Thursday December 4, 2008
Artificial intelligence in ICU !!

A very interesting study - "An artificial intelligence tool to predict fluid requirement in the intensive care unit: a proof-of-concept study" - is just published at ccforum.com

An alternative way of personalizing medicine in the ICU on a realtime basis by using information derived from the application of artificial intelligence on a high resolution database, is proposed. Calculation of maintenance fluid requirement at the height of systemic inflammatory response was selected to investigate the feasibility of this approach.

The Multi-parameter Intelligent Monitoring for Intensive Care II (MIMIC II) is a database of patients admitted to the Beth Israel Deaconess Medical Center ICU.

METHOD: Patients who were on vasopressors for more than 6 hours during the first 24 hours of admission were identified from the database. Demographic and physiologic variables that might affect fluid requirement or reflect the intravascular volume during the first 24 hours in the ICU were extracted from the database. The outcome to be predicted is the total amount of fluid given during the second 24 hours in the ICU, including all the fluid boluses administered.

Investigators represented the variables by learning a Bayesian network from the underlying data. Using ten-fold cross-validation repeated 100 times, the accuracy of the model in predicting the outcome is 77.8%. The network generated has a threshold Bayes factor of 7 representing the posterior probability of the model given the observed data. This Bayes factor translates into p < .05 assuming Gaussian distribution of the variables.

Conclusions: Based on the model, the probability that a patient will require a certain range of fluid on day 2 can be predicted. In the presence of a larger database, analysis may be limited to patients with identical clinical presentation, demographic factors, co-morbidities, current physiologic data, and those who did not develop complications as a result of fluid administration. By better predicting maintenance fluid requirements based on the previous day's physiologic variables, one might be able to prevent hypotensive episodes requiring fluid boluses during the course of the following day.


Reference: click to get article

An artificial intelligence tool to predict fluid requirement in the intensive care unit: a proof-of-concept study - Critical Care 2008, 12:R151 - pdf file

Wednesday December 3, 2008
Sodium retention in Corticosteroids


Q; Which Corticosteroid has highest Relative Sodium Retension (RSR)?
- Choose one

A) Prednisone
B) Methylprednisone
C) Hydrocortisone
D) Dexamethasone




Answer: Hydrocortisone

Hydrocortisone has Relative Sodium Retention of "20" in comaprison to other steroids

Prednisone's RSR is 1

Methylprednisone RSR is 0.5

Dexamethasone RSR is 0

Tuesday December 2, 2008
Hepatic Hydrothorax

Q; How you confirm the cause of pleural effusion (mostly right sided) in cirrhotic patient as hepatic hydrothorax?


Answer: By radioisotope imaging (nuclear medicine)

Pleural effusion in cirrhotic patients (hepatic hydrothorax) may result from migration of ascitic fluid across defects in the diaphragm. Biochemical analysis of ascitic and pleural fluid provides only indirect information about the nature and origin of the effusion.

Transdiaphragmatic movement of ascitic fluid into the pleural space can be demonstrated, generally within 2 hours of intraperitoneal injection of the radiotracer ( 99mTc sulfur colloid scintigraphy).

Radionuclide scintigraphy is a simple, safe and relatively non-invasive method to confirm passage of ascitic fluid across the diaphragm.

Monday December 1, 2008

Life Cycle of Malaria (still image below)