The Feasibility of Applying Inferior Vena Cava Collapse Index to Guide the Use of Fluid Therapy in Neonates with Pulmonary Hemorrhage on Mechanical Ventilation

Purpose. Explore the feasibility of applying Inferior Vena Cava Collapse Index (IVC-CI) in guiding the use of fluid therapy in neonates with Pulmonary Hemorrhage (PH) on mechanical ventilation. Construct a novel and non-invasive technique in accurately and dynamically assess the fluid volume of neonates.Methods. Cases met the diagnostical criteria of Pulmonary Hemorrhage (PH) admitted between July 2016 to June 2018 were reviewed and included into the Control Group for this study. Cases met the same said criteria between July 2018 and June 2020 were included into the Experimental Group. PHILIPS Bedside color Doppler ultrasound system was used in detecting and calculating the IVC-CI, which was later used for patients in experimental group to guide the practice of fluid therapy. A total of 54 cases were reviewed with 8 cases excluded for death during hospitalization. 24 cases were included into the control group, 22 cases were included into the experimental group.Results. Fluid intake volumes were recorded at 0-6th hours, 6th-24th hours and 24th-48th hours with the onset of PH as the initial observation point. For 22 patients in experimental group, the volumes were respectively (64±6) ml/Kg, (71±8) ml/Kg and (102±10) ml/Kg. In the control group, the volumes were (60±4) ml/kg, (93±4) ml/kg and (105±9) ml/kg, respectively. The P values of the two groups during the same time period were 0.013, 0.000, 0.361, suggesting the differences of fluid intake between the two groups during the first 6 hours and the following 18 hours after the onset of PH were of statistical significance.The time taken for the improvement of lactate concentration and oxygenation index for the experimental group were (26.4±6.7) h and (22.6±5.8) h, respectively. The time taken for the same two indexes to improve in the control group were (38.5±6.7) h and (27.0±5.0) h. P values for these two indexes between two groups were 0.015 and 0.009, suggesting statistically significant differences.Conclusion. Ultrasound guided IVC-CI measurement can dynamically evaluate volume status, guide fluid therapy in a targeted manner. A more responsive and selective fluid therapy achieved this way can alleviate the patients’ conditions quicker than traditional therapeutic approaches.

The effect of pH and electrical conductivity of the soaking fluid on the collapse of a silty clay

Different fluids can permeate the soil collapsing at various levels of severity depending on their physicochemical characteristics. This work evaluated the effect of pH and electrical conductivity (ECf) of different soaking fluids on the collapsible behavior of a lateritic silty clay. Double and single oedometer tests were performed using four chemically distinct soaking fluids (water, leachate and two laboratory solutions, one alkaline and one acid). The collapse index (I) was evaluated according to two criteria. In addition, physical-chemical analysis of the soil and measurements of pH and ECf were done. According to the results, the soil is collapsible for the four soaking fluids. No single relationship was found between fluid pH and collapse index, although, the highest values of collapse index were found in the tests soaked with alkaline and acid solutions. Finally, a unique direct relationship was found between the collapse index and the ECf, that is, the higher this parameter, the higher the collapse index value.

USING CORONARY SINUS DIAMETER AND COLLAPSE INDEX TO ESTIMATE RIGHT ATRIAL PRESSURE FOR ECHOCARDIOGRAPHIC SYSTOLIC PULMONARY ARTERIAL PRESSURE MEASUREMENT

Objective: According to Bernoulli Equation, systolic pulmonary artery pressure is obtained echocardiographically by adding estimated right atrial pressure (RAP) to the multiply of square of tricuspid regurgitation flow rate by four. RAP is estimated based on inferior vena cava (IVC) diameter and collapse. Our objective is to investigate usability of coronary sinus(CS) diameter and collapse, measured by echocardiography for estimating RAP. Methods: Our study is a single center, prospective study. 136 patients, over 18 years of age and without exclusion criteria, who admitted to Akdeniz University Hospital Cardiology Department between March 2017 and March 2018 and were scheduled to undergo right heart catheterization for any reason were included study. Results: Patients were divided into two groups as invasively measured RAP ≥10 mmHg (n: 57) and RAP <10 mmHg (n: 79). In group with RAP ≥10 mmHg, maximum IVC and CS diameter were higher than group with RAP <10 mmHg, IVC and CS collapse indices were lower (p <0.001). Optimal cut-off value for maximum IVC diameter was 19.6 mm (sensitivity 63.2%, specificity 87.3%), for IVC collapse index was 46.1 (sensitivity 75%, specificity 79.7%), for maximum CS diameter was 11 mm (sensitivity 64.9%, specificity 77%), for CS collapse index was 39.2 (sensitivity 75.4%, specificity 88.6%). Conclusion: Significant relationship was found between invasively measured RAP and maximum IVC diameter, collapse index and maximum CS diameter and collapse index. Results of CS parameters were as significant as results of IVC parameters therefore it shows that CS can also be used for estimating RAP.

GIS-Based Simulated Annealing Algorithm for the Optimum Location of Fire Stations in the Madrid Region, Spain: Monitoring the Collapse Index

Recent increases in incidents make it unlikely for emergency systems to be able to meet incident requirements. In this paper, we formulate a new territorial measurement approach for the reliability of fire departments, the collapse index, to help decision makers determine their response capability. This new index expresses the maximum simultaneous workload in a pixel over one year, measured over time. Based on this index, we propose a new fire station (FS) optimum location model by applying the simulated annealing method in conjunction with a geographic information system. The formulation of the cost function as the minimum standard deviation of the FS workload, combined with the constraint that the maximum collapse index in any pixel must be less than a certain threshold, are two contributions of this work. Five optimisation processes are developed to locate between up to five FS and create collapse index maps in the Madrid Region. The maximum collapse index in a pixel with a new FS decreases from its initial value of 10,485 min to 2500 min when five new FS are built. The conclusion is that the proposed optimisation model meets the need for reliability in the emergency services and that the collapse index is a good measure to prevent overlapping in the system.

Diameter and collapse index of inferior vena cava as a clinical indicator of resuscitation for critically ill hypotensive patients

Purpose The role of diameter and collapse index of inferior vena cava (DCIIVC) in reflecting intravascular volume status and fluid responsiveness remains unclear. We aimed to evaluate the effectiveness of DCIIVC as a clinical indicator for fluid resuscitation (FR) in critically ill hypotensive patients.Methods This retrospective study enrolled hypotensive patients admitted to the surgical intensive care unit (SICU) between May 2018 and April 2019. Between May and October 2018, fluid therapy was conducted by a physician’s decision (non-DCIIVC group, 32 patients). Between November 2018 and April 2019, DCIIVC was used as a guide (DCIIVC group, 30 patients). Clinical outcomes of the two periods were compared.Results Total amount of fluid intake (TAFI) of non-DCIIVC and DCIIVC group in 24 h was 4,130 and 3,560, respectively (p < 0.05). TAFI in 48 h was 8,420 and 6,910, respectively (p < 0.01). Lactate levels at admission, 24 and 48 h after admission were 4.1 vs 3.8, 3.2 vs 3.1, and 1.9 vs 2.1 mmol/L, respectively. Mean duration of mechanical ventilation, ICU stay, and hospital stay were 4.1 vs 4.5, 7.2 vs 6.3, and 18.1 vs 17.2, respectively. Overall mortality was 16.7% vs 13.3%. There was no significant difference in any other characteristic except TAFI.Conclusion DCIIVC can be used as a tool for indicating FR in critically ill hypotensive patients. This can help physicians infuse fluid restrictively, without adverse outcomes.

Cardiac variation of internal jugular vein as a marker of volume change in haemorrhagic shock

Background. Fluid resuscitation is crucial to counter acute haemorrhagic shock and requires prompt and accurate intravascular volume estimation for optimal fluid administration. This study aimed to evaluate whether cardiac variation of the internal jugular vein (IJV), measured by ultrasound, could detect hypovolemic status and predict response to fluid resuscitation. Methods. Autologous blood transfusion patients for their own elective surgeries were prospectively enrolled at our blood donation centre from August 2014 to January 2015., and movies of vertical B-mode ultrasonography of the IJV were recorded at five points during blood donation, namely, before donation, during donation, end of donation, end of fluid replacement and after hemostasis. Cardiac variation in IJV area and circumference were objectively measured using an automated extraction programme, along with blood pressure and heart rate. Results. We screened 140patients and data from 104 were eventually evaluated. Among the variables analysed, only collapse index area (CIa) and collapse index circumference (CIc) could detect both intravascular volume loss and response to fluid administration Conclusions. The cardiac variation of IJV may be a reliable indicator of intravascular volume loss and response to fluid administration in haemorrhagic shock.

Relative host resistance to Alternaria leaf spot in canola and mustard varieties is defined by Alternaria species

Both Alternaria japonica and A. brassicae cause severe Alternaria leaf spot on canola (Brassica napus) and mustard (B. juncea). We tested 103 Brassicaceae varieties including 93 Australian canola, nine Indian mustard, and a single variety of Ethiopian mustard (B. carinata) under greenhouse conditions to identify host resistance to Alternaria leaf spot caused by A. japonica and A. brassicae in terms of disease incidence (percentage leaf disease incidence, %LDI), disease severity (percentage leaf area diseased, %LAD) and defoliation (percentage leaf collapse index, %LCI). Against A. japonica, across the three parameters, B. napus Surpass 404 CL was the most resistant (%LDI 7.5, %LAD 5.0, %LCI 0). Varieties Hyola 635 CC, Oscar, AG-Outback and Rottnest, with %LDI 15.6–19.4 and %LAD 12.5–15.6, also showed strong resistance, and with %LCI 10. Varieties 47C02, ATR-Signal and Clancy of B. napus showed a moderate level of resistance across %LDI (21.2–25.6) and %LAD (15.0–20.6), along with a low level of defoliation (%LCI 10). Varieties 46C03, 46C72, ATR-Cobbler and Granite TT of B. napus also showed a moderate level of resistance, with %LDI 23.1–28.7, %LAD 18.1–20.6 and %LCI 11.2–14.4. The significance of this resistance against A. japonica is highlighted by the severe disease on B. napus Thunder TT (%LDI 78.8, %LAD 72.5, %LCI 47.5). Against A. brassicae, all varieties showed susceptibility; however, B. napus ATR-Grace was the least susceptible in relation to disease incidence (%LDI 41.2) and severity (%LAD 36.2), and B. napus Hyola 450 TT the most susceptible (%LDI 90.0, %LAD 82.5). Variety Hurricane of B. napus was the least susceptible in terms of consequent defoliation (%LCI 11.2) and B. napus CBTM Tribune the most susceptible (%LCI 81.2). The B. carinata variety BCA 1 (ATC 95065) and all test B. juncea varieties showed susceptibility to both pathogens. These findings demonstrate high levels of resistance across Australian canola varieties against A. japonica that can be directly deployed where A. japonica is important and can be utilised by breeders for improving resistance in future varieties. By contrast, susceptibility across Australian canola and mustard varieties to A. brassicae is concerning, highlighting a need to locate suitable resistances and, until effective host resistance can be located, to develop and deploy cultural and chemical options.