scholarly journals Ultrasonographic Assessment of Extravascular Lung Water in Hospitalized Patients Requiring Hemodialysis: A Prospective Observational Study

2021 ◽  
pp. 1-9
Author(s):  
Jing Miao ◽  
Janina Paula T. Sy-Go ◽  
Meltiady Issa ◽  
Hussam Jenad ◽  
Sandhya Manohar ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Extravascular Lung Water ◽  
Univariate Analysis ◽  
Vena Cava ◽  
Hospitalized Patients ◽  
Smoking History ◽  
Maximum Diameter ◽  
Lung Water ◽  
Full Cohort ◽  
Deming Regression

<b><i>Introduction:</i></b> Sonographic technologies can estimate extravascular lung water (EVLW) in hemodialysis (HD) patients. This study investigated the suitability of a handheld scanner in contrast to a portable scanner for quantifying EVLW in hospitalized patients requiring HD. <b><i>Methods:</i></b> In this prospective study, 54 hospitalized HD patients were enrolled. Bedside lung ultrasound was performed within 30 min before and after dialysis using handheld (phased array transducer, 1.7–3.8 MHz) and portable (curved probe, 5–2 MHz) ultrasound devices. Eight lung zones were scanned for total B-lines number (TBLN). The maximum diameter of inferior vena cava (IVC) was measured. We performed Passing-Bablok regression, Deming regression, Bland-Altman, and logistic regression analysis. <b><i>Results:</i></b> The 2 devices did not differ in measuring TBLN and IVC (<i>p</i> &#x3e; 0.05), showing a high correlation (<i>r</i> = 0.92 and <i>r</i> = 0.51, respectively). Passing-Bablok regression had a slope of 1.11 and an intercept of 0 for TBLN, and the slope of Deming regression was 1.02 within the CI bands of 0.94 and 1.11 in the full cohort. TBLN was logarithmically transformed for Bland-Altman analysis, showing a bias of 0.06 (TBLN = 1.2) between devices. The slope and intercept of the Deming regression in IVC measurements were 0.77 and 0.46, respectively; Bland-Altman plot showed a bias of −0.07. Compared with predialysis, TBLN significantly (<i>p</i> &#x3c; 0.001) decreased after dialysis, while IVC was unchanged (<i>p</i> = 0.16). Univariate analysis showed that cardiovascular disease (odds ratio [OR] 8.94 [2.13–61.96], <i>p</i> = 0.002), smoking history (OR 5.75 [1.8–20.46], <i>p</i> = 0.003), and right pleural effusion (OR 5.0 [1.2–25.99], <i>p</i> = 0.03) were strong predictors of EVLW indicated by TBLN ≥ 4. <b><i>Conclusion:</i></b> The lung and IVC findings obtained from handheld and portable ultrasound scanners are comparable and concordant. Cardiovascular disease and smoking history were strong predictors of EVLW. The use of TBLN to assess EVLW in hospitalized HD patients is feasible. Further studies are needed to determine if TBLN can help guide volume removal in HD patients.

scholarly journals COVID-19 ARDS is characterized by higher extravascular lung water than non-COVID-19 ARDS: the PiCCOVID study

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Rui Shi ◽  
Christopher Lai ◽  
Jean-Louis Teboul ◽  
Martin Dres ◽  
Francesca Moretto ◽  
...  
Keyword(s):  
Extravascular Lung Water ◽  
Transpulmonary Thermodilution ◽  
Diffuse Alveolar Damage ◽  
Lung Mechanics ◽  
Arterial Oxygen ◽  
Prone Positioning ◽  
University Hospitals ◽  
Lung Water ◽  
Pulmonary Vascular Permeability ◽  
Water Index

Abstract Background In acute respiratory distress syndrome (ARDS), extravascular lung water index (EVLWi) and pulmonary vascular permeability index (PVPI) measured by transpulmonary thermodilution reflect the degree of lung injury. Whether EVLWi and PVPI are different between non-COVID-19 ARDS and the ARDS due to COVID-19 has never been reported. We aimed at comparing EVLWi, PVPI, respiratory mechanics and hemodynamics in patients with COVID-19 ARDS vs. ARDS of other origin. Methods Between March and October 2020, in an observational study conducted in intensive care units from three university hospitals, 60 patients with COVID-19-related ARDS monitored by transpulmonary thermodilution were compared to the 60 consecutive non-COVID-19 ARDS admitted immediately before the COVID-19 outbreak between December 2018 and February 2020. Results Driving pressure was similar between patients with COVID-19 and non-COVID-19 ARDS, at baseline as well as during the study period. Compared to patients without COVID-19, those with COVID-19 exhibited higher EVLWi, both at the baseline (17 (14–21) vs. 15 (11–19) mL/kg, respectively, p = 0.03) and at the time of its maximal value (24 (18–27) vs. 21 (15–24) mL/kg, respectively, p = 0.01). Similar results were observed for PVPI. In COVID-19 patients, the worst ratio between arterial oxygen partial pressure over oxygen inspired fraction was lower (81 (70–109) vs. 100 (80–124) mmHg, respectively, p = 0.02) and prone positioning and extracorporeal membrane oxygenation (ECMO) were more frequently used than in patients without COVID-19. COVID-19 patients had lower maximal lactate level and maximal norepinephrine dose than patients without COVID-19. Day-60 mortality was similar between groups (57% vs. 65%, respectively, p = 0.45). The maximal value of EVLWi and PVPI remained independently associated with outcome in the whole cohort. Conclusion Compared to ARDS patients without COVID-19, patients with COVID-19 had similar lung mechanics, but higher EVLWi and PVPI values from the beginning of the disease. This was associated with worse oxygenation and with more requirement of prone positioning and ECMO. This is compatible with the specific lung inflammation and severe diffuse alveolar damage related to COVID-19. By contrast, patients with COVID-19 had fewer hemodynamic derangement. Eventually, mortality was similar between groups. Trial registration number and date of registration ClinicalTrials.gov (NCT04337983). Registered 30 March 2020—Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04337983.

scholarly journals Direct Versus Calculated LDL Cholesterol and C-Reactive Protein in Cardiovascular Disease Risk Assessment in the Framingham Offspring Study

2019 ◽  
Vol 65 (9) ◽  
pp. 1102-1114 ◽  
Author(s):  
Hiroaki Ikezaki ◽  
Virginia A Fisher ◽  
Elise Lim ◽  
Masumi Ai ◽  
Ching-Ti Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Ldl Cholesterol ◽  
Disease Risk ◽  
Univariate Analysis ◽  
Significant Risk ◽  
C Reactive Protein ◽  
Cox Regression Analysis ◽  
Reactive Protein ◽  
Standard Risk

AbstractBACKGROUNDIncreases in circulating LDL cholesterol (LDL-C) and high-sensitivity C-reactive protein (hsCRP) concentrations are significant risk factors for cardiovascular disease (CVD). We assessed direct LDL-C and hsCRP concentrations compared to standard risk factors in the Framingham Offspring Study.METHODSWe used stored frozen plasma samples (−80 °C) obtained after an overnight fast from 3147 male and female participants (mean age, 58 years) free of CVD at cycle 6 of the Framingham Offspring Study. Overall, 677 participants (21.5%) had a CVD end point over a median of 16.0 years of follow-up. Total cholesterol (TC), triglyceride (TG), HDL cholesterol (HDL-C), direct LDL-C (Denka Seiken and Kyowa Medex methods), and hsCRP (Dade Behring method) concentrations were measured by automated analysis. LDL-C was also calculated by both the Friedewald and Martin methods.RESULTSConsidering all CVD outcomes on univariate analysis, significant factors included standard risk factors (age, hypertension, HDL-C, hypertension treatment, sex, diabetes, smoking, and TC concentration) and nonstandard risk factors (non-HDL-C, direct LDL-C and calculated LDL-C, TG, and hsCRP concentrations). On multivariate analysis, only the Denka Seiken direct LDL-C and the Dade Behring hsCRP were still significant on Cox regression analysis and improved the net risk reclassification index, but with modest effects. Discordance analysis confirmed the benefit of the Denka Seiken direct LDL-C method for prospective hard CVD endpoints (new-onset myocardial infarction, stroke, and/or CVD death).CONCLUSIONSOur data indicate that the Denka Seiken direct LDL-C and Dade Behring hsCRP measurements add significant, but modest, information about CVD risk, compared to standard risk factors and/or calculated LDL-C.

scholarly journals Effect of the leukotriene receptor antagonist ONO-1078 on extravascular lung water after coronary ligation in dogs.

1993 ◽  
Vol 57 (2) ◽  
pp. 161-166 ◽  
Author(s):  
HIROYA TANIGUCHI ◽  
YASUO TAKAYAMA ◽  
TOSHIJI IWASAKA ◽  
TERUHIRO TAMURA ◽  
HIROFUMI TAKASHIMA ◽  
...  
Keyword(s):  
Receptor Antagonist ◽  
Extravascular Lung Water ◽  
Leukotriene Receptor Antagonist ◽  
Lung Water ◽  
Coronary Ligation ◽  
Leukotriene Receptor

scholarly journals Oral Care and Prevention of Pneumonia in Hospitalized Patients With Psychiatric Disorders in Japan

2017 ◽  
Vol 8 ◽  
pp. 117967071772040
Author(s):  
Atsushi Hamuro ◽  
Hideki Kawaguchi ◽  
Kazuaki Yamazoe ◽  
Minoru Honda ◽  
Ryuichi Tanaka
Keyword(s):  
Psychiatric Disorders ◽  
Oral Hygiene ◽  
Psychiatric Symptoms ◽  
Univariate Analysis ◽  
Oral Care ◽  
Multivariate Logistic Regression Analysis ◽  
Hospitalized Patients ◽  
Control Group ◽  
Hygiene Intervention ◽  
Time Point

Purpose: Oral care in hospitalized patients with psychiatric disorders is important. However, some patients with psychiatric disorders cannot undergo oral care because of psychiatric symptoms and cognitive decline. The effect of a standardized oral hygiene intervention on the prevention of pneumonia in hospitalized patients with psychiatric disorders was investigated. Method: Patients were divided into 2 groups: control group (N = 259), patients without standardized intervention who were enrolled on April 2014 as the time point of baseline, and intervention group (N = 263), patients with standardized intervention who were enrolled on April 2015 as the time point of baseline. Two end points were evaluated: (1) pneumonia onset within 1 year after the enrollment and (2) no pneumonia for 1 year after the enrollment. The following parameters were compared between the groups: sex, age, psychiatric disorders, past history of diseases of the respiratory system, hypertension, diabetes, hyperlipidemia, heart impairment, and pneumonia. Results: No statistically significant differences were found between the 2 groups in the distributions of characteristics except pneumonia by univariate analysis. The presence of pneumonia was significantly associated with age and the absence of the standardized oral hygiene intervention by multivariate logistic regression analysis. Conclusions: The standardized oral hygiene intervention appears to be effective for preventing pneumonia in patients with psychiatric disorders.

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