Hypotension During Vasopressor Infusion Occurs in Predictable Clusters: A Multicenter Analysis.

Background: Published evidence indicates that mean arterial pressure (MAP) below a goal range (hypotension) is associated with worse outcomes, though MAP management failures are common. We sought to characterize hypotension occurrences in ICUs and consider the implications for MAP management. Methods: Retrospective analysis of 3 hospitals' cohorts of adult ICU patients during continuous vasopressor infusion. Two cohorts were general, mixed ICU patients and one was exclusively acute spinal cord injury patients. "Hypotension-clusters" were defined where there were ≥10 min of cumulative hypotension over a 60-min period and "constant hypotension" was ≥10 continuous minutes. Trend analysis was performed (predicting future MAP using 14 min of preceding MAP data) to understand which hypotension-clusters could likely have been predicted by clinician awareness of MAP trends. Results: In cohorts of 155, 66, and 16 ICU stays, respectively, the majority of hypotension occurred within the hypotension-clusters. Failures to keep MAP above the hypotension threshold were notable in the bottom quartiles of each cohort, with hypotension durations of 436, 167, and 468 min, respectively, occurring within hypotension-clusters per day. Mean arterial pressure trend analysis identified most hypotension-clusters before any constant hypotension occurred (81.2%-93.6% sensitivity, range). The positive predictive value of hypotension predictions ranged from 51.4% to 72.9%. Conclusions: Across 3 cohorts, most hypotension occurred in temporal clusters of hypotension that were usually predictable from extrapolation of MAP trends.

Machine learning approach to classifying declines of physical function and muscle strength associated with cognitive function in older women: gait characteristics based on three speeds.

Background: The aging process is associated with a cognitive and physical declines that affects neuromotor control, memory, executive functions, and motor abilities. Previous studies have made efforts to find biomarkers, utilizing complex factors such as gait as indicators of cognitive and physical health in older adults. However, while gait involves various complex factors, such as attention and the integration of sensory input, cognitive-related motor planning and execution, and the musculoskeletal system, research on biomarkers that simultaneously considers multiple factors is scarce. This study aimed to extract gait features through stepwise regression, based on three speeds, and evaluate the accuracy of machine-learning (ML) models based on the selected features to solve classification problems caused by declines in cognitive function (Cog) and physical function (PF), and in Cog and muscle strength (MS). Methods: Cognitive assessments, five times sit-to-stand, and handgrip strength were performed to evaluate the Cog, PF, and MS of 198 women aged 65 years or older. For gait assessment, all participants walked along a 19-meter straight path at three speeds [preferred walking speed (PWS), slower walking speed (SWS), and faster walking speed (FWS)]. The extracted gait features based on the three speeds were selected using stepwise regression. Results: The ML model accuracies were revealed as follows: 91.2% for the random forest model when using all gait features and 91.9% when using the three features (walking speed and coefficient of variation of the left double support phase at FWS and the right double support phase at SWS) selected for the Cog+PF+ and Cog-PF- classification. In addition, support vector machine showed a Cog+MS+ and Cog-MS- classification problem with 93.6% accuracy when using all gait features and two selected features (left step time at PWS and gait asymmetry at SWS). Conclusion: Our study provides insights into the gait characteristics of older women with decreased Cog, PF, and MS, based on the three walking speeds and ML analysis using selected gait features, and may help improve objective classification and evaluation according to declines in Cog, PF, and MS among older women.