Teddy Hla Profile picture
Oct 24 11 tweets 5 min read
Starting with "Whats *HOT* in data science?" Kirsten COLPAERT
- hype cycle for data science & ML in 2022.
- innovation trigger -> peak of inflated expectations -> trough of disillusionment
#LIVES2022
#datascience #WeAreICU #TogetherICU #IntensiveCare #CriticalCare @ESICM
Still some time for newer tools. Aiming for path towards productivity.
Potential usage of "Synthetic data" to "preserve privacy" and "augment unbalance/or biased data". This is potentially interesting as it allows more transportability of models from one health care system to others.
e.g., 7000,000 patients training set with only 6.8% female. thus will not be applicable to female patients. Chen et al 2021 for synthetic data.
nature.com/articles/s4155…
2. Deep-Learning : learning by example using "neural networks". nature.com/articles/s4174… interesting approach with structured and unstrcutured data turned into tokens without much feature engineering (I am sure people will debate on that ;) ) I find interesting thing though
Deep-learning models widely used in antibiotic discovery in research to help predict antibiotics.

- Reinforcement learning is still in upper slope of hype cycle. 2500 patients ICU Fluid guidance using reinforcement learning.
Difficulty with DRL strategies in real life compared to say computer game is that there is no unobservable counterfactual data.

To unpack this, means cant go back in time and keep all yr variables and re-assign patient to other treatment for example. (easier in computer game)
Natural Language Proccessing : medical records have a lot of texts unfortunately. NLP is helping unlock this further.

- Explainable AI. Contrasting interpretability with Predictive power. model evaluations (F1 score) will not be sufficient. need to understand mechanistically
Saliency mapping as an example to overcome "one-pixel attack". (one pixela attack means adding or changing 1 pixel results in wrong classification by AI model).

How about "Trust worthy AI"? AI algorithm in sepsis learning to say "i dont know"
nature.com/articles/s4174…

- Federated Learning has a lot of potential but early days.

Summary : exciting new growths but need to go to bedside to make it more useful.

@ESICM #LIVES2022
#ai #criticalcare #datascience

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More from @teddyhla

Oct 25
Carolyn Calfee Clinical and Biological phenotypes of ARDS
- what do they have in common?

ARDS : subgrouping since the begining
- sepsis vs. non sepsis
- hyper vs. hypoinflamm
- reactive vs uninflamed
#ventilation #ards #phenotypes #LIVES2022
Are clinical phenotypes biologically distinct?
looking at Trauma vs. Non trauma

ICAM-1 , SP-D, vWF, sTNFr-1 are different.
What about in "Direct" vs. "indirect"
or "Diffuse" vs "focal" -- sRAGE comes up again.

pubmed.ncbi.nlm.nih.gov/17944012/
#ventilation #ARDS #LIVES2022
Image
Read 13 tweets
Oct 25
Mariangela PELLEGRINI
Uppsala- Sweden
"Do we Need a biological definition of ARDS"

- Berlin definition has NO Diffuse alveolar damage .
- the Berlin defn does not capture well
Frohlich - different definitions specificity of 0.63, 0.42, 0.31 even!
#ventilation #ards #LIVES2022
academic.oup.com/bja/article/11…
The BJA article by Frohlich.
Fibrosis only starts after 7 days
Thille article : atsjournals.org/doi/full/10.11…
In essence, different disease processes are happening to the lung at different times in the "ARDS"
pubmed.ncbi.nlm.nih.gov/24429204/
Read 14 tweets
Oct 25
ARDS - new definition or phenotypes by @GicoBellani refreshing with Kigali definition of ARDS - useful not just low resource but during pandemic in supposedly high income settings and only draw back is no PEEp requirement #ards #ventilation #LIVES2022 @ESICM
@GicoBellani @ESICM Resolved versus confirmed ARDS
- prospectively applying Berlin definition did work but if ya wait 24 hrs and re-measure P/F ratio, you end up stratifying much better.
- Better separation of groups

pubmed.ncbi.nlm.nih.gov/29632996/
#ventilation #LIVES2022
@GicoBellani @ESICM Whichever definition - american european consensus or Berlin or Kigali -- all goes back to Ashbaugh original paper in 1967

thelancet.com/journals/lance…

Why are we so confused when it comes to ARDS definition ?

#ards #ventilation #LIVES2022 @ESICM
Read 11 tweets
Oct 25
Next : Mypinder SEKHON on cardiac arrest in COVID-19 era.

Works in Vancouver
COVID 19 era cardiac arrest ARE a lot less sexy with all the PPE. #als #covid19 #resuscitation #LIVES2022
@ESICM
@ESICM Let's look at epidemiology. Northern Italy, Manhattan - COVID hit hard and has impact on other diseases.

e.g., OHCA in Italy during COVID 19 massive spike.
ImageImageImage
Read 9 tweets
Oct 25
NEXT Speaker : VA ecmo for which patients?
Alain COMBES

Severe cardiogenic shock has different phenotypes
1. medical cardiogenic shock(AMI, end stage dilated CM, myocarditis, septic shock)
2. Post cardiotomy refractory CS (post CABG)
#LIVES2022
@ESICM #ecmo #resuscitation #ALS
@ESICM 2022 what do the guidelines say
- ESC recommends short term MCS should be considred in cardiogenic shock.
IABP may be considered but not routinely recommended in post MI
#LIVES2022
Image
Read 18 tweets
Oct 25
what about in refractory cardiac arrest?
ERC - ESICM guidelines 2021
- timing of CAG if no evidence ofr ST segment evaluation.

which means we will end up treating a lot of patients with stent and anticoagulation
TOMAHAWK trial : delayed or early invasive angiography -- no effec.

#LIVES2022
- immediate catheterisation for non ST elevationrr
Read 4 tweets

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