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Michel Dojat

Publications and source records attributed to Michel Dojat.

6 recordsLinked to original sources
PubMed2006

A multicenter randomized trial of computer-driven protocolized weaning from mechanical ventilation.

RATIONALE AND OBJECTIVES: Duration of weaning from mechanical ventilation may be reduced by the use of a systematic approach. We assessed whether a closed-loop knowledge-based algorithm introduced in a ventilator to act as a computer-driven weaning protocol can improve patient outcomes as compared with usual care. METHODS AND MEASUREMENTS: We conducted a multicenter randomized controlled study with concealed allocation to compare usual care for weaning with computer-driven weaning. The computerized protocol included an automatic gradual reduction in pressure support, automatic performance of spontaneous breathing trials (SBT), and generation of an incentive message when an SBT was successfully passed. One hundred forty-four patients were enrolled before weaning initiation. They were randomly allocated to computer-driven weaning or to physician-controlled weaning according to local guidelines. Weaning duration until successful extubation and total duration of ventilation were the primary endpoints. MAIN RESULTS: Weaning duration was reduced in the computer-driven group from a median of 5 to 3 d (p=0.01) and total duration of mechanical ventilation from 12 to 7.5 d (p=0.003). Reintubation rate did not differ (23 vs. 16%, p=0.40). Computer-driven weaning also decreased median intensive care unit (ICU) stay duration from 15.5 to 12 d (p=0.02) and caused no adverse events. The amount of sedation did not differ between groups. In the usual care group, compliance to recommended modes and to SBT was estimated, respectively, at 96 and 51%. CONCLUSIONS: The specific computer-driven system used in this study can reduce mechanical ventilation duration and ICU length of stay, as compared with a physician-controlled weaning process.

Aged↗
PubMed2005

Computer-driven management of prolonged mechanical ventilation and weaning: a pilot study.

OBJECTIVE: To evaluate the ability of a computer-driven system (CDS) to manage pressure-support ventilation over prolonged periods and to predict weaning readiness compared to intensivists. The system continuously adapts pressure support, gradually decreases ventilatory assistance when possible, and indicates weaning readiness. DESIGN AND SETTING: A two-center, prospective, open, clinical, pilot study in medical ICUs of two university hospitals. PATIENTS AND PARTICIPANTS: 42 consecutive mechanically ventilated patients (60+/-14 years, SAPS II 39+/-15), 9 of whom were excluded. INTERVENTIONS: As soon as patients could tolerate pressure support, they were ventilated with the CDS. The times of weaning readiness determined by the intensivists and CDS were compared. MEASUREMENTS AND RESULTS: Weaning was successful in 25 patients and failed in 7; unplanned extubation occurred in 1 patient. Time on CDS ventilation was 3+/-3 days (maximum, 12 days). The CDS detected weaning readiness earlier than the intensivists in 17 patients, and intensivists earlier than the CDS in 4; in 11 patients detection times coincided. CONCLUSIONS: A CDS was successful in fully managing pressure-support ventilation over prolonged periods and often proposed weaning readiness earlier than the intensivists did. Use of this CDS may reduce the duration of mechanical ventilation.

Adult↗
PubMed2004

Automated segmentation of human brain MR images using a multi-agent approach.

Image interpretation consists in finding a correspondence between radiometric information and symbolic labeling with respect to specific spatial constraints. It is intrinsically a distributed process in terms of goals to be reached, zones in the image to be processed and methods to be applied. To cope the the difficulty inherent in this process, several information processing steps are required to gradually extract information. In this paper we advocate the use of situated cooperative agents as a framework for managing such steps. Dedicated agent behaviors are dynamically adapted depending on their position in the image, of their topographic relationships and of the radiometric information available. The information collected by the agents is gathered, shared via qualitative maps, or used as soon as available by acquaintances. Incremental refinement of interpretation is obtained through a coarse to fine strategy. Our work is essentially focused on radiometry-based tissue interpretation where knowledge is introduced or extracted at several levels to estimate models for tissue-intensity distribution and to cope with noise, intensity non-uniformity and partial volume effect. Several experiments on phantom and real images were performed. A complete volume can be segmented in less than 5 min with about 0.84% accuracy of the segmented reference. Comparison with other techniques demonstrates the potential interest of our approach for magnetic resonance imaging (MRI) brain scan interpretation.

Artificial Intelligence↗
PubMed2004

Statistical shape modeling of low level visual area borders.

This paper proposes a statistical modeling of functional landmarks delimiting low level visual areas which are highly variable across individuals. Low level visual areas are first precisely delineated by fMRI retinotopic mapping which provides detailed information about the correspondence between the visual field and its cortical representation. The model is then built by learning the variability within a given training set. It relies on an appropriate data representation and on the definition of an intrinsic coordinate system common to all visual maps. This allows to build a consistent training set on which a principal component analysis is eventually applied. Our approach constitutes a first step toward a functional landmark-based probabilistic atlas of low level visual areas.

Adult↗
PubMedDate not supplied

Global integration of local color differences in transparency perception: An fMRI study.

In normal viewing, the visual system effortlessly assigns approximately constant attributes of color and shape to perceived objects. A fundamental component of this process is the compensation for illuminant variations and intervening media to recover reflectance properties of natural surfaces. We exploited the phenomenon of transparency perception to explore the cortical regions implicated in such processes, using fMRI. By manipulating the coherence of local color differences around a region in an image, we interfered with their global perceptual integration and thereby modified whether the region appeared transparent or not. We found the major cortical activation due to global integration of local color differences to be in the anterior part of the parahippocampal gyrus. Regions differentially activated by chromatic versus achromatic geometric patterns showed no significant differential response related to the coherence/incoherence of local color differences. The results link the integration of local color differences in the extraction of a transparent layer with sites activated by object-related properties of an image.

Adult↗