Background: In 2012, the National Healthcare Safety Network presented a new surveillance definition for ventilator-associated events (VAEs) to objectively define worsening pulmonary status in ventilated patients. VAE subcategories, ventilator-associated condition (VAC), infection-related VAC, and probable ventilator-associated pneumonia (PrVAP), were vetted predominantly in medical intensive care units. Our goal was to evaluate how well VAE criteria characterize pulmonary complications in surgical intensive care unit (SICU) patients.
Methods: Since September 2012, all intubated SICU patients were screened prospectively for VAE and monitored for sustained respiratory dysfunction that did not meet VAE criteria. We diagnosed ventilator-associated pneumonia (VAP) using a clinical definition: Clinical Pulmonary Infection Score (CPIS) greater than 6 and catheter-directed bronchoalveolar lavage cultures with 10 or more colony-forming units per milliliter of pathogenic organisms.
Results: We admitted 704 intubated patients. A total of 437 were intubated for two or more days (mean [SD], age 46 [18] years; 65% male; median ventilator days, 4 [range, 2-9]; median Sequential Organ Failure Assessment [SOFA] score, 8 [range, 5-10]). Using VAE criteria, we identified 37 patients with VAC, 31 with infection-related VAC, and 22 with PrVAP. While the remaining 400 patients did not meet VAE criteria, we identified 111 patients (28%) with respiratory deterioration and diagnosed 99 additional pneumonias. Of the 111 patients, 85 (77%) never had a period of stable/decreasing oxygenation, requiring elevated vent settings upon initiation of ventilation preventing them from meeting VAE criteria. Of the 99 pneumonia patients, 10% had sustained respiratory deterioration treated with elevations in mean airway pressure; they did not meet VAE criteria as the positive end-expiratory pressure or FIO2 was not elevated. Twenty-seven percent never had a period of stable/decreasing oxygenation. Fifty-eight percent had less than 2 days of respiratory deterioration. Agreement between PrVAP and clinical VAP was 77.3% (κ = 0.243, p < 0.001).
Conclusion: The applicability of the new National Healthcare Safety Network categories of VAE to critically ill surgery patients is limited. Agreement between PrVAP and clinical VAP in SICU patients is poor. Most surgical patients are not well categorized by this new definition; a better method of surveillance should be created for this patient population.
Level Of Evidence: Diagnostic study, level III.
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http://dx.doi.org/10.1097/TA.0000000000000425 | DOI Listing |
Sci Rep
December 2024
School of Fashion Media, Jiangxi Institute of Fashion Technology, Nanchang, 330000, China.
This study proposes a novel artificial intelligence (AI)-assisted design model that combines Variational Autoencoders (VAE) with reinforcement learning (RL) to enhance innovation and efficiency in cultural and creative product design. By introducing AI-driven decision support, the model streamlines the design workflow and significantly improves design quality. The study establishes a comprehensive framework and applies the model to four distinct design tasks, with extensive experiments validating its performance.
View Article and Find Full Text PDFComput Biol Med
January 2025
International Laboratory of Bioinformatics, HSE University, Moscow, Russia. Electronic address:
Non-B DNA structures, or flipons, are important functional elements that regulate a large spectrum of cellular programs. Experimental technologies for flipon detection are limited to the subsets that are active at the time of an experiment and cannot capture whole-genome functional set. Thus, the task of generating reliable whole-genome annotations of non-B DNA structures is put on deep learning models, however their quality depends on the available experimental data for training.
View Article and Find Full Text PDFGraefes Arch Clin Exp Ophthalmol
November 2024
Department of Ophthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China.
Purpose: To detect subtle changes in early keratoconus by evaluating corneal epithelial thickness differences among patients with binocular very asymmetric ectasia (VAE) and normal subjects.
Methods: Corneal epithelial thickness was measured using the Fourier-domain AS-OCT system RTVue 100 (Optovue, Fremont, CA, USA). 152 eyes from 76 patients were divided into three groups: Very asymmetry ectasia-ectasia (VAE-E, n = 38), Very asymmetry ectasia-normal topography (VAE-NT, n = 38), and Normal control (NC, n = 76).
iScience
November 2024
Ministry of Education Key Laboratory of Bioinformatics, Center for Synthetic and Systems Biology, Bioinformatics Division, Beijing National Research Center for Information Science and Technology, Department of Automation, Tsinghua University, Beijing 100084, China.
Generative design of promoters has enhanced the efficiency of creation of functional sequences. Though several deep generative models have been employed in biological sequence generation, including variational autoencoder (VAE) or Wasserstein generative adversarial network (WGAN), these models might struggle with mode collapse and low sample diversity. In this study, we introduce the multinomial diffusion model (MDM) for promoter sequence design and propose a structured set of criteria for effectively comparing the performance of generative models.
View Article and Find Full Text PDFJ Clin Med
November 2024
Department of Respiratory Therapy, Kaohsiung Municipal Feng Shan Hospital Under the Management of Chang Gung Medical Foundation, Kaohsiung 83062, Taiwan.
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