Predictive value of change in effective arterial elastance in norepinephrine weaning: a retrospective study

Background: Few studies have described the characteristics of a concealed intratendinous subscapularis tear (CIST), and there is a lack of research on the preoperative predictability of such lesions. Purpose: To describe the characteristics of a CIST as seen on magnetic resonance imaging (MRI) and intraoperatively and to develop a scoring system for predicting such lesions. Study Design: Case series; Level of evidence, 4. Methods: Retrospectively, we identified 43 patients with CISTs among 442 consecutive patients who had undergone rotator cuff repair from July 2014 to June 2016. Range of motion, visual analog scale results for pain and function, and patient-reported outcome scores were evaluated preoperatively and at 1 and 2 years postoperatively. CISTs were classified arthroscopically as small (<5 mm), medium (5-10 mm), and large (>10 mm). We performed repair (≥50%) or debridement (<50%) depending on the total subscapularis tendon tear size including the CIST. Preoperative MRI findings were analyzed by 2 observers and were correlated with the arthroscopic findings. A 10-point scoring system was developed based on characteristics during the physical examination (anterior tenderness, bear hug sign), MRI (biceps tendon displacement and subluxation, subscapularis signal change just lateral to the lesser tuberosity), and arthroscopic surgery (medial biceps tendon lesion, combined subscapularis tendon tear), with a cutoff value of ≥7 predicting a CIST. After the retrospective study, we prospectively enrolled 95 patients to validate the 10-point CIST scoring system. Results: All 43 patients diagnosed with a CIST during the retrospective study improved both range of motion and functional scores at 1 year postoperatively. The interrater agreement of the 2 observers was substantial for the evaluation of all parameters except for subscapularis tear classification, which was moderate. On arthroscopic surgery, 11 small, 19 medium, and 13 large CISTs were detected. The preliminary prospective study showed a sensitivity of 61.9%, specificity of 94.3%, positive predictive value of 89.0%, negative predictive value of 75.7%, and accuracy of 80.0% when the cutoff value was set at ≥7 on the CIST scoring system. Conclusion: A CIST can be suspected using a combination of preoperative MRI and intra-articular diagnostic arthroscopic findings, but a definitive diagnosis requires an arthroscopic view. On the 10-point CIST scoring system, a score of ≥5 can be suggestive of a CIST, and a score of ≥7 is most likely to predict a CIST.

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Estimating the effective arterial elastance at bedside: a reply to a rebuttal

Journal of Clinical Monitoring and Computing ◽

10.1007/s10877-019-00303-1 ◽

2019 ◽

Vol 33 (5) ◽

pp. 941-943

Author(s):

Denis Chemla ◽

Jean-Louis Teboul ◽

Mathieu Jozwiak

Keyword(s):

Arterial Elastance ◽

Effective Arterial Elastance

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A surveillance method to identify patients with sepsis from electronic health records in Hong Kong: a single centre retrospective study

BMC Infectious Diseases ◽

10.1186/s12879-020-05330-x ◽

2020 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Ying Zhi Liu ◽

Raymond Chu ◽

Anna Lee ◽

Charles David Gomersall ◽

Lin Zhang ◽

...

Keyword(s):

Hong Kong ◽

Retrospective Study ◽

Predictive Value ◽

Adult Patients ◽

Single Centre ◽

Study Objective ◽

Suspected Infection ◽

Link Type ◽

Surveillance Method ◽

Electronic Health

Abstract Background Currently there are only two population studies on sepsis incidence in Asia. The burden of sepsis in Hong Kong is unknown. We developed a sepsis surveillance method to estimate sepsis incidence from a population electronic health record (EHR) in Hong Kong using objective clinical data. The study objective was to assess our method’s performance in identifying sepsis using a retrospective cohort. We compared its accuracy to administrative sepsis surveillance methods such as Angus’ and Martin’s methods. Method In this single centre retrospective study we applied our sepsis surveillance method on adult patients admitted to a tertiary hospital in Hong Kong. Two clinicians independently reviewed the clinical notes to determine which patients had sepsis. Performance was assessed by sensitivity, specificity, positive predictive value, negative predictive value and area under the curve (AUC) of Angus’, Martin’s and our surveillance methods using clinical review as “gold standard.” Results Between January 1 and February 28, 2018, our sepsis surveillance method identified 1352 adult patients hospitalised with suspected infection. We found that 38.9% (95%CI 36.3–41.5) of these patients had sepsis. Using a 490 patient validation cohort, two clinicians had good agreement with weighted kappa of 0.75 (95% CI 0.69–0.81) before coming to consensus on diagnosis of uncomplicated infection or sepsis for all patients. Our method had sensitivity 0.93 (95%CI 0.89–0.96), specificity 0.86 (95%CI 0.82–0.90) and an AUC 0.90 (95%CI 0.87–0.92) when validated against clinician review. In contrast, Angus’ and Martin’s methods had AUCs 0.56 (95%CI 0.53–0.58) and 0.56 (95%CI 0.52–0.59), respectively. Conclusions A sepsis surveillance method based on objective data from a population EHR in Hong Kong was more accurate than administrative methods. It may be used to estimate sepsis population incidence and outcomes in Hong Kong. Trial registration This study was retrospectively registered at clinicaltrials.gov on October 3, 2019 (NCT04114214).

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Rebuttal to: “As simple as possible, but not simpler: estimating the effective arterial elastance at bedside”

Journal of Clinical Monitoring and Computing ◽

10.1007/s10877-019-00279-y ◽

2019 ◽

Vol 33 (5) ◽

pp. 937-940 ◽

Cited By ~ 1

Author(s):

Manuel Ignacio Monge Garcia ◽

Zhongping Jian ◽

Jos J. Settels ◽

Feras Hatib ◽

Maurizio Cecconi ◽

...

Keyword(s):

Arterial Elastance ◽

Effective Arterial Elastance

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Hemodynamic correlates of effective arterial elastance in mitral stenosis before and after balloon valvotomy

Journal of Applied Physiology ◽

10.1152/jappl.1997.83.4.1083 ◽

1997 ◽

Vol 83 (4) ◽

pp. 1083-1089 ◽

Cited By ~ 4

Author(s):

Patrice Colin ◽

Michel Slama ◽

Alec Vahanian ◽

Yves Lecarpentier ◽

Gilbert Motté ◽

...

Keyword(s):

Mitral Stenosis ◽

Arterial Compliance ◽

Aortic Pressure ◽

Pulse Interval ◽

Wave Reflections ◽

Arterial Elastance ◽

Before And After ◽

Hydraulic Load ◽

Balloon Valvotomy ◽

Effective Arterial Elastance

Colin, Patrice, Michel Slama, Alec Vahanian, Yves Lecarpentier, Gilbert Motté, and Denis Chemla. Hemodynamic correlates of effective arterial elastance in mitral stenosis before and after balloon valvotomy. J. Appl. Physiol. 83(4): 1083–1089, 1997.—This study had the purpose of documenting the hemodynamic correlates of effective arterial elastance (Ea; i.e., an accurate estimate of hydraulic load) in mitral stenosis (MS) patients. The main hypothesis tested was that Ea relates to the total vascular resistance (R)-to-pulse interval duration ( T) ratio (R/ T) in MS patients both before and after successful balloon mitral valvotomy (BMV). High-fidelity aortic pressure recordings were obtained in 10 patients (40 ± 12 yr) before and 15 min after BMV. Ea value was calculated as the ratio of the steady-state end-systolic aortic pressure (ESAP) to stroke volume (thermodilution). Ea increased after BMV (from 1.55 ± 0.63 to 1.83 ± 0.71 mmHg/ml; P < 0.05). Throughout the procedure, there was a strong linear relationship between Ea and R/ T: Ea = 1.09R/ T − 0.01 mmHg/ml, r = 0.99, P = 0.0001. This ultimately depended on the powerful link between ESAP and mean aortic pressure [MAP; r = 0.99, 95% confidence interval for the difference (MAP − ESAP) from −18.5 to +4.5 mmHg]. Ea was also related to total arterial compliance (area method) and to wave reflections (augmentation index), although to a lesser extent. After BMV, enhanced and anticipated wave reflections were observed, and this was likely to be explained by decreased arterial compliance. The present study indicated that Ea depended mainly on the steady component of hydraulic load (i.e., R) and on heart period (i.e., T) in MS patients.

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