Philippe Jouvet

Université de Montréal | UdeM · Department of Pediatrics

Background: The 2023 international pediatric ventilator liberation clinical practice guidelines provided evidence-based recommendations to guide pediatric critical care providers on how to perform daily aspects of ventilator liberation. However, due to the lack of high-quality pediatric studies, most recommendations were conditional based on very l...

Background: Clinical decision-making is a complex cognitive process that relies on the interpretation of a large variety of data from different sources and involves the use of knowledge bases and scientific recommendations. The representation of clinical data plays a key role in the speed and efficiency of its interpretation. In addition, the incre...

Recent research at CHU Sainte-Justine's Pediatric Critical Care Unit (PICU) has revealed that traditional machine learning methods, such as semi-supervised label propagation and K-nearest neighbors, outperform Transformer-based models in artifact detection from PPG signals, mainly when data is limited. This study addresses the underutilization of a...

This study aimed to investigate the application of label propagation techniques to propagate labels among photoplethysmogram (PPG) signals, particularly in imbalanced class scenarios and limited data availability scenarios, where clean PPG samples are significantly outnumbered by artifact-contaminated samples. We investigated a dataset comprising P...

At the start of the COVID-19 pandemic, Intensive Care Units (ICUs) admitted an unusually high number of patients suffering from the most severe respiratory effect of the disease. The clinicians worked in teams in a context where resources were limited, and efficient resource management was key to ensure on-time healthcare delivery. Our team of rese...

Purpose: Acute respiratory distress syndrome (ARDS) is a life-threatening condition that can cause a dramatic drop in blood oxygen levels due to widespread lung inflammation. Chest radiography is widely used as a primary modality to detect ARDS due to its crucial role in diagnosing the syndrome, and the x-ray images can be obtained promptly. Howev...

Objectives: Ventilator-associated pneumonia (VAP) is a severe care-related disease. The Centers for Disease Control defined the diagnosis criteria; however, the pediatric criteria are mainly subjective and retrospective. Clinical decision support systems have recently been developed in healthcare to help the physician to be more accurate for the e...

Background Individuals vaccinated against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), when infected, can still develop disease that requires hospitalization. It remains unclear whether these patients differ from hospitalized unvaccinated patients with regard to presentation, coexisting comorbidities, and outcomes. Methods Here, w...

Photoplethysmogram (PPG) signals are widely used in healthcare for monitoring vital signs, but they are susceptible to motion artifacts that can lead to inaccurate interpretations. In this study, the use of label propagation techniques to propagate labels among PPG samples is explored, particularly in imbalanced class scenarios where clean PPG samp...

Background: Mathematical models based on the physiology when programmed as a software can be used to teach cardiorespiratory physiology and to forecast the effect of various ventilatory support strategies. We developed a cardiorespiratory simulator for children called "SimulResp." The purpose of this study was to evaluate the quality of SimulResp....

Background COVID-19 has been associated with a broad range of thromboembolic, ischemic, and hemorrhagic complications (coagulopathy complications). Most studies have focused on patients with severe disease from high-income countries (HIC). Objectives The main aims were to compare the frequency of coagulopathy complications in developing countries (...

In children, vital distress events, particularly respiratory, go unrecognized. To develop a standard model for automated assessment of vital distress in children, we aimed to construct a prospective high-quality video database for critically ill children in a pediatric intensive care unit (PICU) setting. The videos were acquired automatically throu...

Background : Pediatric liver transplantation is performed with either whole, reduced, split livers depending on the technical aspects of the surgery and the discrepancy between donor and recipient body dimensions. The optimal method of partial hepatectomy for pediatric transplants remains debated to this day: either in situ (i.e. occurring before l...

BACKGROUND Clinical decision-making is a complex cognitive process that relies on the interpretation of a large variety of data from different sources and involves using knowledge bases and scientific recommendations. The representation of clinical data plays a key role in the speed and efficiency of its interpretation. As well, the increasing use...

Introduction: Acute kidney injury (AKI) has been identified as one of the most common and significant problems in hospitalized patients with COVID-19. However, studies examining the relationship between COVID-19 and AKI in low- and low-middle income countries (LLMIC) are lacking. Given that AKI is known to carry a higher mortality rate in these co...

Introduction: Low cardiac output syndrome in the postoperative period after cardiac surgery leads to an increase in tissue oxygen extraction, assessed by the oxygen extraction ratio. Measurement of the oxygen extraction ratio requires blood gases to be taken. However, the temperature of the skin and various parts of the body is a direct result of...

Background: Delirium is well-recognized in adult inpatient care. However, it is often overlooked in children, being mistaken for pain, anxiety, or age-appropriate agitation. Methods: To assess the impact of a formal teaching session on the diagnostic rates and management of pediatric delirium (PD) in a tertiary care center, we conducted a retros...

In recent years, Transformer-based models such as the Switch Transformer have achieved remarkable results in natural language processing tasks. However, these models are often too complex and require extensive pre-training, which limits their effectiveness for small clinical text classification tasks with limited data. In this study, we propose a s...

Acute respiratory distress syndrome (ARDS), including severe pulmonary COVID infection, is associated with a high mortality rate. It is crucial to detect ARDS early, as a late diagnosis may lead to serious complications in treatment. One of the challenges in ARDS diagnosis is chest X-ray (CXR) interpretation. ARDS causes diffuse infiltrates through...

When dealing with clinical text classification on a small dataset recent studies have confirmed that a well-tuned multilayer perceptron outperforms other generative classifiers, including deep learning ones. To increase the performance of the neural network classifier, feature selection for the learning representation can effectively be used. Howev...

Objectives: Computerised provider order entry (CPOE) systems have been implemented around the world as a solution to reduce ordering and transcription errors. However, previous literature documented many challenges to attain this goal, especially in paediatric settings. The objectives of this study were to (1) analyse the impact of a paediatric CP...

In a pediatric intensive care unit (PICU) of 32 beds, clinicians manage resources 24 hours a day, 7 days a week, from a large-screen dashboard implemented in 2017. This resource management dashboard efficiently replaces the handwriting information displayed on a whiteboard, offering a synthetic view of the bed’s layout and specific information on s...

Objectives: We sought to update our 2015 work in the Second Pediatric Acute Lung Injury Consensus Conference (PALICC-2) guidelines for the diagnosis and management of pediatric acute respiratory distress syndrome (PARDS), considering new evidence and topic areas that were not previously addressed. Design: International consensus conference serie...

Objectives: The use of electronic algorithms, clinical decision support systems, and other clinical informatics interventions is increasing in critical care. Pediatric acute respiratory distress syndrome (PARDS) is a complex, dynamic condition associated with large amounts of clinical data and frequent decisions at the bedside. Novel data-driven t...

Rationale: Pediatric-specific ventilator liberation guidelines are lacking despite the many studies exploring elements of extubation readiness testing. The lack of clinical practice guidelines has led to significant and unnecessary variation in methods used to assess pediatric patients' readiness for extubation. Methods: Twenty-six international ex...

Background Common, operational definitions are crucial to assess interventions and outcomes related to pediatric mechanical ventilation. These definitions can reduce unnecessary variability amongst research and quality improvement efforts, to ensure findings are generalizable and can be pooled to establish best practices. Research Question Can we e...

Background: Mechanical power is a composite variable for energy transmitted to the respiratory system over time that may better capture risk for ventilator-induced lung injury than individual ventilator management components. We sought to evaluate if mechanical ventilation management with a high mechanical power is associated with fewer ventilator...

https://ccforum.biomedcentral.com/articles/10.1186/s13054-022-04155-1#Abs1

IMPACT OF AGE AND AIRWAY RESISTANCE ON THE RELIABILITY OF PEAK INSPIRATORY PRESSURE TO ESTIMATE PLATEAU PRESSURE IN CHILDREN BACKGROUND AND AIM: Peak inspiratory pressure (PIP) measured in decelerating-flow mode (PIPdc), i.e. pressure modes, is close to plateau pressure (Pplat) in children with pediatric acute respiratory distress syndrome. W...

As pediatricians, we all have to deal with new childhood inflammatory disorder due to COVID 19: the Multisystem Inflammatory Syndrome in Children (MIS-C). The recent article by Savorgnan et al. on the physiologic profiles associated with MIS-C proposed a classification through the “MIS-C severity score” (MSS). The authors also identified a combinat...

Background and Aim: The SplashGuard CG (SG) is a barrier enclosure developed to protect healthcare workers from SARS-CoV-2 transmission during aerosol-generating procedures. Our objective was to evaluate the protection provided by the SG against aerosolized particles (AP), using a pediatric simulation model of spontaneous ventilation (SV) and nonin...

Introduction The use of weapons of mass destruction against civilian populations is of serious concern to public health authorities. Chemical weapons are of particular concern. A few studies have investigated medical responses in prehospital settings in the immediate aftermath of a chemical attack, and they were limited by the paucity of clinical d...

When dealing with clinical text classification on a small dataset recent studies have confirmed that a well-tuned multilayer perceptron outperforms other generative classifiers, including deep learning ones. To increase the performance of the neural network classifier, feature selection for the learning representation can effectively be used. Howev...

The rapid progress in clinical data management systems and artificial intelligence approaches enable the era of personalized medicine. Intensive care units (ICUs) are ideal clinical research environments for such development because they collect many clinical data and are highly computerized. Goal: We designed a retrospective clinical study on a...

Background Up to 30% of hospitalised patients with COVID-19 require advanced respiratory support, including high-flow nasal cannulas (HFNC), non-invasive mechanical ventilation (NIV), or invasive mechanical ventilation (IMV). We aimed to describe the clinical characteristics, outcomes and risk factors for failing non-invasive respiratory support in...

Rationale: Pediatric specific ventilator liberation guidelines are lacking despite the many studies exploring elements of extubation readiness testing. The lack of clinical practice guidelines has led to significant and unnecessary variation in methods used to assess pediatric patients' readiness for extubation. Methods: Twenty-six international...

Objective To describe antibiotic treatment durations that pediatric infectious diseases (ID) and critical care clinicians usually recommend for bloodstream infections in critically ill children. Design Anonymous, online practice survey using five common pediatric-based case scenarios of bloodstream infections. Setting Pediatric intensive care uni...

The International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC) COVID-19 dataset is one of the largest international databases of prospectively collected clinical data on people hospitalized with COVID-19. This dataset was compiled during the COVID-19 pandemic by a network of hospitals that collect data using the ISARIC-World...

Objectives To synthesize knowledge describing the impact of social distancing measures (SDM) during the first wave of the COVID-19 pandemic on acute illness in children by focusing on the admission to pediatric emergency departments (PED) and pediatric intensive care units (PICU). Methods We searched Cochrane Database of Systematic Reviews, Cochra...

Objectives We used modified contingent valuation methodology to determine how noninferiority margin sizes influence clinicians’ willingness to accept clinical trial results that compare mortality in critically ill children. Methods We surveyed pediatric infectious diseases and critical care clinicians in Canada, Australia, and New Zealand and rand...

BACKGROUND: Mathematical models based on the physiology when programmed as a software can be used to teach cardiorespiratory physiology and to forecast the effect of various ventilatory support strategies. We developed a cardiorespiratory simulator for children called “SimulResp”. The purpose of this study was to evaluate the quality of SimulResp....

Background Bloodstream infections (BSIs) cause significant morbidity and mortality in critically ill children but treatment duration is understudied. We describe the durations of antimicrobial treatment that critically ill children receive and explore factors associated with treatment duration. Methods We conducted a retrospective observational co...

Introduction The survivability of mass casualties exposed to a chemical attack is dependent on clinical knowledge, evidence-based practice, as well as protection and decontamination capabilities. The aim of this systematic review was to identify the knowledge gaps that relate to an efficient extraction and care of mass casualties caused by exposure...

OBJECTIVES To describe the patient characteristics, clinical management, and infectious etiology in critically ill children with bronchiolitis. The secondary objective was to determine the association between antibiotic use and hospital length of stay among patients without concomitant bacterial infections. METHODS Retrospective cohort study inclu...

Acute kidney injury is common in critically ill children, but the long-term outcomes are not well defined. Objectives: Evaluated whether nonrecovery of kidney function, following acute kidney injury, was associated with postdischarge mortality, healthcare utilization, and chronic kidney disease. Design: Retrospective, two-center, observational...

In this paper, we propose a novel approach to deal with the integration of the cancellation probability due to congestion in the intensive care unit in the (long term) surgical case assignment problem. This problem consists of selecting patients from the wait list to be on the operating list of surgeons for a selected horizon, and assigning a day,...

CONTEXT Respiratory dysfunction is a component of every organ failure scoring system developed, reflecting the significance of the lung in multiple organ dysfunction syndrome. However, existing systems do not reflect current practice and are not consistently evidence based. OBJECTIVE We aimed to review the literature to identify the components of...

Prior criteria for organ dysfunction in critically ill children were based mainly on expert opinion. We convened the Pediatric Organ Dysfunction Information Update Mandate (PODIUM) expert panel to summarize data characterizing single and multiple organ dysfunction and to derive contemporary criteria for pediatric organ dysfunction. The panel was co...

The temperature distribution at the skin surface could be a useful tool to monitor changes in cardiac output. Goal: The aim of this study was to explore infrared thermography as a method to analyze temperature profiles of critically ill children. Methods: Patients admitted to the PICU were included in this study. An infrared sensor was used to take...

PIIS14733099210056 5X.pdf

The efficacy of convalescent plasma for coronavirus disease 2019 (COVID-19) is unclear. Although most randomized controlled trials have shown negative results, uncontrolled studies have suggested that the antibody content could influence patient outcomes. We conducted an open-label, randomized controlled trial of convalescent plasma for adults with...

Background The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruit...

Objectives: Our understanding of pediatric acute respiratory distress syndrome is based on information from studies reporting intermittent, serial respiratory data. We have analyzed a high-resolution, longitudinal dataset that incorporates measures of hypoxemia severity, metrics of lung mechanics, ventilatory ratio, and mechanical power and examin...

Objectives: To determine the association between the implementation of an antimicrobial stewardship program at a local PICU and to determine the association between the presence of an antimicrobial stewardship programs and antimicrobial use across three Canadian PICUs, among critically ill children with bronchiolitis. Design: A multicenter retro...

Pao2 is the gold standard to assess acute hypoxic respiratory failure, but it is only routinely available by intermittent spot checks, precluding any automatic continuous analysis for bedside tools. Objective: To validate a continuous and noninvasive method to estimate hypoxemia severity for all Spo2 values. Derivation cohort: All patients who...

Acute liver failure is a common disease seen in pediatric intensive care and is secondary to various pathologies. The management aims to maintain hemodynamic and respiratory status, avoid bleeding, and prevent infections in order to prevent progression to multiorgan failure. Several extracorporeal liver support therapies (ELST) are proposed to addr...

Children with liver failure may have an acute respiratory failure following one or several simultaneous insults including hepatic encephalopathy, volume overload, pulmonary hemorrhage, pulmonary edema, acute lung injury, and other comorbidities such as ascites with intra-abdominal hypertension, hydrothorax, and muscle weakness due to poor nutrition...

Acute liver failure is characterized by a rapid deterioration in liver functions leading to an encephalopathy, but it has good chances of survival. This chapter details the aetiologies of acute liver failures according to patients age, the clinical presentation, the main complications, management, and prognosis.

Liver injury is frequent in the intensive care unit and its occurrence is associated with poorer outcomes. Multiple and interrelated mechanisms are involved. We review four major pathophysiological pathways of secondary liver injury in critically ill children: hypoxic liver injury, sepsis and the systemic inflammatory response syndrome, venous cong...

Objectives: Significant resources are devoted to neonatal prolonged mechanical ventilation (NPMV), but little is known about the outcomes in those children. Our primary objective was to describe the NPMV respiratory, digestive, and neurological outcomes at 18 months corrected age. Our second objective was on the early identification of which patien...

The Centre Hospitalier Universitaire Sainte-Justine (Montreal, Canada) is a pediatric academic tertiary hospital that has begun the implementation of a commercial computerized provider order entry system (CPOE) in October 2019. The objectives of this paper are 1) to estimate the impact of the CPOE system on medication errors, and 2) to identify vul...

To support the pediatric intensive care unit with the COVID-19 pandemic, we followed a user-centered design process to create a dashboard in a context where direct access to users was impossible. To this end, we applied contextual inquiry, user interview, requirement definition, iterative design with user validation and usability testing in a remot...

The purpose of the study presented herein is to develop a machine learning algorithm based on natural language processing that automatically detects whether a patient has a cardiac failure or a healthy condition by using physician notes in Research Data Warehouse at CHU Sainte Justine Hospital. First, a word representation learning technique was em...

This paper proposes a joint clinical natural language representation learning and supervised classification framework based on machine learning for detecting concept labels in clinical narratives at CHU Sainte Justine Hospital (CHUSJ). The novel framework jointly discovers distributional syntactic and latent semantic (representation learning) from...

Some inborn errors of metabolism involve enzyme defects in the catabolic pathway of amino acids that induce a metabolic encephalopathy by accumulation of neurotoxic metabolites (endogenous intoxication). In these diseases, detailed in this chapter, intermediate products of amino acid catabolism are not detoxified by the liver, accumulate, and contr...

Background Acute kidney Injury (AKI) in children undergoing cardiac surgery (CS) is strongly associated with hospital morbidity. Post-discharge CS AKI outcomes are less clear. We evaluated associations between AKI and post-discharge (a) healthcare utilization, (b) chronic kidney disease (CKD) or hypertension and (c) mortality.Methods This is a retr...

Respiratory failure is one of the most common reasons for admission to the pediatric intensive care unit (PICU), and about half of the patients admitted to PICU need ventilator support. Development of mechanical ventilation has dramatically changed the outcome of pediatric respiratory failure from a commonly fatal condition to a one with very low m...

Background: Clinical data on patients admitted to hospital with coronavirus disease 2019 (COVID-19) provide clinicians and public health officials with information to guide practice and policy. The aims of this study were to describe patients with COVID-19 admitted to hospital and intensive care, and to investigate predictors of outcome to charact...

Few studies have characterized follow-up after pediatric acute kidney injury (AKI). Our aim was to describe outpatient AKI follow-up after pediatric intensive care unit (PICU) admission. Two-center retrospective cohort study (0–18 years; PICU survivors (2003–2005); noncardiac surgery; and no baseline kidney disease). Provincial administrative datab...

Background Long-term care facilities (LTCF) are environments particularly favourable to coronavirus disease (SARS-CoV-2) pandemic outbreaks, due to the at-risk population they welcome and the close proximity of residents. Yet, the transmission dynamics of the disease in these establishments remain unclear. Methods Air and no-touch surfaces of 31 r...

In recent years, substantial progress has been made in the approaches to diagnosis and treatment of severe liver diseases in the pediatric ICU, from various forms of liver failure and hepatitis to acute and chronic liver disease. New techniques and tools are being utilized to prevent patients from experiencing complications and for patients in reco...

Background. The current COVID-19 pandemic has resulted in over 54,800,000 SARS-CoV-2 infections worldwide with a mortality rate of around 2.5%. As observed in other airborne viral infections such as influenza and SARS-CoV-1, healthcare workers are at high risk for infection when performing aerosol-generating medical procedures (AGMP). Additionally,...

Assessment of respiratory function allows early detection of potential disorders in the respiratory system and provides useful information for medical management. There is a wide range of applications for breathing assessment, from measurement systems in a clinical environment to applications involving athletes. Many studies on pulmonary function t...

Objectives As there is no treatment for COVID-19 with a proven mortality benefit at this moment in the pandemic, supportive management including mechanical ventilation is the core management in an intensive care unit (ICU). It is a challenge to provide consistent care in this situation, highly demanding and leading to potential staff shortages in I...

The worldwide repercussions of COVID-19 sparked important research efforts, yet the detailed contribution of aerosols in the transmission of SARS-CoV-2 has not been elucidated. In an attempt to quantify viral aerosols in the environment of infected patients, we collected 100 air samples in acute care hospital rooms hosting 22 patients over the cour...

Background Reliable localization and tracking of the eye region in the pediatric hospital environment is a significant challenge for clinical decision support and patient monitoring applications. Existing work in eye localization achieves high performance on adult datasets but performs poorly in the busy pediatric hospital environment, where face a...