COVID-19 patients.
  • A novel method called cross off-policy evaluation (OPE) was developed to evaluate RL models, using a large dataset from Dutch ICUs and focusing on ventilator settings, with interim and final rewards based on gas exchange indices and patient outcomes.
  • The study found that while many RL policies performed well initially, almost half were deemed suboptimal under more rigorous evaluation, highlighting the importance of detailed clinical policy inspection and restrictions to ensure safety in patient care.
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Background: Esophagectomy for esophageal cancer has a complication rate of up to 60%. Prediction models could be helpful to preoperatively estimate which patients are at increased risk of morbidity and mortality. The objective of this study was to determine the best prediction models for morbidity and mortality after esophagectomy and to identify commonalities among the models.

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Article Synopsis
  • Reinforcement learning (RL) has potential applications in ICU settings for improving decision-making, and a systematic review was conducted to evaluate its impact on critically ill patients.
  • A total of 1,033 articles were screened, resulting in 18 journal articles and 18 conference papers focused on RL techniques; however, all studies only showed RL outperforming clinicians based on retrospective data.
  • The review concluded that while RL techniques reported better decision-making than clinicians, there were no studies proving actual improvements in patient outcomes, and there was a high risk of bias in the evaluation procedures.
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Article Synopsis
  • RBC transfusions are a frequent intervention in ICUs, yet there's a gap in understanding how hemoglobin (Hb) thresholds for transfusion are applied in practice.
  • An international study analyzed transfusion practices in 233 ICUs across 30 countries, including 3,643 adult patients from March 2019 to October 2022.
  • Of the patients studied, 25% received RBC transfusions, with variations in transfusion rates observed across different ICUs, countries, and continents, highlighting diverse clinical practices.
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Background: Exact benefits of currently recommended close monitoring in intermediate high risk acute pulmonary embolism (PE) patients are unknown.

Methods: This prospective observational cohort study determined clinical characteristics, and disease course of intermediate high risk acute PE patients in an academic hospital setting . Frequency of hemodynamic deterioration, use of rescue reperfusion therapy and PE related mortality, were outcomes of interest.

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Background: Fluid therapy is a common intervention in critically ill patients. It is increasingly recognised that deresuscitation is an essential part of fluid therapy and delayed deresuscitation is associated with longer invasive ventilation and length of intensive care unit (ICU) stay. However, optimal timing and rate of deresuscitation remain unclear.

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This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2023. Other selected articles can be found online at  https://www.biomedcentral.

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Background: The optimal thresholds for the initiation of invasive ventilation in patients with hypoxemic respiratory failure are unknown. Using the saturation-to-inspired oxygen ratio (SF), we compared lower versus higher hypoxemia severity thresholds for initiating invasive ventilation.

Methods: This target trial emulation included patients from the Medical Information Mart for Intensive Care (MIMIC-IV, 2008-2019) and the Amsterdam University Medical Centers (AmsterdamUMCdb, 2003-2016) databases admitted to intensive care and receiving inspired oxygen fraction ≥ 0.

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Lung ultrasound (LUS) is a promising tool for diagnosis of acute respiratory distress syndrome (ARDS), but adequately sized studies with external validation are lacking. To develop and validate a data-driven LUS score for diagnosis of ARDS and compare its performance with that of chest radiography (CXR). This multicenter prospective observational study included invasively ventilated ICU patients who were divided into a derivation cohort and a validation cohort.

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