Predicted Body Weight Research Articles

Ventilatory variables and computed tomography features in COVID-19 ARDS and non–COVID-19-related ARDS: a prospective observational cohort study

BackgroundThis study compared the ventilatory variables and computed tomography (CT) features of patients with coronavirus disease 2019 (COVID-19) versus those of patients with pulmonary non–COVID-19-related acute respiratory distress syndrome (ARDS) during the early phase of ARDS.MethodsThis prospective, observational cohort study of ARDS patients in Taiwan was performed between February 2017 and June 2018 as well as between October 2020 and January 2024. Analysis was performed on clinical characteristics, including consecutive ventilatory variables during the first week after ARDS diagnosis. Analysis was also performed on CT scans obtained within one week after ARDS onset.ResultsA total of 222 ARDS patients were divided into a COVID-19 ARDS group (n = 44; 19.8%) and a non–COVID-19 group (all pulmonary origin) (n = 178; 80.2%). No significant difference was observed between the two groups in terms of all-cause hospital mortality (38.6% versus 47.8%, p = 0.277). Pulmonary non–COVID-19 patients presented higher values for mechanical power (MP), MP normalized to predicted body weight (MP/PBW), MP normalized to compliance (MP/compliance), ventilatory ratio (VR), peak inspiratory pressure (Ppeak), and dynamic driving pressure (∆P) as well as lower dynamic compliance from day 1 to day 7 after ARDS onset. In both groups, non-survivors exceeded survivors and presented higher values for MP, MP/PBW, MP/compliance, VR, Ppeak, and dynamic ∆P with lower dynamic compliance from day 1 to day 7 after ARDS onset. The CT severity score for each of the five lung lobes and total CT scores were all significantly higher in the non–COVID-19 group (all p < 0.05). Multivariable logistic regression models revealed that Sequential Organ Failure Assessment (SOFA) score was independently associated with mortality in the COVID-19 group. In the non–COVID-19 group, body mass index, immunocompromised status, SOFA score, MP/PBW and total CT severity scores were independently associated with mortality.ConclusionsIn the early course of ARDS, physicians should be aware of the distinctions between COVID-19-related ARDS and non–COVID-19-related ARDS in terms of ventilatory variables and CT imaging presentations. It is also important to tailor the mechanical ventilation settings according to these distinct subsets of ARDS.

An optimal protective ventilation strategy in lung resection surgery: a prospective, single-center, three-arm randomized controlled trial.

Protective ventilation reduces ventilator-induced acute lung injury postoperatively; however, the optimal strategy for one-lung ventilation (OLV) remains unclear. This study compared three protective ventilation strategies with a postoperative partial pressure of oxygen (PaO2)/fraction of inspired oxygen (FiO2) ratio to reduce the incidence of immediate postoperative pulmonary complications (PPCs) in patients undergoing lung resection surgery. Eighty-seven patients with ASA physical status I-III requiring OLV for lung resection surgery were randomized into three groups according to the applied ventilation strategies: low tidal volume (VT) of 4mL/kg of predicted body weight (PBW) (LV group), medium VT of 6mL/kg of PBW (MV group), and high VT of 8mL/kg of PBW (HV group). All patients received 5 cmH2O of positive end-expiratory pressure (PEEP). The primary outcome was the mean difference of PaO2/FiO2 ratio after surgery. The radiologic findings of acute lung injuries were also evaluated. The incidence of immediate PPCs was determined by PaO2/FiO2 ratio of < 300mmHg and/or newly developed radiological findings within 72h after surgery. The MV group showed the highest PaO2/FiO2 ratio at 6h postoperatively (P = 0.010). There were no significant among-group differences in radiological findings in 3 postoperative days. The MV group showed the lowest incidence of immediate PPCs among the three groups (P = 0.007). During OLV in lung resection surgery, protective ventilation at a VT of 6mL/kg with PEEP of 5 cmH2O may achieve a higher postoperative PaO2/FiO2 ratio, reducing the incidence of immediate PPCs.

Determining the Main Morphometrical Traits to Describe Body Weight in Male Hampala Barb Fish (Hampala macrolepidota)

Aims: Determine the main morphometrical traits influencing body weight in male Hampala Barb (HB) fish. Place and Duration of Study: The fish were taken from Kampar Kiri River at Mentulik Village, Kampar Regency, Riau Province. This research was conducted in February-April 2018. Methodology: The survey method used in this research takes morphometric measurements of fish. Hampala fish is used as the object of research. The survey method is a research method that is carried out directly on the object of research without giving special treatment to the object under study. A total of 26 morphometrical traits were measured from 42 male HB fishes. Results: Research showed that the average body weight of HB fishes was 245.24±136.54 g. Four morphometrical measurements of maximum body height, pre-dorsal length, pre-ventral fin length, and caudal pendulum height were selected as the leading four variables to predict body weight with the coefficient of determination (R2) of 0.95. Therefore, a variable of maximum body height can predict the body weight with an R2 value of 0.91. Conclusion: The body weight of Hampala fish can be accurately predicted with morphometric measurements. The maximum body height can influence the body weight of Hampala fish with the R2 value of 0.91. Overall morphometrical measurements of maximum body height, pre-dorsal length, pre-ventral fin length, and caudal peduncle height can describe the body weight of Hampala fish with R2 = 0.95.

Clinical practice of one-lung ventilation in mainland China: a nationwide questionnaire survey

BackgroundLimited information is available regarding the application of lung-protective ventilation strategies during one-lung ventilation (OLV) across mainland China. A nationwide questionnaire survey was conducted to investigate this issue in current clinical practice.MethodsThe survey covered various aspects, including respondent demographics, the establishment and maintenance of OLV, intraoperative monitoring standards, and complications associated with OLV.ResultsFive hundred forty-three valid responses were collected from all provinces in mainland China. Volume control ventilation mode, 4 to 6 mL per kilogram of predictive body weight, pure oxygen inspiration, and a low-level positive end-expiratory pressure ≤ 5 cm H2O were the most popular ventilation parameters. The most common thresholds of intraoperative respiration monitoring were peripheral oxygen saturation (SpO2) of 90–94%, end-tidal CO2 of 45 to 55 mm Hg, and an airway pressure of 30 to 34 cm H2O. Recruitment maneuvers were traditionally performed by 94% of the respondents. Intraoperative hypoxemia and laryngeal injury were experienced by 75% and 51% of the respondents, respectively. The proportions of anesthesiologists who frequently experienced hypoxemia during OLV were 19%, 24%, and 7% for lung, cardiovascular, and esophageal surgeries, respectively. Up to 32% of respondents were reluctant to perform lung-protective ventilation strategies during OLV. Multiple regression analysis revealed that the volume-control ventilation mode and an SpO2 intervention threshold of < 85% were independent risk factors for hypoxemia during OLV in lung and cardiovascular surgeries. In esophageal surgery, working in a tier 2 hospital and using traditional ventilation strategies were independent risk factors for hypoxemia during OLV. Subgroup analysis revealed no significant difference in intraoperative hypoxemia during OLV between respondents who performed lung-protective ventilation strategies and those who did not.ConclusionsLung-protective ventilation strategies during OLV have been widely accepted in mainland China and are strongly recommended for esophageal surgery, particularly in tier 2 hospitals. Implementing volume control ventilation mode and early management of oxygen desaturation might prevent hypoxemia during OLV.

Mechanical power density, spontaneous breathing indexes, and weaning readiness following prolonged mechanical ventilation.

Evidence suggests that mechanical power (MP) normalized to dynamic compliance, which equals power density, may help identify prolonged ventilated patients at risk for spontaneous breathing trial (SBT) failure. This study compared MP density with traditional spontaneous breathing indexes to predict a patient's capacity to sustain a short trial of unassisted breathing. A prospective observational study on 186 prolonged ventilated, tracheotomized patients. We analyzed the first 30-minute SBT upon weaning center admission, comparing MP density with spontaneous breathing indexes (e.g., predicted body weight normalized tidal volume (VT/PBW), rapid shallow breathing index (RSBI), and the integrative weaning index (IWI)) regarding SBT failure prediction, with diagnostic accuracy expressed as the area under the receiver operating characteristic curve (AUROC). SBT failure occurred in 51 out of 186 patients (27%), who demonstrated significantly lower dynamic compliance (median 29 mL/cmH2O [IQR 26-37] vs. 39 mL/cmH2O [33-45]) and higher MP density (5837 cmH2O2/min [4512-7758] vs. 2922 cmH2O2/min [2001-4094]) before SBT, as well as lower spontaneous VT/PBW (5.7 mL*kg-1 [5.0-6.7] vs. 6.6 mL*kg-1 [5.9-7.8]), higher RSBI (73 min-1*L-1 [57-100] vs. 59 min-1*L-1 [45-76]), and lower IWI (40 L2/cmH2O*%*min*10-3 [27-50] vs. 63 L2/cmH2O*%*min*10-3 [46-91]) after 5 min of unassisted breathing. MP density was more accurate at predicting SBT failures (AUROC 0.86 [95%CI 0.80-0.91]) than VT/PBW (0.58 [0.50-0.65]), RSBI (0.54 [0.47-0.61]), or IWI (0.66 [0.58-0.73])). MP density as a readiness criterion was more accurate at predicting weaning trial failures in prolonged ventilated, tracheotomized patients than traditional indexes assessed during unassisted breathing.

Feasibility and safety of ultra-low volume ventilation (≤ 3 ml/kg) combined with extra corporeal carbon dioxide removal (ECCO2R) in acute respiratory failure patients

BackgroundUltra-protective ventilation is the combination of low airway pressures and tidal volume (Vt) combined with extra corporeal carbon dioxide removal (ECCO2R). A recent large study showed no benefit of ultra-protective ventilation compared to standard ventilation in ARDS (Acute Respiratory Distress Syndrome) patients. However, the reduction in Vt failed to achieve the objective of less than or equal to 3 ml/kg predicted body weight (PBW). The main objective of our study was to assess the feasibility of the ultra-low volume ventilation (Vt ≤ 3 ml/kg PBW) facilitated by ECCO2R in acute respiratory failure patients.MethodsRetrospective analysis of a prospective cohort of patients with either high or low blood flow veno-venous ECCO2R devices. A session was defined as a treatment of ECCO2R from the start to the removal of the device (one patient could have one more than one session). Primary endpoint was the proportion of sessions during which a Vt less or equal to 3 ml/kg PBW at 24 h after the start of ECCO2R was successfully achieved for at least 12 h. Secondary endpoints were respiratory variables, rate of adverse events and outcomes.ResultsForty-five ECCO2R sessions were recorded among 41 patients. Ultra-low volume ventilation (tidal volume ≤ 3 ml/kg PBW, success group) was successfully achieved at 24 h in 40.0% sessions (18 out of 45 sessions, confidence interval 25.3–54.6%). At 24 h, tidal volume in the failure group was 4.1 [3.8–4.5] ml/kg PBW compared to 2.1 [1.9–2.5] in the success group (p < 0.001). After multivariate analysis, blood flow rate was significantly associated with success of ultra-low volume ventilation (adjusted OR per 100 ml/min increase 1.51 (95%CI 1.21–1.90, p = 0.0003).ConclusionUltra-low volume ventilation (≤ 3 ml/kg PBW) was feasible in 18 out of 45 sessions. Higher blood flow rates were associated with the success of ultra-low volume ventilation.

Predicting Body Weight from Birth to Old Age in Giant Pandas Using Machine Learning.

The giant panda (Ailuropoda melanoleuca) is one of the animals with the largest body weight differences between its birth and adult stages, where the newborn cub is 0.1% the size of its mother. The rapid growth of panda cubs has been reported previously, but little is known about the growth pattern of their entire lifetime. In this study, we analyzed body weight records from 206 captive giant pandas collected between 2000 and 2022. The dataset comprised 26,340 measurements, including 12,314 records from 98 males and 14,026 from 108 females, with the oldest male and female being 32 and 37 years old, respectively. Utilizing machine learning, we predicted daily body weights throughout the pandas' lifespan, allowing us to establish detailed daily normative body weight ranges from birth to advanced age. This study presents the first comprehensive analysis of lifetime body weight distribution in giant pandas, enhancing our understanding of their developmental biology and informing improved body weight management strategies for captive populations.

Determination of growth potentials of two chicken strains using day old phenotypic markers

This study focused on assessing one day old effect of some phenotypic markers on production traits in Ross broiler chickens (ROBROS) and Southern ecotype breeds of chicken (SEC) as an alternative for genetic markers. The study was conducted at the Akenten Appiah Menka University of Skills Training and Entrepreneurial Development (AAMUSTED) Animal farm unit in Asante Mampong Campus of Ghana from June to December, 2022. One hundred and eighty (180) Ross broiler and 180 Southern ecotype breeds of chicks were used for the research. For each breed, the chicks were put into four groups with 45 chicks in each group. Breast length (BRL), Back length (BL), Circumference of the head (CH) and day-old body weight (DOBW) were taken on the chicks at one day old in group 1, 2, 3, and 4 respectively using a tailor’s tape and a weighing scale. Chicks within each group were classified into three (3) sub groups and considered as treatments (T) 1, 2 and 3. The treatments were described as higher (T1), medium (T2), and lower (T3) ranges based on the values obtained from the measurement and reared under randomised completely block design (RCBD). Data on production traits were taken up to week 8 for the Ross broiler and 18 weeks for the Southern ecotype chicken. The results from ANOVA using Statistix indicated that for the Ross broiler chickens, T1 in all the groups were significantly (P &lt; 0.05) superior over T3 for feed intake, body weight, body weight gain and feed conversion ratio. T2 were significantly better than T3 in terms of body weight. For the Southern ecotype chickens, T1 were significantly (P &lt; 0.05) better than T3 for feed intake, body weight, and body weight gain. However, for feed intake and body weight gain, T2 were significantly (P &lt; 0.05) better than T3. Pearson correlation analysis also indicated a high, strong and significant (P &lt; 0.05) correlation between day-old phenotypic markers with body weight. Regression equations of day-old phenotypic markers with body weight were positive and significant (P &lt; 0.05) with coefficient of determination (R2) ranging from 0.64 to 0.76 for Ross broilers and 0.81 to 0.95 for Southern ecotype chickens. CH and DOBW had the highest R2 values and thus the best predictors of body weight. Breast length, back length, circumference of the head, and day-old body weight taken on the chicks at one day old were effective in predicting final body weight. It was concluded that, the four (4) phenotypic markers could be used for selection purposes efficiently.

THE SCHAFFER FORMULA CAN’T PREDICT LIVEWEIGHT IN BACK BELLY SHEEP

&lt;p&gt;&lt;strong&gt;Background. &lt;/strong&gt;Schaeffer's formula has been promoted as an alternative to animal weighting in recent years. However, no studies evaluating the Schaeffer formula in the Black Belly hair sheep breed have been developed. &lt;strong&gt;Objective. &lt;/strong&gt;To evaluate Schaeffer's formula for predicting body weight in male and female Black Belly sheep reared under tropical conditions. &lt;strong&gt;Methodology.&lt;/strong&gt; Body weight (BW, kg), thoracic circumference (TC, cm) and body length (BL, cm) were recorded in 120 Black Belly lambs (60 females and 60 males). The lambs were clinically healthy and aged between 6 and 8 months. Schaeffer's formula for calculating BW was BW (kg) = (BL × TC&lt;sup&gt;2&lt;/sup&gt;)/10838. First, the distributions of the values were examined by means of a histogram showing both sets of values simultaneously. The medians of each set were then obtained and statistically compared using the Wilcoxon signed-rank test to test the null hypothesis of no difference between the two sets of measurements considered. &lt;strong&gt;Results.&lt;/strong&gt; In the present study it was observed that Shaeffer's formula underestimated BW in Black Belly sheep (P&amp;lt;0.05) at about 5.84 kg. This weight represents about 20.40% of the observed mean BW. The underestimation was also much greater than expected in males at approximately 6.88 kg, this weight represents approximately 22.40% of the observed mean BW in males. However, for females the difference was 4.09 kg. This weight represents approximately 15.40% of the observed mean BW for females. &lt;strong&gt;Implications.&lt;/strong&gt; Caution should be exercised in using the Schaffer formula for estimating liveweight in black belly sheep, or some adjustment to this equation should be evaluated to increase its precision and accuracy for predicting liveweight in hair sheep breeds. &lt;strong&gt;Conclusion.&lt;/strong&gt; Under the conditions in which the present study was carried out, it was concluded that Shaeffer's formula underestimated BW in Black Belly sheep. The estimated BW differed from the observed BW (P&amp;lt;0.05), and this parameter was underestimated much more than expected in males than in females, showing that this formula is not accurate in estimating BW in male and female Black Belly sheep. As a result, estimates should be treated with caution. There is a need to develop improved prediction equations for adequate estimation of BW of male and female Black Belly sheep.&lt;/p&gt;

Predicting the body weight of crossbred Holstein × Zebu dairy cows using multivariate adaptive regression splines algorithm.

This study aimed to estimate live body weight from body measurements for Holstein × Zebu dairy cows (n = 156) reared under conditions of humid tropics in Mexico using multivariate adaptive regression splines algorithm (MARS) with several train-test proportions. The body measurements included withers height, rump height, hip width, heart girth, body length and diagonal body length. The data were divided into 65:35, 70:30 and 80:20 split data for training and testing sets, respectively. The MARS algorithm was used to construct a prediction model, which predicted the body weight from the body measurements of the test dataset. The results emphasized that the MARS algorithm had an explanation rate for 80:20 train and test set of 0.836 and 0.711, respectively, with minimum Akaike information criterion values. This indicates that it is a reliable way of predicting body weight from body measurements. The results suggest that body weight prediction can be performed with the MARS algorithm in a reliable way, therefore, this algorithm may be a useful tool for animal breeders and researchers in the development of feeding and selection-aimed approaches.

Sex related differences in applied tidal volume with flow-controlled ventilation: a subgroup analysis.

Flow-controlled ventilation (FCV) ensures a constant gas flow whereby precise determination of dynamic compliance is feasible. Accordingly, ventilator pressure settings can be adjusted to achieve the highest compliance. This setting will automatically adapt tidal volume to the functionally available lung volume as a personalized approach. This is in contrast to current ventilation settings, where fixed tidal volumes according to predicted body weight (PBW) are recommended. Aim of this subgroup-analysis was to determine whether applied tidal volume differs in male and female patients after compliance guided individualization of ventilation parameters. A sub-group analysis of 24 patients randomized to receive flow-controlled ventilation in cardiac surgery was performed. Linear mixed-effects model was used in order to investigate sex related differences in respiratory parameters. Compliance guided pressure titration led to comparable pressure settings in male (N.=18) and female (N.=6) patients. In contrast, the applied tidal volume was significantly lower in female patients (8.6 vs. 9.9, 95% CI: -2.3 to -0.2 mL/kg PBW; P=0.029) compared to male individuals, due to a significantly lower compliance (49.3 vs. 70.3, 95% CI: -33.1 to -8.8 mL/cmH<inf>2</inf>O; P=0.003). Gas exchange parameters were comparable in either sex. Female patients were found to receive lower tidal volumes after compliance guided individualization compared to men during cardiac surgery. This finding may indicate that the functionally available lung volume in women is lower and thus using PBW may not adequately comply with sex related differences, which supports the use of a personalized ventilation strategy.

From Avatars to Agents: Self-Related Cues Through Embodiment and Personalization Affect Body Perception in Virtual Reality.

Our work investigates the influence of self-related cues in the design of virtual humans on body perception in virtual reality. In a $2\times 2$ mixed design, 64 participants faced photorealistic virtual humans either as a motion-synchronized embodied avatar or as an autonomous moving agent, appearing subsequently with a personalized and generic texture. Our results unveil that self-related cues through embodiment and personalization yield an individual and complemented increase in participants' sense of embodiment and self-identification towards the virtual human. Different body weight modification and estimation tasks further showed an impact of both factors on participants' body weight perception. Additional analyses revealed that the participant's body mass index predicted body weight estimations in all conditions and that participants' self-esteem and body shape concerns correlated with different body weight perception results. Hence, we have demonstrated the occurrence of double standards through induced self-related cues in virtual human perception, especially through embodiment.

Using interpretable machine learning methods to identify the relative importance of lifestyle factors for overweight and obesity in adults: pooled evidence from CHNS and NHANES

BackgroundOverweight and obesity pose a huge burden on individuals and society. While the relationship between lifestyle factors and overweight and obesity is well-established, the relative contribution of specific lifestyle factors remains unclear. To address this gap in the literature, this study utilizes interpretable machine learning methods to identify the relative importance of specific lifestyle factors as predictors of overweight and obesity in adults.MethodsData were obtained from 46,057 adults in the China Health and Nutrition Survey (2004–2011) and the National Health and Nutrition Examination Survey (2007–2014). Basic demographic information, self-reported lifestyle factors, including physical activity, macronutrient intake, tobacco and alcohol consumption, and body weight status were collected. Three machine learning models, namely decision tree, random forest, and gradient-boosting decision tree, were employed to predict body weight status from lifestyle factors. The SHapley Additive exPlanation (SHAP) method was used to interpret the prediction results of the best-performing model by determining the contributions of specific lifestyle factors to the development of overweight and obesity in adults.ResultsThe performance of the gradient-boosting decision tree model outperformed the decision tree and random forest models. Analysis based on the SHAP method indicates that sedentary behavior, alcohol consumption, and protein intake were important lifestyle factors predicting the development of overweight and obesity in adults. The amount of alcohol consumption and time spent sedentary were the strongest predictors of overweight and obesity, respectively. Specifically, sedentary behavior exceeding 28–35 h/week, alcohol consumption of more than 7 cups/week, and protein intake exceeding 80 g/day increased the risk of being predicted as overweight and obese.ConclusionPooled evidence from two nationally representative studies suggests that recognizing demographic differences and emphasizing the relative importance of sedentary behavior, alcohol consumption, and protein intake are beneficial for managing body weight status in adults. The specific risk thresholds for lifestyle factors observed in this study can help inform and guide future research and public health actions.

Adherence to Lung Protective Ventilation in ARDS: A Mixed Methods Study Using Real-Time Continuously Monitored Ventilation Data.

Lung-protective ventilation is a standard intervention for mitigating ventilator-induced lung injury in patients with ARDS. Despite its efficacy, adherence to contemporary evidence-based guidelines remains suboptimal. We aimed to identify factors that affect the adherence of staff to applying lung-protective ventilation guidelines by analyzing real-time, continuously monitored ventilation data over a 5-year longitudinal period. We conducted retrospective cohort and qualitative studies. Subjects with billing code J80 who survived at least 48 h of continuous mandatory ventilation with volume control in critical care settings between January 1, 2018, and December 31, 2022, were eligible. Tidal volume was measured dynamically (1-min resolution) and averaged hourly. The lung-protective ventilation setting studied was ≤ 6 mL/kg predicted body weight. A subgroup analysis was conducted by considering COVID-19 status. Focus groups of critical-care providers were convened to investigate the possible reasons for the non-utilization of lung-protective ventilation. Among 1,055 subjects, 42.4% were on lung-protective ventilation settings at 48 h. Male sex was correlated with lung-protective ventilation (odds ratio [OR] 1.63, 95% CI 1.08-2.47), whereas age ≥ 60 y was associated with no lung-protective ventilation use (OR 0.61, 95% CI 0.39-0.94] in the subjects with non-COVID-19 etiologies. Improved staff adherence was observed in the subjects with COVID-19 early in the pandemic when COVID-19 (OR 1.48, 95% CI 1.07-2.04), male sex (OR 2.42, 95% CI 1.79-3.29), and neuromuscular blocking agent use within 48 h (OR 1.69, 95% CI 1.25-2.29) were correlated with staff placing subjects on lung-protective ventilation. However, lung-protective ventilation use occurred less frequently by staff managing subjects with cancer (OR 0.59, 95% CI 0.35-0.99) and hypertension (OR 0.62, 95% CI 0.45-0.85). Focus groups supported these findings and highlighted the need for an accurate height measurement on unit admission to determine the appropriate target tidal volume. Staff are not yet universally adherent to lung-protective ventilation best practices. Strategies, for example, continuous monitoring, with frequent feedback to clinical teams may help.

Morphobiometric characterization of donkey resources in Katsina state

This study was conducted to assess the morphological characteristics of the donkey (Equus asinus) population in Katsina State, Nigeria. One hundred and three (103) donkeys (39 female and 64 male), randomly selected, were grouped into three age categories for this study. Data collected included: body weight and ten (10) body measurements. The statistical analysis of variance was applied for estimation the effects of sex and age on the studied parameters. Variance Inflation Factors (VIF), as a multicollinearity diagnostic tool of the independent variables, were incorporated in the regression models. The principal component analysis with a variance maximizing the orthogonal rotation was used to extract the components. The factor analysis identified four (4) principal components (PCs) of morphometric traits which explained about 70.392% of the total variance, with a PC1 accounted for 37.912%. The results showed that the body weight was correlated with HG, PG, BL, RH, SH, EL, TL and NC (ranging from 0.464 to 0.946; p&lt;0.01) and body weight correlated to NL (r = 0.402; p&lt;0.05) and HL (r = 0.375; P&lt;0.05). The best predictors of body weight (BWT) in female and male revealed that the combination of heart girth, body length and rump height featured prominently in the prediction of BWT. Keywords: body weight, donkeys, morphological, prediction, regression

Outcome of Targeted Driving Pressure Mechanical Ventilation in ARDS patients

Background: Lung protective strategy in acute respiratory distress syndrome (ARDS) patients is based on low tidal volume (VT), lower end-inspiratory (plateau) pressure and higher positive end-expiratory pressure (PEEP). But to predict body weight adjusted tidal volume, heterogeneous pathology of the lung in ARDS with different respiratory system compliance (CRS) is not considered. In driving pressure (ΔP=VT / CRS) tidal volume (VT) is normalized to functional lung size. It is unclear whether mechanical ventilation targeting driving pressure (ΔP) is more effective than low tidal volume ventilation (LTVV) in patients with ARDS. Materials and Methods: An open labelled randomized controlled trial was conducted at Intensive Care Unit of Dhaka Medical College Hospital, a tertiary care referral hospital over 12 months from March 2021 to February 2022. Ninety two patients with ARDS, defined by the Berlin criteria, requiring mechanical ventilation were randomized to 1:1 ratio after enrollment in the study using simple random sampling, one group receiving targeted driving pressure (ΔP) that is &lt;/=14cm of H2O ventilation another group receiving low tidal volume ventilation (LTVV) that is 4-6ml/kg PBW. Results: The study found no significant differences between the two groups in terms of clinical variables and laboratory parameters (p &gt; 0.05), except for the duration of mechanical ventilation (MV), which was significantly shorter in the Targeted ΔP group (p&lt;0.05). Aspiration pneumonia was the most common cause of ARDS, occurring in 34.8% of the Targeted ΔP group and 39.1% of the LTVV group. The Targeted ΔP group demonstrated a significant increase in mean respiratory system compliance compared to the LTVV group (p&lt;0.001), and a significantly shorter length of ICU stay (p &lt;0.001). Additionally, the PaO2/FiO2 ratio was significantly higher in the Targeted ΔP group on Days 3, 5, and 7 (p&lt;0.05). Mean exhaled tidal volume was also significantly higher in the Targeted ΔP group on these days (p&lt;0.05). In the Targeted ΔP group, mean driving pressure significantly decreased on Days 3, 5, and 7 (p &lt;0.001), along with a significant reduction in mean plateau pressure (PPlt) (p &lt;0.001). Mean positive end-expiratory pressure (PEEP) significantly decreased on Days 3, 5, and 7 (p &lt;0.001). Respiratory rate significantly decreased on Day 7 (p &lt;0.05). Mean set tidal volume (VT) significantly increased on Days 3, 5, and 7 (p &lt;0.001). Moreover, the 28-day mortality incidence was significantly lower in the Targeted ΔP group compared to the LTVV group (8.7% vs. 26.1%, p &lt;0.05). Conclusion: Targeted Driving pressure (ΔP) guided ventilation offers significant clinical benefits over LTVV in managing ARDS patients in terms of increased respiratory system compliance (CRS), shorter lengths of hospital and ICU stays, and lower in-hospital mortality. Bangladesh Crit Care J September 2024; 12 (2): 81-88

Effect of Ventilator Mode on Ventilator-Free Days in Critically Ill Adults: A Randomized Trial.

For critically ill adults receiving invasive mechanical ventilation, the ventilator mode determines how breaths are delivered. Whether the choice of ventilator mode affects outcomes for critically ill patients is unknown. To compare the effects of three common ventilator modes (volume control, pressure control, and adaptive pressure control) on death and duration of mechanical ventilation. We conducted a pragmatic, cluster-randomized, crossover trial among adults receiving invasive mechanical ventilation in a medical ICU between November 1, 2022 and July 31, 2023. Each month, patients in the participating unit were assigned to receive volume control, pressure control, or adaptive pressure control during continuous mandatory ventilation. The primary outcome was ventilator-free days through 28 days. Among 566 patients included in the primary analysis, the median number of ventilator-free days was 23 [IQR, 0-26] in the volume control group, 22 [0-26] in the pressure control group, and 24 [0-26] in the adaptive pressure control group (P=0.60). The median tidal volume was similar in the three groups, but the percentage of breaths larger than 8mL/kg of predicted body weight differed between volume control (median, 4.0%; IQR, 0.0-14.1), pressure control (10.6%; 0.0-31.5), and adaptive pressure control (4.7%; 0.0-19.2). Incidences of hypoxemia, acidemia, and barotrauma were similar in the three groups. Among critically ill adults receiving invasive mechanical ventilation, the use of volume control, pressure control, or adaptive pressure control did not affect the number of ventilator-free days, however, confidence intervals included differences that may be clinically meaningful.

Exploring body morphometry and weight prediction in Ganjam goats in India through principal component analysis.

The body conformations of 262 adult Ganjam goats were subjected to principal component analysis (PCA) with 11 morphometric variables. The results were then used to predict the mature body weight of the goats. Most of the traits were positively correlated, and the correlations were statistically significant. The three main components that the PCA recovered explained 76.12% of the variation in body morphometry overall. The first component accounted for approximately 54.74% of the overall variation and described almost all the traits except ear length and tail length, as indicated by high component loadings. The second component accounted for approximately 11.48% of the variation, mostly accounting for the variation in tail length. The principal component accounted for 9.89% and mostly explained the variation in ear length. The communalities ranged between 0.557 (horn length) and 0.848 (chest circumference) for the first three extracted components. The highest percentage of variability in chest girth was explained by the first three principal components, whereas it was the lowest for the horn length. In the context of predicting body weight through stepwise regression analysis, nine primary variables accounted for 57.3% of the total variance in body weight. Conversely, utilizing the first principal component alongside six additional principal components as independent variables resulted in capturing 56.3% of the variation in the adult live weight of goats while maintaining model comparability with other pertinent parameters. PCA was used efficiently for body weight prediction from major morphometric traits of Ganjam goats addressing the multicollinearity issue.

A tidal volume of 7 mL/kg PBW or higher may be safe for COVID-19 patients

PurposeThe novel coronavirus disease (COVID-19) has revived the debate on the optimal tidal volume during acute respiratory distress syndrome (ARDS). Some experts recommend 6 mL/kg of predicted body weight (PBW) for all patients, while others suggest 7–9 mL/kg PBW for those with compliance >50 mL/cmH2O. We investigated whether a tidal volume ≥ 7 ml/kg PBW may be safe in COVID-19 patients, particularly those with compliance >50 mL/cmH2O. Materials and methodsThis secondary analysis of a multicenter study compares the Intensive Care Unit (ICU) mortality among 600 patients ventilated with <7 or ≥ 7 mL/kg PBW. Compliance was categorized as <40, 40–50, or > 50 mL/cmH2O. Results346 patients were ventilated with <7 (6.2 ± 0.5) mL/kg PBW and 254 with ≥7 (7.9 ± 0.9) mL/kg PBW. ICU mortality was 33 % and 29 % in the two groups (p = 0.272). At multivariable regression analysis, tidal volume ≥ 7 mL/kg PBW was associated with lower ICU mortality in the overall population (odds ratio: 0.62 [95 %-confidence interval: 0.40–0.95]) and in each compliance category. ConclusionsA tidal volume ≥ 7 (up to 9) mL/kg PBW was associated with lower ICU mortality in these COVID-19 patients, including those with compliance <40 mL/cmH2O. This finding should be interpreted cautiously due to the retrospective study design.Trial registration: ClinicalTrails.govNCT04388670.

Testing preload responsiveness by the tidal volume challenge assessed by the photoplethysmographic perfusion index

BackgroundTo detect preload responsiveness in patients ventilated with a tidal volume (Vt) at 6 mL/kg of predicted body weight (PBW), the Vt-challenge consists in increasing Vt from 6 to 8 mL/kg PBW and measuring the increase in pulse pressure variation (PPV). However, this requires an arterial catheter. The perfusion index (PI), which reflects the amplitude of the photoplethysmographic signal, may reflect stroke volume and its respiratory variation (pleth variability index, PVI) may estimate PPV. We assessed whether Vt-challenge-induced changes in PI or PVI could be as reliable as changes in PPV for detecting preload responsiveness defined by a PLR-induced increase in cardiac index (CI) ≥ 10%.MethodsIn critically ill patients ventilated with Vt = 6 mL/kg PBW and no spontaneous breathing, haemodynamic (PICCO2 system) and photoplethysmographic (Masimo-SET technique, sensor placed on the finger or the forehead) data were recorded during a Vt-challenge and a PLR test.ResultsAmong 63 screened patients, 21 (33%) were excluded because of an unstable PI signal and/or atrial fibrillation and 42 were included. During the Vt-challenge in the 16 preload responders, CI decreased by 4.8 ± 2.8% (percent change), PPV increased by 4.4 ± 1.9% (absolute change), PIfinger decreased by 14.5 ± 10.7% (percent change), PVIfinger increased by 1.9 ± 2.6% (absolute change), PIforehead decreased by 18.7 ± 10.9 (percent change) and PVIforehead increased by 1.0 ± 2.5 (absolute change). All these changes were larger than in preload non-responders. The area under the ROC curve (AUROC) for detecting preload responsiveness was 0.97 ± 0.02 for the Vt-challenge-induced changes in CI (percent change), 0.95 ± 0.04 for the Vt-challenge-induced changes in PPV (absolute change), 0.98 ± 0.02 for Vt-challenge-induced changes in PIforehead (percent change) and 0.85 ± 0.05 for Vt-challenge-induced changes in PIfinger (percent change) (p = 0.04 vs. PIforehead). The AUROC for the Vt-challenge-induced changes in PVIforehead and PVIfinger was significantly larger than 0.50, but smaller than the AUROC for the Vt-challenge-induced changes in PPV.ConclusionsIn patients under mechanical ventilation with no spontaneous breathing and/or atrial fibrillation, changes in PI detected during Vt-challenge reliably detected preload responsiveness. The reliability was better when PI was measured on the forehead than on the fingertip. Changes in PVI during the Vt-challenge also detected preload responsiveness, but with lower accuracy.