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Rare Tumors 2024Laryngeal schwannoma is a rare benign nerve sheath tumor that is slow growing. The diagnosis is made from a combination of clinical, radiological, and histopathological...
Laryngeal schwannoma is a rare benign nerve sheath tumor that is slow growing. The diagnosis is made from a combination of clinical, radiological, and histopathological findings, and the main method of treatment is resection. We report a case of a 69-year-old presenting with a neck mass causing stridor, dysphagia, and orthopnea. CT of the neck showed an enhancing mass measuring 6.3 cm and extending superior to the larynx. Emergent tracheostomy and mass resection were performed, and histopathology and immunohistochemical findings were obtained from the specimen supporting schwannoma. In conclusion, while rare, schwannoma should always be considered as a differential diagnosis for a laryngeal mass. More studies are needed to assess the size and prognosis of the tumor.
PubMed: 38756435
DOI: 10.1177/20363613241255669 -
PloS One 2024This cohort study aimed to investigate the factors associated with noninvasive positive pressure ventilation adherence and assess the long-term effects of noninvasive...
INTRODUCTION
This cohort study aimed to investigate the factors associated with noninvasive positive pressure ventilation adherence and assess the long-term effects of noninvasive positive pressure ventilation adherence in patients with amyotrophic lateral sclerosis (ALS).
METHODS
The medical records of patients with ALS admitted to a tertiary hospital for noninvasive positive pressure ventilation initiation were retrospectively reviewed. Pulmonary function parameters, variables of blood gas analysis, the site of symptom onset, the time from onset and diagnosis to noninvasive positive pressure ventilation application, ALS Functional Rating Scale-Revised, neurophysiological index, and the length of hospital stay were evaluated. The adherence to noninvasive positive pressure ventilation was defined as the use of noninvasive positive pressure ventilation for ≥ 2 h/day or ≥ 4 h/day. The correlations between noninvasive positive pressure ventilation adherence or length of hospital stay and other clinical parameters were analyzed.
RESULTS
Fifty-one patients with ALS were included in the study. The time from onset and diagnosis to NIPPV application was reduced by 16 months in the adherent group than that in the non-adherent group; however, the parameters of blood gas analysis and pulmonary function tests did not differ significantly between the groups. Furthermore, the neurophysiological index of the abductor digiti minimi muscle was higher by 4.05 in the adherent group than that in the non-adherent group. The adherence to noninvasive positive pressure ventilation prolonged tracheostomy-free survival compared to that of non-adherence. Desaturation events, lower forced vital capacity, last pCO2, bicarbonate, and base excess, and higher differences in pCO2, were associated with an increase in the length of hospital stay.
CONCLUSIONS
Noninvasive positive pressure ventilation application shortly after symptom onset and ALS diagnosis in patients with CO2 retention and reduced forced vital capacity can be considered for successful adherence. Adherence to noninvasive positive pressure ventilation may result in reduced tracheostomy conversion rates and prolonged tracheostomy-free survival.
Topics: Humans; Amyotrophic Lateral Sclerosis; Female; Male; Middle Aged; Positive-Pressure Respiration; Noninvasive Ventilation; Aged; Retrospective Studies; Blood Gas Analysis; Length of Stay; Patient Compliance; Respiratory Function Tests; Adult
PubMed: 38748695
DOI: 10.1371/journal.pone.0302515 -
International Journal of Nursing... Jun 2024The release of ChatGPT for general use in 2023 by OpenAI has significantly expanded the possible applications of generative artificial intelligence in the healthcare...
BACKGROUND
The release of ChatGPT for general use in 2023 by OpenAI has significantly expanded the possible applications of generative artificial intelligence in the healthcare sector, particularly in terms of information retrieval by patients, medical and nursing students, and healthcare personnel.
OBJECTIVE
To compare the performance of ChatGPT-3.5 and ChatGPT-4.0 to clinical nurses on answering questions about tracheostomy care, as well as to determine whether using different prompts to pre-define the scope of the ChatGPT affects the accuracy of their responses.
DESIGN
Cross-sectional study.
SETTING
The data collected from the ChatGPT was collected using the ChatGPT-3.5 and 4.0 using access provided by the University of Hong Kong. The data from the clinical nurses working in mainland China was collected using the Qualtrics survey program.
PARTICIPANTS
No participants were needed for collecting the ChatGPT responses. A total of 272 clinical nurses, with 98.5 % of them working in tertiary care hospitals in mainland China, were recruited using a snowball sampling approach.
METHOD
We used 43 tracheostomy care-related questions in a multiple-choice format to evaluate the performance of ChatGPT-3.5, ChatGPT-4.0, and clinical nurses. ChatGPT-3.5 and GPT-4.0 were both queried three times with the same questions by different prompts: no prompt, patient-friendly prompt, and act-as-nurse prompt. All responses were independently graded by two qualified otorhinolaryngology nurses on a 3-point accuracy scale (correct, partially correct, and incorrect). The Chi-squared test and Fisher exact test with post-hoc Bonferroni adjustment were used to assess the differences in performance between the three groups, as well as the differences in accuracy between different prompts.
RESULTS
ChatGPT-4.0 showed significantly higher accuracy, with 64.3 % of responses rated as 'correct', compared to 60.5 % in ChatGPT-3.5 and 36.7 % in clinical nurses ( = 74.192, < .001). Except for the 'care for the tracheostomy stoma and surrounding skin' domain ( = 6.227, = .156), scores from ChatGPT-3.5 and -4.0 were significantly better than nurses' on domains related to airway humidification, cuff management, tracheostomy tube care, suction techniques, and management of complications. Overall, ChatGPT-4.0 consistently performed well in all domains, achieving over 50 % accuracy in each domain. Alterations to the prompt had no impact on the performance of ChatGPT-3.5 or -4.0.
CONCLUSION
ChatGPT may serve as a complementary medical information tool for patients and physicians to improve knowledge in tracheostomy care.
TWEETABLE ABSTRACT
ChatGPT-4.0 can answer tracheostomy care questions better than most clinical nurses. There is no reason nurses should not be using it.
PubMed: 38746816
DOI: 10.1016/j.ijnsa.2024.100181 -
Alternative Therapies in Health and... May 2024To explore the construction of a column line chart-based predictive model for postoperative pulmonary infection severity in tracheostomized patients with cranial brain...
OBJECTIVE
To explore the construction of a column line chart-based predictive model for postoperative pulmonary infection severity in tracheostomized patients with cranial brain injuries.
METHODS
The study included 187 patients with cranial brain injuries who underwent tracheostomy between December 2021 and June 2023. These patients were categorized into moderate-to-severe and mild groups based on the severity of postoperative pulmonary infections. Logistic regression analysis was employed to pinpoint the autonomous risk elements for the severity of postoperative pulmonary infection in tracheostomized patients with cranial brain injuries, and a column line chart predictive model was established using these identified independent risk factors. Receiver Operating Characteristic (ROC) curves and calibration curves were used to assess the predictive performance and clinical application potential of the column line chart model for postoperative pulmonary infection risk in tracheostomized patients with cranial brain injuries.
RESULTS
Among the 187 patients, 83 (44.39%) experienced moderate-to-severe pulmonary infection. Factors such as age ≥60 years, GCS score <8, a history of long-term smoking, ASA >II, non-washable tracheal tubes, malnutrition, using a ventilator, and longer operative time were more prevalent in the moderate-to-severe group compared to the mild group (P < .05). Multivariate logistic regression analysis revealed that age ≥60 years, GCS score <8, a history of long-term smoking, ASA >II, non-washable tracheal tubes, malnutrition, using a ventilator, and longer operative time were independent risk factors for moderate-to-severe pulmonary infection in tracheostomized patients with cranial brain injuries (P < .05). Build a predictive model based on the above six independent risk factors and plot the ROC curve. ROC curve analysis demonstrated that the AUC values for age ≥60 years, GCS score <8, a history of long-term smoking, ASA >II, non-washable tracheal tubes, malnutrition, using a ventilator, and longer operative time in the column line chart model were 0.578, 0.654, 0.711, 0.652, 0.892, 0.598, 0.712, and 0.752, respectively, indicating good predictive performance of the model.
CONCLUSION
The column line chart-based predictive model for postoperative pulmonary infection severity in tracheostomized patients with cranial brain injuries has a high discriminative power and predictive accuracy. It provides a reliable and intuitive means of predicting the severity of postoperative pulmonary infections in these individuals, enabling healthcare personnel to implement timely intervention measures, thus reducing the occurrence of pulmonary infections.
PubMed: 38743890
DOI: No ID Found -
Experimental and Clinical... Apr 2024Posttransplant lymphoproliferative disorder is a life-threatening complication after solid-organ transplants. In adults, recipients of heart transplants have the highest...
Posttransplant lymphoproliferative disorder is a life-threatening complication after solid-organ transplants. In adults, recipients of heart transplants have the highest risk, whereas renal transplant recipients have the lowest risk among all solid-organ transplants. The most common site for posttransplant lymphoproliferative disorders are gastrointestinal tract followed by the graft itself. Airway involvement in posttransplant lymphoproliferative disorder is rarely encountered. We report a case of a 26-year-old renal allograft recipient who presented to the emergency room with airway obstruction necessitating an emergency tracheostomy. Imaging revealed a left tonsillar mass extending into the nasopharynx and retropharyngeal space causing complete oropharyngeal occlusion. Endoscopic biopsy from nasopharyngeal mass showed a diffuse large B-cell lymphoma and was Ebstein-Barr virus positive. Reduction in immunosuppression and treatment with posttransplant lymphoproliferative disorder-1 risk-stratified approach resulted in complete remission.
Topics: Humans; Kidney Transplantation; Adult; Treatment Outcome; Airway Obstruction; Immunosuppressive Agents; Male; Lymphoma, Large B-Cell, Diffuse; Acute Disease; Biopsy; Epstein-Barr Virus Infections; Tracheostomy; Remission Induction; Immunocompromised Host; Nasopharyngeal Neoplasms
PubMed: 38742322
DOI: 10.6002/ect.2024.0061 -
Critical Care Research and Practice 2024The objective of this study was to describe Do-Not-Resuscitate (DNR) practices in a tertiary-care intensive care unit (ICU) in Saudi Arabia, and determine the predictors...
INTRODUCTION
The objective of this study was to describe Do-Not-Resuscitate (DNR) practices in a tertiary-care intensive care unit (ICU) in Saudi Arabia, and determine the predictors and outcomes of patients who had DNR orders.
METHODS
This retrospective cohort study was based on a prospectively collected database for a medical-surgicalIntensive CareDepartment in a tertiary-care center in Riyadh, Saudi Arabia (1999-2017). We compared patients who had DNR orders during the ICU stay with those with "full code." The primary outcome was hospital mortality. The secondary outcomes included ICU mortality, tracheostomy, duration of mechanical ventilation, and length of stay in the ICU and hospital.
RESULTS
Among 24790 patients admitted to the ICU over the 19-year study period, 3217 (13%) had DNR orders during the ICU stay. Compared to patients with "full code," patients with DNR orders were older (median 67 years [Q1, Q3: 55, 76] versus 57 years [Q1, Q3: 33, 71], < 0.0001), were more likely to be females (43% versus 38%, < 0.0001), had worse premorbid functional status (WHO performance status scores 4-5: 606[18.9%] versus 1894[8.8%], < 0.0001), higher prevalence of comorbid conditions, and higher APACHE II score (median 28 [Q1, Q3: 23, 34] versus 19 [Q1, Q3: 13, 25], < 0.0001) and were more likely to be mechanically ventilated (83% versus 55%, < 0.0001). Patients had DNR orders were more likely to die in the ICU (67.8% versus 8.5%, < 0.0001) and hospital (82.4% versus 18.1%, < 0.0001). On multivariable logistic regression analysis, the following were associated with an increased likelihood of DNR status: increasing age (odds ratio (OR) 1.01, 95% confidence interval (CI) 1.01-1.02), higher APACHE II score (OR 1.09, 95% CI 1.08-1.10), and worse WHO performance status score. Patients admitted in recent years (2012-2017 versus 2002-2005) were less likely to have DNR orders (OR 0.35, 95% CI 0.32-0.39, < 0.0001). Patients with DNR orders had higher ICU mortality, more tracheostomies, longer duration of mechanical ventilation and length of ICU stay compared to patients with with "full code" but they had shorter length of hospital stay.
CONCLUSION
In a tertiary-care hospital in Saudi Arabia, 13% of critically ill patients had DNR orders during ICU stay. This study identified several predictors of DNR orders, including the severity of illness and poor premorbid functional status.
PubMed: 38742230
DOI: 10.1155/2024/5516516 -
Cureus Apr 2024Temporomandibular joint (TMJ) ankylosis is a form of TMJ condition that causes mouth opening limitation, ranging from partial reduction to total immobilization of the...
Temporomandibular joint (TMJ) ankylosis is a form of TMJ condition that causes mouth opening limitation, ranging from partial reduction to total immobilization of the jaw. Bony and fibrous ankylosis is most commonly caused by trauma, although it can also happen as a result of surgery, local or systemic infections, or systemic diseases. Childhood TMJ produces facial deformities, which increase with growth and have a major detrimental impact on the patient's psychological development. Each patient with TMJ ankylosis must have a history, physical examination, and radiographic examination in order to determine a definitive diagnosis, severity, involvement of surrounding tissues, and, ultimately, treatment planning. Technical challenges and a high recurrence rate make treating TMJ ankylosis challenging. Intubating a young child with TMJ ankylosis is a difficult job, which is exacerbated by limited mouth opening. This case report describes a five-year-old boy who reported an inability to open his mouth, diagnosed as TMJ ankylosis, and managed in the absence of an appropriately sized tracheostomy tube.
PubMed: 38741843
DOI: 10.7759/cureus.58153 -
Anaesthesiology Intensive Therapy 2024Cricothyrotomy (CTM) is currently recommended as the preferred method due to its ease, speed, and safety in life-threatening airway emergencies where standard tracheal...
INTRODUCTION
Cricothyrotomy (CTM) is currently recommended as the preferred method due to its ease, speed, and safety in life-threatening airway emergencies where standard tracheal intubation and mask ventilation fail.
MATERIAL AND METHODS
This retrospective study analyzed 33 cases of "can't intubate, can't oxygenate or ventilate" (CICOV): 12 of percutaneous dilatational tracheostomy (PDT) and 21 of CTM. The CTM group was younger (median age 44) and mainly consisted of trauma patients. The PDT group was more diverse and procedures were performed by anesthesia and critical care consultants.
RESULTS
Initial success rates were 100% for PDT (12/12) and 86% for CTM (18/21), with one conversion from CTM to PDT. No perioperative complications occurred in the PDT group, while the CTM group experienced two cases of false tracts requiring re-do and three cases of bleeding. Immediate mortality within 24 hours was reported in 5/19 CTM patients and none in the PDT group. Successful liberation from mechanical ventilation at hospital discharge was achieved in 6/12 PDT patients and 11/21 CTM patients. Among the 21 CTM cases, all 16 survivors underwent subsequent tracheostomy. Tracheal decannulation occurred in 4/12 PDT patients and 10/21 CTM patients. Favorable immediate neurological outcomes (GCS ≥ 11T) were observed in 8/12 PDT patients and 8/21 CTM patients, while 3 PDT patients remained anesthetized until death and 7 CTM patients died within the first 72 hours without recovery attempts.
CONCLUSIONS
In experienced hands, PDT could be a legitimate clinical option for the surgical airway in cases of CICOV. CTM may be more suitable for practitioners who encounter CICOV infrequently.
Topics: Humans; Retrospective Studies; Male; Female; Middle Aged; Adult; Tracheostomy; Aged; Intubation, Intratracheal; Respiration, Artificial; Cricoid Cartilage; Young Adult; Airway Management
PubMed: 38741442
DOI: 10.5114/ait.2024.138437 -
Indian Pacing and Electrophysiology... May 2024Vasospastic angina is a clinical condition characterized by coronary artery spasm in angiographically normal coronary arteries. Vasospastic angina can often lead to...
Vasospastic angina is a clinical condition characterized by coronary artery spasm in angiographically normal coronary arteries. Vasospastic angina can often lead to ventricular arrhythmias, sudden cardiac death, or life-threatening bradyarrhythmias, such as high-degree atrioventricular block or asystole. We present the unusual case of a woman with depressive syndrome who underwent emergency surgery for hemostasis of a neck lesion that caused hemorrhagic shock after a suicide attempt. During surgery, the electrocardiogram revealed inferior and posterior ST-segment elevation, total atrioventricular block and torsades de pointes; the patient also suffered 4 minutes of cardiac arrest. A temporary pacemaker was placed. Coronary angiography showed right coronary artery vasospasm. Following a second similar episode after tracheostomy, a permanent pacemaker was implanted. The indication for definitive electrostimulation in such a context and the stimulation mechanisms of the carotid sinus underlying vasospasm constitute the interesting points of this clinical case. LEARNING OBJECTIVE: The indication for definitive electrostimulation in a context of recurrent episodes of high-degree atrioventricular block during vasospastic angina and the stimulation mechanisms of the carotid sinus underlying vasospasm constitute the interesting points of this clinical case.
PubMed: 38740184
DOI: 10.1016/j.ipej.2024.05.005 -
Indian Journal of Critical Care... May 2024Arasu M, Singh AK, LaguduvaH A. A Simple Adaptation for the Convenient Application of Incentive Spirometry in Tracheostomized Critically Ill Patients. Indian J Crit...
Arasu M, Singh AK, LaguduvaH A. A Simple Adaptation for the Convenient Application of Incentive Spirometry in Tracheostomized Critically Ill Patients. Indian J Crit Care Med 2024;28(5):520-521.
PubMed: 38738205
DOI: 10.5005/jp-journals-10071-24712