scholarly journals Correlation Analysis between Mechanical Power and Lung Ultrasound Score and Their Evaluation of Severity and Prognosis in ARDS Patients

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Yongpeng Xie ◽  
Suxia Liu ◽  
Zhifang Mou ◽  
Yanli Wang ◽  
Xiaomin Li
Keyword(s):  
Mechanical Ventilation ◽  
Correlation Analysis ◽  
Lung Ultrasound ◽  
Lung Ventilation ◽  
Mechanical Power ◽  
Apache Ii Score ◽  
Survival Group ◽  
Time Points ◽  
Death Group ◽  
Time Point

Background and Objective. During mechanical ventilation, the energy delivered by a ventilator to the respiratory system in one minute is defined as mechanical power (MP). It describes the combined effects of several mechanical factors, including tidal volume, driving pressure, transpulmonary pressure, flow rate, positive end-expiratory pressure, and respiratory rate on lung ventilation. As such, MP may be useful for evaluating the severity and prognosis of acute respiratory distress syndrome (ARDS), as improvements in pulmonary ventilation directly affect a patient’s prognosis. Recent advances in lung ultrasound technology make it possible to evaluate lung ventilation at the bedside. In this study, MP was monitored in ARDS patients, and its correlation with lung ultrasound scores (LUS) was evaluated. Further analysis also explored the value of MP in evaluating the severity and prognosis of ARDS. Methods. A total of 121 patients with moderate to severe ARDS admitted to the intensive care unit (ICU) from June 2017 to April 2020 and treated with invasive mechanical ventilation were sequentially included in this study. Their general information was collected, and MP was recorded at 0 h, 24 h, 48 h, and 72 h after admission to the ICU. Professionally trained researchers performed the LUS assessments. Patients were divided into the death and survival groups according to their 28-day prognosis. The trend of MP and LUS at the four time points was analyzed. A receiver operating characteristic curve (ROC) was used to analyze the predictive value of MP and LUS scores at 0 h and 72 h for the prognosis (28-day mortality rate) of patients with moderate to severe ARDS. Results. 121 patients were included in the analysis, of which 73 were male and 48 were female. When patients entered the ICU, their oxygenation index ( t : 30885, P < 0.01 ), APACHE II score ( t : 2.105, P < 0.05 ), and SOFA score ( t : 4.134, P < 0.001 ) were higher in the death group than the survival group. The death group had significantly higher MP and LUS at each time point (0 h, 24 h, 48 h, and 72 h) compared to the survival group (all P < 0.05 ). There was a significant upward trend over time in the MP and LUS of the death group, contrasting to a significant downward trend in the survival group (all P < 0.05 ). The Pearson correlation analysis showed that MP and LUS were significantly positively correlated at each time point ( r values: 0 h: 0.3027; 24 h: 0.3705; 48 h: 0.3902; 72 h: 0.5916; all P < 0.01 ). The ROC curves showed that MP and LUS at 72 h were of significant value in predicting the prognosis of ARDS patients, with areas under the curve of 0.866 ± 0.032 and 0.839 ± 0.037 , respectively. Conclusion. There was a significant correlation between the MP and LUS of ARDS patients at four time points from 0 to 72 h, which has a clinical value in evaluating severity and prognosis.

scholarly journals Do Serial Lung Ultrasound Scores Predict Prolonged Mechanical Ventilation in Patients With Severe COVID-19? A Single-centre Retrospective Cohort Study

2021 ◽  
Author(s):  
Hayato Taniguchi ◽  
Aimi Ohya ◽  
Hidehiro Yamagata ◽  
Masayuki Iwashita ◽  
Takeru Abe ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Lung Ultrasound ◽  
Prolonged Mechanical Ventilation ◽  
X Rays ◽  
C Reactive Protein ◽  
Time Points ◽  
Reactive Protein ◽  
Bedside Test ◽  
Successful Extubation

Abstract Background: Some patients with severe coronavirus disease (COVID-19) who present with fibrosis on computed tomography (CT) require prolonged mechanical ventilation (PMV). Lung ultrasound (LUS), a rapid, bedside test, has been reported to have findings consistent with those of CT. Thus, this study aimed to assess whether serial LUS scores could predict PMV or successful extubation in severe COVID-19 patients.Methods: LUS was performed for 20 consecutive severe COVID-19 patients at three time points: admission (day 1), after 48 h (day 3), and seventh-day follow-up (day 7). We compared the LUS score with the results of chest X-rays and laboratory tests at three time points. Moreover, we assessed LUS score to determine the inter-rater reliability (IRR) of the results among examiners.Results: While there were no significant differences in mortality in each PMV and successful extubation groups, there were significant differences in LUS scores on day 3 and day 7; XP score on day 7; and P/F ratio on day 7 in the PMV group (p<0.05). There were significant differences in LUS scores on days 3 and 7, C-reactive protein (CRP) levels on day 7, and P/F ratio on day 7 in the successful extubation group (p<0.05). The areas under the curves (AUCs) of LUS score on days 3 and 7, XP score on day 7, and P/F ratio were 0.88, 0.98, 0.77, and 0.80, respectively in the PMV group; and the AUCs of LUS score on days 3 and 7, CRP levels on day 7, and P/F ratio 0.79, 0.90, 0.82, and 0.79, respectively, in the successful extubation group. Variations in serial LUS scores exhibited significant differences between the groups. The serial LUS score on day 7 was higher than that on day 1 in the PMV group but lower in the successful extubation group (p<0.05). However, there was slight IRR agreement in the LUS score changes on days 1 to 7 (κ= 0.15 [95% CI: 0-0.31]). Conclusions: The serial LUS score of severe COVID-19 patients could predicted PMV and successful extubation. To overcome IRR disagreement, the automatic ultrasound judgement, such as deep learning, would be needed.

scholarly journals Value of Neutrophil to Lymphocyte Ratio, Platelet to Lymphocyte Ratio, and Red Blood Cell Distribution Width in Evaluating the Prognosis of Children with Severe Pneumonia

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Xuejiao Qi ◽  
Yihui Dong ◽  
Xiaojie Lin ◽  
Wencheng Xin
Keyword(s):  
Risk Factors ◽  
Severe Pneumonia ◽  
Apache Ii Score ◽  
Cell Distribution ◽  
Platelet To Lymphocyte Ratio ◽  
Survival Group ◽  
Distribution Width ◽  
Lymphocyte Ratio ◽  
Death Group ◽  
Red Blood Cell Distribution

Objective. To investigate the value of neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and red blood cell distribution width (RDW) in evaluating the prognosis of children with severe pneumonia (SP). Methods. A retrospective analysis of the data of 91 children with SP admitted to our hospital from March 2018 to March 2021. According to the survival status after 28 days of treatment, all children were divided into the survival group (n = 59) and the death group (n = 32). The clinical data and laboratory indicators of the patients were recorded. Multivariate logistic regression was used to analyze the risk factors of prognosis, and the ROC curve was used to analyze the predictive value of each index. Results. The Acute Physiology and Chronic Health Evaluation II (APACHE II) score and CURB-65 score of the death group were higher than those of the survival group ( P < 0.05 ). The RDW, NLR, PLR, and high-sensitivity C-reactive protein, procalcitonin blood lactic acid (Lac) of the death group, were higher than those of the survival group, and LYM was lower than the survival group ( P < 0.05 ). Multivariate regression analysis showed that APACHE II score, RDW, NLR, PLR, and Lac were all independent risk factors for poor prognosis in children with SP ( P < 0.05 ). The AUC of NLR, PLR, and RDW for evaluating the prognosis of children with SP were 0.798, 0.781, and 0.777, respectively. The sensitivity was 56.25%, 90.63%, and 56.25%, respectively, and the specificity was 89.83%, 55.93%, and 91.53%, respectively. The AUC of NLR, PLR, and RDW combined to evaluate the prognosis of children with SP was 0.943. When the best cut-off value was 0.8528, the sensitivity was 93.75%, and the specificity was 91.53%. Conclusion. NLR, PLR, and RDW have certain predictive value for the prognosis of children with SP; the combination of the three indicators has a higher value in evaluating the prognosis of children with SP, which can better guide the prognostic treatment.

scholarly journals The Value of Effective Lung Ventilation Area Ratio Based on CT Image Analysis Is a New Index to Predict the Shorter Outcome of Anti-melanoma Differentiation-Associated Protein 5 Positive Dermatomyositis Associated Interstitial Lung Disease: A Single-Center Retrospective Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Changjian Wang ◽  
Jinfeng Du ◽  
Xilong Mei ◽  
Lingchao Guo ◽  
Fangzhao Li ◽  
...  
Keyword(s):  
Image Analysis ◽  
Interstitial Lung Disease ◽  
Lung Disease ◽  
Age Of Onset ◽  
Lung Ventilation ◽  
Early Death ◽  
Survival Group ◽  
Early Survival ◽  
Poor Outcomes ◽  
Death Group

Background: Anti-melanoma differentiation-associated protein 5 (MDA5) positive dermatomyositis (MDA5+DM) patients have poor outcomes due to rapidly progressive interstitial lung disease (ILD). The accurate assessment of lung involvement is an urgent focus of research.Methods: A computer-aided lung interstitial image analysis technology has been developed, and a quantitative indicator named effective lung ventilation area ratio (ELVAR) that calculates the proportion of the area outside the lung interstitium in lung tissue has been established. 55 newly diagnosed MDA5+DM patients and 46 healthy individuals, matched for age and gender, were enrolled in this study. MDA5+DM patients were classified into early death group or early survival group according to their survival state within 3 months after diagnosis. Clinical characteristics, laboratory and immunological test results, lung involvement (including ELVAR value) and treatment were compared between early death group and early survival group to determine an index that can predict prognoses of patients with MDA5+DM.Results: There were significant differences between early death MDA5+DM patients and early survival MDA5+DM patients about 12 indices including age of onset, CRP, ferritin, albumin, and pulmonary involvement including severity of type I respiratory failure at diagnosis, P/F ratio, oxygen supplementation, values of ELVAR, FVC, and DLCO. The results of ROC analysis and correlation analysis showed the value of ELVAR had good diagnostic value and widely correlation with many clinical characteristics. Univariate analysis and Multivariate analysis showed four factors including age of onset, ferritin, value of ELVAR, and oxygen supplementation &gt;4 L/min significantly value for poor prognosis in MDA5+DM patients. A cutoff value of 0.835 about ELVAR had good predictive power for mortality within 3 months in 54.2% of MDA5+DM patients.Conclusion: The value of ELVAR derived from computed tomography image analysis is a new index that can predict poor outcomes in MDA5+DM patients with rapidly progressive interstitial lung disease.

scholarly journals Value of continuous video EEG and EEG responses to thermesthesia stimulation in prognosis evaluation of comatose patients after cardiopulmonary resuscitation

Open Medicine ◽  
2018 ◽  
Vol 13 (1) ◽  
pp. 35-40 ◽  
Author(s):  
Qiu Jianmin ◽  
You Xueliang ◽  
Liu Liqin ◽  
Wu Yongsheng ◽  
He Licang ◽  
...  
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Thermal Stimulus ◽  
Clinical Value ◽  
Survival Group ◽  
Sensitivity Specificity ◽  
Medical University ◽  
Death Group ◽  
Video Eeg

AbstractObjectiveTo investigate the clinical value of video-electroencephalography (VEEG) and thermal stimulus on evaluating the prognosis of comatose patients after cardiopulmonary resuscitation.MethodsTwenty eight comatose patients with cardiopulmonary resuscitation were included in the department of ICU of the First Teaching Hospital of Fujian Medical University from February 2013 to March 2016. Of the included 28 patients, 20 cases died (death group) and 8 cases survived (survival group) after cardiopulmonary resuscitation. The VEEG, Glasgow Coma Scale (GCS) and APACHE II score were recorded and compared between the death and survival group. The prediction value of death for VEEG, GCS and APACHE II were evaluated through sensitivity, specificity and area under the receiver operating characteristic (ROC) curve (AUC).ResultsGCS and APACHEH II score were statistical different between the death and survival group (P<0.05). With the increase of VEEG grading, the mortality rate of patients increased significantly (P<0.05). Predicting value of mortality for GCS, VEEG and APACHEH II were 57.69%, 61.54% and 71.43% respectively without statistical difference (P>0.05). The death prediction sensitivity and specificity for GCS were 67.0% and 85.0%, for APACHEH II were 95.1% and 85.0%, for VEEG were 100.0% and 85.2%. VEEG has the highest sensitivity, Specificity, coincidence rate and Kappa vale compared to GCS, and APACHEH II.ConclusionVideo-electroencephalography is a useful tool for predicting the death risk for patients who received cardiopulmonary resuscitation.

scholarly journals Factors Influencing Prognosis of Patients with Intra-Abdominal Infection and Its Value in Assessing Prognosis

2020 ◽  
Author(s):  
Jianfei Pan ◽  
Quanwei Zhu ◽  
Xiao Wu ◽  
Xiaoqian Zhang ◽  
Jun Xu ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Prognostic Factors ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Spearman Correlation ◽  
Survival Group ◽  
Abdominal Infection ◽  
Intra Abdominal Infection ◽  
Death Group

Abstract Background: To explore the distribution of pathogenic bacteria in patients with intra-abdominal infection, to clarify the independent factors that affect the prognosis of patients with intra-abdominal infection and its evaluation value for prognosis. Methods The pathogens, underlying diseases and related clinical data of patients with intra-abdominal infection from January 2012 to December 2019 in our hospital were retrospectively collected and the APACHE II score was calculated. The patients were divided into survival group and death group according to the prognosis, and the index between the two groups were compared. Spearman correlation analysis was used to evaluate the correlation between each index and prognosis, multivariate Logistic regression analysis was used to screen the independent prognostic factors. Results 282 patients were included in the study, including 183 males and 99 females, aged 56.99 ± 15.34 years. The survival group was 218cases, the death group was 64 cases, the total intra-abdominal infection mortality was 22.70%. There were significant differences between the two groups in age, serum albumin level, APACHE II score, basic cardiovascular disease and diabetes mellitus (P <0.05). Spearman correlation analysis showed that ALB level was negatively correlated with prognosis, age and APACHE II score were positively correlated with prognosis. Logistic regression analysis showed that age, ALB level and APACHE II score were independent prognostic factors. The area under the curve of the age, ALB level, APACHE II score and these three combined to assess the prognosis were 0.624, 0.698, 0.807 and 0.842 respectively. the sensitivity was 56.30%, 57.80%, 79.70% and 89.10% respectively, and the specificity was 69.30%, 75.20%, 68.80% and 65.10%, respectively. The formula of age combined ALB level and APACHE II score was Y= X1-3.6X2+6.5X3 (X1 was the age, X2 was the ALB level and X3 was the APACHE II score), Y was positively correlated with poor prognosis, and the optimal cutoff value was Y = 40.96. Conclusions Age, ALB level and APACHE II score are independent factors which influencing the prognosis of patients with intra-abdominal infection, and the combination of age, ALB level and APACHE II score can better assess the prognosis of patients with intra-abdominal infection.

Lung ultrasound guided pulmonary recruitment during mechanical ventilation in neonates: A case series

2021 ◽  
pp. 1-9
Author(s):  
M. Pierro ◽  
R. Chioma ◽  
E. Ciarmoli ◽  
P. Villani ◽  
E. Storti ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Lung Ultrasound ◽  
Newborn Infants ◽  
Case Series ◽  
Lung Ventilation ◽  
Patient Positioning ◽  
Open Lung ◽  
Titration Phase ◽  
Lung Expansion ◽  
Fraction Of Inspired Oxygen

BACKGROUND: Recently, the first report of lung ultrasound (LUS) guided recruitment during open lung ventilation in neonates has been published. LUS guided recruitment can change the approach to open lung ventilation, which is currently performed without any measure of lung function/lung expansion in the neonatal population. METHODS: We included all the newborn infants that underwent a LUS-guided recruitment maneuver during mechanical ventilation as a rescue attempt for an extremely severe respiratory condition with oxygen saturation/fraction of inspired oxygen (SpO2/FIO2) ratio below 130 or the inability to wean off mechanical ventilation. RESULTS: We report a case series describing 4 LUS guided recruitment maneuvers, underlying crucial aspects of this technique that can improve the effectiveness of the procedure. In particular, we describe a novel pattern (the S-pattern) that allows us to distinguish the recruitable from the unrecruitable lung and guide the pressure titration phase. Additionally, we describe the optimal LUS-guided patient positioning. CONCLUSIONS: We believe that the inclusion of specifications regarding patient positioning and the S-pattern in the LUS-guided protocol may be beneficial for the success of the procedure.

scholarly journals Cytotoxicity assessment of different doses of ozonated water on dental pulp cells

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ferdiye Küçük ◽  
Sibel Yıldırım ◽  
Serap Çetiner
Keyword(s):  
Cell Viability ◽  
Repeated Measures ◽  
Dental Pulp ◽  
Control Group ◽  
Dental Pulp Cells ◽  
Time Points ◽  
Significant Difference ◽  
Pulp Cells ◽  
Time Point ◽  
Ozonated Water

Abstract Background The purpose of this study was to assess the cytotoxicity of various concentrations of ozonated water (OW) on human primary dental pulp cells. Methods Human primary dental pulp cells were isolated from exfoliated primary canine teeth of an 11-year-old patient with good systemic and oral health. Afterwards, cells were divided into 6 experimental groups; four groups of OW in concentrations of 2 mg/L, 4 mg/L, 8 mg/L, and 16 mg/L, untreated control group, and cell culture without cells. Cytotoxicity was evaluated after exposure for 5-min exposure using Mosmann’s Tetrazolium Toxicity (MTT) assay at 0 h and 48 h time points. Data were analyzed using a repeated measures analysis of variance and Post-hoc tests were performed using Bonferroni correction for multiple comparisons. Results All experimental groups showed proliferation at 0 h time point. However, all groups also experienced a decrease in overtime at 48 h time point (p < 0.05). At both time points 2 mg/L OW showed the highest cell viability as well as proliferation. At 0 h time point, the increase in cell viability for all experimental groups was found statistically significant when compared to positive control group (p < 0.05). At 48 h time point, although 8 mg/L and 16 mg/L OW showed statistically significant reduction in compare to 0 h time point, 2 mg/L and 4 mg/L OW groups didn’t experience any statistically significant difference (p < 0.05). Conclusion Considering our findings, due to ozonated water's induced a higher proliferation rate of dental pulp cells, indicating their biocompatibility and a possible adjuvant on irrigating agent in regenerative endodontic procedures.

scholarly journals Levels of physical activity in four domains and affective wellbeing before and during the Covid-19 pandemic

2021 ◽  
Vol 79 (1) ◽  
Author(s):  
Eliane S. Engels ◽  
Michael Mutz ◽  
Yolanda Demetriou ◽  
Anne K. Reimers
Keyword(s):  
Mental Health ◽  
Physical Activity ◽  
Protective Factor ◽  
Total Sample ◽  
Poor Mental Health ◽  
German Population ◽  
Time Points ◽  
Sport And Exercise ◽  
Over Time ◽  
Time Point

Abstract Background Latest studies indicated that the general mental health level is low during the pandemic. Probably, this deterioration of the mental health situation is partly due to declines in physical activity. The aim of this study was to investigate differences in and the association between affective wellbeing and levels of different domains of physical activity at three time points before and during the pandemic. Method We used a nationwide online panel with a trend data design encompassing a total sample of N = 3517, representing the German population (> 14 years). Four different activity domains (sport and exercise, light outdoor activity, housework/gardening, active travel) and affective wellbeing (positive and negative affect) were assessed at three time points before and during the Covid-19 pandemic (October 2019, March 2020, October 2020). Results Multivariate analyses of variance (MANOVA) indicate differences regarding affective wellbeing over the three time points with the lowest values at the second time point. Levels of activity in the four domains differed significantly over time with the strongest decrease for sport and exercise from the first to the second time point. Partial correlations indicated that the relationships between sport and exercise and positive affect were most consistent over time. Conclusions Overall, our findings suggest that physical activity plays a particularly important role in the pandemic period as a protective factor against poor mental health. Especially sports and exercise seem to be supportive and should be encouraged, e.g. by providing additional support in finding adequate outdoor, home-based or digital substitutes.

scholarly journals Serial computed tomography findings of Coronavirus disease 2019 (COVID-19) pneumonia treated with favipiravir and steroid therapy: report of 11 cases

2021 ◽  
Vol 45 (1) ◽  
Author(s):  
Naoki Irizato ◽  
Hiroshi Matsuura ◽  
Atsuya Okada ◽  
Ken Ueda ◽  
Hitoshi Yamamura
Keyword(s):  
Computed Tomography ◽  
Mechanical Ventilation ◽  
Steroid Therapy ◽  
Time Course ◽  
Ground Glass ◽  
Time Points ◽  
Ct Findings ◽  
Mixed Pattern ◽  
Bronchial Dilatation

Abstract Background This study evaluated the time course of computed tomography (CT) findings of patients with COVID-19 pneumonia who required mechanical ventilation and were treated with favipiravir and steroid therapy. Results Eleven patients with severe COVID-19 pneumonia were included. CT findings assessed at the three time points showed that all patients had ground-glass opacities (GGO) and consolidation and mixed pattern at intubation. Consolidation and mixed pattern disappeared in most of the patients whereas GGO persisted in all patients at 1-month follow-up. In addition to GGO, a subpleural line and bronchus distortion and bronchial dilatation were frequent findings. The degree of resolution of GGO varied depending on each patient. The GGO score correlated significantly with the time from symptoms onset to initiation of steroid therapy (ρ = 0.707, p = 0.015). Conclusions At 1-month follow-up after discharge, non-GGO lesions were absorbed almost completely, and GGO were a predominant CT manifestation. Starting steroid therapy earlier after onset of symptoms in severe COVID-19 pneumonia may reduce the extent of GGO at 1-month follow-up.

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