ObjectiveThe development of the extracorporeal membrane oxygenation in Latin America
represents a challenge in this specialty field. The objective of this article was
to describe the results of a new extracorporeal membrane oxygenation program in an
intensive care unit.MethodsThis retrospective cohort study included 22 patients who required extracorporeal
membrane oxygenation and were treated from January 2011 to June 2014. The baseline
characteristics, indications, duration of the condition, days on mechanical
ventilation, days in the intensive care unit, complications, and hospital
mortality were evaluated.ResultsFifteen patients required extracorporeal membrane oxygenation after lung
transplantation, and seven patients required oxygenation due to acute respiratory
distress. All transplanted patients were weaned from extracorporeal membrane
oxygenation with a median duration of 3 days (Interquartile range - IQR: 2 - 5),
were on mechanical ventilation for a median of 15.5 days (IQR: 3 - 25), and had an
intensive care unit stay of 31.5 days (IQR: 19 - 53) and a median hospital stay of
60 days (IQR: 36 - 89) with 20% mortality. Patients with acute respiratory
distress had a median oxygenation membrane duration of 9 days (IQR: 3 - 14),
median mechanical ventilation time of 25 days (IQR: 13 - 37), a 31 day stay in
therapy (IQR: 11 - 38), a 32 day stay in the hospital (IQR: 11 - 41), and 57%
mortality. The main complications were infections (80%), acute kidney failure
(43%), bleeding at the surgical site and at the site of cannula placement (22%),
plateletopenia (60%), and coagulopathy (30%).ConclusionIn spite of the steep learning curve, we considered this experience to be
satisfactory, with results and complications comparable to those reported in the
literature.
Intracranial Pressure (ICP) is one of the main neuromonitories used today to guide the treatment of acute neurological patients in the Intensive Care Unit (ICU). Within this article the complexity of periods of intracranial hypertension is evaluated and compared with periods of stable intracranial tension. Using the multiparameter intelligent monitoring in intensive care III (MIMIC-III) database from the Beth Israel Deaconess Medical Center the complexity of periods of stable intracranial tension and high intracranial hypertension are evaluated using two quantifiers: the Permutation Entropy and their respective number of missing patterns. Both indicate a loss of complexity in hypertension signals. A physiological explanation of this loss of complexity is given using a dynamical model of the Cerebral Autorregulation and Cerebral Hemodynamics.
Intracranial pressure (ICP) monitoring is commonly used in the follow-up of patients in intensive care units, but only a small part of the information available in the ICP time series is exploited. One of the most important features to guide patient follow-up and treatment is intracranial compliance. We propose using permutation entropy (PE) as a method to extract non-obvious information from the ICP curve. We analyzed the results of a pig experiment with sliding windows of 3600 samples and 1000 displacement samples, and estimated their respective PEs, their associated probability distributions, and the number of missing patterns (NMP). We observed that the behavior of PE is inverse to that of ICP, in addition to the fact that NMP appears as a surrogate for intracranial compliance. In lesion-free periods, PE is usually greater than 0.3, and normalized NMP is less than 90% and p(s1)>p(s720). Any deviation from these values could be a possible warning of altered neurophysiology. In the terminal phases of the lesion, the normalized NMP is higher than 95%, and PE is not sensitive to changes in ICP and p(s720)>p(s1). The results show that it could be used for real-time patient monitoring or as input for a machine learning tool.
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