Reply to Jha: Cardiopulmonary Effects of Increased Mixed Venous Saturation during Venovenous Extracorporeal Membrane Oxygenation
Bibliographic record
Abstract
However, the authors noted a reduction in CO at higher ECMO flow.Expectedly, all direct or derived hemodynamic variables-namely, pulmonary artery pressure, transpulmonary gradient, diastolic pressure gradient, PVR, and right ventricular workload-were lower in the higher ECMO blood group compared with lower ECMO blood flow group because of the reduction in CO.A reduction in the need for native CO at higher ECMO flow does not offer a convincing physiological explanation.As explained, thermodilution-based CO measurement may yield erroneous data because of recirculation in femorojugular circulation.Recirculation could be negligible and thus produce errors in CO measurement in femorofemoral cannulation.Therefore, the reduction in CO could be possible because of reduced venous return as a result of improved SV .O 2 -induced venodilatation and reduction in mean circulatory filling pressure, thereby causing a diminished gradient for venous return (4).At higher ECMO blood flow, the circuit reservoir expands at the cost of the systemic reservoir to maintain a constant total blood volume.Second, improved oxygenation may lead to increased systemic vascular resistance and left ventricular afterload.Therefore, the authors should have also reported the changes in mean arterial pressure (MAP) and systemic vascular resistance at different ECMO flow rates.MAP drives venous return, and pulmonary artery pressure may decrease with a decrease in MAP.Poor oxygenation and hypercarbia at low ECMO flow could have increased sympathetic activity ( 5).The increased sympathetic activity may have chronotropic and inotropic effects.It was evident, as heart rate (95 6 18 vs.87 6 19 beats per minute) and stroke volume (94 6 25 vs. 87 6 4 ml per beat) were higher at low ECMO flow (low SV .O 2 ) compared with high ECMO flow (high SV .O 2 ).An insignificant reduction in pulmonary artery occlusion pressure (13 mm Hg to 12 mm Hg), despite a greater reduction in CO (9.2 L/min to 7.9 L/min), may suggest an increase in left ventricular afterload or reduction in ventricular contractility.Therefore, an echocardiographic assessment of left ventricular systolic function could have further helped in physiological explanations.In conclusion, ECMO flow may be optimized to improve SV .O 2 and should sustain improvement in DO 2 and DO 2 / _ VO 2 ratio.This may be possible only when CO is maintained or increased, accompanied by the reduction in hypoxic pulmonary vasoconstriction and PVR.
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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 | 0.003 | 0.023 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.002 | 0.003 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.030 | 0.029 |
| Insufficient payload (model declined to judge) | 0.004 | 0.004 |
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".