human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Extended follow-up of survivors of ICU treatment  has shown many patients suffer long-term physical and psychological consequences that affect their health-related quality of life . The current lack of rigorous longitudinal studies means that the true prevalence of these physical and psychological problems remains undetermined . Methods / Design The ICON ( Intensive Care Outcome Network ) study is a multi-centre , longitudinal study of survivors of critical illness . Patients will be recruited prior to hospital discharge from 20–30 ICUs in the UK and will be assessed at 3 , 6 , and 12 months following ICU discharge for health-related quality of life as measured by the Short Form-36 ( SF-36 ) and the EuroQoL ( EQ-5D ) ; anxiety and depression as measured by the Hospital Anxiety and Depression Scale ( HADS ) ; and post traumatic stress disorder ( PTSD ) symptoms as measured by the PTSD Civilian Checklist ( PCL-C ) . Postal question naires will be used . Discussion The ICON study will create a valuable UK data base detailing the prevalence of physical and psychological morbidity experienced by patients as they recover from critical illness . Knowledge of the prevalence of physical and psychological morbidity in ICU survivors is important because research to generate models of causality , prognosis and treatment effects is dependent on accurate determination of prevalence . The results will also inform economic modelling of the long-term burden of critical illness . Trial Registration IS RCT Background : Different modes of death are described in selected population s , but few data report the characteristics of death in a general intensive care unit population . This study analyzed the causes and characteristics of death of critically ill patients and compared anticipated death patients to unexpected death counterparts . Methods : An observational multicenter cohort study was performed in 96 intensive care units . During 1 yr , each intensive care unit was r and omized to participate during a 1-month period . Demographic data , characteristics of organ failures ( Sequential Organ Failure Assessment subscore greater than or equal to 3 ) , and organ supports were collected on all patients who died in the intensive care unit . Modes of death were defined as anticipated ( after withdrawal or withholding of treatment or brain death ) or unexpected ( despite engagement of full-level care or sudden refractory cardiac arrest ) . Results : A total of 698 patients were included during the study period . At the time of death , 84 % had one or more organ failures ( mainly hemodynamic ) and 89 % required at least one organ support ( mainly mechanical ventilation ) . Deaths were considered unexpected and anticipated in 225 and 473 cases , respectively . Compared to its anticipated counterpart , unexpected death occurred earlier ( 1 day vs. 5 days ; P < 0.001 ) and had fewer organ failures ( 1 [ 1 to 2 ] vs. 1 [ 1 to 3 ] ; P < 0.01 ) and more organ supports ( 2 [ 2 to 3 ] vs. 1 [ 1 to 2 ] ; P < 0.01 ) . Withdrawal or withholding of treatments accounted for half of the deaths . Conclusions : In a general intensive care unit population , the majority of patients present with at least one organ failure at the time of death . Anticipated and unexpected deaths represent two different modes of dying and exhibit profiles reflecting the different pathophysiologic underlying mechanisms BACKGROUND To assess the factors associated with reintubation in patients who had successfully passed a spontaneous breathing trial . METHODS We used logistic regression and recursive partitioning analyses of  prospect ively collected clinical data from adults admitted to ICUs of 37 hospitals in eight countries , who had undergone invasive mechanical ventilation for > 48 h and were deemed ready for extubation . RESULTS Extubation failure occurred in 121 of the 900 patients ( 13.4 % ) . The logistic regression analysis identified the following associations with reintubation : rapid shallow breathing index ( RSBI ) [ odds ratio ( OR ) , 1.009 per unit ; 95 % confidence interval ( CI ) , 1.003 to 1.015 ] ; positive fluid balance ( OR , 1.70 ; 95 % CI , 1.15 to 2.53 ) ; and pneumonia as the reason for initiating mechanical ventilation ( OR , 1.77 ; 95 % CI , 1.10 to 2.84 ) . The recursive partitioning analysis allowed the separation of patients into different risk groups for extubation failure : ( 1 ) RSBI of > 57 breaths/L/min and positive fluid balance ( OR , 3.0 ; 95 % CI , 1.8 to 4.8 ) ; ( 2 ) RSBI of < 57 breaths/L/min and pneumonia as reason for mechanical ventilation ( OR , 2.0 ; 95 % CI , 1.1 to 3.6 ) ; ( 3 ) RSBI of > 57 breaths/L/min and negative fluid balance ( OR , 1.4 ; 95 % CI , 0.8 to 2.5 ) ; and ( 4 ) RSBI of < 57 breaths/L/min ( OR , 1 [ reference value ] ) . CONCLUSIONS Among routinely measured clinical variables , RSBI , positive fluid balance 24 h prior to extubation , and pneumonia at the initiation of ventilation were the best predictors of extubation failure . However , the combined predictive ability of these variables was weak OBJECTIVE To investigate the timing and value of noninvasive ventilation ( NIV ) as a weaning tool immediately after early extubation in patients with acute respiratory distress syndrome ( ARDS ) . METHODS A prospect i ve r and omized controlled trial was conducted . The ARDS patients with surgical diseases admitted to Department of Respiratory Intensive Care Unit ( RICU ) of the First Affiliated Hospital of Xinjiang Medical University were enrolled . The patients were r and omly divided into sequential group and control group . All patients underwent endotracheal intubation and were mechanically ventilated . Every 12 hours during the first 3 days , the lung recruitment maneuver was performed during pressure control ventilation ( PCV ) . After lung recruitment , all patients were ventilated with synchronized intermittent m and atory ventilation ( SIMV ) + pressure support ventilation ( PSV ) + positive end-expiratory pressure ( PEEP ) or assistant/control ventilation ( A/C ) . The objects in sequential group who met the following criteria including those with oxygen index ( PaO2/FiO2 ) reaching 200 - 250 mmHg ( 1 mmHg=0.133 kPa ) under PEEP of 8 cmH2O ( 1 cmH2O=0.098 kPa ) , and pressure support of 12 cmH2O , and most acute infiltrating lesions having resolved on chest imaging , received noninvasive ventilation ( NIV ) immediately after extubation , and patients in control group continued to have invasive mechanical ventilation via intubation or tracheostomy with an endotracheal tube . The baseline data in both groups and the number of re-intubation in the sequential group were recorded . The duration of invasive mechanical ventilation and total duration of mechanical ventilation , ICU length of stay , the incidence of ventilator-associated pneumonia ( VAP ) , and mortality rate were compared between the two groups . RESULTS 53 consecutive adult patients were enrolled , including 26 in sequential group and 27 cases in control group . The period of endotracheal intubation was 7.0 ( 6.8 , 9.5 ) days , and 7.7 % ( 2/26 ) patients underwent re-intubation in sequential group . There were significant difference in respiratory and circulatory indicators before extubation spontaneous breathing trial ( SBT ) ≤10 minutes in sequential group , indicating that the patients were still in the early stage of extubation sequential NIV . There was no significant difference in indices reflecting respiratory function and circulation between the two groups , except that respiratory rate at 1 hour was slightly increased in sequential group as compared with that of control group , indicating that sequential NIV could maintain invasive ventilation function . There was significant difference in duration of invasive mechanical ventilation [ 7.0 ( 6.8 , 9.5 ) days vs. 21.0 ( 17.0 , 25.0 ) days , Z=-6.048 , P=0.000 ] , duration of total mechanical ventilation ( 18.0±4.1 days vs. 22.0±7.3 days , t=-2.805 , P=0.008 ) , and length of ICU stay ( 21.0±4.1 days vs. 28.0±8.1 days , t=-4.012 , P=0.000 ) between sequential group and control group , but there was no significant differences in the incidence of VAP [ 15.4 % ( 4/26 ) vs. 29.6 ( 8/27 ) , χ(2)=1.535 , P=0.215 ] and mortality rate [ 7.7 % ( 2/26 ) vs. 18.5 % ( 5/27 ) , P=0.420 ] . CONCLUSIONS When PaO2/FiO2 reached 200 - 250 mmHg under the condition of low ventilation , sequential NIV facilitates the early discontinuation of mechanical ventilation in ARDS patients with surgical diseases , with shortening of duration of invasive mechanical ventilation , total mechanical ventilation , and the length of ICU stay BACKGROUND Global epidemiological data regarding outcomes for patients in intensive care units ( ICUs ) are scarce , but are important in underst and ing the worldwide burden of critical illness . We , therefore , did an international audit of ICU patients worldwide and assessed variations between hospitals and countries in terms of ICU mortality . METHODS 730 participating centres in 84 countries prospect ively collected data on all adult ( > 16 years ) patients admitted to their ICU between May 8 and May 18 , 2012 , except those admitted for fewer than 24 h for routine postoperative monitoring . Participation was voluntary . Data were collected daily for a maximum of 28 days in the ICU and patients were followed up for outcome data until death or hospital discharge . In-hospital death was analysed using multilevel logistic regression with three levels : patient , hospital , and country . FINDINGS 10,069 patients were included from ICUs in Europe ( 5445 patients ; 54·1 % ) , Asia ( 1928 ; 19·2 % ) , the Americas ( 1723 ; 17·1 % ) , Oceania ( 439 ; 4·4 % ) , the Middle East ( 393 ; 3·9 % ) , and Africa ( 141 ; 1·4 % ) . Overall , 2973 patients ( 29·5 % ) had sepsis on admission or during the ICU stay . ICU mortality rates were 16·2 % ( 95 % CI 15·5 - 16·9 ) across the whole population and 25·8 % ( 24·2 - 27·4 ) in patients with sepsis . Hospital mortality rates were 22·4 % ( 21·6 - 23·2 ) in the whole population and 35·3 % ( 33·5 - 37·1 ) in patients with sepsis . Using a multilevel analysis , the unconditional model suggested significant between-country variations ( var=0·19 , p=0·002 ) and between-hospital variations ( var=0·43 , p<0·0001 ) in the individual risk of in-hospital death . There was a stepwise increase in the adjusted risk of in-hospital death according to decrease in global national income . INTERPRETATION This large data base highlights that sepsis remains a major health problem worldwide , associated with high mortality rates in all countries . Our findings also show a significant association between the risk of death and the global national income and suggest that ICU organisation has an important effect on risk of death . FUNDING None Background Although the weaning classification based on the difficulty and duration of the weaning process has been evaluated in the different type of intensive care units ( ICUs ) , little is known about clinical outcomes and validity among the three groups in medical ICU . The objectives of this study were to evaluate the clinical relevance of weaning classification and its association with hospital mortality in a medical ICU with a protocol -based weaning program . Methods All consecutive patients admitted to the medical ICU and requiring mechanical ventilation ( MV ) for more than 24 hours were prospect ively registered and screened for weaning readiness by a st and ardized weaning program between July 2010 and June 2013 . Baseline characteristics and outcomes were compared across weaning classifications . Results During the study period , a total of 680 patients were weaned according to the st and ardized weaning protocol . Of these , 457 ( 67 % ) were classified as simple weaning , 136 ( 20 % ) as difficult weaning , and 87 ( 13 % ) as prolonged weaning . Ventilator-free days within 28 days decreased significantly from simple to difficult to prolonged weaning groups ( P < 0.001 , test for trends ) . In addition , reintubation within 48 hours after extubation ( P < 0.001 ) and need for tracheostomy during the weaning process ( P < 0.001 ) increased significantly across weaning groups . Finally , ICU ( P < 0.001 ) , post-ICU ( P = 0.001 ) , and hospital ( P < 0.001 ) mortalities significantly increased across weaning groups . In a multiple logistic regression model , prolonged weaning but not difficult weaning was still independently associated with ICU ( adjusted OR 8.265 , 95 % CI 3.484–19 
    Output:
    
agent
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Extended follow-up of survivors of ICU treatment  has shown many patients suffer long-term physical and psychological consequences that affect their health-related quality of life . The current lack of rigorous longitudinal studies means that the true prevalence of these physical and psychological problems remains undetermined . Methods / Design The ICON ( Intensive Care Outcome Network ) study is a multi-centre , longitudinal study of survivors of critical illness . Patients will be recruited prior to hospital discharge from 20–30 ICUs in the UK and will be assessed at 3 , 6 , and 12 months following ICU discharge for health-related quality of life as measured by the Short Form-36 ( SF-36 ) and the EuroQoL ( EQ-5D ) ; anxiety and depression as measured by the Hospital Anxiety and Depression Scale ( HADS ) ; and post traumatic stress disorder ( PTSD ) symptoms as measured by the PTSD Civilian Checklist ( PCL-C ) . Postal question naires will be used . Discussion The ICON study will create a valuable UK data base detailing the prevalence of physical and psychological morbidity experienced by patients as they recover from critical illness . Knowledge of the prevalence of physical and psychological morbidity in ICU survivors is important because research to generate models of causality , prognosis and treatment effects is dependent on accurate determination of prevalence . The results will also inform economic modelling of the long-term burden of critical illness . Trial Registration IS RCT Background : Different modes of death are described in selected population s , but few data report the characteristics of death in a general intensive care unit population . This study analyzed the causes and characteristics of death of critically ill patients and compared anticipated death patients to unexpected death counterparts . Methods : An observational multicenter cohort study was performed in 96 intensive care units . During 1 yr , each intensive care unit was r and omized to participate during a 1-month period . Demographic data , characteristics of organ failures ( Sequential Organ Failure Assessment subscore greater than or equal to 3 ) , and organ supports were collected on all patients who died in the intensive care unit . Modes of death were defined as anticipated ( after withdrawal or withholding of treatment or brain death ) or unexpected ( despite engagement of full-level care or sudden refractory cardiac arrest ) . Results : A total of 698 patients were included during the study period . At the time of death , 84 % had one or more organ failures ( mainly hemodynamic ) and 89 % required at least one organ support ( mainly mechanical ventilation ) . Deaths were considered unexpected and anticipated in 225 and 473 cases , respectively . Compared to its anticipated counterpart , unexpected death occurred earlier ( 1 day vs. 5 days ; P < 0.001 ) and had fewer organ failures ( 1 [ 1 to 2 ] vs. 1 [ 1 to 3 ] ; P < 0.01 ) and more organ supports ( 2 [ 2 to 3 ] vs. 1 [ 1 to 2 ] ; P < 0.01 ) . Withdrawal or withholding of treatments accounted for half of the deaths . Conclusions : In a general intensive care unit population , the majority of patients present with at least one organ failure at the time of death . Anticipated and unexpected deaths represent two different modes of dying and exhibit profiles reflecting the different pathophysiologic underlying mechanisms BACKGROUND To assess the factors associated with reintubation in patients who had successfully passed a spontaneous breathing trial . METHODS We used logistic regression and recursive partitioning analyses of  prospect ively collected clinical data from adults admitted to ICUs of 37 hospitals in eight countries , who had undergone invasive mechanical ventilation for > 48 h and were deemed ready for extubation . RESULTS Extubation failure occurred in 121 of the 900 patients ( 13.4 % ) . The logistic regression analysis identified the following associations with reintubation : rapid shallow breathing index ( RSBI ) [ odds ratio ( OR ) , 1.009 per unit ; 95 % confidence interval ( CI ) , 1.003 to 1.015 ] ; positive fluid balance ( OR , 1.70 ; 95 % CI , 1.15 to 2.53 ) ; and pneumonia as the reason for initiating mechanical ventilation ( OR , 1.77 ; 95 % CI , 1.10 to 2.84 ) . The recursive partitioning analysis allowed the separation of patients into different risk groups for extubation failure : ( 1 ) RSBI of > 57 breaths/L/min and positive fluid balance ( OR , 3.0 ; 95 % CI , 1.8 to 4.8 ) ; ( 2 ) RSBI of < 57 breaths/L/min and pneumonia as reason for mechanical ventilation ( OR , 2.0 ; 95 % CI , 1.1 to 3.6 ) ; ( 3 ) RSBI of > 57 breaths/L/min and negative fluid balance ( OR , 1.4 ; 95 % CI , 0.8 to 2.5 ) ; and ( 4 ) RSBI of < 57 breaths/L/min ( OR , 1 [ reference value ] ) . CONCLUSIONS Among routinely measured clinical variables , RSBI , positive fluid balance 24 h prior to extubation , and pneumonia at the initiation of ventilation were the best predictors of extubation failure . However , the combined predictive ability of these variables was weak OBJECTIVE To investigate the timing and value of noninvasive ventilation ( NIV ) as a weaning tool immediately after early extubation in patients with acute respiratory distress syndrome ( ARDS ) . METHODS A prospect i ve r and omized controlled trial was conducted . The ARDS patients with surgical diseases admitted to Department of Respiratory Intensive Care Unit ( RICU ) of the First Affiliated Hospital of Xinjiang Medical University were enrolled . The patients were r and omly divided into sequential group and control group . All patients underwent endotracheal intubation and were mechanically ventilated . Every 12 hours during the first 3 days , the lung recruitment maneuver was performed during pressure control ventilation ( PCV ) . After lung recruitment , all patients were ventilated with synchronized intermittent m and atory ventilation ( SIMV ) + pressure support ventilation ( PSV ) + positive end-expiratory pressure ( PEEP ) or assistant/control ventilation ( A/C ) . The objects in sequential group who met the following criteria including those with oxygen index ( PaO2/FiO2 ) reaching 200 - 250 mmHg ( 1 mmHg=0.133 kPa ) under PEEP of 8 cmH2O ( 1 cmH2O=0.098 kPa ) , and pressure support of 12 cmH2O , and most acute infiltrating lesions having resolved on chest imaging , received noninvasive ventilation ( NIV ) immediately after extubation , and patients in control group continued to have invasive mechanical ventilation via intubation or tracheostomy with an endotracheal tube . The baseline data in both groups and the number of re-intubation in the sequential group were recorded . The duration of invasive mechanical ventilation and total duration of mechanical ventilation , ICU length of stay , the incidence of ventilator-associated pneumonia ( VAP ) , and mortality rate were compared between the two groups . RESULTS 53 consecutive adult patients were enrolled , including 26 in sequential group and 27 cases in control group . The period of endotracheal intubation was 7.0 ( 6.8 , 9.5 ) days , and 7.7 % ( 2/26 ) patients underwent re-intubation in sequential group . There were significant difference in respiratory and circulatory indicators before extubation spontaneous breathing trial ( SBT ) ≤10 minutes in sequential group , indicating that the patients were still in the early stage of extubation sequential NIV . There was no significant difference in indices reflecting respiratory function and circulation between the two groups , except that respiratory rate at 1 hour was slightly increased in sequential group as compared with that of control group , indicating that sequential NIV could maintain invasive ventilation function . There was significant difference in duration of invasive mechanical ventilation [ 7.0 ( 6.8 , 9.5 ) days vs. 21.0 ( 17.0 , 25.0 ) days , Z=-6.048 , P=0.000 ] , duration of total mechanical ventilation ( 18.0±4.1 days vs. 22.0±7.3 days , t=-2.805 , P=0.008 ) , and length of ICU stay ( 21.0±4.1 days vs. 28.0±8.1 days , t=-4.012 , P=0.000 ) between sequential group and control group , but there was no significant differences in the incidence of VAP [ 15.4 % ( 4/26 ) vs. 29.6 ( 8/27 ) , χ(2)=1.535 , P=0.215 ] and mortality rate [ 7.7 % ( 2/26 ) vs. 18.5 % ( 5/27 ) , P=0.420 ] . CONCLUSIONS When PaO2/FiO2 reached 200 - 250 mmHg under the condition of low ventilation , sequential NIV facilitates the early discontinuation of mechanical ventilation in ARDS patients with surgical diseases , with shortening of duration of invasive mechanical ventilation , total mechanical ventilation , and the length of ICU stay BACKGROUND Global epidemiological data regarding outcomes for patients in intensive care units ( ICUs ) are scarce , but are important in underst and ing the worldwide burden of critical illness . We , therefore , did an international audit of ICU patients worldwide and assessed variations between hospitals and countries in terms of ICU mortality . METHODS 730 participating centres in 84 countries prospect ively collected data on all adult ( > 16 years ) patients admitted to their ICU between May 8 and May 18 , 2012 , except those admitted for fewer than 24 h for routine postoperative monitoring . Participation was voluntary . Data were collected daily for a maximum of 28 days in the ICU and patients were followed up for outcome data until death or hospital discharge . In-hospital death was analysed using multilevel logistic regression with three levels : patient , hospital , and country . FINDINGS 10,069 patients were included from ICUs in Europe ( 5445 patients ; 54·1 % ) , Asia ( 1928 ; 19·2 % ) , the Americas ( 1723 ; 17·1 % ) , Oceania ( 439 ; 4·4 % ) , the Middle East ( 393 ; 3·9 % ) , and Africa ( 141 ; 1·4 % ) . Overall , 2973 patients ( 29·5 % ) had sepsis on admission or during the ICU stay . ICU mortality rates were 16·2 % ( 95 % CI 15·5 - 16·9 ) across the whole population and 25·8 % ( 24·2 - 27·4 ) in patients with sepsis . Hospital mortality rates were 22·4 % ( 21·6 - 23·2 ) in the whole population and 35·3 % ( 33·5 - 37·1 ) in patients with sepsis . Using a multilevel analysis , the unconditional model suggested significant between-country variations ( var=0·19 , p=0·002 ) and between-hospital variations ( var=0·43 , p<0·0001 ) in the individual risk of in-hospital death . There was a stepwise increase in the adjusted risk of in-hospital death according to decrease in global national income . INTERPRETATION This large data base highlights that sepsis remains a major health problem worldwide , associated with high mortality rates in all countries . Our findings also show a significant association between the risk of death and the global national income and suggest that ICU organisation has an important effect on risk of death . FUNDING None Background Although the weaning classification based on the difficulty and duration of the weaning process has been evaluated in the different type of intensive care units ( ICUs ) , little is known about clinical outcomes and validity among the three groups in medical ICU . The objectives of this study were to evaluate the clinical relevance of weaning classification and its association with hospital mortality in a medical ICU with a protocol -based weaning program . Methods All consecutive patients admitted to the medical ICU and requiring mechanical ventilation ( MV ) for more than 24 hours were prospect ively registered and screened for weaning readiness by a st and ardized weaning program between July 2010 and June 2013 . Baseline characteristics and outcomes were compared across weaning classifications . Results During the study period , a total of 680 patients were weaned according to the st and ardized weaning protocol . Of these , 457 ( 67 % ) were classified as simple weaning , 136 ( 20 % ) as difficult weaning , and 87 ( 13 % ) as prolonged weaning . Ventilator-free days within 28 days decreased significantly from simple to difficult to prolonged weaning groups ( P < 0.001 , test for trends ) . In addition , reintubation within 48 hours after extubation ( P < 0.001 ) and need for tracheostomy during the weaning process ( P < 0.001 ) increased significantly across weaning groups . Finally , ICU ( P < 0.001 ) , post-ICU ( P = 0.001 ) , and hospital ( P < 0.001 ) mortalities significantly increased across weaning groups . In a multiple logistic regression model , prolonged weaning but not difficult weaning was still independently associated with ICU ( adjusted OR 8.265 , 95 % CI 3.484–19 
    Output:
    