developed, the patient would have become critically ill, Dr. Rao says. “There’s no doubt in my mind we would have made the correct diagnosis even without the platform, because the child would have quickly shown ŰƛłŨŹŎłŰ̲̐ ĠăăƚŨĺØĤŅŰ̖ ̱ ƀŹăƔăŅƱƔăłĤŅƀŹăŰĤŰØĺŎŹ ŎėŹĤłăĤŅŎƀŬƕŎŬĺû̐ ĤŅŹăŬłŰŎėŎƀŹõŎłăŰ̖̲̀̀ Following the treatment to restore a normal heart beat, the patient’s heart rate stabilized. “What made the ûĤƫăŬăŅõăĤŅŹĠĤŰõØŰăĤŰŹĠØŹØĠƀłØŅòăĤŅęŹŎĺûłăŹŎ ĺŎŎķØŹØłŎŅĤŹŎŬŹĠØŹĠØûĠĤęĠƱûăĺĤŹƛ̐ ûØŹØŬăõŎƔăŬƛ and actionable trend lines on it,” 'Ŭ̖ ØŎŰØƛŰ̖̀ Dana Mueller, MD, a pediatric
In the year it has been in use in Rady Children’s CTICU, the Sickbay platform has recorded hundreds of patient stays that included extubation readiness trials. To assess how well they did with hitting that extubation sweet spot, the investigators retrospectively reviewed these data while blinded to the outcomes of the human ŹăŰŹŬăƔĤăƕŰ̖̀ “It turns out in looking at our preliminary data, that some patients we deemed as not ready to extubate actually were, which is an important step in limiting
complications,” Dr. Mueller says. “Incorporating Sickbay data into our decision-making might help us liberate kids faster from mechanical ventilation in the future. We hope to incorporate Sickbay review ĤŅŹŎŎƀŬƕŎŬķƲŎƕƕĠăŅØŰŰăŰŰĤŅę ăƚŹƀòØŹĤŎŅŬăØûĤŅăŰŰ̖̲̀ To this end, the Rady Children’s intensivists are also hoping to design a prospective trial that will use the platform’s predictive analytics and algorithm development capabilities to examine AI’s role in helping to assess extubation readiness. To ûŎŰŎăƫăõŹĤƔăĺƛ̐ ŹĠăŹŬĤØĺ̵ ŰŰõŎŨă will have to expand beyond the CTICU, and the walls of the hospital. “Unlike adult ICUs, pediatric ICUs have relatively small patient volumes,” Rao says. “That means we’re going to have to collaborate with other institutions for this trial to get a large enough dataset to generate meaningful results, so the impact will extend far beyond Rady !ĠĤĺûŬăŅ̵ Ű̖̲̀ §Ġă!§R!®łØƛòăŹĠăƱŬŰŹR!® at Rady Children’s to use this kind of technology, but it almost certainly won’t be the last. “This combined approach to AI, predictive analytics and machine learning will eventually become the norm
cardiac intensivist at Rady Children’s, is charged with helping to fully integrate the AI platform into the unit’s ƕŎŬķƲŎƕ̖ ̱ §ĠăŨĺØŹėŎŬłĤŰėƀĺĺƛ up and running in all 30 beds in our CTICU,” she says. “We’re also rolling out the platform in all our cardiac catheterization labs and cardiac operating rooms, so we’ll be able to fully monitor all of our patients even when they leave ŹĠăR!®̖̲̀
UNLIKE ADULT ICUS, PEDIATRIC ICUS HAVE RELATIVELY SMALL PATIENT VOLUMES. THAT MEANS WE’RE GOING TO HAVE TO COLLABORATE WITH OTHER INSTITUTIONS FOR THIS TRIAL TO GET A LARGE ENOUGH DATASET TO GENERATE MEANINGFUL RESULTS, SO THE IMPACT WILL EXTEND FAR BEYOND RADY CHILDREN’S. ROHIT RAO, MD, MEDICAL DOCTOR OF THE CARDIOTHORACIC INTENSIVE CARE UNIT (CTICU) AT RADY CHILDREN’S
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The AI platform is also proving to be a valuable tool in Rady Children’s research program. For example, Dr. Mueller and her colleagues are currently working on a proof-of-concept study using using the evaluation of whether a patient can remove their łăõĠØŅĤõØĺƔăŅŹĤĺØŹŎŬƀŰĤŅęûØŹØ̖̀ Successfully weaning a patient from a ventilator is a delicate balance, Dr. Mueller says, and one that may lend itself well to AI support. “Shorter ventilation times are associated with decreased infectious risk and
throughout neonatology and critical care,” Rao says. “I appreciate the opportunity to be an early adopter and show others how we can use AI to hone our clinical skills ėŎŬŹĠăòăŅăƱŹŎėŎƀŬŨØŹĤăŅŹŰØŅûŹĠăĤŬėØłĤĺĤăŰ̖ nƛ ûŬăØłŎėòăõŎłĤŅęØŰłŎķăØĺØŬłĤŰƕĤŹĠĤŅŬăØõĠ̖̲̀
shorter hospitalizations,” she says. “But if we extubate too early, our patients run the risk of hemodynamic ĤŅŰŹØòĤĺĤŹƛŎŬõØŬûĤØõõŎłŨŬŎłĤŰằ̖̲̀ To work out whether a patient can tolerate extubation from a mechanical ventilator, a respiratory therapist typically conducts a standardized test to determine whether a patient is ready to breathe on their own. An intensivist then considers the test results before ûăõĤûĤŅęƕĠăŹĠăŬŹŎăƚŹƀòØŹằ̖
* This article was created in partnership with Nature Research Custom Media.
WINTER 2024 HEALTHY KIDS MAGAZINE 29
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