Pendelluft as a predictor of weaning in critically ill patients: An observational cohort study.

Objective: Weaning failure is associated with adverse clinical outcomes. This study aimed to evaluate the accuracy of pendelluft during the spontaneous breathing trials (SBT) as a predictor of weaning outcome of patients with mechanical ventilation. Methods: An observational cohort study included 60 critically ill patients who were eligible for extubation. Pendelluft and electrical activity of the diaphragm (Edi) were monitored at baseline and every 10 minutes for the first 30 min of SBT denoted as T0, T1, T2, and T3. The pendelluft was measured using electrical impedance tomography (EIT), and Edi parameters were collected by Edi catheter. Patients were followed up after extubation and were divided into success group and failure group. Pendelluft, Edi parameters, respiratory parameters, and clinical outcomes such as intensive care units (ICU) stay, mortality, and 28-day ventilator-free days were compared between the two groups. Receiver operating characteristic (ROC) curves were constructed to evaluate the ability of pendelluft to predict weaning outcome. Results: Fifty patients (50/60) were successfully weaned from the machine and 10 (10/60) failed, with weaning failure rate of 16.7%. Respiratory parameters such as rapid shallow breathing index (RSBI), respiratory rate (RR) and Edi parameters such as maximum value of Edi (Edimax), Edi variation between a maximum and minimum(ΔEdi) in the failure group were higher than those in the success group. The ICU stay and the 28-day ventilator-free days in the failure group were significantly longer than those in the success group. The 28-day mortality rate was higher in the failure group. The pendelluft mainly occurred in the early stage of SBT. Ventral pendelluft and total pendelluft in the failure group were higher than those in the success group at T1. Edimax and ΔEdi were positively correlated with pendelluft. The area under ROC curve (AUC) showed moderate predictive ability for ventral pendelluft in predicting weaning failure at T1 (AUC 0.76, 95% CI 0.58-0.94, cut-off value > 3% global tidal variation). Conclusion: Pendelluft is one of the factors leading to weaning failure, which may be related to diaphragm function. Measuring pendelluft volume maybe helpful to predict weaning.

A general fractional-order dynamical network: synchronization behavior and state tuning.

A general fractional-order dynamical network model for synchronization behavior is proposed. Different from previous integer-order dynamical networks, the model is made up of coupled units described by fractional differential equations, where the connections between individual units are nondiffusive and nonlinear. We show that the synchronous behavior of such a network cannot only occur, but also be dramatically different from the behavior of its constituent units. In particular, we find that simple behavior can emerge as synchronized dynamics although the isolated units evolve chaotically. Conversely, individually simple units can display chaotic attractors when the network synchronizes. We also present an easily checked criterion for synchronization depending only on the eigenvalues distribution of a decomposition matrix and the fractional orders. The analytic results are complemented with numerical simulations for two networks whose nodes are governed by fractional-order Lorenz dynamics and fractional-order Rössler dynamics, respectively.

On estimates of Lyapunov exponents of synchronized coupled systems.

Lyapunov exponents of a synchronized coupled system consist of those of the underlying individual systems and the transverse systems, based on a mode decomposition along the synchronization manifold. Estimates of bounds on the Lyapunov exponents (including transverse Lyapunov exponents) are derived. Several examples are used to validate the theoretical estimates.