Predicted Body Weight Research Articles

Electric impedance tomography and protective mechanical ventilation in elective robotic-assisted laparoscopy surgery with steep Trendelenburg position: a randomized controlled study

Electrical impedance tomography (EIT) reconstructs functional lung images and evaluates the variations of impedance during the breathing cycle. The aim of this study was to evaluate the effect of protective mechanical ventilation on ventilation distributions recorded by the EIT during elective robotic-assisted laparoscopy surgery with steep Trendelenburg position. This prospective, randomized single center study included patients with healthy lungs undergoing elective robot-assisted laparoscopic urological surgery in general anesthesia. Patients were randomly assigned to either protective lung ventilation or conventional ventilation. In the protective ventilation group, tidal volume (TV) was set at 6 ml/Kg predicted body weight (PBW), with PEEP 6 cmH2O, and recruitment maneuvers (RM) as needed. In the conventional ventilation group, TV was set at 9 ml/Kg PBW, with PEEP 2 cmH2O and RM only as needed. Ventilation distribution was assessed using an EIT device. This study included 40 patients in the functional image analysis. Significant differences were found in ventilation distribution in the region of interest (p < 0.05). Driving pressure was significantly lower in protective ventilation group (p < 0.05). Peak and plateau pressures were not different between the groups while statical significance was found in tidal volume and respiratory rate. EIT may be a valuable tool for monitoring lung function during general anesthesia. During elective robotic-assisted laparoscopy surgery with steep Trendelenburg position, protective mechanical ventilation may have a more homogenous distribution of intraoperative and postoperative ventilation. Larger sample size and long-term evaluation are needed in future studies to assess the benefit of EIT monitoring in operation room.Clinical trial registration ClinicalTrials.gov Identifier: NCT04194177 registered at 11th December 2019.

Ventilation and Complications after Lung Resection: Reply.

We thank Dr. Hoftman and Dr. Umar for their comments1 and their interest in our focused review.2 In their letter to the editor, they refer to their interesting work on the utility of vital capacity to estimate tidal volume in contrast to the widely used predicted body weight in patients undergoing thoracic surgery. Their work did not report on clinical outcomes.3 As these authors acknowledge, their data were derived from a small retrospective dataset, and their results are exploratory. Large clinical trials should be conducted before revising clinical care pathways.1,3 In the continuously enhanced world of personalized medicine, dogma most certainly should be challenged. Our review presented clinical outcome data that showed conflicting results on the association of not only tidal volume but also other parameters of protective lung ventilation bundles and morbidity in patients undergoing lung resection. We stressed the importance of proven risk factors for postoperative pulmonary complications after lung resection, such as decrements in forced expiratory volume in 1 s or diffusion capacity of the lung for carbon monoxide and greater fluid administration during surgery, to be considered when interpreting observational data or in the design of future studies.The expert in mechanical ventilation will stylize many factors including the inspiratory pressures and time, positive end-expiratory pressure, lung compliance, and respiratory rate to optimize breath delivery, which can change hour by hour during surgery. Promoting novices to experts certainly depends on education and experience. Algorithms and consultations with experts can improve critical care delivery. Designing ventilators with machine learning computers could potentially further personalize care.The authors declare no competing interests.

Effects of Individualised High Positive End-Expiratory Pressure and Crystalloid Administration on Postoperative Pulmonary Function in Patients Undergoing Robotic-Assisted Radical Prostatectomy: A Prospective Randomised Single-Blinded Pilot Study

Robotic-assisted laparoscopic prostatectomy (RALP) is typically conducted in steep Trendelenburg position (STP). The aim of the study was to evaluate whether crystalloid administration and individual management of positive end-expiratory pressure (PEEP) improve peri- and post-operative pulmonary function in patients undergoing RALP. Prospective randomised single-centre single-blinded explorative study. Patients were either allocated to a standard PEEP (5 cmH2O) group or an individualised high PEEP group. Furthermore, each group was divided into a liberal and a restrictive crystalloid group (8 vs. 4 mL/kg/h predicted body weight). Individualised PEEP levels were determined by means of preoperative recruitment manoeuvre and PEEP titration in STP. Informed consent was obtained from 98 patients scheduled for elective RALP. The following intraoperative parameters were analysed in each of the four study groups: ventilation setting (peak inspiratory pressure [PIP], plateau pressure, driving pressure [Pdriv], lung compliance [LC] and mechanical power [MP]) and postoperative pulmonary function (bed-side spirometry). The spirometric parameters Tiffeneau index (FEV1/FVC ratio) and mean forced expiratory flow (FEF25-75) were measured pre- and post-operatively. Data are shown as mean ± standard deviation (SD), and groups were compared with ANOVA. A p-value of <0.05 was considered significant. The two individualised high PEEP groups (mean PEEP 15.5 [±1.71 cmH2O]) showed intraoperative significantly higher PIP, plateau pressure and MP levels but significantly decreased Pdriv and increased LC. On the first and second postoperative day, patients with individualised high PEEP levels had a significantly higher mean Tiffeneau index and FEF25-75. Perioperative oxygenation and ventilation and postoperative spirometric parameters were not influenced by restrictive or liberal crystalloid infusion in either of the two respective PEEP groups. Individualised high PEEP levels (≥14 cmH2O) during RALP improved intraoperative blood oxygenation and resulted in more lung-protective ventilation. Furthermore, postoperative pulmonary function was improved for up to 48 h after surgery in the sum of the two individualised high PEEP groups. Restrictive crystalloid infusion during RALP seemed to have no effect on peri- and post-operative oxygenation and pulmonary function.

Challenges in ARDS Definition, Management, and Identification of Effective Personalized Therapies.

Over the last decade, the management of acute respiratory distress syndrome (ARDS) has made considerable progress both regarding supportive and pharmacologic therapies. Lung protective mechanical ventilation is the cornerstone of ARDS management. Current recommendations on mechanical ventilation in ARDS include the use of low tidal volume (VT) 4-6 mL/kg of predicted body weight, plateau pressure (PPLAT) < 30 cmH2O, and driving pressure (∆P) < 14 cmH2O. Moreover, positive end-expiratory pressure should be individualized. Recently, variables such as mechanical power and transpulmonary pressure seem promising for limiting ventilator-induced lung injury and optimizing ventilator settings. Rescue therapies such as recruitment maneuvers, vasodilators, prone positioning, extracorporeal membrane oxygenation, and extracorporeal carbon dioxide removal have been considered for patients with severe ARDS. Regarding pharmacotherapies, despite more than 50 years of research, no effective treatment has yet been found. However, the identification of ARDS sub-phenotypes has revealed that some pharmacologic therapies that have failed to provide benefits when considering all patients with ARDS can show beneficial effects when these patients were stratified into specific sub-populations; for example, those with hyperinflammation/hypoinflammation. The aim of this narrative review is to provide an overview on current advances in the management of ARDS from mechanical ventilation to pharmacological treatments, including personalized therapy.

Accurate estimation of body weight of pigs through smartphone image measurement app

The present investigation was carried out to develop a novel, portable and user-friendly method for hands-off measurement of body dimensions and prediction of body weight of the Ghoongroo breed of pigs (aged 30 to 190 days) using a smartphone object measurement app- On 3D CameraMeasure. Prediction of body weight from body dimensions was carried out through various types of regression analyses. This image-based method was compared with the traditional manual measurement method. Almost all the corresponding body dimensions between manual and image-based methods showed a very high and positive correlation (0.842–0.984). The product of body length and heart girth height measured from the images was identified as the best predictors of body weight. A comparison among stepwise regression and regression on one or two body dimensions showed that linear inclusion of more than one predictor did not increase accuracy. When non-linear regression using the product of two image-morphometric traits (Z=body length x heart girth height) was carried out, the R2 (0.98) value increased significantly. This sex and age-independent equation (Y= -6.335 + 0.024 Z, R2= 0.98) derived from the training dataset from an organized farm accurately predicted the body weights of pigs of an independent test population. The correlation coefficient between the actual body weight and the predicted body weight of pigs from the test population was 0.99. It was concluded that the smartphone image-based method could replace the cumbersome and stressful manual method very effectively. The additional advantages of smartphone image measurements are- robustness, accuracy, simplicity, user-friendliness, and true portability.

Weight Prediction of Landlly Pigs from Morphometric Traits in Different Age Classes Using ANN and Non-Linear Regression Models

The present study was undertaken to identify the best estimator(s) of body weight based on various linear morphometric measures in Landlly pigs using artificial neural network (ANN) and non-linear regression models at three life stages (4th, 6th and 8th week). Twenty-four different linear morphometric measurements were taken on 279 piglets individually at all the stages and their correlations with body weight were elucidated. The traits with high correlation (≥0.8) with body weight were selected at different stages. The selected traits were categorized into 31 different combinations (single, two, three, four and five) and subjected to ANN modelling for determining the best combination of body weight predictors at each stage. The model with highest R2 and lowest MSE was selected as best fit for a particular trait. Results revealed that the combination of heart girth (HG), body length (BL) and paunch girth (PG) was most efficient for predicting body weight of piglets at the 4th week (R2 = 0.8697, MSE = 0.4419). The combination of neck circumference (NCR), height at back (HB), BL and HG effectively predicted body weight at 6 (R2 = 0.8528, MSE = 0.8719) and 8 (R2 = 0.9139, MSE = 1.2713) weeks. The two-trait combination of BL and HG exhibited notably high correlation with body weight at all stages and hence was used to develop a separate ANN model which resulted into better body weight prediction ability (R2 = 0.9131, MSE = 1.004) as compared to age-dependent models. The results of ANN models were comparable to non-linear regression models at all the stages.

Extracorporeal membrane oxygenation for acute respiratory distress syndrome in patients with COVID-19

COVID-19 can lead to acute respiratory distress syndrome (ARDS). In some patients for whom conventional mechanical ventilation is insufficient, venovenous (VV) extracorporeal membrane oxygenation (ECMO) can be life-saving. Retrospective analysis of data from patients with ARDS triggered by COVID-19 who received ECMO therapy between March 2020 and February 2022. Premorbid health condition, course of respiratory distress and respiratory support before, during and after ECMO therapy were registered. Thirty patients received ECMO therapy. Median age was 57 years, median body mass index 28kg/m2, and 23 patients were men. Median duration of lung protective mechanical ventilation with tidal volume 5.8 mL/kg predicted body weight before initiation of ECMO therapy was 8 days. Treatment indication was primarily severe hypoxaemia, frequently combined with hypercapnia. Twenty-three patients developed at least one severe complication while receiving ECMO therapy. Sixteen patients died, 13 during ongoing ECMO therapy. Fourteen were discharged from hospital. Median duration of ECMO and mechanical ventilation was 27 and 37 days, respectively. ECMO therapy for patients with ARDS triggered by COVID-19 can be life-saving, but the treatment is accompanied by severe complications and a high mortality rate.

Prediction of body weight from chest radiographs using deep learning with a convolutional neural network.

Accurate body weights are not necessarily available in routine clinical practice. This study aimed to investigate whether body weight can be predicted from chest radiographs using deep learning. Deep-learning models with a convolutional neural network (CNN) were trained and tested using chest radiographs from 85,849 patients. The CNN models were evaluated by calculating the mean absolute error (MAE) and Spearman's rank correlation coefficient (ρ). The MAEs of the CNN models were 2.63kg and 3.35kg for female and male patients, respectively. The predicted body weight was significantly correlated with the actual body weight (ρ = 0.917, p < 0.001 for females; ρ = 0.915, p < 0.001 for males). The body weight was predicted using chest radiographs by applying deep learning. Our method is potentially useful for radiation dose management, determination of the contrast medium dose, and estimation of the specific absorption rate in patients with unknown body weights.

Mechanical ventilation during cardiopulmonary resuscitation: influence of positive end-expiratory pressure and head-torso elevation

BackgroundEfficient ventilation is important during cardiopulmonary resuscitation (CPR). Nevertheless, there is insufficient knowledge on how the patient’s position affects ventilatory parameters during mechanically assisted CPR. We studied ventilatory parameters at different positive end-expiratory pressure (PEEP) levels and when using an inspiratory impedance valve (ITD) during horizontal and head-up CPR (HUP-CPR). MethodsIn this human cadaver experimental study, we measured tidal volume (VT) and pressure during CPR at different randomized PEEP levels (0, 5 or 10 cmH2O) or with an ITD. CPR was performed, in the following order: horizontal (FLAT), at 18° and then at 35° head-thorax elevation. During the inspiratory phase we measured the net tidal volume (VT) adjusted to predicted body weight (VTPBW), reversed airflow (RAF), and maximum and minimum airway pressure (Pmax and Pmin). ResultsUsing ten thawed fresh-frozen cadavers we analyzed the inspiratory phase of 1843 respiratory cycles, 229 without CPR and 1614 with CPR. In a mixed linear model, thoracic position and PEEP significantly impacted VTPBW (p < 0.001 for each), and the insufflation time, thoracic position and PEEP significantly affected the RAF (p < 0.001 for each) and Pmax (p < 0.001). For Pmin, only PEEP was significant (p < 0.001). In subgroup analysis, at 35° VTPBW and Pmax were significantly reduced compared with the flat or 18° position. ConclusionWhen using mechanical ventilation during CPR, it seems that the PEEP level and patient position are important determinants of respiratory parameters. Moreover, tidal volume seems to be lower when the thorax is positioned at 35°.

Predicting the body weight of indigenous goat breeds from morphological measurements using the classification and regression tree (CART) data mining algorithm

Classification and regression tree (CART) is a tree-based data mining algorithm that develops a model to predict an outcome. This study purposed to create a model to predict the body weight (BWT) of Red Sokoto (RS), Sahel (SH), and West African Dwarf (WAD) goats using morphological measurements (such as body length, BL; head girth, HG; head width, HDW; face length, FAL; height at wither, HTW; rump length, RL; shoulder width, SW; rump width, RW; and rump height, RH). In total, 600 goats were used for this study (200 each of RS, SH, and WAD goats). Pearson?s Moment Correlation was used to evaluate the degree of association between BWT and each morphological measurement. Concomitantly, CART analysis was performed to estimate which independent variable (morphological measurements) played a considerable role in the BWT (dependent variable) prediction. In RS and WAD goats, a positive and statistically significant (p &lt; 0.0001) correlation was observed between BWT and each morphological measurement. However, in SH goats, both positive and negative statistically significant correlations were observed between BWT and morphological measurements. The CART analysis indicated that in RS and WAD goats, HG played a considerable role in BWT prediction, while, in SH goats, BL was considered the most critical independent variable in BWT prediction. Therefore, this study suggests that HG can be used as a prognostic index for BWT estimation in Red Sokoto and West African Dwarf, while BL can be used for Sahel goats. The SAS codes used are available via a GitHub repository (https://github.com/Soullevram/CART).

Impact of Education and Socio-Economic Status on Post-Natal Body Weight using Machine Learning Approach

Background: The maternal education and socio-economic status of the mother greatly affect the growth ofthe baby. Nutritional deficiency is the major cause of motor and physiological disorders in children. Hence,predicting body weight could be used to monitor the growth of the babies. Although the prediction ofweights is standardized by World Health Organization (WHO), for babies based on their gender and age;generalizing it for all locations and socio-economic variations is not possibleMethod: Hence, in this paper, an ANN-based predictive approach to establish the relationship betweenthe factors like socioeconomic status, age, and prior weights to predict the baby’s weight using a locallyacquired dataset. This could be helpful for the health workers to properly diagnose the disease a time ahead.Conclusion: The proposed work suggests predicting the baby’s growth rate using Machine Learning (ML)techniques is both an efficient and feasible approach.

AutoFlow® (volume-guaranteed mode) versus volume-controlled ventilation for the laparoscopic surgery with BlockBuster supraglottic airway: A randomized controlled trial

Abstract Background and Aims: Supraglottic airway devices used in laparoscopic surgeries must be efficient to counter the increased peak airway pressure (PAWP) and airway leakage that can occur in laparoscopic surgeries. Hence, the implication of AutoFlow in ventilator strategy is propounded nowadays that facilitates low PAWP and high dynamic compliance to achieve targeted tidal volume and end-tidal carbon dioxide (ETCO2). BlockBuster™ Laryngeal mask furnishing minimum airway leak. The primary objective was to compare PAWP using the two modes of ventilation through the BlockBuster LMA after intubation, pneumoperitoneum, and Trendelenburg position. The secondary objective was to observe hemodynamic vitals. Methodology: In this single-center randomized controlled trial, we recruited 80 American Society of Anesthesiologists grade I and II adult patients undergoing elective laparoscopic surgeries. They were randomized by computer-generated method into two groups: volume-controlled AutoFlow® (VCAF) and volume-controlled (VC) group. Ventilation settings for both groups set to tidal volume 5–6 ml/kg of predicted body weight, positive end-expiratory pressure 5 cm H2O, I: E ratio 1:2, and respiratory rate 12–16/min to maintain targeted ETCO2 of 30–35 cm H2O. Intraabdominal pressure was set to 14 mmHg during pneumoperitoneum and 15° Trendelenburg position. Results: Mann–Whitney U-test for continuous variables and t-test for categorical variables. Data were presented as median (interquartile range). P &lt;0.05 was considered statistically significant. During laparoscopic surgeries with BlockBuster™ PAWP at pneumoperitoneum was (20 cm H2O vs. 27 cm H2O) and Trendelenburg position (19 cm H2O vs. 27 cm H2O) was significant lower with VCAF (AutoFlow® ventilation) than with VC (P &lt; 0.05). Conclusion: PAWP is significantly low in AutoFlow mode as compared to volume control mode with BlockBuster LMA. In addition, LMA BlockBuster provides good sealing pressure.

Linear Models for Predicting Body Weight of Crossbred Chickens

Prediction of body weight with linear body measurements of 531day-old crossbred chickens was determined by stepwise regression analysis for mixed sexes at 4 and 8 weeks and separate sexes at 12, 16 and 20 weeks. Shank length was the best single predictor of body weight in Isa Brown x naked neck (IBxNa) at 4 weeks (coefficient of determination, R2 = 65%) and in feathered x Isa Brown (FxIB) at 8 weeks (R2 = 96%). In males, body weight was best predicted by drumstick length (DL) in IBxNa (R2 = 90%) at 12 weeks and in Isa Brown x frizzle feathered (IBxF) at 16 (R2 = 85%) and 20 (R2 = 81%) weeks. The best single predictors of body weight in females were body length (BL) (R2 = 91%), body girth (BG) (R2 = 90%) and body width (BW) (R2 = 90%) in naked neck x Isa Brown (NaxIB) at 12, 16 and 20 weeks, respectively. The best partial predictors of body weight were BG and wing length at 4 weeks (R2 =97%) and BG, BL and keel length (KL) at 8 weeks (R2 =97%) in IBxF; BW and DL (R2 =76%) in normal feathered x Isa Brown (NxIB) males at 16 weeks and BW and DL (R2 =97%) in NxIB females at 20 weeks. The higher R2 values obtained in the models for females made prediction of their body weight more accurate than that of the males. In general, the R2 of mixed sexes ranged from 50-97% and 62-97% at 4 and 8 weeks and for males and females, it ranged from 50-90% and 57-91%; 51-85% and 53-90%; 49-81% and 51-90% at 12, 16 and 20 weeks, respectively. Body weight was best predicted at 8 weeks, and irrespective of genotype, sex and age, the best predictors in single or partial state were BG, BL, KL, BW and DL.

Comparison of Effects of Volume-Controlled and Pressure-Controlled Ventilation during Laparoscopic Surgeries in Birat Medical College Teaching Hospital

Introduction: The pneumoperitoneum created during laparoscopic surgery has numerous effects on the patient ranging from respiratory to hemodynamics. The two common methods of ventilator are volume control and pressure control. The volume control method has been commonly used during general anesthesia. Pressure control method has been used in intensive care unit for improving the respiratory mechanics.&#x0D; Objective: The study aims to compare the effects of pressure control to volume control ventilation in patients undergoing laparoscopic surgery. The hypothesis of the study is that pressure control method improves the respiratory mechanics by decreasing the peak airway pressure and increasing the lung compliance.&#x0D; Methodology: The total of 100 patients who underwent laparoscopic surgery were undertaken for this study. The 50 in each group (PCV and VCV) were allotted randomly. As per predicted body weight, the tidal volume was adjusted to 8 ml/kg, for both the modes of ventilation, peep 5 mm of Hg with fio2 of 100% and I:E-1:2,. The variations in peak airway pressure, mean airway pressure, lung compliance, SPO2 and hemodynamic parameters were observed at baseline (T1), at pneumoperitoneum (T2), after 10 minutes of pneumoperitonium (T3) and at 20 minutes after pneumoperitonium (T4).&#x0D; Results: The pressure control group on comparison to volume control mode group showed significant decrease in peak airway pressure while increase in mean airway pressure and increase in lung compliance at different points of pneumoperitoneum. However there was no significant change in hemodynamics between the two groups in patient undergoing laparoscopic surgery.&#x0D; Conclusion: We conclude that respiratory mechanics improve when the patient is on pressure control ventilation in compared to volume control method of ventilation. Whereas there is no difference in hemodynamic parameters between the two methods.&#x0D;

Assessment of Equations to Predict Body Weight and Chemical Composition in Growing/Finishing Cattle and Effects of Publication Year, Sex, and Breed Type on the Deviation from Observed Values.

Body weight and chemical composition are important aspects of beef cattle nutrition and management; however, existing equations estimating relationships among empty body and carcass chemical components were developed over 40 years ago using different cattle genetics and production systems. The objective of this analysis was to evaluate existing equations in predicting empty body and carcass chemical composition and determine the effect of sex, breed type, and publication year. A dataset was developed from published literature that contained 388 treatment means from 46 studies published between 1970 and 2020. Two equations relating shrunk body weight (SBW) to empty body weight (EBW), and 8 equations relating EBW and hot carcass weight (HCW) were found in the literature and evaluated using the developed dataset. Three sets of equations relating empty body chemical components, 4 sets of equations relating carcass chemical components, and 2 sets of equations relating carcass with empty body chemical components were found in the literature and evaluated using the dataset. Precision and accuracy of the equations were evaluated by simple linear regression of observed on predicted values, mean bias (MB), and concordance correlation coefficient (CCC). Additionally, the fixed effects of publication year, sex, and breed type on the deviation from observed values were evaluated using a general linear model. Both equations relating SBW to EBW and all equations relating EBW to HCW had high precision, but accuracy varied from -3.22 to -0.11% and -9.35 to -3.73% MB, respectively, and all the equations were affected by sex and breed type with 8 out of the 10 equations affected by publication year. For prediction of empty body chemical composition assuming empty body water is known, the 3 sets of equations varied in precision for protein (0.18 to 0.46), but not for fat (0.88 to 0.96) or ash (0.06 to 0.13) based on CCC, although the precision of prediction of protein and ash were poor. Accuracy of the 3 sets of equations varied for predicting empty body fat, protein, and ash with MB of -19.73 to -3.81, 1.67 to 15.91, and -0.16 to 15.75%, respectively. All 3 sets of equations were affected by publication year and breed type for predicting empty body fat, protein, and ash, and by sex for ash. For prediction of carcass chemical components assuming carcass water is known, the precision was similar among the 4 sets of equations for predicting fat (0.92 to 0.95), protein (0.34 to 0.40), and ash (-0.02 to -0.01) based on CCC, although precision was poor for protein and ash, but accuracy varied for prediction of carcass fat, protein and ash with MB of -11.20 to -2.52, 2.72 to 8.92, and -4.66 to 20.12%, respectively. Publication year and breed type affected the prediction of carcass fat and protein, and publication year, sex, and breed type affected the prediction of carcass ash for all 4 sets of equations. The precision of predicting empty body chemical components assuming carcass chemical components are known was high for water (0.96 and 0.98), fat (0.97 and 0.98), protein (0.97 and 0.97), and ash (0.98 and 0.96) and similar between the 2 sets of equations based on CCC. The accuracy of predicting empty body water (-1.68 and -0.33%), fat (6.38 and 2.70%), protein (0.85 and -0.54%), and ash (-0.65 and -4.54%) was moderate to high, but differed between sets of equations for fat and ash. Publication year influenced the prediction of empty body water for both sets of equations and ash for one of the equations, whereas, breed type influenced the prediction of water, protein, and ash, but not fat for both equations. Overall, existing equations may have major limitations to predicting empty body protein and ash unless carcass protein and ash are known. Additionally, all the equations were affected by some combination of publication year, sex, and breed type for one or more chemical components. Thus, a more robust set of equations should be developed to account for sex, breed type, and more recent cattle genetics and management systems.

Ultra-lung-protective ventilation and biotrauma in severe ARDS patients on veno-venous extracorporeal membrane oxygenation: a randomized controlled study

BackgroundUltra-lung-protective ventilation may be useful during veno-venous extracorporeal membrane oxygenation (vv-ECMO) for severe acute respiratory distress syndrome (ARDS) to minimize ventilator-induced lung injury and to facilitate lung recovery. The objective was to compare pulmonary and systemic biotrauma evaluated by numerous biomarkers of inflammation, epithelial, endothelial injuries, and lung repair according to two ventilator strategies on vv-ECMO.MethodsThis is a prospective randomized controlled study. Patients were randomized to receive during 48 h either ultra-lung-protective ventilation combining very low tidal volume (1–2 mL/kg of predicted body weight), low respiratory rate (5–10 cycles per minute), positive expiratory transpulmonary pressure, and 16 h of prone position or lung-protective-ventilation which followed the ECMO arm of the EOLIA trial (control group).ResultsThe primary outcome was the alveolar concentrations of interleukin-1-beta, interleukin-6, interleukin-8, surfactant protein D, and blood concentrations of serum advanced glycation end products and angiopoietin-2 48 h after randomization. Enrollment was stopped for futility after the inclusion of 39 patients. Tidal volume, respiratory rate, minute ventilation, plateau pressure, and mechanical power were significantly lower in the ultra-lung-protective group. None of the concentrations of the pre-specified biomarkers differed between the two groups 48 h after randomization. However, a trend to higher 60-day mortality was observed in the ultra-lung-protective group compared to the control group (45 vs 17%, p = 0.06).ConclusionsDespite a significant reduction in the mechanical power, ultra-lung-protective ventilation during 48 h did not reduce biotrauma in patients with vv-ECMO-supported ARDS. The impact of this ventilation strategy on clinical outcomes warrants further investigation.Trial registration Clinical trial registered with www.clinicaltrials.gov (NCT03918603). Registered 17 April 2019.

Lung-protective ventilation during Trendelenburg pneumoperitoneum surgery: A randomized clinical trial

Study objectiveTo assess the effects of a protective ventilation strategy during Trendelenburg pneumoperitoneum surgery on postoperative oxygenation. DesignsParallel-group, randomized trial. SettingOperating room of a university hospital, Italy. PatientsMorbidly obese patients undergoing Trendelenburg pneumoperitoneum gynaecological surgery. InterventionsParticipants were randomized to standard (SV: tidal volume = 10 ml/kg of predicted body weight, PEEP = 5 cmH2O) or protective (PV: tidal volume = 6 ml/kg of predicted body weight, PEEP = 10 cmH2O, recruitment maneuvers) ventilation during anesthesia. MeasurementsPrimary outcome was PaO2/FiO2 one hour after extubation. Secondary outcomes included day-1 PaO2/FiO2, day-2 respiratory function and intraoperative respiratory/lung mechanics, assessed through esophageal manometry, end-expiratory lung volume (EELV) measurement and pressure-volume curves. Main resultsSixty patients were analyzed (31 in SV group, 29 in PV group). Median [IqR] tidal volume was 350 ml [300–360] in PV group and 525 [500–575] in SV group. Median PaO2/FiO2 one hour after extubation was 280 mmHg [246–364] in PV group vs. 298 [250–343] in SV group (p = 0.64). Day-1 PaO2/FiO2, day-2 forced vital capacity, FEV-1 and Tiffenau Index were not different between groups (all p > 0.10). Intraoperatively, 59% of patients showed complete airway closure during pneumoperitoneum, without difference between groups: median airway opening pressure was 17 cmH2O. In PV group, airway and transpulmonary driving pressure were lower (12 ± 5 cmH2O vs. 17 ± 7, p < 0.001; 9 ± 4 vs. 13 ± 7, p < 0.001), PaCO2 and respiratory rate were higher (48 ± 8 mmHg vs. 42 ± 12, p < 0.001; 23 ± 5 breaths/min vs. 16 ± 4, p < 0.001). Intraoperative EELV was similar between PV and SV group (1193 ± 258 ml vs. 1207 ± 368, p = 0.80); ratio of tidal volume to EELV was lower in PV group (0.45 ± 0.12 vs. 0.32 ± 0.09, p < 0.001). ConclusionsIn obese patients undergoing Trendelenburg pneumoperitoneum surgery, PV did not improve postoperative oxygenation nor day-2 respiratory function. PV was associated with intraoperative respiratory mechanics indicating less injurious ventilation. The high prevalence of complete airway closure may have affected study results. Trial registrationProspectively registered on http://clinicaltrials.govNCT03157479 on May 17th, 2017.

Effectiveness of Adherence to a Mediterranean Diet in the Management of Overweight Women: The Prospective Interventional Cohort Study

Evidence indicates that unhealthy eating habits constitute multilevel obstacles threatening health and well-being. Studies suggest that consumer choices have turned irremovably towards Western diets. The Mediterranean diet (MD) is considered one of the most effective in preventing and treating overweight and obesity, yet its results and associations are ambiguous. This explanatory research aims to examine the effect of the MD on anthropometric and biochemical variables in 181 females from an Eastern European country. The sample was divided into three distinct clusters based on age (tricenarian, quadragenarian, and quinquagenarian). Anthropometric and biochemical examinations in the three-month MD program plan failed to provide convincing evidence of the benefits of the MD on selected integrands. However, total body fat (FATP) values between groups showed a significant difference (p ≤ 0.032) between groups A and C (p ≤ 0.029), which can be attributed to the age of the cohort (30-39 vs. 50-60 years). Values in groups A and B (p ≤ 0.001) and C and A (p ≤ 0.001) were significant between the cohorts but did not indicate any changes in visceral fat (VFATL) in the individual groups. The presented findings can have implications for further investigation and the development of more comprehensive instruments, incorporating critical add-on constituents that will be appropriate to monitor, evaluate, and predict body weight management in experimentation.

Very Low Driving-Pressure Ventilation in Patients With COVID-19 Acute Respiratory Distress Syndrome on Extracorporeal Membrane Oxygenation: A Physiologic Study

To determine in patients with acute respiratory distress syndrome (ARDS) on venovenous extracorporeal membrane oxygenation (VV ECMO) whether reducing driving pressure (ΔP) would decrease plasma biomarkers of inflammation and lung injury (interleukin-6 [IL-6], IL-8, and the soluble receptor for advanced glycation end-products sRAGE). A single-center prospective physiologic study. At a single university medical center. Adult patients with severe COVID-19 ARDS on VV ECMO. Participants on VV ECMO had the following biomarkers measured: (1) pre-ECMO with low-tidal-volume ventilation (LTVV), (2) post-ECMO with LTVV, (3) during low-driving-pressure ventilation (LDPV), (4) after 2 hours of very low driving-pressure ventilation (V-LDPV, main intervention ΔP=1 cmH2O), and (5) 2 hours after returning to LDPV. Twenty-six participants were enrolled; 21 underwent V-LDPV. There was no significant change in IL-6, IL-8, and sRAGE from LDPV to V-LDPV and from V-LDPV to LDPV. Only participants (9 of 21) with nonspontaneous breaths had significant change (p < 0.001) in their tidal volumes (Vt) (mean ± SD), 1.9 ± 0.5, 0.1 ± 0.2, and 2.0 ± 0.7 mL/kg predicted body weight (PBW). Participants with spontaneous breathing, Vt were unchanged-4.5 ± 3.1, 4.7 ± 3.1, and 5.6 ± 2.9 mL/kg PBW (p=0.481 and p=0.065, respectively). There was no relationship found when accounting for Vt changes and biomarkers. Biomarkers did not significantly change with decreased ΔPs or Vt changes during the first 24 hours post-ECMO. Despite deep sedation, reductions in Vt during V-LDPV were not reliably achieved due to spontaneous breaths. Thus, patients on VV ECMO for ARDS may have higher Vt (ie, transpulmonary pressure) than desired despite low ΔPs or Vt.

Mechanical power is associated with weaning outcome in critically ill mechanically ventilated patients

Several single-center studies have evaluated the predictive performance of mechanical power (MP) on weaning outcomes in prolonged invasive mechanical ventilation (IMV) patients. The relationship between MP and weaning outcomes in all IMV patients has rarely been studied. A retrospective study was conducted on MIMIC-IV patients with IMV for more than 24 h to investigate the correlation between MP and weaning outcome using logistic regression model and subgroup analysis. The discriminative ability of MP, MP normalized to dynamic lung compliance (Cdyn-MP) and MP normalized to predicted body weight (PBW-MP) on weaning outcome were evaluated by analyzing the area under the receiver-operating characteristic (AUROC). Following adjustment for confounding factors, compared with the reference group, the Odds Ratio of weaning failure in the maximum MP, Cdyn-MP, and PBW-MP groups increased to 3.33 [95%CI (2.04–4.53), P < 0.001], 3.58 [95%CI (2.27–5.56), P < 0.001] and 5.15 [95%CI (3.58–7.41), P < 0.001], respectively. The discriminative abilities of Cdyn-MP (AUROC 0.760 [95%CI 0.745–0.776]) and PBW-MP (AUROC 0.761 [95%CI 0.744–0.779]) were higher than MP (AUROC 0.745 [95%CI 0.730–0.761]) (P < 0.05). MP is associated with weaning outcomes in IMV patients and is an independent predictor of the risk of weaning failure. Cdyn-MP and PBW-MP showed higher ability in weaning failure prediction than MP.