Evolution of Mechanical Ventilation Practices in Neonatal Cardiac Patients: Single-Center Retrospective Analysis of Three 1-Year Epochs During 2000–2020
Bibliographic record
Abstract
OBJECTIVES: We sought to better understand how mechanical ventilation (MV) practices have evolved in neonates after cardiac surgery and evaluate whether such changes were associated with outcomes. DESIGN: Single-center, retrospective study of three different 1 year-long periods: 2001, 2011, and 2020. SETTING: Quaternary institution with a dedicated cardiac PICU in Toronto, ON, Canada. PATIENTS: Neonates (≤ 28 d) receiving MV after cardiac surgery. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Settings, modes, duration of MV, noninvasive ventilation (NIV), PICU, and hospital stay were compared across epochs. A competing risk analysis was performed to determine whether changes in MV delivery were associated with MV liberation. The study included 291 patients with 101 (35%), 96 (33%), and 94 (32%) in 2001, 2011, and 2020, respectively. We did not identify differences in baseline characteristics, diagnosis, and severity category across our epochs. We found the following practice changes by epoch. First, a decrease in tidal volume (V t ) from (mean ± sd ) 12.1 ± 3.1 in 2001 to 6-7 mL/kg in 2011 and 2020 ( p < 0.001). This practice was associated with chronological reduction in driving pressure (DP): 15.4 ± 2.5, 14.3 ± 2.2, and 13.0 ± 2.6 cm H 2 O ( p < 0.001). Second, postextubation NIV was used more frequently in 2020. Third, faster weaning was introduced by 2020 and an increase in ventilator-free days, including NIV days, was observed ( p < 0.001). Fourth, after adjusting for demographic characteristics, epoch, severity, MV pre-surgery, higher V t , and DP were associated with lower prevalence of MV liberation, with respective hazard ratios (HRs) 0.818 (95% CI, 0.699-0.957); p = 0.012 and HR 0.865 (95% CI, 0.825-0.907); p < 0.001. CONCLUSIONS: In neonates requiring MV after cardiac surgery, we have found that practices in our center changed over three 1-year epochs, from 2001, to 2011, and to 2020. Reduction in V t and early weaning when combined were associated with more ventilator-free days. Decrease in DP and V t were both associated with sooner MV liberation.
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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 | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
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".