scholarly journals A case report of individualized ventilation in a COVID-19 patient – new possibilities and caveats to consider with flow-controlled ventilation

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Patrick Spraider ◽  
Gabriel Putzer ◽  
Robert Breitkopf ◽  
Julia Abram ◽  
Simon Mathis ◽  
...  
Keyword(s):  
Medical Center ◽  
Standard Of Care ◽  
Dynamic Compliance ◽  
Dissipated Energy ◽  
Lung Protective Ventilation ◽  
Controlled Ventilation ◽  
Ventilation Modes ◽  
Personalized Ventilation ◽  
Ventilator Settings

Abstract Background Flow-controlled ventilation (FCV) is a novel ventilation method increasingly being used clinically, particularly during the current COVID-19 pandemic. However, the continuous flow pattern in FCV during inspiration and expiration has a significant impact on respiratory parameters and ventilatory settings compared to conventional ventilation modes. In addition, the constant flow combined with direct intratracheal pressure measurement allows determination of dynamic compliance and ventilation settings can be adjusted accordingly, reflecting a personalized ventilation approach. Case presentation A 50-year old women with confirmed SARS-CoV-2 infection suffering from acute respiratory distress syndrome (ARDS) was admitted to a tertiary medical center. Initial ventilation occurred with best standard of care pressure-controlled ventilation (PCV) and was then switched to FCV, by adopting PCV ventilator settings. This led to an increase in oxygenation by 30 %. Subsequently, to reduce invasiveness of mechanical ventilation, FCV was individualized by dynamic compliance guided adjustment of both, positive end-expiratory pressure and peak pressure; this intervention reduced driving pressure from 18 to 12 cm H2O. However, after several hours, compliance further deteriorated which resulted in a tidal volume of only 4.7 ml/kg. Conclusions An individualized FCV approach increased oxygenation parameters in a patient suffering from severe COVID-19 related ARDS. Direct intratracheal pressure measurements allow for determination of dynamic compliance and thus optimization of ventilator settings, thereby reducing applied and dissipated energy. However, although desirable, this personalized ventilation strategy may reach its limits when lung function is so severely impaired that patient’s oxygenation has to be ensured at the expense of lung protective ventilation concepts.

scholarly journals Lung-protective Ventilation Combined With Pressure-controlled Ventilation Volume-guaranteed in Children Undergoing One-lung Ventilation: A Randomised Controlled Trial

2021 ◽  
Author(s):  
Change Zhu ◽  
Saiji Zhang ◽  
Shenghua Yu ◽  
Yuting Zhang ◽  
Rong Wei
Keyword(s):  
Thoracoscopic Surgery ◽  
Controlled Trial ◽  
Lung Ventilation ◽  
Dynamic Compliance ◽  
Pulmonary Complications ◽  
Protective Ventilation ◽  
Lung Protective Ventilation ◽  
One Lung Ventilation ◽  
Controlled Ventilation ◽  
Lung Aeration

Abstract The purpose of study was to evaluate the effect of lung-protective ventilation (LPV) combined with PCV-VG in children undergoing OLV. Patients were randomly assigned to the LPV combined with PCV-VG group (PCV-VG) or LPV group (volume-controlled ventilation). Both groups received tidal-volume ventilation of 8 ml kg-1 body weight during two-lung ventilation, 6 ml kg‑1 during OLV, with sustained 5 cmH2O positive end-expiratory pressure.The PCV-VG group exhibited lower PIP than the LPV group at T1 (16.8±2.3 vs. 18.7±2.7, P=0.001), T2 (20.2±2.7 vs. 22.4±3.3, P=0.001), and T3 (23.8±3.2 vs. 26.36±3.7, P=0.01). Dynamic compliance was higher in the PCV-VG group at T1, T2 , and T3 (P=0.01). After anaesthesia induction, lung aeration deteriorated, but with no immediate postoperative difference in both groups. Postoperative lung aeration improved and returned to normal from 2.5 h postextubation in both groups. No differences were observed in postoperative pulmonary complications, intra-operative desaturation, hospital stay. In paediatric patients, who underwent thoracoscopic surgery, PCV-VG combined with LPV was superior to LPV in its ability to provide ventilation with lower PIP and higher dynamic compliance. However, the long-term benefits of different ventilation strategies should be further investigated.

(Uncontrolled) Donation after Cardiac Determination of Death: A Note of Caution

2008 ◽  
Vol 36 (4) ◽  
pp. 760-765 ◽  
Author(s):  
Christopher James Doig ◽  
David A. Zygun
Keyword(s):  
Organ Failure ◽  
Organ Transplant ◽  
Standard Of Care ◽  
Determination Of Death ◽  
The Past ◽  
The World ◽  
Tissue Recovery ◽  
End Stage

“I think there’s a big strong belief in [...] the community … and maybe it’s in the world at large that somehow the doctors are more concerned about harvesting the organs than what’s best for the patient.”1 In the past 45 years, organ and tissue recovery and transplantation have moved from the occasional and experimental to a standard of care for end-stage organ failure; receiving an organ transplant is for many the only opportunity for increased quantity and/or quality of life. The increasing prevalence of diseases such as viral hepatitis, diabetes, and hypertension has significantly increased the incidence of end-organ failure. Additionally, surgical advances have permitted less stringent qualification criteria, so that people of advanced age or patients who may be in a physiologically fragile state are now eligible to be organ recipients. These changes have created a significant demand for organs.

scholarly journals WAVE TRANSMISSION THROUGH TRAPEZOIDAL BREAKWATERS

1978 ◽  
Vol 1 (16) ◽  
pp. 129 ◽  
Author(s):  
Ole Secher Madsen ◽  
Paisal Shusang ◽  
Sue Ann Hanson
Keyword(s):  
Energy Dissipation ◽  
Approximate Method ◽  
Cross Section ◽  
Wave Energy ◽  
Graphical Form ◽  
Dissipated Energy ◽  
Simple Method ◽  
Reflection And Transmission ◽  
Transmission Coefficients

In a previous paper Madsen and White (1977) developed an approximate method for the determination of reflection and transmission characteristics of multi-layered, porous rubble-mound breakwaters of trapezoidal cross-section. This approximate method was based on the assumption that the energy dissipation associated with the wave-structure interaction could be considered as two separate mechanisms: (1) an external, frictional dissipation on the seaward slope; (2) an internal dissipation within the porous structure. The external dissipation on the seaward slope was evaluated from the semi-theoretical analysis of energy dissipation on rough, impermeable slopes developed by Madsen and White (1975). The remaining wave energy was represented by an equivalent wave incident on a hydraulically equivalent porous breakwater of rectangular cross-section. The partitioning of the remaining wave energy among reflected, transmitted and internally dissipated energy was evaluated as described by Madsen (1974), leading to a determination of the reflection and transmission coefficients of the structure. The advantage of this previous approximate method was its ease of use. Input data requirements were limited to quantities which would either be known (water depth, wave characteristics, breakwater geometry, and stone sizes) or could be estimated (porosity) by the design engineer. This feature was achieved by the employment of empirical relationships for the parameterization of the external and internal energy dissipation mechanisms. General solutions were presented in graphical form so that calculations could proceed using no more sophisticated equipment than a hand calculator (or a slide rule). This simple method gave estimates of transmission coefficients in excellent agreement with laboratory measurements whereas its ability to predict reflection coefficients left a lot to be desired.

scholarly journals Impact of tocilizumab administration on mortality in severe COVID-19

2020 ◽  
Author(s):  
Andrew Tsai ◽  
Oumou Diawara ◽  
Ronald G Nahass ◽  
Luigi Brunetti
Keyword(s):  
Pulmonary Disease ◽  
Propensity Scores ◽  
Medical Center ◽  
Healthcare Providers ◽  
Severity Of Illness ◽  
Standard Of Care ◽  
Care Group ◽  
Chronic Pulmonary Disease ◽  
Cytokine Storm ◽  
Novel Coronavirus

Background The novel coronavirus disease 2019 (COVID-19) worldwide pandemic has placed a significant burden on hospitals and healthcare providers. The immune response to this disease is thought to lead to a cytokine storm, which contributes to the severity of illness. There is an urgent need to confirm whether the use of tocilizumab provides a benefit in individuals with COVID-19. Methods A single-center propensity-score matched cohort study, including all consecutive COVID-19 patients, admitted to the medical center who were either discharged from the medical center or expired between March 1, 2020, and May 5, 2020, was performed. Patients were stratified according to the receipt of tocilizumab for cytokine storm and matched to controls using propensity scores. The primary outcome was in-hospital mortality. Results A total of 132 patients were included in the matched dataset (tocilizumab=66; standard of care=66). Approximately 73% of the patients were male. Hypertension (55%), diabetes mellitus (31%), and chronic pulmonary disease (15%) were the most common comorbidities present. There were 18 deaths (27.3%) in the tocilizumab group and 18 deaths (27.3%) in the standard of care group (odds ratio, 1.0; 95% confidence interval, 0.465 - 2.151; p=1.00). Advanced age, history of myocardial infarction, dementia, chronic pulmonary disease, heart failure, and malignancy were significantly more common in patients who died. Interpretation The current analysis does not support the use of tocilizumab for the management of cytokine storm in patients with COVID-19. Use of this therapeutic agent should be limited to the context of a clinical trial until more evidence is available.

Humeral Fractures Without Obvious Etiologies in Children Less Than 3 Years of Age: When Is It Abuse?

PEDIATRICS ◽  
1995 ◽  
Vol 96 (4) ◽  
pp. 667-671
Author(s):  
Richard T. Strait ◽  
Robert M. Siegel ◽  
Robert A. Shapiro
Keyword(s):  
Medical Center ◽  
Retrospective Chart Review ◽  
Humeral Fracture ◽  
Humeral Fractures ◽  
Supracondylar Fractures ◽  
Fractures In Children ◽  
Arm Injuries ◽  
Made In

Objective. To determine the occurrence and frequency of abuse in children with humeral fractures without immediately obvious etiologies who are less than 3 years old and present with arm injuries. Methods. A retrospective chart review was conducted of all children less than 3 years old treated for a humeral fracture at Children's Hospital Medical Center between July 1, 1990, and September 10, 1993. One hundred twenty-four charts of children with humeral fractures were reviewed for possible abuse using previously developed criteria. Charts were evaluated independently by the investigators. Consensus was reached on classification of each chart into the following categories: abuse, indeterminate, or not abuse. Results. Abuse was diagnosed in 9 of 25 (36%) children less than 15 months of age, but in only 1 of 99 (1%) children older than 15 months (P < .05). Abuse was excluded in 91 of 124 (73%) children. No determination of abuse (indeterminate) could be made in 23 of 124 (18.5%) children. In children less than 15 months of age, abuse was diagnosed in 2 of 10 (20%) with supracondylar fractures and in 7 of 12 (58%) with spiral/oblique fractures. Conclusion. The prevalence of abuse in our children presenting with humeral fractures was much lower than in other published reports, especially in the children over the age of 15 months. However, we found a higher prevalence of supracondylar fractures associated with abuse than those same reports. Given these findings, abuse should be considered in all children less than 15 months of age with humeral fractures, including those with supracondylar fractures. The majority of humeral fractures in children are accidental, especially beyond the age of 15 months.

Interventions using Virtual Reality : Tele Psych in Pediatrics (Preprint)

2021 ◽  
Author(s):  
Erin Bogdanski
Keyword(s):  
Virtual Reality ◽  
Private Practice ◽  
Mental Health Treatment ◽  
Single Case ◽  
Standard Of Care ◽  
Individual Psychotherapy ◽  
Single Case Study ◽  
Pediatric Mental Health

UNSTRUCTURED This is a single case study of using virtual reality ( Thera VR ™) for individual psychotherapy for treating PTSD with Trauma Focused CBT. This case study is an exploratory comparison between standard Telehealth using. 2D device with full HMD ( head mounted device ) with avatar technology. The case study is based on the usage of live telemedicine sessions in private practice, then detailing the benefits of cognitive, behavioral and neurological use of the Thera VR ™ technology. Determination of these results suggest the benefits of virtual reality as tele psych, and suggest further research and trials focused on pediatric mental health treatment be observed as new standard of care.

Utilization of Diagnostic Testing for Renal Anomalies and Congenital Heart Disease in Patients with Microtia

2020 ◽  
Vol 162 (4) ◽  
pp. 554-558
Author(s):  
Vaibhav H. Ramprasad ◽  
Amber D. Shaffer ◽  
Noel Jabbour
Keyword(s):  
Congenital Heart ◽  
Medical Center ◽  
Tertiary Care ◽  
Diagnostic Testing ◽  
Case Series ◽  
Standard Of Care ◽  
Renal Ultrasound ◽  
Renal Anomalies ◽  
Children's Hospital ◽  
Children’S Hospital

Objective Congenital ear anomalies are associated with congenital cardiac and renal defects. Renal ultrasounds, electrocardiogram, and echocardiogram can be utilized for diagnosis of these concurrent defects. No standard of care exists for the workup of patients with microtia. The goals of this study were to describe the utilization of diagnostic testing for cardiac and renal anomalies and to identify their prevalence in patients with microtia. Study Design Case series with chart review. Setting Children’s Hospital of Pittsburgh of the University of Pittsburgh Medical Center. Subjects and Methods This study is an Institutional Review Board–approved retrospective review of consecutive patients born between 2002 and 2016 who were diagnosed with microtia and seen in the otolaryngology clinic at a tertiary care children’s hospital. Demographics, sidedness and grade of microtia, comorbid diagnoses, and details of renal and cardiovascular evaluations were recorded. Factors associated with retroperitoneal ultrasound and cardiac testing were assessed with logistic regression. Results Microtia was present in 102 patients, and 98 patients were included as they received follow-up. Microtia was associated with craniofacial syndrome in 34.7% of patients. Renal ultrasound was performed in 64.3% of patients, and 12.9% of patients with ultrasounds had renal aplasia. Cardiac workup (electrocardiogram or echocardiogram) was completed in 60.2% of patients, and of this subset, 54.2% had a congenital heart defect. Conclusion Diagnostic testing revealed renal anomalies and cardiac defects in patients with isolated microtia at a higher rate than in the general population. This suggests the need for further evaluation of the role of routine screening in patients with microtia.

Are there disparities in the utilization of sentinel lymph node biopsies in patients with breast cancer?

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 117-117
Author(s):  
Archana Radhakrishnan ◽  
Paula Silverman ◽  
Robert R. Shenk ◽  
Cheryl L. Thompson
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Racial Differences ◽  
Early Stage ◽  
Medical Center ◽  
Standard Of Care ◽  
Axillary Staging ◽  
Axillary Lymph ◽  
Medical Centers

117 Background: Racial disparities in outcomes continue to persist amongst breast cancer (BC) patients (pts). Standard of care for the surgical evaluation of early BC has changed from axillary lymph node dissection being recommended for axillary staging to sentinel lymph node biopsy (SLNB) for clinically node-negative pts. SLNB, however, can be deferred if findings would not alter treatment plans. The goal of this study is to determine if SLNB rates differ by race, age, insurer, community vs academic setting or surgeon. Causes contributing to disparities will be considered. Methods: Pts undergoing primary surgery for early stage BC from 2010-2011 at our academic teaching hospital and two affiliated community medical centers were identified from the tumor registry. Data abstracted included demographics, insurance type, medical center and surgeon. For pts without SLNB, clinical information was confirmed with medical record review. Unadjusted comparison of factors for pts who did and did not have SLNB was evaluated with a t-test or chi square test. Logistic regression modeling assessed significance of demographic and clinical factors predicting SLNB. Results: 499 pts were identified; 114 (23%) were black, 373 (75%) white, and 12 (2%) others/unknown race. SLNB was performed in 443 (89%) of total pts, without racial differences (86% of black and 89% of white pts (p=0.31) had SLNB). Average age of pts who had SLNB was younger (60.4) than those who did not (76.3) (p<0.01). As compared to those with managed care insurance (97%) or Medicaid (91%), only 78% of Medicare pts had SLNB (p<0.01). There was no statistical difference in SLNB rates between academic and community medical centers or by surgeon. Chart review determined that the standard of care was met in 55/56 pts who did not have SLNB; reasons for no SLNB include advanced age (range 79-95), in-breast recurrences, and positive nodes pre-operatively. Conclusions: Utilization rates of SLNB did not differ between black and white BC pts. Differences were seen based on age and insurer. Although only 89% of pts had SLNB, careful evaluation for reasons reveals medically appropriate treatment in almost all cases. These results suggest cautionary interpretation of large database findings.

scholarly journals Analytical methods and performance of the immunoassay methods for determination of vitamin d in comparison to mass spectrometry / Analitičke metode i izvođenje imunometrijskih određivanja vitamina d u poređenju sa masenom spektrometrijom

2012 ◽  
Vol 31 (4) ◽  
pp. 333-338 ◽  
Author(s):  
Nikolina Babić
Keyword(s):  
Mass Spectrometry ◽  
Vitamin D ◽  
Transition Period ◽  
Medical Center ◽  
Pediatric Population ◽  
Well Being ◽  
Technical Expertise ◽  
Assay Sensitivity ◽  
Clinical Laboratories

Summary Demand for vitamin D testing has been on a constant rise worldwide, partially due to mounting evidence linking vitamin D status to overall health and well-being. Currently available assays measure 25-hydroxy vitamin D (25-OHD), a major circulating form of vitamin D. Available methodologies include immunoassays and mass spectrometry based methods (LC-MS/MS). Until recently, the only immunoassays available for diagnostic use in the US have been DiaSorin radioimmunoassay (RIA) and an automated immunoassay on a LIAISON® platform. Within the last year, Siemens and Abbott successfully launched immuno - assays for determination of total vitamin D on their respective automated platforms, Centaur® and ARCHITECT®. Development of robust and precise Vitamin D immunoassays has historically been plagued with difficulty. One of the major challenges is development of specific antibodies against such a small antigen. Vitamin D is also highly hy - drophobic molecule predominantly bound to vitamin D binding protein (DBP). It is likely, therefore, that immuno - assays might be affected to varying extent by the DBP concentration. Adoption of LC-MS/MS into clinical laboratories has enabled development of accurate and almost fully automated methods that could handle increasing volume demands, especially in large volume reference laboratories. Smaller to mid-size hospital laboratories as well as physician offices have neither funds nor technical expertise to implement LC-MS/MS based testing. Our laboratory at the University of Chicago Medical Center has also seen in - crease in vitamin D volume and currently performs close to 20,000 25-OHD assays per year. We have recently deve - loped an LC-MS/MS method for quantitation of 25-OHD2 (obtained from plant sources) and 25-OHD3 (endogenous and animal sources). Prior to acquisition of LC-MS/MS instrument, we performed 25-OHD analysis by RIA. Du - ring the transition period, we encountered several challenges, including the necessity to streamline sample preparation as well as the bias introduced by calibration dif ferences. We chose to match our LC-MS/MS method to the RIA method in order to make this transition transparent to the clinician. Most immunoassays available today are acceptable for clinical use and might be method of choice for smaller laboratories. Larger clinical laboratories and aca demic institutions that possess technical expertise, particularly the ones with large pediatric population where assay sensitivity and specificity may be important, might find LC-MS/MS methodology a more suitable choice.

scholarly journals Evaluation of a Multiplex Bead Immunoassay for Determination of Immune Status to Varicella-Zoster Virus in Medical Center Students and Employees

2015 ◽  
Vol 22 (3) ◽  
pp. 351-353 ◽  
Author(s):  
Michael J. Loeffelholz ◽  
Harry E. Prince
Keyword(s):  
Varicella Zoster Virus ◽  
Enzyme Immunoassay ◽  
Predictive Value ◽  
Immune Status ◽  
Medical Center ◽  
Igg Antibodies ◽  
Varicella Zoster ◽  
Multiplex Bead ◽  
Bead Immunoassay

ABSTRACTThis study evaluated an enzyme immunoassay, a multiplex bead immunoassay (MBIA), and the anticomplement immunofluorescence (ACIF) test for detecting varicella-zoster virus IgG antibodies in sera from medical center students and employees. The agreement between methods was ≥95%. The MBIA was less sensitive than was the ACIF test, with a negative predictive value of 66.7%.

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