Predictive factors for difficult mask ventilation in the obese surgical population

BackgroundDifficult Mask Ventilation (DMV), is a situation in which it is impossible for an unassisted anesthesiologist to maintain oxygen saturation >90% using 100% oxygen and positive pressure ventilation to prevent or reverse signs of inadequate ventilation during mask ventilation. The incidence varies from 0.08 – 15%. Patient-related anatomical features are by far the most significant cause. We analyzed data from an obese surgical population (BMI> 30 kg/m2) to identify specific risk and predictive factors for DMV.MethodsFive hundred and fifty seven obese patients were identified from a database of 1399 cases associated with preoperative airway examinations where mask ventilation was attempted. Assessment of mask ventilation in this group was stratified by a severity score (0-3), and a step-wise selection method was used to identify independent predictors. The area under the curve of the receiver-operating-characteristic was then used to evaluate the model’s predictive value. Adjusted odds ratios and their 95% confidence intervals were also calculated.ResultsDMV was observed in 80/557 (14%) patients. Three independent predictive factors for DMV in obese patients were identified: age 49 years, short neck, and neck circumference 43 cm. In the current study th sensitivity for one factor is 0.90 with a specificity 0.35. However, the specificity increased to 0.80 with inclusion of more than one factor.ConclusionAccording to the current investigation, the three predictive factors are strongly associated with DMV in obese patients. Each independent risk factor alone provides a good screening for DMV and two factors substantially improve specificity. Based on our analysis, we speculate that the absence of at least 2 of the factors we identified might have a significant negative predictive value and can reasonably exclude DMV, with a negative likelihood ratio 0.81.

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Classification of Thyroid Nodules with Stacked Denoising Sparse Autoencoder

International Journal of Endocrinology ◽

10.1155/2020/9015713 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8

Author(s):

Zexin Li ◽

Kaiji Yang ◽

Lili Zhang ◽

Chiju Wei ◽

Peixuan Yang ◽

...

Keyword(s):

Likelihood Ratio ◽

Predictive Value ◽

Thyroid Nodules ◽

Area Under The Curve ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Discriminative Ability ◽

Sparse Autoencoder ◽

Immune Related Genes

Purpose. Several commercial tests have been used for the classification of indeterminate thyroid nodules in cytology. However, the geographic inconvenience and high cost confine their widespread use. This study aims to develop a classifier for conveniently clinical utility. Methods. Gene expression data of thyroid nodule tissues were collected from three public databases. Immune-related genes were used to construct the classifier with stacked denoising sparse autoencoder. Results. The classifier performed well in discriminating malignant and benign thyroid nodules, with an area under the curve of 0.785 [0.638–0.931], accuracy of 92.9% [92.7–93.0%], sensitivity of 98.6% [95.9–101.3%], specificity of 58.3% [30.4–86.2%], positive likelihood ratio of 2.367 [1.211–4.625], and negative likelihood ratio of 0.024 [0.003–0.177]. In the cancer prevalence range of 20–40% for indeterminate thyroid nodules in cytology, the range of negative predictive value of this classifier was 37–61%, and the range of positive predictive value was 98–99%. Conclusion. The classifier developed in this study has the superb discriminative ability for thyroid nodules. However, it needs validation in cytologically indeterminate thyroid nodules before clinical use.

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Diagnostic Performance of Bronchoalveolar Lavage (1,3)-β-d-Glucan Assay for Pneumocystis jirovecii Pneumonia

Journal of Fungi ◽

10.3390/jof6040200 ◽

2020 ◽

Vol 6 (4) ◽

pp. 200

Author(s):

Shiwei Zhou ◽

Kathleen A. Linder ◽

Carol A. Kauffman ◽

Blair J. Richards ◽

Steve Kleiboeker ◽

...

Keyword(s):

Bronchoalveolar Lavage ◽

Test Performance ◽

Predictive Value ◽

Operating Characteristic ◽

Area Under The Curve ◽

Lavage Fluid ◽

Pneumocystis Pneumonia ◽

Pneumocystis Jirovecii ◽

Pneumocystis Jirovecii Pneumonia ◽

Characteristic Area

We evaluated the performance of the (1,3)-β-d-glucan (BDG) assay on bronchoalveolar lavage fluid (BALF) as a possible aid to the diagnosis of Pneumocystis jirovecii pneumonia. BALF samples from 18 patients with well-characterized proven, probable, and possible Pneumocystis pneumonia and 18 well-matched controls were tested. We found that the best test performance was observed with a cut-off value of 128 pg/mL; receiver operating characteristic/area under the curve (ROC/AUC) was 0.70 (95% CI 0.52–0.87). Sensitivity and specificity were 78% and 56%, respectively; positive predictive value was 64%, and negative predictive value was 71%. The low specificity that we noted limits the utility of BALF BDG as a diagnostic tool for Pneumocystis pneumonia.

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Prediction of Difficult Mask Ventilation

Anesthesiology ◽

10.1097/00000542-200005000-00009 ◽

2000 ◽

Vol 92 (5) ◽

pp. 1229-1236 ◽

Cited By ~ 519

Author(s):

Olivier Langeron ◽

Eva Masso ◽

Catherine Huraux ◽

Michel Guggiari ◽

André Bianchi ◽

...

Keyword(s):

Body Mass Index ◽

Multivariate Analysis ◽

Confidence Interval ◽

Body Mass ◽

Univariate Analysis ◽

Positive Pressure ◽

Mask Ventilation ◽

Airway Patency ◽

Difficult Mask Ventilation ◽

History Of

Background Maintenance of airway patency and oxygenation are the main objectives of face-mask ventilation. Because the incidence of difficult mask ventilation (DMV) and the factors associated with it are not well known, we undertook this prospective study. Methods Difficult mask ventilation was defined as the inability of an unassisted anesthesiologist to maintain the measured oxygen saturation as measured by pulse oximetry > 92% or to prevent or reverse signs of inadequate ventilation during positive-pressure mask ventilation under general anesthesia. A univariate analysis was performed to identify potential factors predicting DMV, followed by a multivariate analysis, and odds ratio and 95% confidence interval were calculated. Results A total of 1,502 patients were prospectively included. DMV was reported in 75 patients (5%; 95% confidence interval, 3.9-6.1%), with one case of impossible ventilation. DMV was anticipated by the anesthesiologist in only 13 patients (17% of the DMV cases). Body mass index, age, macroglossia, beard, lack of teeth, history of snoring, increased Mallampati grade, and lower thyromental distance were identified in the univariate analysis as potential DMV risk factors. Using a multivariate analysis, five criteria were recognized as independent factors for a DMV (age older than 55 yr, body mass index > 26 kg/m2, beard, lack of teeth, history of snoring), the presence of two indicating high likelihood of DMV (sensitivity, 0.72; specificity, 0.73). Conclusion In a general adult population, DMV was reported in 5% of the patients. A simple DMV risk score was established. Being able to more accurately predict DMV may improve the safety of airway management.

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Difficult Mask Ventilation in Obese Patients: New Predictive Tests?

Medical Bulletin of Haseki ◽

10.4274/haseki.galenos.2018.4127 ◽

2019 ◽

Vol 57 (1) ◽

pp. 15-19

Author(s):

Bengü Gülhan Aydın ◽

Gamze Küçükosman ◽

Özcan Pişkin ◽

Rahşan Dilek Okyay ◽

Hilal Ayoğlu

Keyword(s):

Obese Patients ◽

Mask Ventilation ◽

Predictive Tests ◽

Difficult Mask Ventilation

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Validation of the Indonesian Version of Modified Checklist for Autism in Toddlers: a diagnostic study

Paediatrica Indonesiana ◽

10.14238/pi60.3.2020.159-65 ◽

2020 ◽

Vol 60 (3) ◽

pp. 159-65

Author(s):

Hendra Salim ◽

Soetjiningsih Soetjiningsih ◽

I Gusti Ayu Trisna Windiani ◽

I Gede Raka Widiana ◽

PITIKA ASPR

Keyword(s):

Predictive Value ◽

Characteristic Curve ◽

Area Under The Curve ◽

Negative Likelihood Ratio ◽

Autism Spectrum ◽

Diagnostic Study ◽

Diagnostic Validity ◽

Dsm Iv ◽

Pediatric Outpatients ◽

Sensitivity Specificity

Background Autism is a developmental disorder for which early detection in toddlers is recommended because of its increased prevalence. The Modified Checklist for Autism in Toddlers (M-CHAT) is an easy-to-interprete tool that can be filled out by parents. It has been translated into the Indonesian language but needs to be validated. Objective To evaluate the diagnostic validity of the Indonesian version of M-CHAT in detection of autism spectrum disorder in Indonesia. Methods A diagnostic study was conducted at Sanglah Hospital, Denpasar, Bali, from March 2011 to August 2013. Pediatric outpatients aged 18 to 48 months were included. The Indonesian version of the M-CHAT tool was filled by parents. Autism assessment was done according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV-TR). The assessment results were analyzed with the MedCalc program software, in several steps: (i) reliability of M-CHAT; (ii) description, distribution, and proportion to determine the characteristics of the subjects of research; and (iii) validity of M-CHAT compared to the gold standard DSM-IV-TR by a receiver operating characteristic curve and several area under the curve cut-off points, in order to assess the sensitivity, specificity, positive predictive value, negative predictive value, and positive and negative likelihood ratio, accompanied by the 95% confidence interval of each value. Results The Indonesian version of M-CHAT in toddlers had 82.35% sensitivity and 89.68% specificity, using the cut-off point of more than 6 failed questions. Conclusion The Indonesian version M-CHAT translated by Soetjiningsih has optimal diagnostic validity for detection of autism in toddlers.

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Intra-abdominal pressure for predicating extubation failure in mechanically ventilated patients: it does work

Archives of Medical Science ◽

10.5114/aoms/141894 ◽

2021 ◽

Author(s):

Qian Chen ◽

Junjun Zou ◽

Beilei Zhang ◽

Feifei Cui ◽

Meifen Shen ◽

...

Keyword(s):

Predictive Value ◽

Operating Characteristic ◽

Area Under The Curve ◽

Reference Value ◽

Extubation Failure ◽

Abdominal Pressure ◽

Early Recovery ◽

Mechanically Ventilated ◽

Length Of Icu Stay ◽

Ventilated Patients

IntroductionReducing the extubation failure is vital to the early recovery of patients with mechanical ventilation(MV). We aimed to explore the predictive value of the change of intra-abdominal pressure(ΔIAP) before extubation on the extubation failure in MV patients.Material and methodsPatients undergone MV for more than 24 hours were selected. We used a urodynamic monitor to measure ΔIAP 30 minutes before extubation. The characteristics and prognosis of MV patients were analyzed. Receiver operating characteristic(ROC) curve was drawn to analyze the predictive value of ΔIAP for extubation failure.ResultsA total of 173 MV patients were included. The risks of extubation failure increased with the decrease of ΔIAP. The risk of extubation failure in ΔIAP≤21mmHg group was 5.7 times that of the ΔIAP≥38mmHg group (OR 5.7, 95%CI 1.5-22.0), the risk of extubation failure in ΔIAP 22～37 mmHg group was 3.8 times that of the ΔIAP≥38mmHg group (OR 3.8, 95%CI 1.0-15.3). The area under the curve (AUC) predicted by ΔIAP for extubation failure was 0.721, the cutoff value was 31mmHg with 82.8% sensitivity and 48.6% specificity. There were no significant differences in the duration of MV, length of ICU stay, and death in ICU of the three groups of patients (all P>0.05).ConclusionsThe ΔIAP has good reference value for predicting extubation failure, which is negatively correlated with the risk of extubation failure in patients with MV. For MV patients with ΔIAP≤31mmHg, they may have higher risk of extubation failure, early alert and interventions are highlighted for those patients.

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Classical (adiponectin, leptin, resistin) and new (chemerin, vaspin, omentin) adipocytokines in patients with prediabetes

Hormone Molecular Biology and Clinical Investigation ◽

10.1515/hmbci-2017-0031 ◽

2018 ◽

Vol 0 (0) ◽

Cited By ~ 9

Author(s):

Antoaneta Gateva ◽

Yavor Assyov ◽

Adelina Tsakova ◽

Zdravko Kamenov

Keyword(s):

Insulin Resistance ◽

Predictive Value ◽

Operating Characteristic ◽

Area Under The Curve ◽

Serum Adiponectin ◽

Endocrine Organ ◽

Serum Leptin ◽

Discriminating Power ◽

Study Population ◽

Obese Subjects

Abstract Background In the last decade, there has been an increased interest toward fat tissue as an endocrine organ that secretes many cytokines and bioactive mediators that play a role in insulin sensitivity, inflammation, coagulation and the pathogenesis of atherosclerosis. The aim of this study was to investigate classical (adiponectin, leptin, resistin) and new (chemerin, vaspin, omentin) adipocytokine levels in subjects with prediabetes [impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT)] and obese subjects with normoglycemia. Methods In this study, 80 patients with a mean age of 50.4 ± 10.6 years were recruited, divided into two groups with similar age and body mass index (BMI) – with obesity and normoglycemia (n = 41) and with obesity and prediabetes (n = 39). Results Serum adiponectin levels were significantly higher in subjects with normoglycemia compared to patients with prediabetes. Adiponectin has a good discriminating power to distinguish between patients with and without insulin resistance in our study population [area under the curve (AUC) = 0.728, p = 0.002]. Other adipocytokine levels were not significantly different between the two groups. The patients with metabolic syndrome (MetS) had significantly lower levels of leptin compared to those without MetS (33.03 ± 14.94 vs. 40.24 ± 12.23 ng/mL) and this difference persisted after adjustment for weight and BMI. Receiver operating characteristic (ROC) analysis showed that low serum leptin can predict the presence of MetS (p = 0.03), AUC = 0.645. Conclusion Serum adiponectin is statistically higher in patients with normoglycemia compared to those with prediabetes and has a predictive value for distinguishing between patients with and without insulin resistance in the studied population. Serum leptin has a good predictive value for distinguishing between patients with and without MetS in the studied population.

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Correlation of Neck Circumference with Difficult Mask Ventilation and Difficult Laryngoscopy in Morbidly Obese Patients: an Observational Study

Obesity Surgery ◽

10.1007/s11695-018-3263-3 ◽

2018 ◽

Vol 28 (9) ◽

pp. 2860-2867 ◽

Cited By ~ 1

Author(s):

Aylin Özdilek ◽

Cigdem Akyol Beyoglu ◽

Şafak Emre Erbabacan ◽

Birsel Ekici ◽

Fatiş Altındaş ◽

...

Keyword(s):

Observational Study ◽

Neck Circumference ◽

Difficult Laryngoscopy ◽

Morbidly Obese ◽

Obese Patients ◽

Mask Ventilation ◽

Difficult Mask Ventilation

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Clinical Significance of Serum HE4, CA125, CA724, and CA19-9 in Patients With Endometrial Cancer

Technology in Cancer Research & Treatment ◽

10.1177/1533034616666644 ◽

2016 ◽

Vol 16 (4) ◽

pp. 435-439 ◽

Cited By ~ 14

Author(s):

Jing Bian ◽

Xiaoxu Sun ◽

Bo Li ◽

Liang Ming

Keyword(s):

Endometrial Cancer ◽

Receiver Operating Characteristic ◽

Predictive Value ◽

Operating Characteristic ◽

Area Under The Curve ◽

International Federation ◽

Characteristic Analysis ◽

Predictive Values ◽

Gynecology And Obstetrics ◽

Receiver Operating

Purpose: Serum markers with increased sensitivity and specificity for endometrial cancer are required. To date, no good marker has met this standard. The aims of our study were to evaluate the utility of tumor markers HE4, CA125, CA724, and CA19-9 as potential markers in patients diagnosed with endometrial cancer. Methods: Blood samples from 105 patients with endometrial cancer and 87 healthy women were analyzed by Roche electrochemiluminescent immunoassay, and serum values were measured for the following biomarkers: HE4, CA125, CA724, and CA19-9. Results: Serum HE4, CA125, CA724, and CA19-9 concentrations were significantly higher in patients with endometrial cancer, compared with controls ( P < .001). In the receiver operating characteristic analysis, the area under the curve value for combination of HE4, CA125, CA724, and CA19-9 was 82.1% (95% confidence interval: 75.3%-86.2%), the maximum area of the test groups. For all stages of patients with endometrial cancer, HE4 had higher sensitivity (58%), positive predictive value (60%), and negative predictive value (67%) than any other single tumor marker, and in the combination of HE4, CA125, CA724, and CA19-9, the sensitivity and positive predictive values reached 59.1% and 88%, respectively. Meanwhile, the receiver operating characteristic area under the curve of the combination of the 4 markers was significantly increased than any other group, either in stage I or in stage II to IV cases. HE4 and CA125 both correlate with advanced age; in addition, HE4 was related to pathology subtypes and positive adnexal involvement, CA125 was related to International Federation of Gynecology and Obstetrics stage, CA19-9 was related to International Federation of Gynecology and Obstetrics stage, and CA724 was correlated with positive lymph node. Conclusion: Combination of HE4, CA125, CA724, and CA19-9 has the highest value in diagnosing endometrial cancer, and they can be a useful tissue immune marker for patients with endometrial cancer.

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