Ventilation Status Research Articles

Influence of a Structural Prior Mask on EIT Image Reconstruction.

Electrical Impedance Tomography (EIT) is a low-cost imaging method with promising results in visualizing ventilation distribution within the lungs. However, in clinical settings, the interpretability of EIT images is often limited by blurred anatomical alignment and reconstruction artifacts. Integrating structural priors into the EIT reconstruction process can enhance the interpretability of EIT images. In this contribution, we introduced a patient-specific structural prior mask into the EIT reconstruction process. Such prior mask ensures that only conductivity changes within the lung regions are reconstructed. With the aim to investigate the influence of the structural prior mask on the EIT images, we conducted numerical simulations in terms of four different ventilation status. EIT images were reconstructed with Gauss-Newton algorithm and discrete cosine transform-based EIT algorithm. We carried out quantitative analysis including the reconstruction error and figures of merit for the evaluation. The results show that the morphological structures of the lungs introduced by the prior mask are preserved in the EIT images, and the reconstruction artefacts are also limited. In conclusion, the incorporation of the structural prior mask enhances the interpretability of EIT images in clinical settings.Clinical relevance-The correct interpretation of an EIT image is crucial for a clinical diagnosis. This research demonstrates that a structural prior mask might have the potential to improve the interpretability of an EIT image, which facilitates the clinicians with a better understanding of EIT results.

A study to assess the effectiveness of Self-instructional Module on knowledge regarding ABG among student nurses in selected college of city

Arterial blood gas analysis is a basic and useful laboratory test for the critical care of patient. ABG is an essential investigation for assessing clinical oxygenation and acid base status in critically ill patient, providing information about ventilation, oxygenation and acid base status, the three closely and interrelated physiological parameters that maintain pH homeostasis. Among student Nurses in selected college of city. An arterial blood Gas (ABG) tests explicitly blood taken from an artery ABG analysis assesses a patient’s partial pressure of oxygen (PaO2) and carbon dioxide (PaCO2). The objectives of study were to assess existing level of knowledge regarding ABG analysis among the students nurses in selected college, Assess the post test knowledge regarding the ABG analysis among the student nurses in selected college, to assess the effectiveness of SIM on ABG analysis among the students nurses in Selected college, to find out the association between post-test levels of knowledge with selected Demographic level. A structured questionnaire to collect the knowledge score was use for data collection and the analysis was done with the help of inferential and descriptive statistics. The data collection was done from 60 samples from basic BSc nursing 3rd year students. The pre test shows 26.67% of the nursing student had poor level of knowledge score, 58.33% had average and 15% had good level of knowledge score. The post test shows 5% nursing student had average level of knowledge score 35% had good and 60% of nursing student have excellent level of knowledge score. The calculated t value is 15.07 are much higher than the tabulated value at 5% level of significance. Hence it is statistically interpreted that the self-instructional module on knowledge regarding ABG analysis among nursing students was effective

Comparison of efficacy of methylprednisolone with dexamethasone in moderate to severe COVD-19 patients in a tertiary care hospital

Background: The aim was to compare efficacy of methylprednisolone with dexamethasone in moderate to severe COVID-19 patients in a tertiary care hospital. Method: A retrospective observational study was conducted by collecting data of moderate to severe COVID-19 patients admitted to covid wards of a tertiary care hospital for a period of six months. Demographic data, information about SpO2 changes, duration of hospitalization, marker status and ventilation status were parameters collected and used to compare between two groups. Results: Total number of patients in this study were 130. Out of which 65 patients who were on Methylprednisolone belonged to group A and 65 patients taking dexamethasone belonged to group B. In group A 56 (86.2%) were males and 9 (13.8%) were females. In group B 51 (78.5%) were males and 14 (21.5%) were females. Mean age in group A was 54.75±14.96 (age range b/w 25-80 years) and in group B was 55.43±15.83 (age range between 23-84 years). Patients in group A showed more presence of comorbidity (44.6%) as compared to group B (32.3%). Mean SpO2 level on day 1 in group A was 86.37±7.58 and in group B was 88.11±4.38. On day of discharge mean SpO2 level was 95.05±1.54 in group A and 94.63±2.09 in group B. Mean length of hospital stay in group A was 9.78±7.38 and in group B was 7.88±4.76. Improvement in marker status for group A was 100% and for group B 95.4%. Ventilation status in both groups showed 100% improvement. Conclusions: Both steroids are effective in management of moderate to severe COVID-19 patients.

Association between input/weight ratio and acute kidney injury in obese critical ill patients: a propensity analysis of multicenter clinical databases.

Rehydration volume may be underestimated in obese critically ill patients, which can lead to acute kidney injury (AKI). This study aimed to investigate the association between input/weight ratio (IWR) and AKI risk in obese critical patients. This retrospective observational study analyzed data from three large open databases. Patients were divided into lean and obese groups and matched 1:1 based on age, sex, APACHE II score, SOFA score, sepsis status, mechanical ventilation status, renal replacement therapy status, and hospital type. The exposure of interest was the mean IWR during the first three ICU admission days. The primary outcome was the incidence of AKI within 28days after ICU admission. Cox regression analysis was used to evaluate the association between IWR and AKI risk. A total of 82,031 eligible patients were included in the study, with 25,427 obese patients matched with 25,427 lean patients. The IWRs were significantly lower in the obese groups in both the unmatched cohort (35.85 ± 19.05 vs. 46.01 ± 30.43ml/kg, p < 0.01) and the matched cohort (36.13 ± 19.16 vs. 47.34 ± 31.13ml/kg, p < 0.01). An increase in IWR was significantly associated with decreased creatinine levels, increased urine output and a lower AKI risk. The interaction terms of IWR and obesity were significantly associated with decreased AKI incidence in both the unmatched cohort (hazard ratio [HR] = 0.97, 95% CI 0.96-0.97, p < 0.01) and the matched cohort (HR = 0.97, 95% CI 0.96-0.97, p < 0.01). Inadequate rehydration of patients with obesity may contribute to an increased risk of AKI in patients with obesity. These results highlight the need for better rehydration management in patients with obesity.

SP28. The Risk Analysis Index Has Superior Frailty Discrimination Than the Modified Frailty Index-5 for Predicting Poor Cranioplasty Outcomes

PURPOSE: Cranioplasty is a common surgical procedure where autologous or synthetic materials are used to repair cranial defects and although considered simple and low-risk, it is surprisingly associated with significant morbidity and mortality. Although increased patient age has been shown to be a predictor of poor postoperative outcomes, no studies have evaluated frailty’s impact on cranioplasty outcomes. This study examined the association between frailty and cranioplasty by comparing effect sizes of the Risk Analysis Index-Administrative (RAI-A), Modified Frailty Index-5 (mFI-5), and increasing patient age on the primary outcome of 30-day mortality and secondary outcomes of non-home discharge rates and postoperative complications, as measured by the Clavien-Dindo (CD) complication classification system: (CD I: surgical site infection, CD II: postoperative bleeding or transfusion(s), CD IIIb: reoperation under general anesthesia, CD IV: sepsis, septic shock, pulmonary embolism, myocardial infraction, ventilator status, 30-day mortality). METHODS: The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) was queried for all patients undergoing cranioplasty between 2012-2020. Data for baseline demographics, comorbidities, operative characteristics, and postoperative outcomes were evaluated. Statistical analysis was performed on IBM SPSS Statistics ver. 28.0 (IBM Co., Armonk, NY, USA). The discriminatory thresholds of RAI-A, mFI-5, and increasing patient age on 30-day mortality were evaluated using receiver operating characteristics (ROC) curve analysis. The area under the curve (AUC) is represented as a C-statistic with a 95% confidence interval (CI). Two distinct multivariable analyses were conducted for RAI-A and mFI-5 to measure the independent relationships between frailty and outcomes. Covariates controlled for included race, BMI, primary procedure, cranial defect size, and material type. Additionally, the mFI-5 model was age-adjusted, allowing for direct comparison of effect sizes between age and frailty. We excluded age from the model for RAI-A to prevent any collinearity, since age contributes to the total RAI-A score. RESULTS: There were 2,864 included study patients with a median age of 57 years (IQR, 44-67), and a higher proportion of patients were female (57.0%), and white (68.5%). The RAI-A demonstrated better predictive ability for 30-day mortality (C-Statistic: 0.741, 95% CI: 0.678-0.804) compared to mFI-5 (C-Statistic: 0.574, 95% CI: 0.489-0.659) and increasing patient age (C-Statistic: 0.671, 95% CI: 0.610-0.732). On multivariable analyses, RAI-A demonstrated superior independent associations with mortality, NHD, CDII, and CDIII when compared to mFI-5 and increasing patient age. (p<0.05). CONCLUSIONS: The RAI-A demonstrated superior discrimination than the mFI-5 and increasing patient age in predicting poor outcomes following cranioplasty. The high rates of operative morbidity (5.0-36.5%) and mortality (0.4-3.2%) after cranioplasty highlight the importance of being able to predict which patients are at increased risk for poor cranioplasty outcomes, so that shared decision making regarding the potential risk and benefits of treatment can occur. Multivariable Analyses for Postoperative Outcomes

Communication functions of adult patients admitted to intensive care: A multicentre, binational point prevalence study

BackgroundPatient communication is profoundly impacted during the intensive care unit (ICU) stay. While the impacts of altered communication are recognised, there is a paucity of data on the prevalence of communication attempts as well as modes utilised by patients and unit practices to manage communication function. ObjectiveThe objectives of this study were to describe the prevalence and characteristics of observed communication attempts (nonverbal, verbal, and use of the staff call bell) in adult ICU patients and report on unit-level practices on communication management. MethodsA prospective, binational, cross-sectional point-prevalence study was conducted across 44 Australia and New Zealand adult ICUs. Data on communication attempts, modes, ICU-level guidelines, training, and resources were collected in June 2019. ResultsAcross 44 ICUs, 470 of 623 (75%) participants, including ventilated and nonventilated patients, were attempting to communicate on the study day. Of those invasively ventilated via an endotracheal tube for the entire study day, 42 of 172 (24%) were attempting to communicate and 39 of 45 (87%) patients with a tracheostomy were attempting to communicate. Across the cohort, the primary mode of communication was verbal communication, with 395 of 470 (84%) patients using speech; of those 371 of 395 (94%) spoke English and 24 of 395 (6%) spoke a language other than English. Participants attempting to communicate on the study day had a shorter length of stay (LOS), a mean difference of 3.8 days (95% confidence interval: 0.2; 5.1) shorter LOS in the ICU than those not attempting to communicate, and a mean difference 7.9 days (95% confidence interval: 3.1; 12.6) shorter LOS in hospital overall. Unit-level practices and supports were collected. Six of 44 (14%) ICUs had a protocol for communication management, training was available in 11 of 44 (25%) ICUs, and communication resources were available in 37 of 44 (84%) ICUs. ConclusionThree-quarters of patients admitted to the ICU were attempting to communicate on the study day, with multiple methods used to support verbal and nonverbal communication regardless of ventilation status. Guidance and training were absent from the majority of ICUs, indicating a need for development and implementation of policies, training, and resources.

Dynamic ventilation certificate for smart universities using artificial intelligence techniques

The issue of room ventilation has recently gained momentum due to the COVID-19 pandemic. Ventilation is in fact of particular relevance in educational environments. Smart University platforms, today widespread, are a good starting point to offer control services of different relevant indicators in universities. This study advances a Ventilation Quality Certificate (VQC) for Smart Universities. The certificate informs the university community of the ventilation status of its buildings and premises. It also supports senior management's decision-making, because it allows assessing preventive measures and actions taken. The VQC algorithm models the adequacy of classroom ventilation according to the number of persons present. The input used is the organisation's existing data relating to CO2 concentration and number of room occupants. AI techniques, specifically Artificial Neural Networks (ANN), were employed to determine the relationship between the different data sources included. A prototype of value-added services was developed for the Smart University platform of the University of Alicante, which allowed to implement the resulting models, together with the VQC. The prototype is currently being replicated in other universities. The case study allowed us to validate the VQC, demonstrating both its usefulness and the advantage of using pre-existing university services and resources.

Study of Correlation of Arterial Blood Gas Measurements with Peripheral Venous Blood Gas Values in Adult Patients Admitted in ICU in Tertiary Care Hospital in Central India – A Cross-Sectional Study

Objectives: Arterial blood gas (ABG) analysis is an essential investigation for assessment of ventilation, oxygenation and acid–base status in critically ill patients. Arterial puncture to obtain arterial blood is more invasive procedure than venous and has more potential complications. The present study was undertaken to find out the correlation between arterial and peripheral venous blood gas (VBG) values for PO2 (Partial pressure of oxygen), PCO2 (Partial pressure of carbon dioxide), pH (Potential of hydrogen) and HCO3 (bicarbonates). Material and Methods: A total of 131 consecutive patients admitted to intensive care unit (ICU) requiring ABG analysis to determine their acid–base status or ventilatory status were included in the study. Arterial and venous blood samples were obtained with a heparinised syringe within &lt;15 min, after performing modified Allen’s test and were analysed using blood gas analysis machine. The mean of pH, pCO2, HCO3, and PO2, values in arterial and venous samples was determined, along with peripheral arterial oxygen saturation (SpO2) of patients. Results: ABG and VBG analysis correlated well for pH, pCO2 and HCO3, as their correlation coefficient (r) were 0.976, 0.992 and 0.984, respectively, whereas PO2 has correlation coefficient of 0.010 which suggests that there was poor correlation in PO2. For each unit increase in pCO2, pH and HCO3 of VBG, all these ABG changes by 0.9831 units, 0.914 units and 0.992 units, respectively. Peripheral O2 saturation (SpO2) correlates well with arterial O2 saturation, however, does not correlate with venous O2 saturation. Conclusion: The results show that VBG analysis can be a substitute for ABG for evaluation of ventilatory function and acid–base imbalance for pH, pCO2 and HCO3 in patients of ICU setup in many clinical contexts.

When breast cancer comes to the ICU: outcomes and prognostic factors

Background Breast cancer is the most prevalent neoplasm in women in North American and European countries. Data about intensive care unit (ICU) requirements and the related outcomes are scarce. Furthermore, long-term outcome after ICU discharge has not been described. Material and methods We conducted a retrospective monocenter study including patients with breast cancer requiring unplanned ICU admission over a 14-year period (2007–2020). Results 177 patients (age = 65[57–75] years) were analyzed. Breast cancer was at a metastatic stage for 122 (68.9%) patients, recently diagnosed in 25 (14.1%) patients or in progression under treatment in 76 (42.9%) patients. Admissions were related to sepsis in 56 (31.6%) patients, to iatrogenic/procedural complication in 19 (10.7%) patients and to specific oncological complications in 47 (26.6%) patients. Seventy-two (40.7%) patients required invasive mechanical ventilation, 57 (32.2%) vasopressors/inotropes, and 26 (14.7%) renal replacement therapy. In-ICU and one-year mortality rates were 20.9% and 57.1%, respectively. Independent factors associated with in-ICU mortality were invasive mechanical ventilation and impaired performance status. One-year mortality in ICU survivors was independently associated with specific complications, triple negative cancer, and impaired performance status. After hospital discharge, most patients (77.4%) were able to continue or initiate antitumoral treatment. Conclusion ICU admission was linked to the underlying malignancy in one-quarter of breast cancer patients. Despite the low in-ICU mortality rate (20.9%) and thereafter continuation of cancer treatment in most survivors (77.4%), one-year mortality reached 57.1%. Impaired performance status prior to the acute complication was a potent predictor of both short-term and long-term outcomes.

MP52-06 CLINICAL AND SOCIODEMOGRAPHIC CHARACTERISTICS OF PATIENTS WITH SPINAL CORD INJURY ARE INDEPENDENTLY ASSOCIATED WITH CHOICE OF BLADDER MANAGEMENT METHOD

You have accessJournal of UrologyCME1 Apr 2023MP52-06 CLINICAL AND SOCIODEMOGRAPHIC CHARACTERISTICS OF PATIENTS WITH SPINAL CORD INJURY ARE INDEPENDENTLY ASSOCIATED WITH CHOICE OF BLADDER MANAGEMENT METHOD Megan Stout, Juan Peng, Yu-Ying Chen, Huacong Wen, Jan Schwab, and Nima Baradaran Megan StoutMegan Stout More articles by this author , Juan PengJuan Peng More articles by this author , Yu-Ying ChenYu-Ying Chen More articles by this author , Huacong WenHuacong Wen More articles by this author , Jan SchwabJan Schwab More articles by this author , and Nima BaradaranNima Baradaran More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003300.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Clinical factors are known to impact choice of bladder management method (BMM) in patients with spinal cord injury (SCI) such as injury level, impairment severity, manual dexterity, as well as patient preference. The primary objective of this study was to evaluate the effect of sociodemographic characteristics of patients in this context. METHODS: From the Spinal Cord Injury Model System adult patients (>18 at time of injury) were screened. Exclusion criteria included death within one year of injury and lack of BMM data. Outcomes of interest included age, gender, race, education, marital status, household income, employment status, health insurance type, injury level, injury etiology, ventilatory status, neurological impairment category (quadriplegic vs paraplegic), composite poverty scale, and American Spine Injury Association (ASIA) impairment scale. Logistic regression models and multivariate analysis was used to determine associations between sociodemographic factors and use of indwelling catheters as primary choice of BMM. RESULTS: A total of 12,708 patients were screened and 9,097 were included. Majority of patients were male (79.4%), white (71.2%), had an average annual income of <$25,000 (33.3%) and public insurance (68.5%). Most were tetraplegic (47.3%) with ASIA score of “A” (complete impairment, 57.5%).The BMM breakdown was those that used indwelling catheters (34.4%) versus those with “other” methods (intermittent catheterization, external catheters, or urinary diversion; 65.6%). On multivariate analysis, after adjusting for disease characteristics, men were significantly more likely to be impacted by sociodemographic factors. In men, white race, non-Hispanic ethnicity, having public insurance, lower income, higher impairment severity, older age at injury and longer injury duration was associated with higher use of indwelling catheters (Figure 1). In females, only age at injury and neurologic impairment were significant. CONCLUSIONS: Sociodemographic variables are significantly associated with the choice of BMM in men with SCI. The reason for the discrepancy between genders is unknown. Further analysis utilizing this database to discern BMM choice between groups could guide future patient counseling and optimization of care. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e704 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Megan Stout More articles by this author Juan Peng More articles by this author Yu-Ying Chen More articles by this author Huacong Wen More articles by this author Jan Schwab More articles by this author Nima Baradaran More articles by this author Expand All Advertisement PDF downloadLoading ...

Impact of ocular care training of nursing staff on the incidence of ocular surface disorder in medical intensive care unit patients.

To assess the knowledge of nursing staff on ocular care in medical intensive care unit (ICU) and to compare the incidence of ocular surface disorders in patients of medical ICU pre- and post-training. Methods: Two hundred patients admitted in medical ICU for more than 24 h underwent a detailed ocular examination along with documentation of ICU stay, ventilation status, and Glasgow coma scale (GCS) scoring. An assessment on ocular care knowledge among the nursing staff of medical ICU was done. They were further given training in the form of audio-visuals and demonstration, and an eye care protocol was given to them. The second phase of the study was carried out in the same manner. A comparison was made between pre-training and post-training incidence of ocular surface disorders among ICU patients. Ventilated patients had more eye discharge. Incidence of eye discharge was more in patients with duration of stay of more than 7 days in ICU. Ocular surface disorders closely correlated with the degree of lagophthalmos. There was significant reduction in ocular morbidity following ocular care training of the nursing staff. Eye care is a very important part of nursing care in sedated and ventilated patients in the ICU. Ophthalmic consultations are routinely needed in ICU subjects who are hospitalized for more than 1 week or if the ICU staff suspects any eye problems.

A prediction model for predicting the risk of acute respiratory distress syndrome in sepsis patients: a retrospective cohort study

BackgroundThe risk of death in sepsis patients with acute respiratory distress syndrome (ARDS) was as high as 20–50%. Few studies focused on the risk identification of ARDS among sepsis patients. This study aimed to develop and validate a nomogram to predict the ARDS risk in sepsis patients based on the Medical Information Mart for Intensive Care IV database.MethodsA total of 16,523 sepsis patients were included and randomly divided into the training and testing sets with a ratio of 7:3 in this retrospective cohort study. The outcomes were defined as the occurrence of ARDS for ICU patients with sepsis. Univariate and multivariate logistic regression analyses were used in the training set to identify the factors that were associated with ARDS risk, which were adopted to establish the nomogram. The receiver operating characteristic and calibration curves were used to assess the predictive performance of nomogram.ResultsTotally 2422 (20.66%) sepsis patients occurred ARDS, with the median follow-up time of 8.47 (5.20, 16.20) days. The results found that body mass index, respiratory rate, urine output, partial pressure of carbon dioxide, blood urea nitrogen, vasopressin, continuous renal replacement therapy, ventilation status, chronic pulmonary disease, malignant cancer, liver disease, septic shock and pancreatitis might be predictors. The area under the curve of developed model were 0.811 (95% CI 0.802–0.820) in the training set and 0.812 (95% CI 0.798–0.826) in the testing set. The calibration curve showed a good concordance between the predicted and observed ARDS among sepsis patients.ConclusionWe developed a model incorporating thirteen clinical features to predict the ARDS risk in patients with sepsis. The model showed a good predictive ability by internal validation.

Exposure to Arterial Hyperoxia During Extracorporeal Membrane Oxygenator Support and Mortality in Patients With Cardiogenic Shock.

Exposure to hyperoxia, a high arterial partial pressure of oxygen (PaO2), may be associated with worse outcomes in patients receiving extracorporeal membrane oxygenator (ECMO) support. We examined hyperoxia in the Extracorporeal Life Support Organization Registry among patients receiving venoarterial ECMO for cardiogenic shock. We included Extracorporeal Life Support Organization Registry patients from 2010 to 2020 who received venoarterial ECMO for cardiogenic shock, excluding extracorporeal CPR. Patients were grouped based on PaO2 after 24 hours of ECMO: normoxia (PaO2 60-150 mmHg), mild hyperoxia (PaO2 151-300 mmHg), and severe hyperoxia (PaO2 >300 mmHg). In-hospital mortality was evaluated using multivariable logistic regression. Among 9959 patients, 3005 (30.2%) patients had mild hyperoxia and 1972 (19.8%) had severe hyperoxia. In-hospital mortality increased across groups: normoxia, 47.8%; mild hyperoxia, 55.6% (adjusted odds ratio, 1.37 [95% CI, 1.23-1.53]; P<0.001); severe hyperoxia, 65.4% (adjusted odds ratio, 2.20 [95% CI, 1.92-2.52]; P<0.001). A higher PaO2 was incrementally associated with increased in-hospital mortality (adjusted odds ratio, 1.14 per 50 mmHg higher [95% CI, 1.12-1.16]; P<0.001). Patients with a higher PaO2 had increased in-hospital mortality in each subgroup and when stratified by ventilator settings, airway pressures, acid-base status, and other clinical variables. In the random forest model, PaO2 was the second strongest predictor of in-hospital mortality, after older age. Exposure to hyperoxia during venoarterial ECMO support for cardiogenic shock is strongly associated with increased in-hospital mortality, independent from hemodynamic and ventilatory status. Until clinical trial data are available, we suggest targeting a normal PaO2 and avoiding hyperoxia in CS patients receiving venoarterial ECMO.

Predicting the severity of COVID-19 patients using the CD24-CSF1R index in whole blood samples

Coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, has become one of the most serious public health crises worldwide. Most infected people are asymptomatic but are still able to spread the virus. People with mild or moderate illnesses are likely to recover without hospitalization, while critically ill patients face a higher risk of organ injury or even death. In this study, we aimed to identify a novel biomarker that can predict the severity of COVID-19 patients. Clinical information and RNA-seq data of leukocytes from whole blood samples with and without a COVID-19 diagnosis (n = 100 and 26, respectively) were retrieved from the National Center for Biotechnology Information Gene Expression Omnibus database. Raw data were processed using the Transcripts Per Million (TPM) method and then transformed using log2 (TPM+1) for normalization. The CD24-CSF1R index was established. Violin plots, Kaplan-Meier curves, ROC curves, and multivariate Cox proportional hazards regression analyses were performed to evaluate the prognostic value of the established index. The CD24-CSF1R index was significantly associated with ICU admission (n = 50 ICU, 50 non-ICU) and ventilatory status (n = 42 ventilation, 58 non-ventilation) with p = 4.186e-11 and p = 1.278e-07, respectively. The ROC curve produced a relatively accurate prediction of ICU admission with an AUC of 0.8524. Additionally, patients with a high index had significantly fewer mechanical ventilation-free days than patients with a low index (p = 6.07e−07). Furthermore, the established index showed a strong prognostic ability for the risk of using a ventilator in the multivariate Cox regression model (p < 0.001). The CD24-CSF1R index was significantly associated with COVID-19 severity. The established index could have potential implications for prognosis, disease severity stratification, and clinical management.

Effect of indoor air quality on the association of long-term exposure to low-level air pollutants with cognition in older adults

BackgroundHow indoor air quality affects the temporal associations of long-term exposure to low-level air pollutants with cognition remains unclear. MethodsThis cohort study (2011–2019) included 517 non-demented older adults at baseline with four repeated cognitive assessments. The time-varying exposure to PM2.5, PM10, NO2, SO2, CO, and O3 was estimated for each participant from 1994 to 2019. Indoor air quality was determined by ventilation status and daily indoor time. Generalized linear mixed models were used to analyze the association of air pollutants, indoor air quality, and cognition adjusting for important covariates. ResultsOver time, per 2.97 μg/m3 (i.e., an interquartile range) increment of PM2.5 was associated with the poor performance of memory (Z score of a cognitive test, βˆ:-0.14), attention (βˆ:-0.13), and executive function (βˆ:-0.20). Similarly, per 2.05 μg/m3 increase in PM2.5-10 was associated with poor global cognition [adjusted odds ratio (aOR): 1.48, βˆ:-0.28], attention (βˆ:-0.07), and verbal fluency (βˆ:-0.09); per 4.94 μg/m3 increase in PM10 was associated with poor global cognition (aOR: 1.78; βˆ:-0.37). In contrast, per 2.74 ppb increase in O3 was associated with better global cognition (βˆ:0.36 to 0.47). These associations became more evident in participants with poor ventilation or short daily indoor time (<12.5 h/day). For global cognition, the exposure to a 10-μg/m3 increment in PM2.5, PM2.5-10, and PM10 corresponded to 1.4, 5.8, and 2.8 years of aging, respectively. ConclusionThis study demonstrated how indoor air quality in areas using clean fuels differentially affected the associations of long-term exposure to low-level air pollutants with cognition. Tightening air quality standards may help prevent dementia.

When to proceed to surgical rib fixation?-A single-institution clinical experience.

Surgical rib fixation for multiple rib fractures and flail chest has become more common in the 2000s with interesting results in selected patients. However, surgical rib fixation lacks a consensus on the delay to surgery and the benefits on postoperative clinical outcomes. Our goal was to determine if delay to surgery can affect postoperative outcomes. We analyzed a retrospective database including all consecutive patients referred for surgical rib fixation. All outcomes were explored according to trauma mechanism, associated lesions, initial ventilatory status, delay to surgery, surgical technique and a specific focus was made towards post-operative care and pulmonary complications. Logistic regressions were performed to evaluate the association between delay to surgery [before 48 hours (early group), 48 hours to 7 days (mid group), more than 7 days (late group)] and pneumonia and failure of extubating. From 2010 to 2020, 159 patients underwent surgical rib fixation. The median hospital length of stay was 18 days (interquartile range, 13-30 days). Pulmonary infections were encountered in 67 patients (42.2%) with about two third of early pneumonia (<5 days). The one-month mortality rate was 1.9%. Delay to surgery was not associated with either pneumonia (P>0.05) or failure of extubating (P>0.05). Surgical rib fixation can be delayed without increasing the risk of pulmonary complications. Stabilizing other clinical situations can be safely prioritized if needed. A global evaluation including characteristics of trauma and lung evaluation must be considered before surgical stabilization of rib fracture.

Efficacy of Phrenic Nerve Block and Suprascapular Nerve Block in Amelioration of Ipsilateral Shoulder Pain after Thoracic Surgery: A Systematic Review and Network Meta-Analysis

Background and Objectives: Ipsilateral shoulder pain (ISP) is a common complication after thoracic surgery. Severe ISP can cause ineffective breathing and impair shoulder mobilization. Both phrenic nerve block (PNB) and suprascapular nerve block (SNB) are anesthetic interventions; however, it remains unclear which intervention is most effective. The purpose of this study was to compare the efficacy and safety of PNB and SNB for the prevention and reduction of the severity of ISP following thoracotomy or video-assisted thoracoscopic surgery. Materials and methods: Studies published in PubMed, Embase, Scopus, Web of Science, Ovid Medline, Google Scholar and the Cochrane Library without language restriction were reviewed from the publication's inception through 30 September 2022. Randomized controlled trials evaluating the comparative efficacy of PNB and SNB on ISP management were selected. A network meta-analysis was applied to estimate pooled risk ratios (RRs) and weighted mean difference (WMD) with 95% confidence intervals (CIs). Results: Of 381 records screened, eight studies were eligible. PNB was shown to significantly lower the risk of ISP during the 24 h period after surgery compared to placebo (RR 0.44, 95% CI 0.34 to 0.58) and SNB (RR 0.43, 95% CI 0.29 to 0.64). PNB significantly reduced the severity of ISP during the 24 h period after thoracic surgery (WMD -1.75, 95% CI -3.47 to -0.04), but these effects of PNB were not statistically significantly different from SNB. When compared to placebo, SNB did not significantly reduce the incidence or severity of ISP during the 24 h period after surgery. Conclusion: This study suggests that PNB ranks first for prevention and reduction of ISP severity during the first 24 h after thoracic surgery. SNB was considered the worst intervention for ISP management. No evidence indicated that PNB was associated with a significant impairment of postoperative ventilatory status.

Is perception reality? Associations among “light” cigarettes and number of cigarettes smoked per day

IntroductionCigarette filter ventilation and light descriptors are associated with lowered perceptions of risk and smoking more cigarettes per day (CPD). This study examined the relationship between usual cigarette ventilation, perception, and CPD. MethodsA crowdsourced sample (N = 995) of individuals who smoke higher-ventilated (=>20% ventilation) or lower-ventilated (=<10% ventilation) cigarettes identified their usual cigarette as “light” or “full flavor”, and reported their average CPD. ResultsWe found: 1) no association between ventilation status and perception of light versus full flavor (AUC=0.58), with the inaccurate perception being more prevalent in younger individuals (p = 0.041) and those who smoke L&M (73%, p < 0.001) and Camel (61%, p = 0.006) brands; and 2) perception, but not ventilation of usual cigarette, was significantly associated with CPD (p = 0.006), with individuals who perceived their cigarettes as light reporting an average of 13% more cigarettes per day (2.6 CPD), compared to those who perceived their cigarette as full flavor. ConclusionsPerceptions of light versus full-flavor, but not ventilation status, predicted CPD. These findings may inform anti-smoking health communication strategies and smoking cessation interventions. ImplicationsTobacco control policies should eradicate the perception of cigarettes as light or full-flavored. Future research investigating the associations between cigarette filter ventilation and smoking behavior should consider the confounding effects that may lie in an individual's perceptions of their cigarettes.

Predictive Machine Learning Algorithms in Anticipating Problems with Airway Management

Machine learning is artificial intelligence (AI) which can predict the output variable with the fed input features. This allows computers to learn from experience without being programmed. The outcome variable in machine learning algorithm may be continuous variable or categorical variable. Supervised machine learning is commonly applied artificial intelligence (AI) in medical field. Decision tree, gradient boost machine (GBM) learning, extreme GBM (XGBM), Support vector machine, K nearest neighbour and multi-layer perceptron are few machine learning algorithms which are being utilised to address the classification and regression problems. Though the incidence of difficult intubation (DI) is rare, occurrence of such event in an unanticipated situation can result in development of arrhythmias due to desaturation and cardiac arrest if not intervened on time. It is preferred to choose the physical parameters that can predict the difficult airway more accurately in clinical scenario and train the algorithm rather than including all the non-specific parameters. Body mass index (BMI) [&gt;30 kg.m-2: anticipated difficult mask ventilation (DMV), direct laryngoscopy (DL) and DI], inter-insicor distance (IID) (&lt;2 cm: anticipated DL), modified Mallampati (MMP) (Grade 1 and 2: Ease of intubation; Grade 3 and 4: anticipated DI), temporomandibular distance (TMD) (&lt;6.5 cm - anticipated DI), restriction of neck extension (if present: anticipated DL and DI), receded mandible (if present: anticipated DL and DI), and poor submandibular space compliance (if present: anticipated DL and DI) parameters which are used to predict DA by clinical assessment, can be used to feed to train the machine learning algorithm. Despite using these sophisticated tools, extubation may fail and patients require reintubation in ICU. It is very challenging to assess the lung compliance in spontaneously breathing patients as compliance will be overestimated due to generation of negative pressure. Cause for which patient has been placed on mechanical ventilation is resolved/resolving, BMI (&gt;30 kg.m-2), intact sensorium (absence of delirium), absence of consolidation, absence of copious secretions, oxygenation status (PaO2/FiO2: &gt;250), ventilation status (paCO2: 30-45 mmHg), measure of work of breathing (respiratory rate, rapid shallow breathing index), heart rate and blood pressure during spontaneous breathing trial (SBT) and diaphragmatic thickness fraction can be used as input features to predict the success of extubation in critically ill patients. With widespread utility of applications in medical fraternity, applications for prediction of difficult airway (or for weaning success) can be programmed which can be accessed by the clinicians to predict DA, thereby all the preparations for managing DA may be done to prevent adverse consequences of unanticipated difficult airway.

Discussion Guide for the van Nieuw Amerongen Article.

Discussion Guide for the van Nieuw Amerongen Article.