bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pelvic Incidence Is Associated With Sacral Curvature, Sacroiliac Joint Angulation, and Sacral Ala Width
Authors: Abola Matthew V. , Teplensky Jason R. , Cooperman Daniel R. , Bauer Jennifer M. , Liu Raymond W. 
Published: April 2018

Study Design.
Cross-sectional anatomical study in dry cadaveric specimens.

Objective.
This study evaluates how the sacroiliac (SI) joint angulation, midsagittal sacral curvature, and sacral ala width relate to pelvic incidence (PI).

Summary of Background Data.
Numerous spinopelvic pathologies have been linked with pelvic incidence; however, the manner in which sacral morphology fits into this association is largely unknown.

Methods.
A total of 120 cadaveric sacra and corresponding innominate bones were obtained from an osteological collection. Pelvic incidence was measured in a previously validated method. To gauge ala width, calipers were used to measure the distance between the midpoint of the sacral endplate and the anterolateral aspect of the right and left ala. Sacral curvature was evaluated by measuring the difference of the direct distance and the curved bony distance from the sacral promontory to the inferior aspect of the fourth intervertebral foramen. Three separate angle measurements were made to quantify the angulation of the SI joint, which we divided into an upper and lower limb. Angle 1 approximated the relationship between the upper limb and the sacral endplate; angle 2 between the upper and lower limbs; angle 3 between the lower limb and a tangential line to the fourth sacral foramen.

Results.
Average age at death for all specimens was 31.9 ± 6.3 years with 63% representation of males and an equal distribution of Caucasian and African Americans. The mean PI of our study population was 45.1 ± 12.6°. Results from our regression showed statistically significant associations between our measured angles evaluating SI joint angulation (angles 1, 2, 3) and PI. Standardized beta for angle 1 was −0.421, angle 2 was 0.419, and angle 3 was −0.439 (all P < 0.001). Additionally, the average endplate-ala distance (beta = −0.254) and average difference between tape-caliper measurements, our measurement for sacral arc, (beta = 0.178) were significantly associated with PI (all P < 0.05).

Conclusion.
Our data supports the theory that increased PI is associated with a highly angulated and curved sacrum, with corresponding changes in the SI joint, and narrowed sacral alae.

Level of Evidence: N/A
An Open-Loop, Physiologic Model–Based Decision Support System Can Provide Appropriate Ventilator Settings
Authors: Karbing Dan Stieper , Spadaro Savino , Dey Nilanjan , Ragazzi Riccardo , Marangoni Elisabetta , Dalla Corte Francesca , Moro Federico , Lodahl David , Hansen Niklas Schurmann , Winding Robert , Rees Stephen Edward , Volta Carlo Alberto 
Published: April 2018

Objectives:
To evaluate the physiologic effects of applying advice on mechanical ventilation by an open-loop, physiologic model–based clinical decision support system.

Design:
Prospective, observational study.

Setting:
University and Regional Hospitals’ ICUs.

Patients:
Varied adult ICU population.

Interventions:
Advice were applied if accepted by physicians for a period of up to 4–8 hours.

Measurements and Main Results:
Seventy-two patients were included for data analysis. Acceptance of advice was high with 95.7% of advice applied. In 41 patients in pressure support ventilation, following system advice led to significant decrease in PS, with PS reduced below 8 cm H2O in 15 patients (37%), a level not prohibiting extubation. Fraction of end-tidal CO2 values did not change, and increase in respiratory rate/VT was within clinical limits, indicating that in general, the system maintained appropriate patient breathing effort. In 31 patients in control mode ventilation, pressure control and tidal volume settings were decreased significantly, with tidal volume reduced below 8 mL/kg predicted body weight in nine patients (29%). Minute ventilation was maintained by a significant increase in respiratory rate. Significant reductions in Fio
2 were seen on elevated baseline median values of 50% in both support and control mode–ventilated patients, causing clinically acceptable reductions in oxygen saturation.

Conclusions:
The results indicate that during a short period, the clinical decision support system provided appropriate suggestions of mechanical ventilation in a varied ICU population, significantly reducing ventilation to levels which might be considered safe and beneficial.
Markedly Deranged Injury Site Metabolism and Impaired Functional Recovery in Acute Spinal Cord Injury Patients With Fever
Authors: Gallagher Mathew J. , Zoumprouli Argyro , Phang Isaac , Schwab Jan M. , Kopp Marcel A. , Liebscher Thomas , Papadopoulos Marios C. , Saadoun Samira 
Published: April 2018

Objectives:
To characterize the effect of fever after acute, traumatic spinal cord injury on injury site metabolism and patient outcome.

Design:
Longitudinal cohort study. In 44 patients (London cohort), we determined the effect of fever on intrathecal injury site metabolism by analyzing 1,767 hours of intraspinal pressure and 759 hours of microdialysis data. We also determined the effect of fever burden, computed for the first 2 weeks in hospital, on neurologic outcome. A distinct cohort of 33 patients (Berlin cohort) was used to independently validate the effect of fever burden on outcome.

Setting:
ICUs in London and Berlin.

Patients:
Seventy-seven patients with acute, traumatic spinal cord injuries.

Interventions:
In the London patients, a pressure probe and a microdialysis catheter were placed intradurally on the surface of the injured cord for up to a week.

Measurements and Main Results:
Fever (> 37.5°C) occurs frequently (37% of the time) after spinal cord injury. High-grade fever (≥ 38°C) was associated with significantly more deranged metabolite levels than normothermia (36.5–37.5°C), that is, lower tissue glucose (median 2.0 vs 3.3 mM), higher lactate (7.8 vs 5.4 mM), higher glutamate (7.8 vs 6.4 µM), and higher lactate-to-pyruvate ratio (38.9 vs 29.3). High-grade fever was particularly detrimental on injury site metabolism when the peripheral leukocyte count was high. In the London and Berlin cohorts, high fever burden correlated with less neurologic improvement.

Conclusions:
Early after spinal cord injury, fever is associated with more deranged injury site metabolism than normothermia and worse prognosis.
Clinical Outcomes and Mortality Impact of Hyperbaric Oxygen Therapy in Patients With Carbon Monoxide Poisoning
Authors: Rose Jason J. , Nouraie Mehdi , Gauthier Marc C. , Pizon Anthony F. , Saul Melissa I. , Donahoe Michael P. , Gladwin Mark T. 
Published: April 2018

Objectives:
Carbon monoxide poisoning affects 50,000 per year in the United States alone. Mortality is approximately 3%, and up to 40% of survivors suffer from permanent neurocognitive and affective deficits. Hyperbaric oxygen therapy has shown benefit on reducing the long-term neurologic sequelae of carbon monoxide poisoning but has not demonstrated improved survival. The objective of this study is to assess the efficacy of hyperbaric oxygen for acute and long-term mortality in carbon monoxide poisoning using a large clinical databank.

Design:
Retrospective analysis.

Setting:
University of Pittsburgh Medical Center healthcare system (Pittsburgh, PA).

Patients:
One-thousand ninety-nine unique encounters of adult patients with carbon monoxide poisoning.

Interventions:
None.

Measurements and Main Results:
Baseline demographics, laboratory values, hospital charge transactions, discharge disposition, and clinical information from charting were obtained from the electronic medical record. In propensity-adjusted analysis, hyperbaric oxygen therapy was associated with a reduction in inpatient mortality (absolute risk reduction, 2.1% [3.7–0.9%]; p = 0.001) and a reduction in 1-year mortality (absolute risk reduction, 2.1% [3.8–0.4%]; p = 0.013).

Conclusions:
These data demonstrate that hyperbaric oxygen is associated with reduced acute and reduced 1-year mortality. Further studies are needed on the mortality effects of hyperbaric oxygen therapy in carbon monoxide poisoning.
Ventilator Bundle and Its Effects on Mortality Among ICU Patients: A Meta-Analysis*
Authors: Pileggi Claudia , Mascaro Valentina , Bianco Aida , Nobile Carmelo G. A. , Pavia Maria 
Published: April 2018

Objectives:
To assess the effectiveness of the ventilator bundle in the reduction of mortality in ICU patients.

Data Sources:
PubMed, Scopus, Web of Science, Cochrane Library for studies published until June 2017.

Study Selection:
Included studies: randomized controlled trials or any kind of nonrandomized intervention studies, made reference to a ventilator bundle approach, assessed mortality in ICU-ventilated adult patients.

Data Extraction:
Items extracted: study characteristics, description of the bundle approach, number of patients in the comparison groups, hospital/ICU mortality, ventilator-associated pneumonia–related mortality, assessment of compliance to ventilator bundle and its score.

Data Synthesis:
Thirteen articles were included. The implementation of a ventilator bundle significantly reduced mortality (odds ratio, 0.90; 95% CI, 0.84–0.97), with a stronger effect with a restriction to studies that reported mortality in ventilator-associated pneumonia patients (odds ratio, 0.71; 95% CI, 0.52–0.97), to studies that provided active educational activities was analyzed (odds ratio, 0.88; 95% CI, 0.78–0.99), and when the role of care procedures within the bundle (odds ratio, 0.87; 95% CI, 0.77–0.99). No survival benefit was associated with compliance to ventilator bundles. However, these results may have been confounded by the differential implementation of evidence-based procedures at baseline, which showed improved survival in the study subgroup that did not report implementation of these procedures at baseline (odds ratio, 0.82; 95% CI, 0.70–0.96).

Conclusions:
Simple interventions in common clinical practice applied in a coordinated way as a part of a bundle care are effective in reducing mortality in ventilated ICU patients. More prospective controlled studies are needed to define the effect of ventilator bundles on survival outcomes.
End-of-Life Care in ICUs in East Asia: A Comparison Among China, Korea, and Japan
Authors: Park So Young , Phua Jason , Nishimura Masaji , Deng Yiyun , Kang Yan , Tada Keiichi , Koh Younsuck 
Published: April 2018

Objectives:
To compare physicians’ perceptions and practice of end-of-life care in the ICU in three East Asian countries cultures similarly rooted in Confucianism.

Design:
A structured and scenario-based survey of physicians who managed ICU patients from May 2012 to December 2012.

Setting:
ICUs in China, Korea, and Japan.

Subjects:
Specialists who are either intensivists or nonintensivist primary attending physicians in charge of patients (195 in China, 186 in Korea, 224 in Japan).

Interventions:
None.

Measurements and Main Results:
Country was independently associated with differences in the practice of limiting multiple forms of life-sustaining treatments on multivariable generalized linear model analysis. Chinese respondents were least likely to apply do-not-resuscitate orders, even if they existed (p < 0.001). Japanese respondents were most likely to practice do not resuscitate for terminally ill patients during cardiac arrest, even when no such prior order existed (p < 0.001). Korean respondents’ attitudes were in between those of Chinese and Japanese respondents as far as withdrawing total parenteral nutrition, antibiotics, dialysis, and suctioning was concerned. Chinese respondents were most uncomfortable discussing end-of-life care issues with patients, while Japanese respondents were least uncomfortable (p < 0.001). Chinese respondents were more likely to consider financial burden when deciding on limiting life-sustaining treatment (p < 0.001). Japanese respondents felt least exposed to personal legal risks when limiting life-sustaining treatment (p < 0.001), and the Korean respondents most wanted legislation to guide this issue (p < 0.001). The respondents’ gender, religion, clinical experience, and primary specialty were also independently associated with the different perceptions of end-of-life care.

Conclusions:
Despite similarities in cultures and a common emphasis on the role of family, differences exist in physician perceptions and practices of end-of-life ICU care in China, Korea, and Japan. These findings may be due to differences in the degree of Westernization, national healthcare systems, economic status, and legal climate.
Early Evidence of Sepsis-Associated Hyperperfusion—A Study of Cerebral Blood Flow Measured With MRI Arterial Spin Labeling in Critically Ill Septic Patients and Control Subjects*
Authors: Masse Marie-Hélène , Richard Marie Anne , D’Aragon Frédérick , St-Arnaud Charles , Mayette Michael , Adhikari Neill K. J. , Fraser William , Carpentier André , Palanchuck Steven , Gauthier David , Lanthier Luc , Touchette Matthieu , Lamontagne Albert , Chénard Jean , Mehta Sangeeta , Sansoucy Yanick , Croteau Etienne , Lepage Martin , Lamontagne François 
Published: April 2018

Objectives:
Mechanisms underlying sepsis-associated encephalopathy remain unclear, but reduced cerebral blood flow, alone or in conjunction with altered autoregulation, is reported as a potential contributor. We compared cerebral blood flow of control subjects and vasopressor-dependent septic patients.

Design:
Randomized crossover study.

Setting:
MRI with arterial spin labeling.

Patients:
Ten sedated septic patients on mechanical ventilation (four with controlled chronic hypertension) and 12 control subjects (six with controlled chronic hypertension) were enrolled. Mean ± sd ages were 61.4 ± 10.2 and 44.2 ± 12.8 years, respectively (p = 0.003). Mean Acute Physiology and Chronic Health Evaluation II score of septic patients at ICU admission was 27.7 ± 6.6.

Interventions:
To assess the potential confounding effects of sedation and mean arterial pressure, we measured cerebral blood flow with and without sedation with propofol in control subjects and at a target mean arterial pressure of 65 mm Hg and greater than or equal to 75 mm Hg in septic patients. The sequence of sedation versus no sedation and mean arterial pressure targets were randomized.

Measurements and Main Results:
In septic patients, cerebral blood flow measured at a mean arterial pressure target of 65 mm Hg (40.4 ± 10.9 mL/100 g/min) was not different from cerebral blood flow measured at a mean arterial pressure target of greater than or equal to 75 mm Hg (41.3 ± 9.8 mL/100 g/min; p = 0.65). In control subjects, we observed no difference in cerebral blood flow measured without and with sedation (24.8 ± 4.2 vs 24.9 ± 5.9 mL/100 g/min; p = 0.93). We found no interaction between chronic hypertension and the effect of sedation or mean arterial pressure targets. Cerebral blood flow measured in sedated septic patients (mean arterial pressure target 65 mm Hg) was 62% higher than in sedated control subjects (p = 0.001).

Conclusions:
In septic patients, cerebral blood flow was higher than in sedated control subjects and did not vary with mean arterial pressure targets. Further research is required to understand the clinical significance of cerebral hyperperfusion in septic patients on vasopressors and to reassess the neurologic effects of current mean arterial pressure targets in sepsis.
Inclusion of Unstructured Clinical Text Improves Early Prediction of Death or Prolonged ICU Stay*
Authors: Weissman Gary E. , Hubbard Rebecca A. , Ungar Lyle H. , Harhay Michael O. , Greene Casey S. , Himes Blanca E. , Halpern Scott D. 
Published: April 2018

Objectives:
Early prediction of undesired outcomes among newly hospitalized patients could improve patient triage and prompt conversations about patients’ goals of care. We evaluated the performance of logistic regression, gradient boosting machine, random forest, and elastic net regression models, with and without unstructured clinical text data, to predict a binary composite outcome of in-hospital death or ICU length of stay greater than or equal to 7 days using data from the first 48 hours of hospitalization.

Design:
Retrospective cohort study with split sampling for model training and testing.

Setting:
A single urban academic hospital.

Patients:
All hospitalized patients who required ICU care at the Beth Israel Deaconess Medical Center in Boston, MA, from 2001 to 2012.

Interventions:
None.

Measurements and Main Results:
Among eligible 25,947 hospital admissions, we observed 5,504 (21.2%) in which patients died or had ICU length of stay greater than or equal to 7 days. The gradient boosting machine model had the highest discrimination without (area under the receiver operating characteristic curve, 0.83; 95% CI, 0.81–0.84) and with (area under the receiver operating characteristic curve, 0.89; 95% CI, 0.88–0.90) text-derived variables. Both gradient boosting machines and random forests outperformed logistic regression without text data (p < 0.001), whereas all models outperformed logistic regression with text data (p < 0.02). The inclusion of text data increased the discrimination of all four model types (p < 0.001). Among those models using text data, the increasing presence of terms “intubated” and “poor prognosis” were positively associated with mortality and ICU length of stay, whereas the term “extubated” was inversely associated with them.

Conclusions:
Variables extracted from unstructured clinical text from the first 48 hours of hospital admission using natural language processing techniques significantly improved the abilities of logistic regression and other machine learning models to predict which patients died or had long ICU stays. Learning health systems may adapt such models using open-source approaches to capture local variation in care patterns.
Impact of ICU Structure and Processes of Care on Outcomes After Severe Traumatic Brain Injury: A Multicenter Cohort Study
Authors: McCredie Victoria A. , Alali Aziz S. , Scales Damon C. , Rubenfeld Gordon D. , Cuthbertson Brian H. , Nathens Avery B. 
Published: April 2018

Objectives:
It is uncertain whether dedicated neurocritical care units are associated with improved outcomes for critically ill neurologically injured patients in the era of collaborative protocol-driven care. We examined the association between dedicated neurocritical care units and mortality and the effects of standardized management protocols for severe traumatic brain injury.

Design:
We surveyed trauma medical directors from centers participating in the American College of Surgeons Trauma Quality Improvement Program to obtain information about ICU structure and processes of care. Survey data were then linked to the Trauma Quality Improvement Program registry, and random-intercept hierarchical multivariable modeling was used to evaluate the association between dedicated neurocritical care units, the presence of standardized management protocols and mortality.

Setting:
Trauma centers in North America participating in Trauma Quality Improvement Program.

Patients:
Data were analyzed from 9,773 adult patients with isolated severe traumatic brain injury admitted to 134 Trauma Quality Improvement Program centers between 2011 and 2013.

Interventions:
None.

Measurements and Main Results:
Only 50 ICUs (37%) were dedicated neurocritical care units, whereas 84 (63%) were general ICUs. Rates of standardized management protocols were similar comparing dedicated neurocritical care units and general ICUs. Among severe TBI patients admitted to trauma centers enrolled in Trauma Quality Improvement Program, care in a dedicated neurocritical care unit did not improve risk-adjusted in-hospital survival (odds ratio, 0.97; 95% CI, 0.80–1.19; p = 0.79). However, the presence of a standardized management protocol for these patients was associated with lower risk-adjusted in-hospital mortality (odds ratio, 0.77; 95% CI, 0.63–0.93; p = 0.009).

Conclusions:
Compared with dedicated neurocritical care models, standardized management protocols for severe traumatic brain injured patients are process-targeted intervention strategies that may improve clinical outcomes.
Early Enteral Nutrition Provided Within 24 Hours of ICU Admission: A Meta-Analysis of Randomized Controlled Trials*
Authors: Tian Feng , Heighes Philippa T. , Allingstrup Matilde J. , Doig Gordon S. 
Published: April 2018

Objectives:
To identify, appraise, and synthesize the most current evidence to determine whether early enteral nutrition alters patient outcomes from critical illness.

Data Sources:
Medline and Embase were searched. The close out date was November 20, 2017.

Study Selection:
Early enteral nutrition was defined as a standard formula commenced within 24 hours of ICU admission. Comparators included any form of nutrition support “except” early enteral nutrition. Only randomized controlled trials conducted in adult patients requiring treatment in an ICU were eligible for inclusion.

Data Extraction:
The primary outcome was mortality. Secondary outcomes included pneumonia, duration of mechanical ventilation, and ICU and hospital stay.

Data Synthesis:
Six-hundred ninety-nine full-text articles were retrieved and screened. Sixteen randomized controlled trials enrolling 3,225 critically ill participants were included. Compared with all other types of nutrition support, commencing enteral nutrition within 24 hours of ICU admission did not result in a reduction in mortality (odds ratio, 1.01; 95% CI, 0.86–1.18; p = 0.91; I
2 = 32%). However, there was a differential treatment effect between a priori identified subgroups (p = 0.032): early enteral nutrition reduced mortality compared with delayed enteral intake (odds ratio, 0.45; 95% CI, 0.21–0.95; p = 0.038; I
2 = 0%), whereas a mortality difference was not detected between early enteral nutrition and parenteral nutrition (odds ratio, 1.04; 95% CI, 0.89–1.22; p = 0.58; I
2 = 30%). Overall, patients who were randomized to receive early enteral nutrition were less likely to develop pneumonia (odds ratio, 0.75; 95% CI, 0.60–0.94; p = 0.012; I
2 = 48%).

Conclusions:
Overall, there was no difference between early enteral nutrition and all other forms of nutrition support. A priori planned subgroup analysis revealed early enteral nutrition reduced mortality and pneumonia compared with delayed enteral intake; however, there were no clear clinical advantages of early enteral nutrition over parenteral nutrition.