Preoperative Microvascular Dysfunction: A Prospective, Observational Study Expanding Risk Assessment Strategies in Major Thoracic Surgery

2012 ◽  
Vol 94 (1) ◽  
pp. 226-233 ◽  
Author(s):  
Robert Schier ◽  
Jochen Hinkelbein ◽  
Hanke Marcus ◽  
Reza Mehran ◽  
Randa El-Zein ◽  
...  
2020 ◽  
Author(s):  
Thomas Galetin ◽  
Mark Schieren ◽  
Benjamin Marks ◽  
Jerome Defosse ◽  
Erich Stoelben

Summary Background Chest X‑ray (CXR) after thoracic surgery contributes to patient discomfort and costs and is of limited therapeutic value. Lung ultrasound (LU) for pneumothorax may be an alternative to CXR, but diagnostic accuracy data are heterogeneous and biased by insufficient sonographic technique and patient selection. Reported sensitivities range from 0.21 to 1.0. We evaluated the sensitivity of LU on the first day after thoracic surgery under routine conditions. Methods We performed a prospective observational study (trial-ID DRKS00014557). Consecutive patients undergoing lung resection received standardized LU in addition to routine CXR on the first postoperative day. Ultrasound examiner and radiologist were blinded to corresponding X‑ray and ultrasound findings. CXR was used as reference to determine diagnostic test performance of ultrasound. The conformity of sonography- and routine-based therapeutic decisions was evaluated. Results A total of 68 patients were examined. The mean duration of ultrasound was 145 ± 64 s. CXR identified 23 patients with pneumothorax with a mean apex-to-cupola size of 1.5 ± 1.0 cm. Ultrasound detected 18 patients with pneumothorax. The computed sensitivity of LU was 0.48 (95% confidence interval [0.36; 0.60]). Specificity was between 0.81 and 1.0, the negative predictive value 0.76 [0.66; 0.86]. The sensitivity of CXR was 0.56 [0.44; 0.68]. Air leakage via chest tube correlated weakly with CXR (spearman’s rho = 0.26) and moderately with LU (rho = 0.43). The conformity between sonographically based recommendations and the actual therapy based on routine diagnostics was 96%. Conclusions Sensitivity of ultrasound for pneumothorax detection nearly reached CXR and resulted in equally safe patient management. Our data can serve as a pilot study for upcoming larger-scaled controlled trials.


PLoS ONE ◽  
2020 ◽  
Vol 15 (2) ◽  
pp. e0228940 ◽  
Author(s):  
Jilles M. Fermont ◽  
Charlotte E. Bolton ◽  
Marie Fisk ◽  
Divya Mohan ◽  
William Macnee ◽  
...  

BMJ Open ◽  
2013 ◽  
Vol 3 (1) ◽  
pp. e002050 ◽  
Author(s):  
Helge Kasch ◽  
Alice Kongsted ◽  
Erisela Qerama ◽  
Flemming W Bach ◽  
Tom Bendix ◽  
...  

Author(s):  
Charlotte G.G.M. Pauwels ◽  
Agnes W. Boots ◽  
Wouter F. Visser ◽  
Jeroen L.A. Pennings ◽  
Reinskje Talhout ◽  
...  

Human smoking behavior influences exposure to smoke toxicants and is important for risk assessment. In a prospective observational study, the smoking behavior of Marlboro smokers was measured for 36 h. Puff volume, duration, frequency, flow and inter-puff interval were recorded with the portable CReSSmicro™ device, as has often been done by other scientists. However, the use of the CReSSmicro™ device may lead to some registration pitfalls since the method of insertion of the cigarette may influence the data collection. Participants demonstrated consistent individual characteristic puffing behavior over the course of the day, enabling the creation of a personalized puffing profile. These puffing profiles were subsequently used as settings for smoking machine experiments and tar, nicotine and carbon monoxide (TNCO) emissions were generated. The application of human puffing profiles led to TNCO exposures more in the range of Health Canada Intense (HCI)-TNCO emissions than for those of the International Standardization Organization (ISO). Compared to the ISO regime, which applies a low puff volume relative to human smokers, the generation of TNCO may be at least two times higher than when human puffing profiles were applied on the smoking machine. Human smokers showed a higher puffing intensity than HCI and ISO because of higher puffing frequency, which resulted in more puffs per cigarette, than both HCI and ISO.


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