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Fig. 4 | Critical Care

Fig. 4

From: Individualized resuscitation strategy for septic shock formalized by finite mixture modeling and dynamic treatment regimen

Fig. 4

Optimal resuscitation strategy estimated by DTR. A Comparisons between actual and optimal fluid volume over days. The optimal fluid strategy is consistent with the concept of resuscitation/de-resuscitation model, especially in class 1 (baseline class) and class 3 (renal dysfunction class). However, class 3 showed earlier de-resuscitation than class 1 (day 1 vs. 3). More fluid could be given on day 0 for classes 1 to 4, indicating that initial resuscitation was usually inadequate in clinical practice. B Impact of delta fluid intake on mortality estimated by a logistic regression model fitting on validation set. Delta fluid intake was calculated as the difference between actual and optimal fluid intake at patient \(\bullet\) day level and was categorized into five levels: very low (<−1000 mL), low (− 1000 to − 500 mL), optimal (− 500 to 500 mL), high (500 to 1000 mL) and very high (> 1000 mL). Odds ratio was reported by using optimal as reference. C Risk factors for fluid overloading. D DTR internal validation was performed by examining the relationship between delta fluid intake and mortality outcome. The trained DTR model estimated optimal fluid intake for each subject in the dataset from the Chinese multicenter cohort and a logistic regression model was trained by including a quadratic term for delta fluid intake. The parabolic curve indicates that the lowest mortality can be obtained at an optimal fluid strategy. E Comparisons between actual and optimal norepinephrine dose over days, stratified by class membership. The optimal dose was larger than the actual dose on day 0 for classes 1, 3, 4 and 5, indicating early initiation of norepinephrine could be beneficial for most classes. However, class 2 (critical class) showed lower/delayed initial dose would be beneficial. Combined with the result from fluid intake, it was deducible that initial large adequate fluid volume and delayed norepinephrine use were potentially beneficial for class 2. F Validation of the DTR model in the validation set by exploring the relative risk of mortality for different levels of delta norepinephrine dose. G Multivariable regression model exploring risk factors for norepinephrine overdose. H DTR model validation by examining the relationship between delta norepinephrine dose and mortality outcome

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