scholarly journals Tracheal stenosis in prolonged mechanically ventilated patients: prevalence, risk factors, and bronchoscopic management

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Alessandro Ghiani ◽  
Konstantinos Tsitouras ◽  
Joanna Paderewska ◽  
Dieter Munker ◽  
Swenja Walcher ◽  
...  

Abstract Background Various complications may arise from prolonged mechanical ventilation, but the risk of tracheal stenosis occurring late after translaryngeal intubation or tracheostomy is less common. This study aimed to determine the prevalence, type, risk factors, and management of tracheal stenoses in mechanically ventilated tracheotomized patients deemed ready for decannulation following prolonged weaning. Methods A retrospective observational study on 357 prolonged mechanically ventilated, tracheotomized patients admitted to a specialized weaning center over seven years. Flexible bronchoscopy was used to discern the type, level, and severity of tracheal stenosis in each case. We described the management of these stenoses and used a binary logistic regression analysis to determine independent risk factors for stenosis development. Results On admission, 272 patients (76%) had percutaneous tracheostomies, and 114 patients (32%) presented mild to moderate tracheal stenosis following weaning completion, with a median tracheal cross-section reduction of 40% (IQR 25–50). The majority of stenoses (88%) were located in the upper tracheal region, most commonly resulting from localized granulation tissue formation at the site of the internal stoma (96%). The logistic regression analysis determined that obesity (OR 2.16 [95%CI 1.29–3.63], P < 0.01), presence of a percutaneous tracheostomy (2.02 [1.12–3.66], P = 0.020), and cricothyrotomy status (5.35 [1.96–14.6], P < 0.01) were independently related to stenoses. Interventional bronchoscopy with Nd:YAG photocoagulation was a highly effective first-line treatment, with only three patients (2.6%) ultimately referred to tracheal surgery. Conclusions Tracheal stenosis is commonly observed among prolonged ventilated patients with tracheostomies, characterized by localized hypergranulation and mild to moderate airway obstruction, with interventional bronchoscopy providing satisfactory results.

Author(s):  
Qilin Zhang ◽  
Yanli Wu ◽  
Tiankuo Han ◽  
Erpeng Liu

Background: The cognitive function of the elderly has become a focus of public health research. Little is known about the changes of cognitive function and the risk factors for cognitive impairment in the Chinese elderly; thus, the purposes of this study are as follows: (1) to describe changes in cognitive function in the Chinese elderly from 2005–2014 and (2) to explore risk factors for cognitive impairment of the Chinese elderly. Design and setting: A total of 2603 participants aged 64 years and above participated in the Chinese Longitudinal Healthy Longevity Survey (CLHLS) and were followed up from 2005 to 2014. Cognitive function and cognitive impairment were assessed using the Chinese version of the Mini-Mental State Examination (MMSE). Binary logistic regression analysis was used to estimate the odds ratio (OR) and 95% confidence intervals (CI) of cognitive impairment. Results: Results revealed that the cognitive function of the Chinese elderly shows diversified changes: deterioration (55.09%), unchanged (17.21%) and improvement (27.70%). In addition, there are significant demographic differences in gender, age, education, marriage and other aspects when it comes to the changes of cognitive function in Chinese elderly. In the binary logistic regression analysis, female, increased age, lower education level, no spouse, less income, worse PWB (psychological well-being), less fresh fruit and vegetable intake, more activities of daily living (ADL) limitations, lower social engagement were significantly associated with higher odds for cognitive impairment. Conclusions: Various interventions should be implemented to maintain cognitive function in Chinese elderly.


2020 ◽  
Author(s):  
Yulei Dong ◽  
Ning Tang ◽  
Shengru Wang ◽  
Jianguo Zhang ◽  
Hong Zhao

Abstract Background: Risk factors and clinical outcome associated with distal adding on in Lenke 2AR adolescent idiopathic scoliosis (AIS) are not fully elucidated.Methods: Radiographic data of Lenke 2AR AIS patients treated by posterior pedicle screws in a single institution were retrospectively analyzed. Patients who developed distal adding on were compared with patients who did not. Clinical assessment were carried out by SF-36 and SRS-22 questionnaire. Risk factors of distal adding on were explored by binary logistic regression analysis.Results: A total of 88 patients completed an average of 2.9 (2-12.9) years of follow-up were included. 18 (20.5%) patients met the criterion of distal adding on while the rest of 70 cases did not at follow up.Clinical parameters were comparable before surgery and became lower at follow up in adding on group in dimensions of vitality (63.1±11.4Vs.67.5±11.8,P=0.026), mental health (73.9±9.2Vs.77.8±10.2,P=0.039), self-image (3.9±0.3Vs.4.2±0.3,P=0.021) and satisfaction (4.0±0.3Vs.4.5±0.4,P=0.035). The proportion of selection lowest instrumented vertebra (LIV) higher than last touching vertebra(LTV) was significantly higher in adding on group. (6/18vs 4/70, P=0.004) Binary logistic regression analysis revealed that preoperative main thoracic curve magnitude (OR=1.118,P=0.041), preoperative lumbar lordosis (OR=1.091,P=0.029), and the gap between LIV and LTV(OR=6.123,P=0.043) were independent risk factors associated with adding on.Conclusions: In Lenke 2AR AIS cases, the selection of LIV higher than LTV is closely correlated with the development of adding-on. Patients with minor main thoracic curve and lumbar lordosis are more likely to develop distal adding on. Adding on may cause discontent of patients .


2020 ◽  
Vol 8 ◽  
Author(s):  
Chen Dong ◽  
Minhui Zhu ◽  
Luguang Huang ◽  
Wei Liu ◽  
Hengxin Liu ◽  
...  

Abstract Background Tissue expansion is used for scar reconstruction owing to its excellent clinical outcomes; however, the complications that emerge from tissue expansion hinder repair. Infection is considered a major complication of tissue expansion. This study aimed to analyze the perioperative risk factors for expander infection. Methods A large, retrospective, single-institution observational study was carried out over a 10-year period. The study enrolled consecutive patients who had undergone tissue expansion for scar reconstruction. Demographics, etiological data, expander-related characteristics and postoperative infection were assessed. Univariate and multivariate logistic regression analysis were performed to identify risk factors for expander infection. In addition, we conducted a sensitivity analysis for treatment failure caused by infection as an outcome. Results A total of 2374 expanders and 148 cases of expander infection were assessed. Treatment failure caused by infection occurred in 14 expanders. Multivariate logistic regression analysis identified that disease duration of ≤1 year (odds ratio (OR), 2.07; p &lt; 0.001), larger volume of expander (200–400 ml vs &lt;200 ml; OR, 1.74; p = 0.032; &gt;400 ml vs &lt;200 ml; OR, 1.76; p = 0.049), limb location (OR, 2.22; p = 0.023) and hematoma evacuation (OR, 2.17; p = 0.049) were associated with a high likelihood of expander infection. Disease duration of ≤1 year (OR, 3.88; p = 0.015) and hematoma evacuation (OR, 10.35; p = 0.001) were so related to high risk of treatment failure. Conclusions The rate of expander infection in patients undergoing scar reconstruction was 6.2%. Disease duration of &lt;1 year, expander volume of &gt;200 ml, limb location and postoperative hematoma evacuation were independent risk factors for expander infection.


Author(s):  
Sneha Sharma ◽  
Raman Tandon

Abstract Background Prediction of outcome for burn patients allows appropriate allocation of resources and prognostication. There is a paucity of simple to use burn-specific mortality prediction models which consider both endogenous and exogenous factors. Our objective was to create such a model. Methods A prospective observational study was performed on consecutive eligible consenting burns patients. Demographic data, total burn surface area (TBSA), results of complete blood count, kidney function test, and arterial blood gas analysis were collected. The quantitative variables were compared using the unpaired student t-test/nonparametric Mann Whitney U-test. Qualitative variables were compared using the ⊠2-test/Fischer exact test. Binary logistic regression analysis was done and a logit score was derived and simplified. The discrimination of these models was tested using the receiver operating characteristic curve; calibration was checked using the Hosmer—Lemeshow goodness of fit statistic, and the probability of death calculated. Validation was done using the bootstrapping technique in 5,000 samples. A p-value of <0.05 was considered significant. Results On univariate analysis TBSA (p <0.001) and Acute Physiology and Chronic Health Evaluation II (APACHE II) score (p = 0.004) were found to be independent predictors of mortality. TBSA (odds ratio [OR] 1.094, 95% confidence interval [CI] 1.037–1.155, p = 0.001) and APACHE II (OR 1.166, 95% CI 1.034–1.313, p = 0.012) retained significance on binary logistic regression analysis. The prediction model devised performed well (area under the receiver operating characteristic 0.778, 95% CI 0.681–0.875). Conclusion The prediction of mortality can be done accurately at the bedside using TBSA and APACHE II score.


2019 ◽  
Vol 152 (Supplement_1) ◽  
pp. S64-S65
Author(s):  
David Gustafson ◽  
Osvaldo Padilla

Abstract Introduction Gallbladder adenocarcinoma (GBC) is a rare malignancy. Frequency of incidental adenocarcinoma of the gallbladder in the literature is approximately 0.2% to 3%. Typically, GBC is the most common type and is discovered late, not until significant symptoms develop. Common symptoms include right upper quadrant pain, nausea, anorexia, and jaundice. A number of risk factors in the literature are noted for GBC. These risk factors are also more prevalent in Hispanic populations. This study sought to compare patients with incidental gallbladder adenocarcinomas (IGBC) to those with high preoperative suspicion for GBC. Predictor variables included age, sex, ethnicity, radiologic wall thickening, gross pathology characteristics (wall thickness, stone size, stone number, and tumor size), histologic grade, and staging. Methods Cases of GBC were retrospectively analyzed from 2009 through 2017, yielding 21 cases. Data were collected via Cerner EMR of predictor variables noted above. Statistical analysis utilized conditional logistic regression analysis. Results The majority of patients were female (n = 20) and Hispanic (n = 19). There were 14 IGBCs and 7 nonincidental GBCs. In contrast with previous research, exact conditional logistic regression analysis revealed no statistically significant findings. For every one-unit increase in AJCC TNM staging, there was a nonsignificant 73% reduction in odds (OR = 0.27) of an incidental finding of gallbladder carcinoma. Conclusion This study is important in that it attempts to expand existing literature regarding a rare type of cancer in a unique population, one particularly affected by gallbladder disease. Further studies are needed to increase predictive knowledge of this cancer. Longer studies are needed to examine how predictive power affects patient outcomes. This study reinforces the need for routine pathologic examination of cholecystectomy specimens for cholelithiasis.


Author(s):  
Devi Meenakshi K. ◽  
Arasar Seeralar A. T. ◽  
Srinivasan Padmanaban

Background: Very low birth weight (VLBW) babies are at increased risk of a number of complications both immediate and late. Worldwide it has been observed that these babies contribute to a significant extent to neonatal mortality and morbidity. Aim of the study was to study the risk factors contributing to mortality in VLBW babies and to evaluate the morbidity pattern in these infants.Methods: A retrospective analysis of data retrieved from the case records of VLBW babies admitted in the NICU of Kilpauk Medical College between January 2015 to December 2015. Out of the 2360 intramural babies admitted during the study period, 99 babies were less than 1500 gms. The risk factors for these babies were analyzed for their association with the outcome. Data were statistically analyzed.Results: In present study, we found that sex of the baby, gestational age, obstetric score, birth asphyxia, pulmonary haemorrhage, ROP and presence of shock were found to be associated with increased mortality. By logistic regression analysis it was observed that birth weight of the baby (p value 0.002), duration of stay (p value 0.0006), presence of shock (p<0.0001), were the risk factors significantly associated with poor outcome.Conclusions: Among the maternal and neonatal factors analyzed in the study using logistic regression analysis, birth weight, duration of hospital stay and presence of shock were significantly related to poor outcome. Of these presence of shock was the single most important factor that predicted increased mortality.


Author(s):  
Askalech Feyisa Jobira ◽  
Abdulnasir Abdulmelike Mohammed

AbstractMotivation is one of the most researched yet crucial topics in academia from various perspectives. Despite this, researches show mixed results about the effect of extrinsic motivation on intrinsic motivation and organizational performance. Studies in Ethiopia also lack causal analysis and theoretical underpinning that made contributions from academia very little. Hence, this research is important to assess the effect of extrinsic motivation on intrinsic motivation and organizational performance from a cognitive evaluation theory perspective. The researchers adopted an explanatory research design with a quantitative approach. The entire 119 employees of the Oromia Seed Enterprise, Bale branch were included in the study to collect primary data through a close-ended questionnaire. The collected data was processed by SPSS software version 20. The relationship analysis was addressed by correlation and binary logistic regression analysis. Seen from extrinsic and intrinsic motivation aspects, the findings of the study showed that Oromia Seed Enterprise had a moderate level of organizational performance and a moderate level of employees’ motivation. The correlation analysis result indicated that employees’ extrinsic and intrinsic motivation had a positive relationship with organizational performance. The binary logistic regression analysis also indicated that extrinsic and intrinsic motivation had a positive and significant influence on organizational performance. However, the interaction effect of intrinsic and extrinsic motivation on organizational performance was not significant, implying the absence of influence when both intrinsic and extrinsic motivations happen at the same time. Finally, the study results have a theoretical contribution for compensating the lack of actual experience in the Ethiopian organization’s context. Equally, the understanding of the moderated relationship among the study variables may encourage Oromia Seed Enterprise and its managers to develop a practical motivation system, which entertains the complex interaction of motivation variables to improve organizational performance. In addition, studies of this nature can inform policymakers to strengthen an incentive system as well as other motivation veins in the Ethiopian public organizations.


Author(s):  
Sendi Nugraha Nurdiansah ◽  
Laelatul Khikmah

The phenomenon of poverty is a serious problem faced by almost every country in the world. This is because poverty can affect various aspects of people's lives. One of the causes of poverty is due to lack of income and assets to meet basic needs such as food, clothing, housing, health level and acceptable education. In addition, poverty occurs because of the powerlessness of society to get out of the problems it faces. The Central Java regional government incorporated poverty issues into the Regional Medium-Term Development Plan (RPJMD) because Central Java has a high number of poor people. This was done as an effort by the Central Java government to reduce poverty. Therefore, research is needed to find out the variables that most influence poverty in order to assist the government in developing the RPJMD. To find out what factors influence poverty in Central Java with the dichotomous categorical response variable, binary logistic regression analysis was used. The results showed that based on the analysis conducted did not obtain a logistic regression equation model because there were no significant parameters because there were no variables that had a sig value <0.05. Existing variables are Number of Population, Female Head of Household, Number of Children not in School, Number of Disabled Individuals, Number of Chronic Disease Individuals, Unemployment, Non-Electricity Lighting Sources, Unprotected Drinking Water Sources, Kerosene and Wood Cooking Fuels, Location Facilities Defecation (BAB) Not Available, so there are no variables that affect the level of poverty in Central Java Province.


Sign in / Sign up

Export Citation Format

Share Document