Publications by authors named "Harm-Jan de Grooth"
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.
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.
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.
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.
Importance: Red blood cell (RBC) transfusion is common among patients admitted to the intensive care unit (ICU). Despite multiple randomized clinical trials of hemoglobin (Hb) thresholds for transfusion, little is known about how these thresholds are incorporated into current practice.
Objective: To evaluate and describe ICU RBC transfusion practices worldwide.
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.
View Article and Find Full Text PDFThis 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.
View Article and Find Full Text PDFBackground: 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.
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.
View Article and Find Full Text PDFIntroduction: Accurate and actionable diagnosis of Acute Kidney Injury (AKI) ahead of time is important to prevent or mitigate renal insufficiency. The purpose of this study was to evaluate the performance of Kinetic estimated Glomerular Filtration Rate (KeGFR) in timely predicting AKI in critically ill septic patients.
Methods: We conducted a retrospective analysis on septic ICU patients who developed AKI in AmsterdamUMCdb, the first freely available European ICU database.
Background: Lung ultrasound (LUS) can be used to monitor critically ill patients with COVID-19, but the optimal number of examined lung zones is disputed.
Methods: This was a prospective observational study. The objective was to investigate whether concise (6 zones) and extended (12 zones) LUS scoring protocols are clinically equivalent in critically ill ICU subjects with COVID-19.
Background: The anatomic site for central venous catheter insertion influences the risk of central venous catheter-related intravascular complications. We developed and validated a predictive score of required catheter dwell time to identify critically ill patients at higher risk of intravascular complications.
Methods: We retrospectively conducted a cohort study from three multicenter randomized controlled trials enrolling consecutive patients requiring central venous catheterization.
Background: Monitoring and controlling lung stress and diaphragm effort has been hypothesized to limit lung injury and diaphragm injury. The occluded inspiratory airway pressure (Pocc) and the airway occlusion pressure at 100 ms (P0.1) have been used as noninvasive methods to assess lung stress and respiratory muscle effort, but comparative performance of these measures and their correlation to diaphragm effort is unknown.
View Article and Find Full Text PDFArticle Synopsis
- Prone positioning has emerged as a key treatment for mechanically ventilated COVID-19 patients, but it requires significant labor and can have negative effects, making it essential to identify which patients will benefit from the procedure.
- A study utilized data from over 1,100 intubated patients across 25 hospitals in the Netherlands, applying various machine learning models to predict the success of prone positioning after 4 hours by evaluating improvements in respiratory metrics.
- Despite extensive analysis using different machine learning techniques, the study found that distinguishing between patients who would respond positively to prone positioning and those who would not had limited success, indicating potential challenges in predicting treatment outcomes.