Low Pressure Low Frequency Jet Ventilation: Techniques, Safety and Complications

2022 ◽  
pp. 000348942110726
Author(s):  
Calvin W. Myint ◽  
Stephanie E. Teng ◽  
Jennifer J. Butler ◽  
Jacline V. Griffeth ◽  
Mark A. Fritz ◽  
...  

Objective: Manual jet ventilation is a specialized oxygenation and ventilation technique that is not available in all facilities due to lack of technical familiarity and fear of complications. The objective is to review our center’s 15 year experience with low pressure low frequency jet ventilation (LPLFJV). Methods: Retrospective review of procedures utilizing LPLFJV from 2005 to 2019 were performed collecting patient demographic, surgery type and complications. Fisher exact test, Chi square, and t-test were used to determine statistical significance. Results: Four hundred fifty-seven patients underwent a total of 891 microlaryngeal surgeries—279 cases for voice disorders, 179 for lesions, and 433 for airway stenosis. The peak jet pressure for all cases did not exceed 20 psi and average peak pressure for the last 100 procedures in this case series was 14.9 ± 4.6 psi. The average lowest oxygen saturation for all cases was 95% ± 0.6%. Brief intubation was required in 154 cases (17%). Surgical duration was significantly longer for cases requiring intubation P < .001. The need for intubation was not associated with smoking or cardiopulmonary disease, but was strongly associated with body mass index (BMI). Intubation rates were 7% for normal weight (BMI < 25, N = 216), 13% for overweight (BMI 25-30, N = 282), 24% for obese (BMI 30-40, N = 342), and 37% for morbidly obese (BMI > 40, N = 52) patients. Three patients developed respiratory distress in the recovery unit and 2 patients required intubation. Conclusion: LPLFJV assisted by intermittent endotracheal intubation is an exceedingly safe and effective intraoperative oxygenation and ventilationmodality for a broad variety of laryngeal procedure.

Author(s):  
Fernando Collado-Mesa ◽  
Monica M Yepes ◽  
Kristopher Arheart

Abstract Objective To explore current practice patterns of reporting and issuing recommendations based on the presence of breast arterial calcifications on mammography and existing knowledge of their prevalence and associated factors. Methods An online anonymous 19-question survey was distributed to 2583 practicing radiologists who were members of the Society of Breast Imaging. Questions covered demographics, breast imaging training, practice type, and knowledge regarding the epidemiology and potential clinical significance of breast arterial calcifications detected on mammograms. Differences between groups were calculated using the chi-square test or Fisher exact test. An α level of 0.05 was used to determine statistical significance. Results Response rate was 22% (364/1662). The median age of respondents was 51 years (range: 29–76) and most were female (248/323, 77%). The most prevalent characteristics among respondents were as follows: 69% (223/323) had completed a breast imaging fellowship, 55% (179/323) were in private practice, 49% (158/323) practiced dedicated breast imaging, and 38% (124/323) had been in practice for more than 20 years. The prevalence of breast arterial calcifications was correctly estimated to be 1%–30% by 39% (125/323) of respondents. Most respondents correctly recognized the growing evidence of an association between breast arterial calcifications and coronary artery disease (275/323, 85%). However, only 15% (48/323) always reported the presence of these calcifications, and of those who report them at any time, only 0.7% (2/274) always issued recommendations. Conclusion There are differences in both knowledge of the epidemiology of breast arterial calcifications and practices around their reporting amongst breast radiologists.


Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Matthew Koch ◽  
Christopher Stapleton ◽  
Ridhima Guniganti ◽  
Gregory J Zipfel ◽  
Sepideh Amin-hanjani

Introduction: Dural artertiovenous fistulae (dAVF) are rare causes of secondary intracranial hemorrhage (ICH) and there remains a paucity of knowledge regarding their natural history. To date our knowledge comes from small case series. CONDOR, (Consortium for Dural Arteriovenous Fistula Outcomes Research), a large multi-institutional retrospective registry, provides a unique opportunity to evaluate the outcomes of patients presenting with dAVF related hemorrhages. Methods: We performed a retrospective review of 1077 dAVF patients from the CONDOR registry and selected those patients who presented with hemorrhage secondary to the dAVF. Patient characteristics, clinical presentation/follow-up, and radiographic details were analyzed for associations with patient outcomes. An outcome of mRS 0-2 was categorized as a “good” outcome and 3-6 as “poor”. Statistics were performed in SAS 9.4 with chi square, fisher’s exact test, and stepwise select variable multivariate analysis; P<.05 was marked as the level for statistical significance. Results: Evaluation of the CONDOR dataset yielded 267 patients who presented with hemorrhage. The mean age of the population was 59 ±13y.o, 30% were female, 40% had a history of smoking and 93% were not on anticoagulants. The median follow-up was 1.4 years. The mortality was 4.0 % at follow-up, and 83% of patients had a good outcome (mRS 0-2). Univariate analysis found age (p=0.001), anticoagulant use (p=0.006), and presentation mRS (p=0.03) were associated with poor outcome at follow-up. Subtype of hemorrhage (parenchymal hemorrhage or subarachnoid hemorrhage), smoking, and cortical venous shunting of the lesion, (i.e. Cognard grade IIb and greater) did not reach statistical significance. On multivariate analysis age (p=0.023) and mRS (p=0.035) at presentation but not anti-coagulant use (p=0.11) was associated with follow-up mRS. Conclusion: Within the largest individual patient series to date, we found that dAVF presenting with hemorrhage was associated with a relatively low risk of mortality. Age and mRS at presentation were most strongly predictive of outcome. Our results suggest that dAVF hemorrhage may be associated with a less morbid outcome than other forms of secondary hemorrhage.


2013 ◽  
Vol 48 (4) ◽  
pp. 295-301 ◽  
Author(s):  
John A. Bosso ◽  
Adam Sieg ◽  
Patrick D. Mauldin

Background Hospital antibiograms, which are commonly used to determine empiric antibiotic therapy and as a tool in stewardship in a given institution, are open to bias when combining susceptibility results from various sources, hospital locations, and patient groups. Methods We assessed such differences, using Pseudomonas aeruginosa as a test case, with susceptibility data from 2008 through 2010 in our institution. Each year's data were analyzed separately. A variety of specific or subcategorical antibiograms were compared with each other as well as with versions including all tested isolates and those with results from inpatients and outpatients only. Statistical significance was determined at the .01 level using either chi-square or Fisher exact test, and clinical significance was defined as ≥10 percentage points. Results A variety of clinically significant differences were found that illustrated important differences within the intensive care unit environment and based on population, specifically adult versus pediatric. Concordance between statistically significant and clinically significant differences was poor. Conclusion These results corroborate and extend previous similar observations and point to the potential importance of subanalyses in preparing the annual hospital antibiogram.


1993 ◽  
Vol 70 (03) ◽  
pp. 393-396 ◽  
Author(s):  
Mandeep S Dhami ◽  
Robert D Bona ◽  
John A Calogero ◽  
Richard M Hellman

SummaryA retrospective study was done to determine the incidence of and the risk factors predisposing to clinical venous thromboembolism (VTE) in patients treated for high grade gliomas. Medical records of 68 consecutive patients diagnosed and treated at Saint Francis Hospital and Medical Center from January 1986 to June 1991 were reviewed. The follow up was to time of death or at least 6 months (up to December 1991). All clinically suspected episodes of VTE were confirmed by objective tests. Sixteen episodes of VTE were detected in 13 patients for an overall episode rate of 23.5%. Administration of chemotherapy (p = 0.027, two tailed Fisher exact test) and presence of paresis (p = 0.031, two tailed Fisher exact test) were statistically significant risk factors for the development of VTE. Thrombotic events were more likely to occur in the paretic limb and this difference was statistically significant (p = 0.00049, chi square test, with Yates correction). No major bleeding complications were seen in the nine episodes treated with long term anticoagulation.We conclude that venous thromboembolic complications are frequently encountered in patients being treated for high grade gliomas and the presence of paresis and the administration of chemotherapy increases the risk of such complications.


2020 ◽  
Vol 41 (6) ◽  
pp. 436-441 ◽  
Author(s):  
Daniel A. Rosloff ◽  
Kunal Patel ◽  
Paul J. Feustel ◽  
Jocelyn Celestin

Background: Undifferentiated somatoform (US) idiopathic anaphylaxis (IA) is considered a psychogenic disorder characterized by a lack of observable physical findings and poor response to treatment. Although failure to diagnose true anaphylaxis can have disastrous consequences, identification of US-IA is crucial to limit unnecessary expenses and use of health care resources. Objective: To better define the presentation and understand the potential relationship between US-IA and underlying psychiatric comorbidities. Methods: We retrospectively reviewed 110 visits by 107 patients to our institution for evaluation and management of anaphylaxis over a 1-year period. The patients were classified as having either criteria positive (CP) or criteria negative (CN) anaphylaxis based on whether they met Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network Symposium criteria for the clinical diagnosis of anaphylaxis. Patient characteristics, including objective and subjective signs and symptoms, and the presence of psychiatric diagnoses were collected and analyzed. Statistical significance was assessed by using the Fisher exact test. A literature review of US-IA and other psychogenic forms of anaphylaxis was performed. Results: Patients with CP anaphylaxis were more likely to present with hypotension, wheezing, urticaria, and vomiting than were patients with CN anaphylaxis. The patients with CN anaphylaxis were more likely to present with subjective symptoms of sensory throat tightness or swelling compared with patients with CP anaphylaxis. No significant difference was detected in the prevalence of psychiatric conditions between the two groups. Conclusion: Patients who met previously established diagnostic criteria for anaphylaxis were more likely to present with objective physical findings than those who did not meet criteria for true anaphylaxis. CN patients who presented for treatment of anaphylaxis were more likely to present with subjective symptoms. Formal diagnostic criteria should be used by clinicians when evaluating patients with suspected anaphylaxis.


2020 ◽  
Vol 103 (6) ◽  
pp. 548-552

Objective: To predict the quality of anticoagulation control in patients with atrial fibrillation (AF) receiving warfarin in Thailand. Materials and Methods: The present study retrospectively recruited Thai AF patients receiving warfarin for three months or longer between June 2012 and December 2017 in Central Chest Institute of Thailand. The patients were classified into those with SAMe-TT₂R₂ of 2 or less, and 3 or more. The Chi-square test or Fisher’s exact test was used to compare the proportion of the patients with poor time in therapeutic range (TTR) between the two groups of SAMe-TT₂R₂ score. The discrimination performance of SAMe-TT₂R₂ score was demonstrated with c-statistics. Results: Ninety AF patients were enrolled. An average age was 69.89±10.04 years. Most patients were persistent AF. An average CHA₂DS₂-VASc, SAMe-TT₂R₂, and HAS-BLED score were 3.68±1.51, 3.26±0.88, and 1.98±0.85, respectively. The present study showed the increased proportion of AF patients with poor TTR with higher SAMe-TT₂R₂ score. The AF patients with SAMe-TT₂R₂ score of 3 or more had a larger proportion of patients with poor TTR than those with SAMe-TT₂R₂ score of 2 or less with statistical significance when TTR was below 70% (p=0.03) and 65% (p=0.04), respectively. The discrimination performance of SAMe-TT₂R₂ score was demonstrated with c-statistics of 0.60, 0.59, and 0.55 when TTR was below 70%, 65% and 60%, respectively. Conclusion: Thai AF patients receiving warfarin had a larger proportion of patients with poor TTR when the SAMe-TT₂R₂ score was higher. The score of 3 or more could predict poor quality of anticoagulation control in those patients. Keywords: Time in therapeutic range, Poor quality of anticoagulation control, Warfarin, SAMe-TT₂R₂, Labile INR


Author(s):  
Laima Alam

Objectives:Relation of demographics of hepatocellular-carcinoma with the aetiology.Tumour characteristics in relation to anti-viral therapy and presence of viral-DNA/RNATreatment modalities offeredMethods: This cross-sectional study enrolled all the patients aged 18-70 years with diagnosed hepatocellular carcinoma either through Triphasic Contrast-Enhanced-CT scan and/or Magnetic Resonance Imaging or biopsy presenting to the Outpatient-Department or multi-disciplinary-team meetings for the year 2019. Demographic variables, biochemical analysis including liver profile and stage of cirrhosis, viral-status, tumour staging and the treatment modalities offered were all noted. ANOVA (normal) and Kruskal-Wallis (non-normal) tests were used to compare quantitative data whereas chi-square-test and fisher-exact-test were used to compare qualitative-data.Results: Out of 195 patients with hepatocellular carcinoma, 76% were males in their fifth to sixth decades of life, 96% had cirrhosis, 94% corresponded to viral hepatocellular-carcinoma (82% Hepatitis-C-Virus, 9% Hepatitis-B-Virus and 3% coinfection), 60% of the cirrhotics landed in Child-Pugh A category with tumour staging BCLC-B being the predominant one (43.6%) and single and multiple bilateral nodules were the commonest lesions encountered. Platelets and Alanine-Transaminase had a significant relation across aetiological groups. Lymph-nodes were the most common extra-hepatic organs for metastasis and the presence of viral PCR had a significant impact on the tumour aggressiveness. Thirty-two percent of the patients were amenable to curative treatment.Conclusion: Viral infection is the main cause of rising prevalence of this tumour in Pakistan. Treatment modalities are expensive and expertise are lacking. A nationwide cancer registry is required for the exact disease burden and tumour behaviour for our population. Continuous....


2021 ◽  
Author(s):  
Huy Gia Vuong ◽  
Truong P.x. Nguyen ◽  
Hanh T.t. Ngo ◽  
Lewis Hassell ◽  
Kennichi Kakudo

Malignant thyroid teratoma (MTT) is a very rare thyroid malignancy. These neoplasms have been reported only in case reports and small-sized case series so far. In this study, we searched for MTTs in the Surveillance, Epidemiology, and End Result (SEER) program during 1975-2016. Subsequently, we incorporated the SEER data with published MTT cases in the literature to analyze the characteristics and prognostic factors of MTTs. Integrated data were analyzed using Chi-square or Fisher’s exact test for categorical covariates, and t-test or Mann-Whitney test for continuous variables. We included 28 studies with 36 MTT cases and found additional 8 cases from the SEER program for final analyses. Our results showed that MTT is typically seen in adult females. These neoplasms were associated with an aggressive clinical course with high rates of extrathyroidal extension (80%) and nodal involvement (62%). During follow-up, the development of recurrence and metastases were common (42% and 46%, respectively), and one-third of patients died at the last follow-up. Large tumor size (p = 0.022) and the presence of metastases during follow-up (p = 0.008) were associated with a higher mortality rate. In conclusion, our study demonstrated the characteristic features of MTT patients and outlined some parameters associated with a negative outcome which could help clinicians better predict the clinical course of these neoplasms.


2016 ◽  
Vol 50 (2) ◽  
pp. 263-271 ◽  
Author(s):  
Sandra Maria Sampaio Enes ◽  
Simone Perufo Opitz ◽  
André Ricardo Maia da Costa de Faro ◽  
Mavilde de Luz Gonçalves Pedreira

Abstract OBJECTIVE To identify the presence of phlebitis and the factors that influence the development of this complication in adult patients admitted to hospital in the western Brazilian Amazon. METHOD Exploratory study with a sample of 122 peripheral intravenous catheters inserted in 122 patients in a medical unit. Variables related to the patient and intravenous therapy were analyzed. For the analysis, we used chi-square tests of Pearson and Fisher exact test, with 5% significance level. RESULTS Complication was the main reason for catheter removal (67.2%), phlebitis was the most frequent complication (31.1%). The mean duration of intravenous therapy use was 8.81 days in continuous and intermittent infusion (61.5%), in 20G catheter (39.3%), inserted in the dorsal hand vein arc (36.9 %), with mean time of usage of 68.4 hours. The type of infusion (p=0.044) and the presence of chronic disease (p=0.005) and infection (p=0.007) affected the development of phlebitis. CONCLUSION There was a high frequency of phlebitis in the sample, being influenced by concomitant use of continuous and intermittent infusion of drugs and solutions, and more frequent in patients with chronic diseases and infection.


Author(s):  
Deivy Cirayow ◽  
Arthur Hendrik Philips Mawuntu ◽  
Herlyani Khosama

FACTORS THAT INFLUENCE HIV ASSOCIATED PERIPHERAL NEUROPATHY IN MANADOABSTRACTIntroduction: There are  several sociodemographic and clinical factors that influence the development of HIV associated peripheral  neuropathy (HIV-PN). Manado has different sociodemographic and clinical characteristics  from other regions. However, the percentage of HIV-PN and its influencing factors are unknown.Aims: To know the percentage of HIV-PN and factors that influence this disorder in Manado.Methods: A crosssectional study conducted in HIV/AIDS clinic R.D. Kandou hospital Manado between November2016–January 2017. Neuropathy evaluation was performed using brief peripheral neuropathy screening (BPNS), neuropathic pain diagnostic questionnaire (DN4), and electroneurography. A Chi-square or Fisher exact test was done to analyze categorical variables, independent T or Mann-Whitney test was done for numerical variables, and linear regression was done in multivariate analysis.Results: 50 subjects were included, most were male (70%), and the mean age was 32.98 (±9.726) years, with HIV- NP percentage was 46%. Age >30 years old, low hemoglobin count, CD4, and low international  HIV dementia scale (IHDS) significantly associated with HIV-NP. Working subjects were 13.6 times more likely to have HIV-PN.Discussion: HIV-PN prevalence was relatively high, influenced by age >30 years old an low hemoglobin, CD4, andIHDS. As a factor, working was escalating the likelihood of NP-HIV by 13.9 times.Keywords: HIV/AIDS, influencing factors, peripheral neuropathyABSTRAKPendahuluan: Neuropati perifer terkait human immunodeficiency virus/HIV (NP-HIV) dapat dipengaruhi oleh beberapa faktor klinis dan sosiodemografis. Manado mempunyai karakteristik yang berbeda dengan daerah lain, namun belum diketahui persentase NP-HIV dan faktor-faktor yang memengaruhinya.Tujuan: Mengetahui persentase NP-HIV dan faktor-faktor yang memengaruhinya di Manado.Metode: Penelitian potong lintang terhadap pasien HIV/AIDS di poliklinik HIV/AIDS RSUP Prof. dr. R.D. Kandou, Manado, pada November 2016–Januari 2017.  Evaluasi neuropati dilakukan menggunakan brief peripheral  neuropathy screening (BPNS), neuropathic pain diagnostic questionnaire (DN4), dan elektroneurografi. Digunakan uji Chi-square atau Fisher exact untuk menganalisis variabel kategorik, uji T independen atau Mann-Whitney untuk variabel numerik, dan regresi linear untuk analisis multivariat.Hasil: Didapatkan 50 subjek yang memenuhi kriteria penelitian dengan mayoritas laki-laki (70%), rerata usia32,98±9,726 tahun, dan mengalami NP-HIV sebanyak 46%. Usia >30 tahun, kadar hemoglobin, jumlah CD4, dan skor international  HIV dementia scale (IHDS) yang rendah berhubungan secara bermakna dengan adanya NP-HIV. Adapun subjek yang bekerja berisiko 13,6 kali lebih besar mengalami NP-HIV.Diskusi: Didapatkan prevalensi NP-HIV yang cukup tinggi dengan dipengaruhi oleh usia >30 tahun serta kadar hemoglobin, CD4, dan skor IHDS yang rendah. Faktor bekerja juga meningkatkan kecenderungan 13,9 kali mengalami NP terkait HIV.Kata kunci: Faktor-faktor yang memengaruhi, HIV/AIDS, neuropati perifer


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