Investigation of a Novel Noninvasive Risk Analytics Algorithm With Laboratory Central Venous Oxygen Saturation Measurements in Critically Ill Pediatric Patients
BACKGROUND:. Accurate assessment of oxygen delivery relative to oxygen demand is crucial in the care of a critically ill patient. The central venous oxygen saturation (Svo2) enables an estimate of cardiac output yet obtaining these clinical data requires invasive procedures and repeated blood sampli...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer
2025-01-01
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| Series: | Critical Care Explorations |
| Online Access: | http://journals.lww.com/10.1097/CCE.0000000000001204 |
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| author | Sarah A. Teele, MD, MSHPEd Avihu Z. Gazit, MD Craig Futterman, MD William G. La Cava, PhD David S. Cooper, MD, MPH, MBA Steven M. Schwartz, MD, MS Joshua W. Salvin, MD, MPH |
| author_facet | Sarah A. Teele, MD, MSHPEd Avihu Z. Gazit, MD Craig Futterman, MD William G. La Cava, PhD David S. Cooper, MD, MPH, MBA Steven M. Schwartz, MD, MS Joshua W. Salvin, MD, MPH |
| author_sort | Sarah A. Teele, MD, MSHPEd |
| collection | DOAJ |
| description | BACKGROUND:. Accurate assessment of oxygen delivery relative to oxygen demand is crucial in the care of a critically ill patient. The central venous oxygen saturation (Svo2) enables an estimate of cardiac output yet obtaining these clinical data requires invasive procedures and repeated blood sampling. Interpretation remains subjective and vulnerable to error. Recognition of patient’s evolving clinical status as well as the impact of therapeutic interventions may be delayed.
OBJECTIVE:. The predictive analytics algorithm, inadequate delivery of oxygen (IDo2) index, was developed to noninvasively estimate the probability of a patient’s Svo2 to fall below a preselected threshold.
DERIVATION COHORT:. A retrospective multicenter cohort study was conducted using data temporally independent from the design and development phase of the IDo2 index.
VALIDATION COHORT:. A total of 20,424 Svo2 measurements from 3,018 critically ill neonates, infants, and children were retrospectively analyzed. Collected data included vital signs, ventilator data, laboratory data, and demographics.
PREDICTION MODEL:. The ability of the IDo2 index to predict Svo2 below a preselected threshold (30%, 40%, or 50%) was evaluated for discriminatory power, range utilization, and robustness.
RESULTS:. Area under the receiver operating characteristic curve (AUC) was calculated for each index threshold. Datasets with greater amounts of available data had larger AUC scores. This was observed across each configuration. For the majority of thresholds, Svo2 values were observed to be significantly lower as the IDo2 index increased.
CONCLUSIONS:. The IDo2 index may inform decision-making in pediatric cardiac critical care settings by providing a continuous, noninvasive assessment of oxygen delivery relative to oxygen demand in a specific patient. Leveraging predictive analytics to guide timely patient care, including support for escalation or de-escalation of treatments, may improve care delivery for patients and clinicians. |
| format | Article |
| id | doaj-art-e59a40eac6f84c8e8df5b488825dae25 |
| institution | Kabale University |
| issn | 2639-8028 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Critical Care Explorations |
| spelling | doaj-art-e59a40eac6f84c8e8df5b488825dae252025-01-24T09:19:27ZengWolters KluwerCritical Care Explorations2639-80282025-01-0171e120410.1097/CCE.0000000000001204202501000-00010Investigation of a Novel Noninvasive Risk Analytics Algorithm With Laboratory Central Venous Oxygen Saturation Measurements in Critically Ill Pediatric PatientsSarah A. Teele, MD, MSHPEd0Avihu Z. Gazit, MD1Craig Futterman, MD2William G. La Cava, PhD3David S. Cooper, MD, MPH, MBA4Steven M. Schwartz, MD, MS5Joshua W. Salvin, MD, MPH61 Division of Cardiovascular Critical Care Medicine, Department of Cardiology, Boston Children’s Hospital, Boston, MA.2 Division of Pediatric Cardiac Critical Care Medicine, Department of Critical Care Medicine, Pittsburgh Children’s Hospital, Pittsburgh, PA.3 Division of Cardiac Critical Care Medicine, Department of Pediatrics, George Washington University, Children’s National Hospital, Washington, DC.4 Computational Health Informatics Program, Boston Children’s Hospital, Boston, MA.6 Department of Pediatrics, University of Cincinnati College of Medicine, The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH.7 Division of Cardiac Critical Care Medicine, Departments of Critical Care Medicine and Pediatrics, The Hospital for Sick Children and The University of Toronto Temerty Faculty of Medicine, Toronto, ON, Canada.1 Division of Cardiovascular Critical Care Medicine, Department of Cardiology, Boston Children’s Hospital, Boston, MA.BACKGROUND:. Accurate assessment of oxygen delivery relative to oxygen demand is crucial in the care of a critically ill patient. The central venous oxygen saturation (Svo2) enables an estimate of cardiac output yet obtaining these clinical data requires invasive procedures and repeated blood sampling. Interpretation remains subjective and vulnerable to error. Recognition of patient’s evolving clinical status as well as the impact of therapeutic interventions may be delayed. OBJECTIVE:. The predictive analytics algorithm, inadequate delivery of oxygen (IDo2) index, was developed to noninvasively estimate the probability of a patient’s Svo2 to fall below a preselected threshold. DERIVATION COHORT:. A retrospective multicenter cohort study was conducted using data temporally independent from the design and development phase of the IDo2 index. VALIDATION COHORT:. A total of 20,424 Svo2 measurements from 3,018 critically ill neonates, infants, and children were retrospectively analyzed. Collected data included vital signs, ventilator data, laboratory data, and demographics. PREDICTION MODEL:. The ability of the IDo2 index to predict Svo2 below a preselected threshold (30%, 40%, or 50%) was evaluated for discriminatory power, range utilization, and robustness. RESULTS:. Area under the receiver operating characteristic curve (AUC) was calculated for each index threshold. Datasets with greater amounts of available data had larger AUC scores. This was observed across each configuration. For the majority of thresholds, Svo2 values were observed to be significantly lower as the IDo2 index increased. CONCLUSIONS:. The IDo2 index may inform decision-making in pediatric cardiac critical care settings by providing a continuous, noninvasive assessment of oxygen delivery relative to oxygen demand in a specific patient. Leveraging predictive analytics to guide timely patient care, including support for escalation or de-escalation of treatments, may improve care delivery for patients and clinicians.http://journals.lww.com/10.1097/CCE.0000000000001204 |
| spellingShingle | Sarah A. Teele, MD, MSHPEd Avihu Z. Gazit, MD Craig Futterman, MD William G. La Cava, PhD David S. Cooper, MD, MPH, MBA Steven M. Schwartz, MD, MS Joshua W. Salvin, MD, MPH Investigation of a Novel Noninvasive Risk Analytics Algorithm With Laboratory Central Venous Oxygen Saturation Measurements in Critically Ill Pediatric Patients Critical Care Explorations |
| title | Investigation of a Novel Noninvasive Risk Analytics Algorithm With Laboratory Central Venous Oxygen Saturation Measurements in Critically Ill Pediatric Patients |
| title_full | Investigation of a Novel Noninvasive Risk Analytics Algorithm With Laboratory Central Venous Oxygen Saturation Measurements in Critically Ill Pediatric Patients |
| title_fullStr | Investigation of a Novel Noninvasive Risk Analytics Algorithm With Laboratory Central Venous Oxygen Saturation Measurements in Critically Ill Pediatric Patients |
| title_full_unstemmed | Investigation of a Novel Noninvasive Risk Analytics Algorithm With Laboratory Central Venous Oxygen Saturation Measurements in Critically Ill Pediatric Patients |
| title_short | Investigation of a Novel Noninvasive Risk Analytics Algorithm With Laboratory Central Venous Oxygen Saturation Measurements in Critically Ill Pediatric Patients |
| title_sort | investigation of a novel noninvasive risk analytics algorithm with laboratory central venous oxygen saturation measurements in critically ill pediatric patients |
| url | http://journals.lww.com/10.1097/CCE.0000000000001204 |
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