bedside test
Recently Published Documents


TOTAL DOCUMENTS

205
(FIVE YEARS 46)

H-INDEX

25
(FIVE YEARS 2)

2022 ◽  
Vol 16 (1) ◽  
Author(s):  
Mohamed Abdel-Bary ◽  
Alaa Rashad ◽  
Hamed Elgendy ◽  
Mohammed Zaki ◽  
Mahmoud Youssef Abdelhamid ◽  
...  

Abstract Background We aim to assess the role of diaphragm ultrasonography in evaluating the outcome of surgical diaphragmatic plication in adults with symptomatic unilateral diaphragmatic eventration. Results Forty patients with symptomatic unilateral diaphragmatic eventration underwent surgical diaphragmatic plication between 2015 and 2020. The etiology was idiopathic in 34 (85%) cases, and 37 (92.5%) of them were suffering from dyspnea. Diaphragm ultrasonography showed no diaphragmatic movement on the affected side in 10 (25%) patients and a paradoxical movement in 30 (75%) patients. Surgical diaphragmatic plication was done successfully in all cases. Postoperative complications were reported in 3 (7.5%) cases, with no mortality. There was a highly significant improvement in dyspnea at 1 week and 6 months follow-up. CXR showed a highly significant decrease in the mean height of eventration at 1 week 3.7 ± 1.2 cm (P < 0.001), and 6 months 2.6 ± 0.9 cm (P < 0.001), compared to preoperative values (10.1 ± 2.8 cm). diaphragm ultrasonography showed normal motility of the plicated cupola in all cases, and there was a highly significant decrease in the mean height of eventration at 1 week (3.1 ± 1.1 cm, P < 0.001), and 6 months (2.3 ± 0.5 cm, P < 0.001) compared to preoperative values (10.3 ± 2.2 cm). There was a highly significant increase in the diaphragm thickness at 1 week (2.7 ± 0.3 mm, P < 0.001), and 6 months (2.9 ± 0.2 mm, P < 0.001), compared to the preoperative value. There was a highly significant improvement in the degree of excursion 1 week (25 ± 4.3 mm, P < 0.001), and 6 months (28 ± 5.2 mm, P < 0.001), compared to the preoperative value (15 ± 6.2 mm). No fluid collection or surroundings organ injuries were detected. The mean FVC and FEV1 showed a highly significant improvement at 1 week (66.7 ± 6%, 78.2 ± 9.8%), and 6 months (68.8 ± 5.7%, 80.4 ± 10.3%), compared to the preoperative value (58.8 ± 8% and 70.9 ± 10.3%). Conclusions Surgical diaphragmatic plication is an effective and safe procedure that can be performed to treat symptomatic adults with unilateral diaphragmatic eventration. Diaphragm ultrasonography can be used as a simple bedside test to evaluate unilateral diaphragmatic eventration cases and their postoperative follow-up.


2021 ◽  
Vol 11 (1) ◽  
pp. 179
Author(s):  
Yaroslava Longhitano ◽  
Christian Zanza ◽  
Tatsiana Romenskaya ◽  
Angela Saviano ◽  
Tonia Persiano ◽  
...  

The use of non-invasive respiratory strategies (NIRS) is crucial to improve oxygenation in COVID-19 patients with hypoxemia refractory to conventional oxygen therapy. However, the absence of respiratory symptoms may delay the start of NIRS. The aim of this study was to determine whether a simple bedside test such as single-breath counting test (SBCT) can predict the need for NIRS in the 24 h following the access to Emergency Department (ED). We performed a prospective observational study on 120 patients with COVID-19 pneumonia. ROC curves were used to analyze factors which might predict NIRS requirement. We found that 36% of patients had normal respiratory rate and did not experience dyspnea at rest. 65% of study population required NIRS in the 24 h following the access to ED. NIRS-requiring group presented lower PaO2/FiO2 (235.09 vs. 299.02), SpO2/FiO2 ratio (357.83 vs. 431.07), PaCO2 (35.12 vs. 40.08), and SBCT (24.46 vs. 30.36) and showed higher incidence of dyspnea at rest (57.7% vs. 28.6%). Furthermore, SBCT predicted NIRS requirement even in the subgroup of patients without respiratory symptoms (AUC = 0.882, cut-off = 30). SBCT might be a valuable tool for bedside assessment of respiratory function in patients with COVID-19 pneumonia and might be considered as an early clinical sign of impending respiratory deterioration.


Author(s):  
Ishan Agrawal ◽  
Maitreyee Panda ◽  
Debashree Sahoo ◽  
Adya Kinkar Panda ◽  
Manas Ranjan Puhan

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 2137-2137
Author(s):  
Kanak Parmar ◽  
Wasawat Vutthikraivit ◽  
Amritpal Singh ◽  
Christina Morataya ◽  
Gaspar Del Rio Pertuz ◽  
...  

Abstract Background Veno-Venous Extracorporeal Membrane Oxygenation (ECMO) technology provides as a alternative approach in the intensive care of patients with respiratory failure due to varied causes who are not responsive to conventional treatment. As per the 2014 Extracorporeal Life Support Organization (ELSO) guidelines, in order to to maintain circuit patency and minimize thromboembolic complications, anticoagulation is used, but the optimal strategy remains to be defined. Activated clotting time (ACT) is the most utilized bedside test to adjust anticoagulation. Therefore, we performed an extended analysis of all published studies on the incidence of thromboembolic and bleeding events in patients with acute respiratory distress syndrome who were put on ECMO. Methods A comprehensive search of several databases from inception to November 25, 2020, limited to English language and excluding animal studies, was conducted. The databases included Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily, Ovid Embase, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus. The studies were classified into low anticoagulation target (ACT&lt;180) or high anticoagulation target (ACT&gt;180). A meta-analysis was performed of all eligible studies with the data on the incidences of thromboembolic and bleeding complications in patients with ARDS on VV-ECMO during different intensities of anticoagulation. Results A total of 6 eligible studies (4 retrospective and 2 case series) were identified, including in total 190 patients for 100 patient years. Our study showed that there is two times higher chances of bleeding when ACT goal is &gt;180 versus a lower ACT range of &lt;180 (Risk ratio 2.07, 95% CI 1.23-3.46, P 0.0056). The incidence of thrombosis did not change in the two group (Risk ratio 1.17, 95% CI 0.45-3, P 0.7516). Conclusions Currently there is a lack of data for anticoagulation strategies during VV-ECMO for patients in respiratory failure. Our study aimed to find an appropriate anticoagulation target for this patient group. The results show that although anticoagulation is required for circuit patency, there is an increased risk of bleeding when higher anticoagulation targets are set. Disclosures No relevant conflicts of interest to declare.


2021 ◽  
Vol 14 (10) ◽  
pp. e245301
Author(s):  
Rajkumar Rajendram ◽  
Arif Hussain ◽  
Naveed Mahmood ◽  
Gabriele Via

Right-to-left (RTL) interatrial shunt (IAS) may complicate select cases of COVID-19 pneumonia. We describe the use of serial imaging to monitor shunt in critically ill patients. A 52-year-old man presented with COVID-19 pneumonia. Hypoxia worsened despite maximal medical therapy and non-invasive ventilation. On day 8, saline microbubble contrast-enhanced transthoracic echocardiography revealed a patent foramen ovale (PFO) with RTLIAS. Invasive ventilation was initiated the next day. The course was complicated by intermittent severe desaturation without worsening aeration or haemodynamic instability, so PFO closure was considered. However, on day 12, saline microbubble contrast-enhanced transoesophageal echocardiography excluded RTLIAS. The patient was extubated on day 27 and discharged home 12 days later. Thus, RTLIAS may be dynamic and changes can be detected and monitored by serial imaging. Bedside echocardiography with saline microbubble contrast, a simple, minimally invasive bedside test, may be useful in the management of patients with severe hypoxia.


2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
P Thacker ◽  
D Amaratunga ◽  
K Shah ◽  
R Watson ◽  
A Singh ◽  
...  

Abstract Background Bedside assessment of intravascular volume in patients with chronic congestive heart failure (CHF) is often difficult. Under- and over-diuresis are common causes of morbidity and readmissions in these patients. Purpose We hypothesized that ultrasound assessment of the internal jugular vein would be easier and more reproducible than clinically assessing jugular venous pressure (JVP). Our goal was to create a bedside test that would be simpler to learn than inferior vena cava (IVC) assessment and easier to perform in obese patients. Methods Adults with HF (n=53, 52% men, mean age 65 years, mean BMI 29.6 kg/m2, mean LVEF 44%) scheduled for right heart catheterization (RHC) had an ultrasound of their right internal jugular (RIJ) vein performed immediately prior. Cross-sectional area of RIJ was measured during normal breathing with patients at 90 and 45 degrees recumbency and was indexed by height (RIJI). JVP was also assessed clinically. Results were compared to right atrial pressure (RAP) measured by RHC. Operators were blinded to RHC results and vice versa. Results JVP was correctly assessed clinically in only 43%. RIJI at 90 and 45 degrees were significantly larger in patients with elevated RAP compared to euvolemic patients (Table). At 90 degrees, RIJI of &gt;15 predicted a RAP of &gt;10 mmHg with 68% sensitivity and 72% specificity. At 45 degrees, RIJI of &gt;10 predicted a RAP of &gt;10 mmHg with 94% sensitivity and a negative predictive value of 80% (Table). Simply being able to see the RIJ at 90 degrees (n=34) had an 82.4% positive predictive value for elevated RAP. IVC data could not be obtained on 23% of patients due to body habitus or inability to lay flat. Conclusion Ultrasonographic RIJI is more accurate than clinical assessment in patients with CHF and can be accurately performed even in obese patients. It requires only a basic linear ultrasound probe and was easily performed by clinicians at various stages of training with reproducible results. With the increased availability of bedside ultrasound in clinical practice, it is a feasible method of evaluating chronic CHF patients. FUNDunding Acknowledgement Type of funding sources: None.


QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Tarek Mohamed Youssef ◽  
Ahmed El Saady Mohmmed Khyal ◽  
Mohamed Magdy Salama ◽  
Elary Abdel Maseeh Poles

Abstract Background Cirrhosis represents the final common histological pathway for a wide variety of chronic liver diseases. Occurrence of ascites is the most common presentation of liver cirrhosis. Spontaneous bacterial peritonitis (SBP) is observed in 15–26% of patients hospitalized with ascites. Objectives The aims of this study was to evaluate the usefulness of AF lactoferrin for the diagnosis of SBP and to identify a clinically useful cut-off level that can be used for future development of an important clinical, economic and time saving rapid bedside test for the diagnosis of SBP in cirrhotic ascites. Patients and Methods This study was conducted on 40 patients with decompensated chronic liver disease and ascites with and without spontaneous bacterial peritonitis admitted to Nasser institute for researches and treatment Hospital and Internal Medicine department, Faculty of Medicine, Ain Shams University from November 2017 to April 2018. Results Females were affected more than males by SBP, SBP has higher incidence in elderly compared to control group, no significant difference between studied groups regards to risk factors and Child class, HCV infection was the main etiology of liver cirrhosis in both groups while HBV infection was much less common with no significant difference between studied groups. Patients in SBP group showed positive reaction to CRP compared to control group with significant difference between them. No statistical significant differences between studied groups regards to abdominal ultrasonographic findings. Liver enzymes (ALT) and ALP were higher in SBP patients compared to non SBP patients with significant difference between them. SBP patients have higher TLC and lower MCV and platelets count compared to non SBP patients with significant difference between them. No statistical significant difference between studied groups regards to INR, Hb and MCH values. Conclusion Outcomes of our study provide evidence of the clinical usefulness of AF lactoferrin levels in patients with cirrhosis to differentiate those with and without SBP.


2021 ◽  
Vol 14 ◽  
Author(s):  
Edward Beamer ◽  
Mary Isabel O’Dea ◽  
Aisling A. Garvey ◽  
Jonathon Smith ◽  
Aida Menéndez-Méndez ◽  
...  

Background: Evidence suggests that earlier diagnosis and initiation of treatment immediately after birth is critical for improved neurodevelopmental outcomes following neonatal encephalopathy (NE). Current diagnostic tests are, however, mainly restricted to clinical diagnosis with no molecular tests available. Purines including adenosine are released during brain injury such as hypoxia and are also present in biofluids. Whether blood purine changes can be used to diagnose NE has not been investigated to date.Methods: Blood purines were measured in a mouse model of neonatal hypoxia and infants with NE using a novel point-of-care diagnostic technology (SMARTChip) based on the summated electrochemical detection of adenosine and adenosine metabolites in the blood.Results: Blood purine concentrations were ∼2–3-fold elevated following hypoxia in mice [2.77 ± 0.48 μM (Control) vs. 7.57 ± 1.41 μM (post-hypoxia), p = 0.029]. Data in infants with NE had a 2–3-fold elevation when compared to healthy controls [1.63 ± 0.47 μM (Control, N = 5) vs. 4.87 ± 0.92 μM (NE, N = 21), p = 0.0155]. ROC curve analysis demonstrates a high sensitivity (81%) and specificity (80%) for our approach to identify infants with NE. Moreover, blood purine concentrations were higher in infants with NE and seizures [8.13 ± 3.23 μM (with seizures, N = 5) vs. 3.86 ± 0.56 μM (without seizures, N = 16), p = 0.044].Conclusion: Our data provides the proof-of-concept that measurement of blood purine concentrations via SMARTChip technology may offer a low-volume bedside test to support a rapid diagnosis of NE.


2021 ◽  
Vol 116 (3) ◽  
pp. e6-e7
Author(s):  
Michelle Volovsky ◽  
Maria G. Duarte ◽  
Hugh S. Taylor ◽  
Amir Mor

Sign in / Sign up

Export Citation Format

Share Document