Overt and Occult Hypoxemia in Patients Hospitalized With COVID-19.

Unlabelled: Progressive hypoxemia is the predominant mode of deterioration in COVID-19. Among hypoxemia measures, the ratio of the Pao to the Fio (P/F ratio) has optimal construct validity but poor availability because it requires arterial blood sampling. Pulse oximetry reports oxygenation continuously (ratio of the Spo to the Fio [S/F ratio]), but it is affected by skin color and occult hypoxemia can occur in Black patients.

A novel predictive analytics score reflecting accumulating disease burden-an investigation of the cumulative CoMET score.

Objective: Predictive analytics tools variably take into account data from the electronic medical record, lab tests, nursing charted vital signs and continuous cardiorespiratory monitoring to deliver an instantaneous prediction of patient risk or instability. Few, if any, of these tools reflect the risk to a patient accumulated over the course of an entire hospital stay.

Approach: We have expanded on our instantaneous CoMET predictive analytics score to generate the cumulative CoMET score (cCoMET), which sums all of the instantaneous CoMET scores throughout a hospital admission relative to a baseline expected risk unique to that patient.

Overt and occult hypoxemia in patients hospitalized with novel coronavirus disease 2019.

Background: Progressive hypoxemia is the predominant mode of deterioration in COVID-19. Among hypoxemia measures, the ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen (P/F ratio) has optimal construct validity but poor availability because it requires arterial blood sampling. Pulse oximetry reports oxygenation continuously, but occult hypoxemia can occur in Black patients because the technique is affected by skin color.

Early Vital Sign Differences in Very Low Birth Weight Infants with Severe Intraventricular Hemorrhage.

Objective: Severe intraventricular hemorrhage (sIVH, grades 3 and 4) is a serious complication for very low birth weight (VLBW) infants and is often clinically silent requiring screening cranial ultrasound (cUS) for detection. Abnormal vital sign (VS) patterns might serve as biomarkers to identify risk or occurrence of sIVH.

Study Design: This retrospective study was conducted in VLBW infants admitted to two level-IV neonatal intensive care units (NICUs) between January 2009 and December 2018.

Pathophysiologic Signature of Impending ICU Hypoglycemia in Bedside Monitoring and Electronic Health Record Data: Model Development and External Validation.

Objectives: We tested the hypothesis that routine monitoring data could describe a detailed and distinct pathophysiologic phenotype of impending hypoglycemia in adult ICU patients.

Design: Retrospective analysis leading to model development and validation.

Setting: All ICU admissions wherein patients received insulin therapy during a 4-year period at the University of Virginia Medical Center.

Autism risk in neonatal intensive care unit patients associated with novel heart rate patterns.

Background: Neonatal intensive care unit (NICU) patients are at increased risk for autism spectrum disorder (ASD). Autonomic nervous system aberrancy has been described in children with ASD, and we aimed to identify heart rate (HR) patterns in NICU patients associated with eventual ASD diagnosis.

Methods: This retrospective cohort study included NICU patients from 2009 to 2016 with archived HR data and follow-up beyond age 3 years.

The Relationship Between Acuity of Organ Failure and Predictive Validity of Sepsis-3 Criteria.

Unlabelled: The Sepsis-3 taskforce defined sepsis as suspicion of infection and an acute rise in the Sequential Organ Failure Assessment score by 2 points over the preinfection baseline. Sepsis-3 studies, though, have not distinguished between acute and chronic organ failure, and may not accurately reflect the epidemiology, natural history, or impact of sepsis. Our objective was to determine the extent to which the predictive validity of Sepsis-3 is attributable to chronic rather than acute organ failure.

Heart rate fragmentation gives novel insights into non-autonomic mechanisms governing beat-to-beat control of the heart's rhythm.

To demonstrate how heart rate fragmentation gives novel insights into non-autonomic mechanisms of beat-to-beat variability in cycle length, and predicts survival of cardiology clinic patients, over and above traditional clinical risk factors and measures of heart rate variability. We studied 2893 patients seen by cardiologists with clinical data including 24-hour Holter monitoring. Novel measures of heart rate fragmentation alongside canonical time and frequency domain measures of heart rate variability, as well as an existing local dynamics score were calculated.

Low Variability of Blood Pressure Predicts Abnormal Electroencephalogram in Infants with Hypoxic Ischemic Encephalopathy.

Objective: This study aimed to evaluate the role of an objective physiologic biomarker, arterial blood pressure variability, for the early identification of adverse short-term electroencephalogram (EEG) outcomes in infants with hypoxic-ischemic encephalopathy (HIE).

Study Design: In this multicenter observational study, we analyzed blood pressure of infants meeting these criteria: (1) neonatal encephalopathy determined by modified Sarnat exam, (2) continuous mean arterial blood pressure (MABP) data between 18 and 27 hours after birth, and (3) continuous EEG performed for at least 48 hours. Adverse outcome was defined as moderate-severe grade EEG at 48 hours.