Value of extravascular lung water measurement vs portable chest x-ray in the management of pulmonary edema

Background Most infants and children admitted to the pediatricintensive care unit (PICU) have respiratory distress and pulmonarydisease as underlying conditions. Mechanical ventilation may beused to limit morbidity and mortality in children with respiratoryfailure.Objective To assess a correlation between chest x-ray findingsand outcomes of patients with mechanical ventilation.Methods This retrospective study was held in Dr. KariadiHospital, Semarang, Indonesia. Data was collected from themedical records of children admitted to the PICU from Januaryto December 2010, who suffered from respiratory distress andused mechanical ventilation. We compared chest x-ray findings tothe outcomes of patients. Radiological expertise was provided byradiologists on duty at the time. Chi-square and logistic regressiontests were used for statistical analysis.Results There were 63 subjects in our study, consisting of 28 malesand 35 females. Patient outcomes were defined as survived or died,43 subjects ( 68%) and 20 subjects (3 2%), respectively. Chest x-rayfindings revealed the following conditions: bronchopneumonia48% (P=0.298; 95%CI 0.22 to 1.88), pleural effusion 43%(P=0.280; 95%CI 0.539 to 4.837) , pulmonary edema 6%(P=0.622; 95%CI 0.14 to 14.62) and atelectasis 3% (P=0.538;95%CI 0.03 to 7 .62). None of the chest x-ray findings significantlycorrelated to patient outcomes.Conclusion Chest x-ray findings do not correlate to patientoutcomes in pediatric subjects with mechanical ventilation inthe PICU of Dr. Kariadi Hospital, Semarang, Indonesia.

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Abstract P18: Report on the Treatment Process and Impact of Mechanical Thrombectomy Before and After Coronavirus Disease in a Newly Opened Hospital of South Korea

Stroke ◽

10.1161/str.52.suppl_1.p18 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Jin EUN ◽

Hae-Kwan Park

Keyword(s):

Emergency Treatment ◽

Treatment Process ◽

Mechanical Thrombectomy ◽

X Ray ◽

X Ray Imaging ◽

New Process ◽

Before And After ◽

Portable Chest ◽

Chest X Ray ◽

Adequate Management

Introduction: The difficulty neurointernvetionists face in keeping “Time is brain” in the middle of the COVID-19 pandemic are inevitable. Our health system began shutting down entire hospital for two weeks after a transport agent was diagnosed with COVID-19. It took an additional two weeks to establish the process of emergency treatment. We intend to introduce our protocols and report on their progress so far. Post-COVID-19 Protocol (Figure 1) Methods: A total of 52 patients underwent mechanical thrombectomy at Eunpyeong St. Mary’s Hospital before the Covid-19 outbreak. For 18 patients who underwent mechanical thrombectomy through a new process after COVID-19, door-to-image time, door-to-puncture time, and TICI grade were compared. Results: For the treatment of all patients, portable chest x-ray imaging was performed, but the door-to-initial-brain-image time (min) was 15.5 vs. 15 (before COVID-19 vs. after COVID-19) (p=0.265). Door-to-needle-time (min) showed a delay of 9 minutes, from 144.5 to 153.5, but it was not statistically significant (p=0.299). Up to 95.2% of patients before COVID-19 achieved TICI grade 2b or higher, and 100% of patients after COVID-19 have achieved TICI grade 2b or 3. (Table 1) Conclusions: Overall, there was a slight increase in the door-to-needle time, but clear protocols and guidelines for management and collaboration with the clinical workforce have been able to reduce delays and ensure timely and adequate management. When referring to the protocol implemented while preparing for infectious diseases, it will be a reference not only for COVID-19, but also for other diseases that may occur in the future.

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Regional measurements of pulmonary edema by using magnetic resonance imaging

Journal of Applied Physiology ◽

10.1152/jappl.1998.84.6.2143 ◽

1998 ◽

Vol 84 (6) ◽

pp. 2143-2153 ◽

Cited By ~ 20

Author(s):

S. D. Caruthers ◽

C. B. Paschal ◽

N. A. Pou ◽

R. J. Roselli ◽

T. R. Harris

Keyword(s):

Magnetic Resonance Imaging ◽

Oleic Acid ◽

Magnetic Resonance ◽

Pulmonary Edema ◽

Surface Area ◽

Extravascular Lung Water ◽

Three Dimensional ◽

Indicator Dilution ◽

Resonance Imaging ◽

Lung Water

A three-dimensional magnetic resonance imaging (MRI) method to measure pulmonary edema and lung microvascular barrier permeability was developed and compared with conventional methods in nine mongrel dogs. MRIs were obtained covering the entire lungs. Injury was induced by injection of oleic acid (0.021–0.048 ml/kg) into a jugular catheter. Imaging followed for 0.75–2 h. Extravascular lung water and permeability-related parameters were measured from multiple-indicator dilution curves. Edema was measured as magnetic resonance signal-to-noise ratio (SNR). Postinjury wet-to-dry lung weight ratio was 5.30 ± 0.38 ( n = 9). Extravascular lung water increased from 2.03 ± 1.11 to 3.00 ± 1.45 ml/g ( n = 9, P < 0.01). Indicator dilution studies yielded parameters characterizing capillary exchange of urea and butanediol: the product of the square root of equivalent diffusivity of escape from the capillary and capillary surface area ( D 1/2 S) and the capillary permeability-surface area product ( PS). The ratio of D 1/2 Sfor urea to D 1/2 Sfor butanediol increased from 0.583 ± 0.027 to 0.852 ± 0.154 ( n = 9, P < 0.05). Whole lung SNR at baseline, before injury, correlated with D 1/2 Sand PS ratios (both P < 0.02). By using rate of SNR change, the mismatch of transcapillary filtration flow and lymph clearance was estimated to be 0.2–1.8 ml/min. The filtration coefficient was estimated from these values. Results indicate that pulmonary edema formation during oleic acid injury can be imaged regionally and quantified globally, and the results suggest possible regional quantification by using three-dimensional MRI.

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