NEXT: Who's "high risk" in ICU? Nicolas Bennett - Zurich, Switzerland.
reminds me of NELA score development in UK.
Declaration : he now works for industry (known side effect for medics doing data science ) @ESICM#criticalcare#ai#datascience#LIVES2022
#sepsis classification using MIMIC-3 - time series data. Time-series classficiation.
his labels are also earlier. main improvement is due to missing data Mx. "Missingness" is not random as assumption "more data available" in sicker pts.
Despite performance, did not evaluate further as want to move onto real-time risk development rather than retrospective.
Uses 4 data sets ; MIMIC-III, eICU Pollart et al, HiRID, AUMC Thoral et al.
Time-varying and static variables.
Prediction models considered : NN architectures with transformer models. baseline LGBM, GLM, features: NEWS, MEWS, SIRS,SOFA.
AUROC, precision at 80% recall and median earliness.
Outlook : do we want to rely on treatment-related information? Misalignment between time dynamics of label, data availability and expectations of prediction risk. Uses vasopressor adjusted map value.
interesting view from 1 of senior physicians :: SOFA score has nothing to do with sepsis. it was designed first to detect "abnormalities". Are we barking up the wrong tree ?
- 2nd Q: does prediction matter or makes any difference?speaker is non clinician so said hard to comment
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
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
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