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BackgroundWeaning is typically regarded as a process of discontinuing mechanical ventilation in the daily practice of an intensive care unit (ICU). Among the ICU patients, 39%-40% need mechanical ventilator for sustaining their lives. The predictive rate of successful weaning achieved only 35-60% for decisions made by physicians. Clinical decision support systems (CDSSs) are promising in enhancing diagnostic performance and improve healthcare quality in clinical setting. To our knowledge, a prospective study has never been conducted to verify the effectiveness of the CDSS in ventilator weaning before. In this study, the CDSS capable of predicting weaning outcome and reducing duration of ventilator support for patients has been verified.MethodsA total of 380 patients admitted to the respiratory care center of the hospital were randomly assigned to either control or study group. In the control group, patients were weaned with traditional weaning method, while in the study group, patients were weaned with CDSS monitored by physicians. After excluding the patients who transferred to other hospitals, refused further treatments, or expired the admission period, data of 168 and 144 patients in the study and control groups, respectively, were used for analysis.ResultsThe results show that a sensitivity of 87.7% has been achieved, which is significantly higher (p<0.01) than the weaning determined by physicians (sensitivity: 61.4%). Furthermore, the days using mechanical ventilator for the study group (38.41 ± 3.35) is significantly (p<0.001) shorter than the control group (43.69 ± 14.89), with a decrease of 5.2 days in average, resulting in a saving of healthcare cost of NT$45,000 (US$1,500) per patient in the current Taiwanese National Health Insurance setting.ConclusionsThe CDSS is demonstrated to be effective in identifying the earliest time of ventilator weaning for patients to resume and sustain spontaneous breathing, thereby avoiding unnecessary prolonged ventilator use and decreasing healthcare cost.

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To detect the early developmental stages of arteriovenous access (AVA) stenosis in hemodialysis patients, this study explored a stenosis detector based on the Burg method and the fractional-order chaos system (FOCS). The bruit developed by the blood flowing through AVA can be a viable noninvasive strategy for monitoring AVA functions. We used the Burg method of the autoregressive model to estimate the frequency spectra of phonographic signals recorded by an electronic stethoscope in patients' AVAs and to identify the spectral peaks in the region of 25-800 Hz. The frequency spectra differed significantly between normal and stenosis statuses in AVA. We found that the frequency and amplitude in power spectra analysis varied in accordance with the severity of AVA stenosis. However, the correlation of these parameters for classifying the degree of stenosis is limited when only using the Burg method. Therefore, we used an FOCS to monitor the differing frequency spectra between the normal condition and AVA stenosis. The variances of these two conditions were dynamic errors that were the coupling variables that tracked the responses between the master system and the slave system. A total of 42 patients who had received percutaneous transluminal angioplasty (PTA) for their failing AVAs was recruited for this study. In this study, the dynamic error, Index Ψ, was used to calculate the frequency spectrum redistribution in patients undergoing PTA. In addition, ΔImp was the index used to evaluate improvements in the luminal diameter between pre- and post-PTA. Therefore, we used linear regression to model the relationship between ΔImp and Index Ψ. The findings indicate that the proposed method has enhanced efficiency, especially in the venous anastomosis (V-site). The FOCS is a novel and simple algorithm for analyzing the residual AVA stenosis of PTA treatment.

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