Feng-Ching Lin’s research while affiliated with Taipei Medical University and other places

Background: To analyze the predictability of an automatic tube compensation (ATC) screening test compared with the conventional direct liberation test performed before continuous oxygen support for MV liberation. Methods: This retrospective study analyzed tracheostomized patients with prolonged MV in a weaning unit of a medical center in Taiwan. In March 2020, a four-day ATC test to screen patient eligibility for ventilator liberation was implemented, intended to replace the direct liberation test. We compared the predictive accuracy of these two screening methods on the relevant outcomes in the two years before and one year after the implementation of this policy. Results: Of the 403 cases, 246 (61%) and 157 (39%) received direct liberation and ATC screening tests, respectively. These two groups had similar outcomes: successful weaning upon leaving the Respiratory Care Center (RCC), success on day 100 of MV, success at hospital discharge, and in-hospital survival. Receiver operating characteristic curve analysis showed that the ATC screening test had better predictive ability than the direct liberation test for RCC weaning, discharge weaning, 100-day weaning, and in-hospital survival. Conclusion: This closed-circuit ATC screening test before ventilator liberation is a feasible and valuable method for screening PMV patients undergoing ventilator liberation in the pandemic era. Its predictability for a comparison with the open-circuit oxygen test requires further investigation.

(a) Objective: Obstructive sleep apnea syndrome (OSAS) is typically diagnosed through polysomnography (PSG). However, PSG incurs high medical costs. This study developed new models for screening the risk of moderate-to-severe OSAS (apnea-hypopnea index, AHI ≥15) and severe OSAS (AHI ≥30) in various age groups and sexes by using anthropometric features in the Taiwan population. (b) Participants: Data were derived from 10,391 northern Taiwan patients who underwent PSG. (c) Methods: Patients’ characteristics – namely age, sex, body mass index (BMI), neck circumference, and waist circumference – was obtained. To develop an age- and sex-independent model, various approaches – namely logistic regression, k-nearest neighbor, naive Bayes, random forest (RF), and support vector machine – were trained for four groups based on sex and age (men or women; aged <50 or ≥50 years). Dataset was separated independently (training:70%; validation: 10%; testing: 20%) and Cross-validated grid search was applied for model optimization. Models demonstrating the highest overall accuracy in validation outcomes for the four groups were used to predict the testing dataset. (d) Results: The RF models showed the highest overall accuracy. BMI was the most influential parameter in both types of OSAS severity screening models. (e) Conclusion: The established models can be applied to screen OSAS risk in the Taiwan population and those with similar craniofacial features.

Study objectives: Dementia is associated with sleep disorders. However, the relationship between dementia and sleep arousal remains unclear. This study explored the associations among sleep parameters, arousal responses, and risk of mild cognitive impairment (MCI). Methods: Participants with the chief complaints of memory problems and sleep disorders were screened from the sleep center database of Taipei Medical University Shuang-Ho Hospital, and the parameters related to the Cognitive Abilities Screening Instrument (CASI), Clinical Dementia Rating (CDR), and polysomnography (PSG) were determined. All the examinations were conducted within 6 months and without a particular order. The participants were divided into those without cognitive impairment (CDR = 0) and those with MCI (CDR = 0.5). Mean comparison, linear regression models, and logistic regression models were employed to investigate the associations among obtained variables. Results: This study included 31 participants without MCI and 37 with MCI (17 with amnestic MCI; 20 with multidomain MCI). Patients with MCI had significantly higher mean values of the spontaneous arousal index (SpArI) and SpArI in the nonrapid eye movement (NREM) stage (SpArINREM) than those without MCI. An increased risk of MCI was significantly associated with an increase SpArI and SpArINREM with various adjustments. Significant associations between the CASI scores and the oximetry parameters and sleep disorder indexes were observed. Conclusions: Repetitive respiratory events with hypoxia were associated with cognitive dysfunction. Spontaneous arousal, especially in NREM sleep, was related to the risk of MCI. However, additional longitudinal studies are required to confirm their causality.

Few studies have investigated the measurement of oxygen uptake (V˙O2) in tracheostomized patients undergoing unassisted breathing trials (UBTs) for liberation from mechanical ventilation (MV). Using an open-circuit, breath-to-breath method, we continuously measured V˙O2 and relevant parameters during 120-min UBTs via a T-tube in 49 tracheostomized patients with prolonged MV, and calculated mean values in the first and last 5-min periods. Forty-one (84%) patients successfully completed the UBTs. The median V˙O2 increased significantly (from 235.8 to 298.2 ml/min; P = 0.025) in the failure group, but there was no significant change in the success group (from 223.1 to 221.6 ml/min; P = 0.505). In multivariate logistic regression analysis, an increase in V˙O2 > 17% from the beginning period (odds ratio [OR] 0.084; 95% confidence interval [CI] 0.012–0.600; P = 0.014) and a peak inspiratory pressure greater than − 30 cmH2O (OR 11.083; 95% CI 1.117–109.944; P = 0.04) were significantly associated with the success of 120-min UBT. A refined prediction model combining heart rate, energy expenditure, end-tidal CO2 and oxygen equivalent showed a modest increase in the area under the receiver operating characteristic curve of 0.788 (P = 0.578) and lower Akaike information criterion score of 41.83 compared to the traditional prediction model including heart rate and respiratory rate for achieving 48 h of unassisted breathing. Our findings show the potential of monitoring V˙O2 in the final phase of weaning in tracheostomized patients with prolonged MV.

Background Assessment of preparedness of weaning has been recommended before extubation for mechanically ventilated patients. We aimed to understand the association of a structured assessment of weaning preparedness with successful liberation. Methods We retrospectively investigated patients with acute respiratory failure who experienced an extubation trial at the medical intensive care units of a medical center and compared the demographic and clinical characteristics between those patients with successful and failed extubation. A composite score to assess the preparedness of weaning, the WEANSNOW score, was generated consisting of eight components, including W eaning parameters, E ndotracheal tube, A rterial blood gas analysis, N utrition, S ecretions, N euromuscular-affecting agents, O bstructive airway problems and W akefulness. The prognostic ability of the WEANSNOW score for extubation was then analyzed. Results Of the 205 patients included, 138 (67.3%) patients had successful extubation. Compared with the failure group, the success group had a significantly shorter duration of MV before the weaning attempt (11.2 ± 11.6 vs. 31.7 ± 26.2 days, p < 0.001), more with congestive heart failure (42.0% vs. 25.4%, p = 0.020), and had different distribution of the types of acute respiratory failure ( p = 0.037). The failure group also had a higher WEANSNOW score (1.22 ± 0.85 vs. 0.51 ± 0.71, p < 0.001) and worse Rapid Shallow Breathing Index (93.9 ± 63.8 vs. 56.3 ± 35.1, p < 0.001). Multivariate logistic regression analysis showed that a WEANSNOW Score = 1 or higher (OR = 2.880 (95% CI [1.291–6.426]), p = 0.010) and intubation duration >21 days (OR = 7.752 (95% CI [3.560–16.879]), p < 0.001) were independently associated with an increased probability of extubation failure. Conclusion Assessing the pre-extubation status of intubated patients in a checklist-based approach using the WEANSNOW score might provide valuable insights into extubation failure in patients in a medical ICU for acute respiratory failure. Further prospective studies are warranted to elucidate the practice of assessing weaning preparedness.

Background Obstructive Sleep Apnea Syndrome (OSAS) is a major global health concern and is typically diagnosed by in-lab polysomnography (PSG). This examination though has high medical manpower costs and alternative portable methods have further limitations. This paper develops a new model for screening the risk of OSAS in different age groups and gender by using body profiles. The effects of body profiles for different subgroups in sleep stage alteration and OSAS severity are also investigated. Methods The data is derived from 6614 Han-Taiwanese subjects who have previously undergone PSG in order to assess the severity of OSAS in the sleep center of Taipei Medical University Shuang-Ho Hospital between March 2015 and October 2019. Characteristics of subjects, including age, gender, body mass index (BMI), neck circumference, and waist circumference, were obtained from a questionnaire. Pearson regression was used to evaluate the correlations between body profiles and sleep stages as well as sleep disorder indexes. To develop an age and gender independent model, random forests (RF), which is an ensemble learning method with high explainability, were trained by the four groups by gender and age (older or younger than 50 years old) with ratios of 70% (training dataset) and 30% (testing dataset), respectively. Prediction performance was evaluated by sensitivity, specificity and accuracy. Variable importance was assessed by averaging the impurity decrease to account for the effect of different factors. Results Results indicate that high BMI, neck circumference and waist circumference decreased the duration of slow-wave sleep and increased the sleep disorder indices and the percentage of wake and N1. Additionally, screening models for different gender and age utilizing anthropometric features as predictors via RF were established and demonstrated to have high accuracy (75.63% for younger males, 74.72% for elder males, 78.81% for younger females, and 72.10% for elder females). Feature importance indicated that waist circumference was the highest contributing factor in females and elder males, whereas the BMI was the highest contribution in younger males. Conclusions The authors recommend the use of the prediction models for those with Han-Taiwanese craniofacial features.

Background and objective: Weaning parameters are commonly measured through an endotracheal tube in mechanically ventilated patients recovering from acute respiratory failure, however this practice has rarely been evaluated in tracheostomized patients. This study aimed to investigate changes in weaning parameters measured before and after tracheostomy, and to explore whether the data measured after tracheostomy were associated with weaning outcomes in difficult-to-wean patients. Methods: In a two-year study period, we enrolled orotracheally intubated patients who were prepared for tracheostomy due to difficult weaning. Weaning parameters were measured before and after the conversion to tracheostomy and compared, and the post-tracheostomy data were tested for associations with weaning outcomes. Results: A total of 86 patients were included. After tracheostomy, maximum inspiratory pressure (mean difference (Δ) = 4.4, 95% CI, 2.7 to 6.1, P<0.001), maximum expiratory pressure (Δ = 5.4, 95% CI, 2.9 to 8.0, P<0.001) and tidal volume (Δ = 33.7, 95% CI, 9.0 to 58.5, P<0.008) significantly increased, and rapid shallow breathing index (Δ = -14.6, 95% CI, -25.4 to -3.7, P<0.009) and airway resistance (Δ = -4.9, 95% CI, -5.8 to -4.0, P<0.001) significantly decreased. The patients who were successfully weaned within 90 days of the initiation of mechanical ventilation had greater increments in maximum inspiratory pressure (5.9 vs. 2.4, P = 0.04) and maximum expiratory pressure (8.0 vs. 2.0, P = 0.02) after tracheostomy than those who were unsuccessfully weaned. Conclusions: In conclusion, the conversion from endotracheal tube to tracheostomy significantly improved the measured values of weaning parameters in difficult-to-wean patients who subsequently weaned successfully from the mechanical ventilator. The change was significant only for airway resistance in patients who failed weaning. Trial registration: ClinicalTrials.gov NCT01312142.