Session orale pédiatrique (1)
Bibliographic record
Abstract
Introduction: Maintaining spontaneous ventilation during mechanical ventilation (MV) seems beneficial regarding oxygenation, lung recruitment, ventilatory pressure, and diaphragm function.This necessitates synchronizing MV with the child breathing efforts.In adults, patientventilator asynchrony is independently associated with MV duration.We hypothesized that patient-ventilator asynchrony is frequent in critically ill children and may be associated with a longer MV duration. Patients and methods:This prospective observational study was conducted in patients 1 week to 18 years old, with conventional MV for acute respiratory failure.After parental consent, recordings were obtained when spontaneous breathing was steadily observed.To assess the patient ventilatory drive, diaphragm electrical activity (Edi) was recorded using a specific nasogastric catheter (Edi catheter, Maquet).Ventilatory pressure (Pvent) was obtained to reflect ventilator action.Breath-by-breath Edi and Pvent plots were analyzed semi-automatically by two independent investigators to identify the timings of patient efforts and ventilator support.Inspiratory trigger and cycling-off delays, non-assisted breaths, and auto-triggered assist were calculated.An automatic method was also used to assess asynchrony more objectively.This method classifies the cycles based on their trigger and cycling-off delays (expressed in % of respective inspiratory or expiratory time) and provides the % of adequately supported breaths (both delays < 33%).Results are reported as median (interquartile).Results: 52 patients 9 (1-35) months old, with PIM2 score 2 (1-4), were evaluated 3 (1-7) days after intubation.Inspiratory Pvent was 22 (19-23) cmH2O and tidal volumes 6.7 (5.5-7.4)ml/kg.Trigger and cycling off delays were 143 (80-240) ms and 150 (-120-360) ms, corresponding to 20 (16-36) % of the time.In addition, 15 (4-35) % breaths were non-assisted, and 7 (2-19) % assists were autotriggered, resulting in 79% patients with more than 10% asynchronous cycles.The automatic analysis showed that only 27 ± 28% of breaths were adequately supported.Ventilatory drive was very low in 29% patients (maximal Edi < 2 mcV).No relation was observed between asynchrony and MV duration.Discussion: The severity of asynchrony may be the consequence of inefficient triggering algorithm or inappropriate ventilatory settings.As suggested by the frequent low ventilatory drive, excessive ventilatory support or sedation may also play a role.The rarity of adequate synchrony makes the association with ventilation duration difficult to interpret. Conclusion:In this study, the children and the ventilator were poorly synchronized.Asynchrony was not associated with MV duration.Unexpectedly, the ventilatory drive was frequently blunted.Strategies to improve synchronisation should be evaluated and future studies should investigate the clinical impact of respiratory inactivity in children.
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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 | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.002 | 0.003 |
| Insufficient payload (model declined to judge) | 0.454 | 0.190 |
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; the direct Gemma label and the distilled Codex classifier agree on what is shown here.
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".