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BMC Anesthesiology Jul 2024Appropriate selection of double-lumen tube sizes for one-lung ventilation is crucial to prevent airway damage. Current selection methods rely on demographic factors or... (Observational Study)
Observational Study
BACKGROUND
Appropriate selection of double-lumen tube sizes for one-lung ventilation is crucial to prevent airway damage. Current selection methods rely on demographic factors or 2D radiography. Prediction of left bronchial diameter is indispensable for choosing the adequate tube size. This prospective observational study investigates if current selection methods sufficiently predict individuals' left bronchial diameters for DLT selection compared to the 3D reconstruction.
METHODS
100 patients necessitating thoracic surgery with one-lung ventilation and left-sided double-lumen tubes, ≥ 18 years of age, and a set of chest X-rays and 2D thorax CT scans for 3D reconstruction of the left main bronchus were included between 07/2021 and 06/2023. The cross-validated prediction error and the width of the 95%-prediction intervals of the 3D left main bronchial diameter utilizing linear prediction models were based on current selection methods.
RESULTS
The mean bronchial diameter in 3D reconstruction was 13.6 ± 2.1 mm. The ranges of the 95%-prediction intervals for the bronchial diameter were 6.4 mm for demographic variables, 8.3 mm for the tracheal diameter from the X-ray, and 5.9 mm for bronchial diameter from the 2D-CT scans. Current methods violated the suggested '≥1 mm' safety criterion in up to 7% (men) and 42% (women). Particularly, 2D radiography overestimated women's left bronchial diameter. Current methods even allowed the selection of double-lumen tubes with bronchial tube sections greater than the bronchial diameter in women.
CONCLUSIONS
Neither demographic nor 2D-radiographic methods sufficiently account for the variability of the bronchial diameter. Wide 95%-prediction intervals for the bronchial diameter hamper accurate individual double-lumen tube selection. This increases women's risk of bronchial damage, particularly if they have other predisposing factors. These patients may benefit from 3D reconstruction of the left main bronchus.
TRIAL REGISTRATION
Not applicable.
Topics: Humans; Female; Male; Imaging, Three-Dimensional; Prospective Studies; Middle Aged; Aged; Tomography, X-Ray Computed; Intubation, Intratracheal; Bronchi; One-Lung Ventilation; Adult
PubMed: 38956485
DOI: 10.1186/s12871-024-02605-7 -
Saudi Medical Journal Jul 2024To evaluated the home healthcare efficacy in managing tracheostomy patients at King Abdulaziz Medical City under the Ministry of National Guard Health Affairs. Home...
OBJECTIVES
To evaluated the home healthcare efficacy in managing tracheostomy patients at King Abdulaziz Medical City under the Ministry of National Guard Health Affairs. Home healthcare is care provided to patients in the convenience of their homes to ensure high-quality care based on healthcare providers' supervision.
METHODS
This retrospective cohort study utilizing a non-probability consecutive sampling technique, including all available tracheal patients with no exclusion criteria, was carried out in Riyadh, Saudi Arabia, between January 2019 and June 2022. The collected data included patient demographic variables and respiratory settings (ventilation type, daily ventilation need, tracheostomy duration, and ventilator settings). The outcomes included mortality rate and therapeutic outcomes of tracheal management.
RESULTS
Of the 183 patients in the study, the most common type of respiratory-related infection was pneumonia (53%). Unlike respiratory-related causes, The mortality rate of patients admitted to the intensive care unit that was unrelated to respiratory causes was statistically significant (57%) (=0.003). The mortality rate of patients who used aerosol tracheal collars (34%) was markedly higher than mechanically ventilated patients (57%) (=0.004). The mortality rate following discharge from HHC was 40%, and was higher among patients aged >70 years (47%) (=0.04).
CONCLUSION
Pneumonia was associated with the majority of ventilator-related infections and resulted in hospital readmissions. Ensuring proper practices and caregiver education is crucial to decrease the incidence of ventilator-related infections.
Topics: Humans; Tracheostomy; Retrospective Studies; Male; Home Care Services; Female; Middle Aged; Aged; Saudi Arabia; Respiration, Artificial; Adult; Pneumonia, Ventilator-Associated; Intensive Care Units; Cohort Studies
PubMed: 38955441
DOI: 10.15537/smj.2024.45.7.20240294 -
Journal of Clinical Monitoring and... Jul 2024This pilot study aimed to investigate the relation between cardio-respiratory parameters derived from Central Venous Pressure (CVP) waveform and Extubation Failure (EF)...
This pilot study aimed to investigate the relation between cardio-respiratory parameters derived from Central Venous Pressure (CVP) waveform and Extubation Failure (EF) in mechanically ventilated ICU patients during post-extubation period. This study also proposes a new methodology for analysing these parameters during rest/sleep periods to try to improve the identification of EF. We conducted a prospective observational study, computing CVP-derived parameters including breathing effort, spectral analyses, and entropy in twenty critically ill patients post-extubation. The Dynamic Warping Index (DWi) was calculated from the respiratory component extracted from the CVP signal to identify rest/sleep states. The obtained parameters from EF patients and patients without EF were compared both during arbitrary periods and during reduced DWi (rest/sleep). We have analysed data from twenty patients of which nine experienced EF. Our findings may suggest significantly increased respiratory effort in EF patients compared to those successfully extubated. Our study also suggests the occurrence of significant change in the frequency dispersion of the cardiac signal component. We also identified a possible improvement in the differentiation between the two groups of patients when assessed during rest/sleep states. Although with caveats regarding the sample size, the results of this pilot study may suggest that CVP-derived cardio-respiratory parameters are valuable for monitoring respiratory failure during post-extubation, which could aid in managing non-invasive interventions and possibly reduce the incidence of EF. Our findings also indicate the possible importance of considering sleep/rest state when assessing cardio-respiratory parameters, which could enhance respiratory failure detection/monitoring.
PubMed: 38954170
DOI: 10.1007/s10877-024-01171-0 -
Intensive Care Medicine Experimental Jul 2024The spatiotemporal progression and patterns of tissue deformation in ventilator-induced lung injury (VILI) remain understudied. Our aim was to identify lung clusters...
BACKGROUND
The spatiotemporal progression and patterns of tissue deformation in ventilator-induced lung injury (VILI) remain understudied. Our aim was to identify lung clusters based on their regional mechanical behavior over space and time in lungs subjected to VILI using machine-learning techniques.
RESULTS
Ten anesthetized pigs (27 ± 2 kg) were studied. Eight subjects were analyzed. End-inspiratory and end-expiratory lung computed tomography scans were performed at the beginning and after 12 h of one-hit VILI model. Regional image-based biomechanical analysis was used to determine end-expiratory aeration, tidal recruitment, and volumetric strain for both early and late stages. Clustering analysis was performed using principal component analysis and K-Means algorithms. We identified three different clusters of lung tissue: Stable, Recruitable Unstable, and Non-Recruitable Unstable. End-expiratory aeration, tidal recruitment, and volumetric strain were significantly different between clusters at early stage. At late stage, we found a step loss of end-expiratory aeration among clusters, lowest in Stable, followed by Unstable Recruitable, and highest in the Unstable Non-Recruitable cluster. Volumetric strain remaining unchanged in the Stable cluster, with slight increases in the Recruitable cluster, and strong reduction in the Unstable Non-Recruitable cluster.
CONCLUSIONS
VILI is a regional and dynamic phenomenon. Using unbiased machine-learning techniques we can identify the coexistence of three functional lung tissue compartments with different spatiotemporal regional biomechanical behavior.
PubMed: 38954052
DOI: 10.1186/s40635-024-00641-8 -
Journal of Bronchology & Interventional... Jul 2024CT-to-body divergence-described as the difference between preprocedural CT scans and intraprocedural lung architecture-is a significant barrier to improving diagnostic... (Observational Study)
Observational Study
BACKGROUND
CT-to-body divergence-described as the difference between preprocedural CT scans and intraprocedural lung architecture-is a significant barrier to improving diagnostic yield during navigational bronchoscopy. A major proposed contributor to CT-to-body divergence is the development of atelectasis, which can confound visualization of peripheral lung lesions via radial probe endobronchial ultrasound (RP-EBUS). High positive end-expiratory pressure (PEEP) ventilatory strategies have been used to decrease atelectasis, allowing the lesion to re-APPEAR on intraprocedure imaging. However, standardized PEEP levels may not be appropriate for all patients due to hemodynamic and ventilatory impacts.
METHODS
We performed a multicenter, prospective observational study in which patients were imaged with RP-EBUS under general anesthesia to determine if subsegmental atelectasis would resolve as incremental increases in PEEP were applied. Resolution of atelectasis was based on the transition from a non-aerated pattern to an aerated appearance on RP-EBUS. RP-EBUS images were reviewed by 3 experienced operators to determine correlation.
RESULTS
Forty-three patients underwent RP-EBUS examination following navigational bronchoscopy. Thirty-seven patients underwent incremental PEEP application and subsequent RP-EBUS imaging. Atelectasis was determined to have resolved in 33 patients (88.2%) following increased PEEP. The intraclass correlation coefficient between reviewers was 0.76. A recruitment maneuver was performed in 7 (16.3%) patients after atelectasis persisted at maximal PEEP. Atelectasis was not identified in the examined subsegments in 6 (10.8%) patients despite zero PEEP.
CONCLUSION
RP-EBUS is an effective tool to monitor what pressure atelectasis within a lung segment has resolved with increasing levels of PEEP.
Topics: Humans; Positive-Pressure Respiration; Pulmonary Atelectasis; Bronchoscopy; Prospective Studies; Male; Female; Aged; Middle Aged; Endosonography; Tomography, X-Ray Computed
PubMed: 38953737
DOI: 10.1097/LBR.0000000000000969 -
Ugeskrift For Laeger Jun 2024This case report describes laryngeal oedema occurring in a 35-year-old woman with chronic bowel-associated dermatosis-arthritis syndrome, and stenosis of the left main...
This case report describes laryngeal oedema occurring in a 35-year-old woman with chronic bowel-associated dermatosis-arthritis syndrome, and stenosis of the left main bronchus. The oedema was attributed to persistent cough exacerbated by delayed treatment and intubation-related irritation. Evaluations ruled out inflammatory, autoimmune, and malignant causes. Literature lacks on specific descriptions of cough-induced laryngeal oedema, emphasizing the need for a multidisciplinary approach and early intervention in complex cases to prevent severe hospitalizations in patients with known serious conditions and symptom exacerbation.
Topics: Humans; Adult; Female; Cough; Laryngeal Edema; Respiration, Artificial; Intubation, Intratracheal
PubMed: 38953687
DOI: 10.61409/V12230792 -
Ugeskrift For Laeger Jul 2024This is a case report of a 66-year-old male patient with spinocerebellar ataxia type 1 and a family history of anaesthesia-related death was anaesthetised with total...
This is a case report of a 66-year-old male patient with spinocerebellar ataxia type 1 and a family history of anaesthesia-related death was anaesthetised with total intravenous anaesthesia and neuromuscular blockade for laparoscopic cholecystectomy. Anaesthesia and surgery were uneventful. In the post-anesthesia care unit, the patient developed acute respiratory distress and was admitted to the intensive care unit (ICU) for mechanical ventilation. He recovered respiratorically and was released from the ICU after four days. Risks associated with anaesthesia in patients with neurodegenerative disorders should be considered before performing surgery.
Topics: Humans; Male; Aged; Anesthesia, General; Cholecystectomy, Laparoscopic
PubMed: 38953675
DOI: 10.61409/V01240044 -
Environmental Science. Processes &... Jul 2024The Chemical Assessment of Surfaces and Air (CASA) study aimed to understand how chemicals transform in the indoor environment using perturbations (, cooking, cleaning)...
The Chemical Assessment of Surfaces and Air (CASA) study aimed to understand how chemicals transform in the indoor environment using perturbations (, cooking, cleaning) or additions of indoor and outdoor pollutants in a well-controlled test house. Chemical additions ranged from individual compounds (, gaseous ammonia or ozone) to more complex mixtures (, a wildfire smoke proxy and a commercial pesticide). Physical perturbations included varying temperature, ventilation rates, and relative humidity. The objectives for CASA included understanding (i) how outdoor air pollution impacts indoor air chemistry, (ii) how wildfire smoke transports and transforms indoors, (iii) how gases and particles interact with building surfaces, and (iv) how indoor environmental conditions impact indoor chemistry. Further, the combined measurements under unperturbed and experimental conditions enable investigation of mitigation strategies following outdoor and indoor air pollution events. A comprehensive suite of instruments measured different chemical components in the gas, particle, and surface phases throughout the study. We provide an overview of the test house, instrumentation, experimental design, and initial observations - including the role of humidity in controlling the air concentrations of many semi-volatile organic compounds, the potential for ozone to generate indoor nitrogen pentoxide (NO), the differences in microbial composition between the test house and other occupied buildings, and the complexity of deposited particles and gases on different indoor surfaces.
PubMed: 38953218
DOI: 10.1039/d4em00209a -
Lung India : Official Organ of Indian... Jul 2024Ventilator-associated pneumonia (VAP) is the commonest healthcare-associated infection (HAI) in intensive care units (ICU), especially in trauma patients. VAP imposes a...
BACKGROUND
Ventilator-associated pneumonia (VAP) is the commonest healthcare-associated infection (HAI) in intensive care units (ICU), especially in trauma patients. VAP imposes a significant cost burden on the healthcare ecosystem. However, there are few data from the developing world.
METHODOLOGY
We conducted this study in the trauma ICU (TICU) of PGIMER, Chandigarh, from October 2021 to December 2022. The incidence, incidence density, and average length of stay (ALOS) of both VAP and non-VAP patients were established. The health system cost was assessed using a mixed (top-down and bottom-up) micro-costing approach. We collected data for all the resources (direct and indirect costs) utilized during service delivery and estimated the health system cost per bed per day.
RESULTS
In this study, 494 patients were admitted to TICU, of which 484 received Mechanical Ventilation (MV) and 47 developed VAP. We included 41 and 44 patients with and without VAP. The VAP incidence rate was 9.7% and the VAP incidence density was 10.79/1000 MV days. The ALOS for VAP patients was 21 days, and for non- VAP patients was 8.2 days. Our study estimated a total health system cost of INR 25,927 per bed per day. The health system cost of treating a VAP patient was INR 544,467 compared to INR 207,416 for a non-VAP patient.
CONCLUSION
Treatment of VAP poses substantial costs for the health system and patients. There is a need to focus on preventing VAP, which would eventually reduce the length of stay and the resultant financial impact on the health system and the patient.
PubMed: 38953191
DOI: 10.4103/lungindia.lungindia_597_23 -
Sudanese Journal of Paediatrics 2024Critically ill children frequently encounter the most common and potentially life-threatening electrolyte disturbances, i.e., hyponatremia. It is an independent risk...
Critically ill children frequently encounter the most common and potentially life-threatening electrolyte disturbances, i.e., hyponatremia. It is an independent risk factor for prolonged hospitalization in the intensive care unit and increased in-hospital mortality. Hyponatremia occurs in up to 20%-30% of admissions in the pediatric intensive care unit (PICU). This observational study was conducted in the PICU of a tertiary care hospital in a developing country from September 2018 to September 2019. Admission criteria in our PICU are the need for mechanical ventilation, fulminant hepatic failure, vasopressor support, respiratory failure and poorly controlled seizure. We studied 256 children, aged 1 month to 18 years, with normal serum sodium at admission. In our study, 72 (28.1%) children developed hyponatremia, and about two third (n=48, 66.7%) of them developed withi 72 hours of admission in PICU. The majority of children ( = 46, 63.9%) in the hyponatremic group were below 5 years. Wasted children ( = 68, 26.6%) in the hyponatremic and isonatremic groups were 20 (27.8%) and 48 (26%), respectively. The most common etiology of hyponatremia was cerebral salt wasting syndrome ( = 20, 27.8%) followed by drug-induced cases ( = 19, 26.4%). The drugs responsible were diuretics and anti-epileptics. In our study, multiorgan failure (OR = 5.05, 95%CI = 1.90-13.43; = 0.0001), shock (OR = 7.38, 95%CI = 3.56-12.28; = 0.0001), vasopressor use (OR = 6.74, 95%CI = 3.45-13.17; = 0.0001) and coagulopathy (OR = 6.74, 95%CI = 3.45-13.17; = 0.0001) were the risk factors for the development of hyponatremia. Mortality among the hyponatremic group (44.4%) was significantly higher than in the isonatremic group (21.7%). Hyponatremia is a common electrolyte disturbance found in critically ill patients and is associated with prolonged hospitalization and increased mortality.
PubMed: 38952624
DOI: 10.24911/SJP.106-1672832695