Academic research

A study performed at Hospital Universitari Vall d’Hebron in Spain examined the influence of noise on newborns by continuously measuring environmental noise levels, heart rate, mean arterial pressure and oxygen saturation for a preterm newborn for 56 hours in two different locations, for three different types of time intervals (quiet, noisy and nursing). In the NICU, the main sources of noise are alarms, the opening and closing of the incubator’s drawer and door, loud conversations, equipment ventilators, the sound of mobile phones, using furniture and normal conversations. The research staff carried out continuous direct observation and wrote down the source of the sounds, including nursing manipulation, and the approximate time interval of its occurrence. All information was transferred in real time to MetaVision and was later extracted for the study. The authors found that noise altered all of the physiological variables considered, aside from the maximal HR and the maximal SpO2, and had an effect on the newborn that was similar to that of nursing.  Regulation of noise in the NICU should take into account both sustained noise and isolated short noises inside the cot and should limit the averaged sound level and the maximum noise level.

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A large-scale retrospective cohort study at Antwerp University Hospital examined the association between abnormal chloremia and ICU and hospital mortality. The authors assessed the link with mortality both on the ICU and in the hospital, retrieving data such as demographic information, SAPS-3 and reason for admission from MetaVision. The authors found that after careful controlling for confounders, hyperchloremia was significantly associated with increased 30-day ICU and hospital mortality, but did not find that a low strong ion difference to be linked with negative outcome. They conclude that there is no simplistic extrapolation of their and other findings on hyperchloremia to the ongoing discussion on the detrimental effects of chloride-rich solutions.

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A study performed at Johns Hopkins Hospital sought to define the impact of delta hemoglobin (ΔHb) relative to nadir Hb levels on the likelihood of transfusion, as well as characterise the impact of ΔHb and nadir Hb on morbidity among a large cohort of patients undergoing complex hepatopancreatobiliary (HPB) surgery. The authors identified patients who underwent pancreatic or hepatic resection between January 1, 2009 and June 30, 2015 and obtained and analysed data on the perioperative ΔHb, nadir Hb and blood utilisation, using the MetaVision automated anaesthesia information management system to extract data on intraoperative transfusion and Hb. The authors found that the combination of the Hb trigger with ΔHb was associated with transfusion practices among providers and that larger ΔHb values, as well as receipt of transfusion, were strongly associated with risk of perioperative complication following HPB surgery. They conclude that “Collectively, the data strongly suggest that the combination of the Hb trigger with ΔHb is likely the preferred manner to assess transfusion practices among providers, as well as identify patients at risk for postoperative complications.”

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A study was performed to examine and validate a sepsis prediction method, InSight, for the new Sepsis-3 definitions in retrospective data, make predictions using a minimal set of variables from within the electronic health record data, compare the performance of this approach with existing scoring systems and investigate the effects of data sparsity on InSight performance. The authors found that despite using little more than vitals, InSight is an effective tool for predicting sepsis onset and performs well even with randomly missing data.  The data for this study was taken from the Multiparameter Intelligent Monitoring in Intensive Care (MIMIC)-III version 1.3 dataset, compiled from the Beth Israel Deaconess Medical Center in Boston between 2001 and 2012. The MIMIC-III set includes anonymised data from over 52,000 ICU stays and more than 40,000 patients using both CareVue and MetaVision. The authors point out that “The use of only MetaVision patients deserves special discussion. For ICU stays logged using the CareVue system, data about procedures performed (i.e., cultures being taken) does not appear in the MIMIC-III database in as detailed and comprehensive a fashion as for ICU stays logged using MetaVision. Further, while the MIMIC-III version 1.3 dataset includes information from the BIDMC microbiology lab, reporting positive cultures and the results thereof for all patients, negative cultures are not reported consistently. The combination of these facts means that negative cultures are underreported for CareVue patients. This in turn implies that suspicion of infection, as defined by the cooccurrence of culture and antibiotics, is systematically underrepresented in these ICU stays, resulting in a sepsis prevalence of 3.5% for CareVue patients versus 11.3% for MetaVision. In light of this disparity, we chose to exclude CareVue patients from our analyses.”

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A study performed at University Hospital of Antwerp aimed to develop new quantitative features for the Perfusion Index signal recorded continuously over the first 24 hours of life in a cohort of extremely low gestational age newborns and to assess the association of these features with normal and adverse short-term outcome. The authors conclude that low values and reduced short-term variability of Perfusion Index on day 1 are associated with adverse outcomes. These results contribute to the current understanding of preterm circulatory adaptation and suggest that the Perfusion Index could become a monitoring tool for peripheral perfusion in extremely preterm infants. MetaVision was used to digitally store Perfusion Index values.

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A single-center, retrospective analysis performed at Johns Hopkins examined the effect of leukoreduced perioperative blood transfusion (PBT) on oncologic outcomes and perioperative morbidity in radical cystectomy (RC) patients who received neoadjuvant chemotherapy (NAC), quantifying exposure with a novel dose index variable. This is the first study to examine the effect of PBT on morbidity and cancer-specific survival (CSS) in patients who uniformly received NAC prior to undergoing RC for bladder cancer. The authors queried the Johns Hopkins Radical Cystectomy database for patients who had undergone NAC followed by RC from 2010 to 2013. Using this database, along with the MetaVision electronic anaesthesia records, the authors were able to differentiate intraoperative and postoperative transfusions. The study results showed that PBT was associated with increased perioperative morbidity and length of stay and that intraoperative BT was independently associated with adverse oncologic outcomes after adjusting for clinical and pathologic parameters. The authors propose that a restrictive transfusion strategy may reduce morbidity and decrease length of stay after RC.

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A retrospective cohort study done by Leiden University Medical Center assessed the incidence, survival and predictors of vasoplegia in patients undergoing heart failure surgery. Haemodynamic, laboratory, clinical and survival data were collected prospectively in several patient information systems, including MetaVision, and analysed retrospectively. The authors found that vasoplegia frequently occurs after heart failure surgery and results in an impaired 90-day survival. Additionally, anaemia and a higher thyroxine level were associated with an increased risk of developing vasoplegia, whereas a higher creatinine clearance and the use of a beta blocker were associated with a reduced risk of vasoplegia. The authors have incorporated these factors into a proposed risk model that may guide treatment strategy.

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A monocentric retrospective study at Soroka Medical Center in Israel examined the true prognostic clinical significance of a positive fluid balance in septic ICU patients. The authors suggest that positive cumulative fluid balance is one of the major factors that can predict the clinical outcome of critically ill patients during their ICU stay and after their discharge from the ICU. The cumulative fluid balance was automatically calculated by MetaVision and reflected the net cumulative balance of daily inputs and outputs after each patient’s admission to the ICUs.

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A study at Johns Hopkins Hospital assessed the added predictive value of including receipt of intraoperative transfusion to the Surgical Apgar Score (SAS). The authors conclude that, “In summary, inclusion of intraoperative transfusion in a modified SAS significantly improves the ability of the score to risk-stratifying patients with regards to postoperative morbidity and mortality. Taken together, given the variability of intraoperative transfusion usage, its discordance with EBL (estimated blood loss), and its strong negative impact on postoperative outcomes, the inclusion of intraoperative transfusion should be included in a modified SAS.” Intraoperative patient hemodynamic parameters (heart rate, mean arterial pressure, systolic pressure, diastolic pressure, respiratory rate, temperature) and transfusion utilisation data were extracted from MetaVision.

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