Academic research

MetaVision was used to gather data for a major multicenter retrospective observational study of the frequency of clinically relevant pDDIs (potential drug-drug interactions), which will be of value in further enhancing configuration of clinical decision support systems to the ICU setting.

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Continuous measurement of mechanical power is necessary to establish a safe protective strategy during mechanical ventilation with the aim to minimize ventilation induced lung injury (VILI), an acute lung injury affecting the airways and parenchyma which is mostly seen in patients ventilated for acute respiratory distress syndrome (ARDS). In this article, the authors developed a simplified equation to calculate dynamic mechanical power (MPdyn) at the bedside, using IMDsoft-MetaVision to record mechanical ventilator breathing parameters every minute from a total of forty adult patients hospitalized with ARDS. This equation was compared to the standard Gattinoni’s mechanical power equation (MPstd), which is considered difficult to calculate manually by healthcare professionals at the bedside. Analysis of the results, using univariable logistic regression analyses, showed that MPdyn and MPstd equation correlated significantly (R-squared=0.98). No statistically significant difference was found between MPdyn and MPstd in Bland-Altman analysis with patient power means. These results suggest that physicians may easily calculate mechanical power using MPdyn at the bedside in patients on volume control mode with different PEEP and I:E ratios. The authors concluded that although there is not enough data to show the reliability of power values computed by the MPdyn equation in ventilator modes other than volume control, it has the potential to monitor power values to identify the risk of VILI.

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A study performed at Sheba Medical Center aimed to investigate the effect of mode (direct feeding at the breast versus expressing) and exclusivity (breast milk combined with formula versus breast milk only) as well as maternal perceptions on the duration of breast milk feeding (BMF) among preterm infants. The MetaVision clinical information system served as a platform for organising the data, which included maternal demographics (age, years of education, income, marital status) and obstetric characteristics (fertility treatment, gestational age, and delivery mode). The authors found that two factors were associated with duration of BMF among infants born before 32 weeks of gestational age: direct feeding at the breast and duration of exclusive BMF. They conclude that “Further studies are needed in order to assess interventions such as early skin to skin and breast milk expression, maternal rooming-in, minimising use of pacifier, test-weighting, as well as consultant availability, during and after discharge, which would encourage mothers of preterm infant to engage in breast milk feeding exclusively and to feed directly at the breast.”

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A study performed at Paoli-Calmettes Institute proposed that a low dose of hydrocortisone could help with modulation of immune response in the critically ill population. The authors reported on 190 onco-haematology patients admitted to the ICU and treated with mechanical ventilation over four years. To their knowledge, this is the first study reporting prognosis data with regard to VAP specifically in the cancer population. All data were extracted and analysed by senior physicians from MetaVision ICU. The authors found a positive effect of early low-dose hydrocortisone treatment in preventing VAP and conclude that “Critically ill cancer patients could benefit from the administration of low-dose hydrocortisone in the days surrounding mechanical ventilation initiation. This interesting result should be evaluated in a future large-scale randomized controlled trial.”

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A retrospective study performed at Centre Hospitalier Universitaire Vaudois (CHUV) in Switzerland aimed to evaluate the effect of Levosimendan on cardiac output parameters in cardiac children with low cardiac output syndrome (LCOS). This study is one of the largest studies relating to the efficacy of Levosimendan in children with LCOS, which remains a major complication after congenital heart surgery. Demographic and clinical data were collected from MetaVision. The authors found that in accordance with other paediatric studies done in similar settings, Levosimendan helps stabilise and can even improve the haemodynamic condition of patients when the usual inotropic treatments have failed. It may prevent the need for mechanical cardiac support, although this should be confirmed by additional studies. They conclude that, “Levosimendan is a cardioprotective drug that will undoubtedly become part of the standard of care of the prevention and management of LCOS.”

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A retrospective and observational study performed at Soroka Medical Center in Israel analysed the minute-to-minute urine flow rate (UFR) and its variability in hypotensive multiple trauma patients during the first 6 hours of their ICU stay, parameters that have not been previously reported. Clinical data were extracted from MetaVision. The authors suggest that UFR variability can serve as a reliable incipient marker of occult hypovolemia and also as an indicator of the end-point of blood volume resuscitation, and propose that it should be one of the parameters used to monitor the hemodynamic status of critically ill multiple trauma patients. Additionally, they suggest that that more comprehensive randomised and prospective studies should be undertaken to evaluate the potential clinical role of UFR variability and its influence on the ICU outcomes of multiple trauma patients.

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A retrospective study aimed to describe the current scope and safety of prescribing activity undertaken by critical care pharmacists after the recent introduction of this service in a single large UK teaching hospital. As far as the authors know, this is the first study that has specifically evaluated the practice of prescribing pharmacists in UK critical care units (CCU). All general CCUs used MetaVision for electronic prescribing. The system had been customised and checked by pharmacists and included default doses for most medicines. The authors found that critical care pharmacists undertook significant prescribing activity across a wide range of therapeutic areas and that pharmacist prescribing errors were extremely uncommon. The authors note that “The low error rate in the study may have been positively influenced by the e-prescribing system having default dosing for many drugs.”

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A prospective observational study performed at the surgical and medical ICUs of UZ Leuven in Belgium hypothesised that infected ICU patients can be distinguished from non-infected ICU patients based on dynamic features of serum cytokine concentrations and heart rate time series. The authors used simple metrics to quantify these time series to obtain an accurate classification of infected patients. Heart rate measurements were stored in MetaVision. The authors found that heart rate seemed to be a better marker for infection than information captured by cytokine time series when the exact stage of infection is not known. They propose that the predictive value of (expensive) biomarkers should always be weighed against the routinely monitored data, and that these biomarkers have to demonstrate added value.

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A study examined the relationship between early pain-related stress (PRS) and neurodevelopmental outcomes among low-risk very preterm infants at the age of one year corrected age (CA). The authors hypothesised that increased cumulative exposure to pain would be associated with lower developmental scores. They found that among low-risk, invasive mechanical ventilation (IMV) preterm infants, increased exposure to PRS as measured by the NISS or SBP is directly and significantly associated with lower neurodevelopmental scores at 12.5 months CA. To the best of their knowledge, this is the first study that used both methods to study the correlation between PRS exposure and neurodevelopmental outcomes. Medical records from MetaVision, used in their neonatal department, served as a platform for collecting maternal and infant data.

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