Proceedings of Réanimation 2019, the French Intensive Care Society International Congress
Bibliographic record
Abstract
Introduction: Mechanical Insufflation-Exsufflation (MI-E) by using a specific device is commonly used to increase weak cough, as in patients with chronic neuromuscular weakness or in intensive care unit (ICU) patients with ICU-acquired neuro-myopathy.The assessment of the efficacy of MI-E device is commonly done by measuring peak cough flow (PCF).Upper airways collapse is frequently associated with neuromuscular disease and may compromise MI-E efficacy.Tracheomalacia is another disease that may impede PCF to increase with MI-E device.The goal of present study was to carry out a bench study to assess the effect of MI-E on PCF with and without the presence of a collapsible tube.Our hypothesis was that PCF was lower with than without collapsible tube.Patients and methods: We used a lung simulator (TTL Michigan Instruments) with adjustable compliance (C) and resistance (R) to which a MI-E (CoughAssist E70, Philips-Respironics) was attached, with or without a latex collapsible tube.Flow and pressure were proximal to the lung simulator.Six C-R combinations were tested, each with and without the collapsible tube.For each C-R combination, we set ± 30, ± 40 and ± 50 cmH2O inspiratory expiratory pressure at the MI-E device.MI-E device was set in automatic mode with inspiratory time of 3 s, expiratory time of 3.2 s and pause of 2 s.Each set was recorded by using a data logger (Biopac 150, Biopac inc.) and the last 5 cycles were used for the analysis done by using Acqknowledge software (Biopac inc.).The peak expiratory flow during the first 100 ms after onset of expiration was taken as the surrogate of PCF.The corresponding pressure was also recorded.Results: Contrary to our hypothesis, the peak expiratory flow during the first 100 ms of exsufflation phase is higher with than without the collapsible tube in every C-R condition, as shown in figure 1.For the C20R5 condition the effect of the collapsible tube on the intercept (-0.35 cm H 2 O) was not significant but this was offset by a significant increase in slope (+ 0.12 L s cm H 2 O).For the other conditions, the collapsible tube significantly increased PCF at 30 cm H 2 O expiratory pressure and the gap further increased above this pressure because the slope increased with the collapsible tube. Conclusion:We found that peak expiratory was higher with than without collapsible tube.In vivo measurements in patients should be done to confirm this finding.
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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 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.001 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.142 | 0.064 |
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".