Monitoring Lung Function with Electrical Impedance Tomography in the Intensive Care Unit.

Electrical Impedance Tomography (EIT) is a groundbreaking, non-invasive, and radiation-free imaging technique for continuous, real-time ventilation monitoring. It also has an application in pulmonary perfusion monitoring. EIT quantifies ventilation and perfusion patterns across the lung from the measurement and processing of impedance changes in the thorax.

Imaging the pulmonary vasculature in acute respiratory distress syndrome.

Acute respiratory distress syndrome (ARDS) is characterized by a redistribution of regional lung perfusion that impairs gas exchange. While speculative, experimental evidence suggests that perfusion redistribution may contribute to regional inflammation and modify disease progression. Unfortunately, tools to visualize and quantify lung perfusion in patients with ARDS are lacking.

Electrical Impedance Tomography Identifies Evolution of Regional Perfusion in a Porcine Model of Acute Respiratory Distress Syndrome.

Background: Bedside electrical impedance tomography could be useful to visualize evolving pulmonary perfusion distributions when acute respiratory distress syndrome worsens or in response to ventilatory and positional therapies. In experimental acute respiratory distress syndrome, this study evaluated the agreement of electrical impedance tomography and dynamic contrast-enhanced computed tomography perfusion distributions at two injury time points and in response to increased positive end-expiratory pressure (PEEP) and prone position.

Methods: Eleven mechanically ventilated (VT 8 ml · kg-1) Yorkshire pigs (five male, six female) received bronchial hydrochloric acid (3.

Regional lung perfusion using different indicators in electrical impedance tomography.

Management of acute respiratory distress syndrome (ARDS) is classically guided by protecting the injured lung and mitigating damage from mechanical ventilation. Yet the natural history of ARDS is also dictated by disruption in lung perfusion. Unfortunately, diagnosis and treatment are hampered by the lack of bedside perfusion monitoring.

Improving pulmonary perfusion assessment by dynamic contrast-enhanced computed tomography in an experimental lung injury model.

Pulmonary perfusion has been poorly characterized in acute respiratory distress syndrome (ARDS). Optimizing protocols to measure pulmonary blood flow (PBF) via dynamic contrast-enhanced (DCE) computed tomography (CT) could improve understanding of how ARDS alters pulmonary perfusion. In this study, comparative evaluations of injection protocols and tracer-kinetic analysis models were performed based on DCE-CT data measured in ventilated pigs with and without lung injury.

Does Masked Interviewing Encourage Holistic Review in Residency Selection? A Mixed-Methods Study.

Medical educators increasingly champion holistic review. However, in U.S.

Motor Vehicle Crash Risk among Adults Undergoing General Surgery: A Retrospective Case-crossover Study.

Background: Surgery causes transient impairment in cognition and function, which may impact driving safety. The authors hypothesized that the risk of a motor vehicle crash would increase after compared to before surgery.

Methods: The authors performed a nested case-crossover study within population-based observational data from the New Jersey Safety Health Outcomes Data Warehouse.

A Prospective Observational Study on Short and Long-Term Outcomes of COVID-19 Patients with Acute Hypoxic Respiratory Failure Treated with High-Flow Nasal Cannula.

(1) The use of high-flow nasal cannula (HFNC) combined with frequent respiratory monitoring in patients with acute hypoxic respiratory failure due to COVID-19 has been shown to reduce intubation and mechanical ventilation. (2) This prospective, single-center, observational study included consecutive adult patients with COVID-19 pneumonia treated with a high-flow nasal cannula. Hemodynamic parameters, respiratory rate, inspiratory fraction of oxygen (FO), saturation of oxygen (SO), and the ratio of oxygen saturation to respiratory rate (ROX) were recorded prior to treatment initiation and every 2 h for 24 h.

Respiratory mechanics and mortality in coronavirus disease 2019 acute respiratory distress syndrome: A retrospective cohort study.

Background: The association between commonly monitored respiratory parameters, including compliance and oxygenation and clinical outcomes in acute respiratory distress syndrome (ARDS) from coronavirus disease 2019 (COVID-19) remains unclear, limiting prognostication and the delivery of targeted treatments. Our project aim was to identify if any such associations exist between clinical outcomes and respiratory parameters.

Methods: We performed a retrospective observational cohort study of confirmed COVID-19 positive patients admitted to a single dedicated intensive care unit at a university hospital from March 27 to April 26, 2020.

Association of hospitalization with driving reduction and cessation in older adults.

Background: Driving has not been considered as part of the social cost of acute illness and may go unnoticed in the post-hospital care of older adults. Decreases in driving after hospitalization and at-risk populations have not been investigated.

Objective: To determine the association between driving reduction and cessation and hospitalization in older adults by using nationally representative data.

Using Medicare claims in identifying Alzheimer's disease and related dementias.

Introduction: This study develops a measure of Alzheimer's disease and related dementias (ADRD) using Medicare claims.

Methods: Validation resembles the approach of the American Psychological Association, including (1) content validity, (2) construct validity, and (3) predictive validity.

Results: We found that four items-a Medicare claim recording ADRD 1 year ago, 2 years ago, 3 years ago, and a total stay of 6 months in a nursing home-exhibit a pattern of association consistent with a single underlying ADRD construct, and presence of any two of these four items predict a direct measure of cognitive function and also future claims for ADRD.

The role of the interview in residency selection: A mixed-methods study.

Context: Residency programmes invest considerable time and resources in candidate interviews as a result of their perceived ability to reveal important social traits. However, studies examining the ability of interviews to predict resident performance have shown mixed findings, and the role of the interview in candidate evaluation remains unclear. This mixed-methods study, conducted in an anaesthesiology residency programme at a large academic medical centre, examined how interviews contributed to candidate assessment and whether the addition of behavioural questions to interviews altered their role in the evaluation process.

Observational Study of the Associations of Participation in High School Football With Self-Rated Health, Obesity, and Pain in Adulthood.

American football is the most popular high school sport in the United States, yet its association with health in adulthood has not been widely studied. We investigated the association between high school football and self-rated health, obesity, and pain in adulthood in a retrospective cohort study of data from the Wisconsin Longitudinal Study (1957-2004). We matched 925 males who played varsity football in high school with 1,521 males who did not play football.

Preoperative Sedative-hypnotic Medication Use and Adverse Postoperative Outcomes.

Objective: To determine the association between preoperative benzodiazepine and nonbenzodiazepine receptor agonist ("Z-drugs") use and adverse outcomes after surgery.

Background: Prescriptions for benzodiazepines and Z-drugs have increased over the past decade. Despite this, the association of preoperative benzodiazepines and Z-drug receipt with adverse outcomes after surgery is unknown.

Prevalence and Multivariable Factors Associated With Preoperative Cognitive Impairment in Outpatient Surgery in the United States.

Preoperative cognitive impairment increases the risk of adverse events after surgery but its prevalence in outpatient surgery has not been defined. We aimed to determine the prevalence and multivariable factors associated with cognitive impairment in individuals who present for outpatient surgery. We used data from the Health and Retirement Study, a longitudinal panel survey of older Americans.

The older adult with preexisting neurocognitive disorder.

Purpose Of Review: With the ageing population, there is an increasing number of patients with a neurocognitive disorder (NCD) who undergo surgical procedures. The aim of this review is to highlight the epidemiology of preoperative NCD.

Recent Findings: New guidelines have defined NCD into mild NCD and major NCD consistent with terminology from the wider clinical community.

Association Between Obesity, Age, and Functional Decline in Survivors of Cardiac Surgery.

Background/objectives: Little is known about the effect of obesity on functional decline after cardiac surgery, especially in elderly adults. Our goal was to determine the association between obesity and functional decline in the 2 years after cardiac surgery and the interaction between obesity and age.

Design: Retrospective cohort study.

A retrospective cohort study examining the association between body mass index and mortality in severe sepsis.

Body mass index (BMI) is an easily calculated indicator of a patient's body mass including muscle mass and body fat percentage and is used to classify patients as underweight or obese. This study is to determine if BMI extremes are associated with increased 28-day mortality and hospital length of stay (LOS) in emergency department (ED) patients presenting with severe sepsis. We performed a retrospective chart review at an urban, level I trauma center of adults admitted with severe sepsis between 1/2005 and 10/2007, and collected socio-demographic variables, comorbidities, initial and most severe vital signs, laboratory values, and infection sources.

Administrative issues to ensure safe anesthesia care in the office-based setting.

Purpose Of Review: Office-based practice is distinct from other ambulatory practices and has unique considerations for an effective administrative structure to support its operations.

Recent Findings: National guidelines have been promulgated by various entities addressing both management and clinical care aspects of the practice. Specific regulations vary by practice location, and practitioners need to comply with the pertinent accreditation and licensing requirements.

The effect of obesity on clinical outcomes in presumed sepsis: a retrospective cohort study.

Sepsis is a major cause of hospital admissions and mortality. Nevertheless, there are significant gaps in our knowledge of the epidemiology of sepsis in obese people, who now represent more than one-third of the population in the United States. The objective of this study was to measure the association between obesity and mortality from presumed sepsis.