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Bibliographic record
Abstract
Introduction: To assess the impact of an early-standardized echocardiography (ESE) hemodynamic assessment in patients with shock. Hypothesis: ESE, when performed early in the resuscitation of patients with shock will change management and improve outcomes including survival and duration of mechanical ventilation. Methods: Location: Single center quaternary-level hospital. As of January 4th 2012 patients referred to the critical care service with shock had an ESE performed using a hand-held devise (V-Scan, GE Healthcare) within 36 hours of admission to the intensive care unit (ICU). Scans were performed by one of three Intensivists with advanced training in echocardiography. Recommendations for fluid and inotropic management and etiology of shock were made according to the results of the ESE. We conducted a prospective cohort study compared to a historical control of 159 patients presenting in shock. Seventy-nine patients had a standardized ultrasound exam assessing for cardiac function (valvular, pericardium, left and right left ventricular function) and volume status (by application of the inferior vena cava collapsibility index), patients were followed for 28 days. Results: Significant valvular pathology was identified in 14 (17.7%) patients, 29 (36.7%) patients were deemed to have moderate to severe cardiac dysfunction. Volume responsiveness was identified in 19 (24.1%) patients. Recommendations to restrict fluids was made in 54 (70%) patients; augmenting inotropic support was suggested in 12 (15.2%) patients and increased vasopressors were recommended in 15 (19%) patients. After adjusting for the dose of vasopressor upon presentation, patients receiving ESE compared to controls had improved 28-day survival versus standard management (71% vs 57%, p<0.001). ESE also increased median days alive and free of vasopressors [23 (4-25) vs 17 (0-24), p=0.013] and mechanical ventilation [19 (2-26) vs 14 (0-21), p=0.002] compared to standard management. Conclusions: ESE when used early in the assessment of critically ill patients with shock appears to improve survival and reduce the duration of mechanical ventilation and vasopressor support. A prospective randomized control trial is required to verify these result.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.005 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.001 | 0.003 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.310 | 0.195 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".