Two independent observers blinded for the EVLW measurements by the TDD analyzed the EIT measurements. Interobserver variation was studied by calculating Pearson’s correlation coefficient. Receiver operator characteristic (ROC) analysis was used to assess the optimal cutoff level of the IR to diagnose an increased amount of EVLW (> 10 mL/kg). The ROC curve shows the calculated sensitivity and specificity for a test over a range of cutoff points and can be used to determine the best cutoff point. The closer the area under the curve to 1, the better the diagnostic performance of a test. Read the rest of this entry »

Electrical Impedance Tomography in the Assessment of Extravascular Lung Water in Noncardiogenic Acute Respiratory Failure: Statistical AnalysisTDD: In this study, TDD assessment of the amount of EVLW was performed using the COLD System (Pulsion Medical Systems; Munich, Germany). The principle is based on the injection of two indicators (indocyanine green [ICG] and cold glucose 5% [4°C]), with detection of their dilution curves after passage through the pulmonary circulation. The ICG and glucose (10 to 12 mL; 1 mg ICG was dissolved in 1 mL glucose 5%) are administered in the right atrium and detected in the femoral artery. ICG is protein-bound and therefore confined to the intravascular space. The thermal indicator distributes in the extravascular compartment. Source
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In ARDS, lung density increases from the ventral to the dorsal lung regions in the supine position and an increased amount of EVLW causes compression atelectasis in the posterior part. Because EIT can visualize regional ventilation, we hypothesized that differences in the ventilation-induced impedance changes occurring between the anterior part and posterior part of the lungs may provide information about the EVLW content. Read the rest of this entry »

Electrical Impedance Tomography in the Assessment of Extravascular Lung Water in Noncardiogenic Acute Respiratory Failure: ProtocolEIT: In this study, EIT measurements were performed using a portable data acquisition system (Sheffield Applied Potential Tomograph, DAS-01P, Mark I; IBEES; Sheffield, UK), which has been described before. In the present study, the 16 electrodes (Meditrace; Technomed; Beek, The Netherlands) were equidistantly spaced around the thorax. Impedance measurements were performed at the third intercostal level, with the patient in a supine position. A source that generates an alternating current (50 KHz, 5 mA peak to peak) was used to measure impedance. Reading here
Data sets, consisting of 50 images, with an interval time of 1.13 s were recorded. One image consisted of 10 averaged data collection cycles used to minimize artifacts in impedance. Read the rest of this entry »

Patients
The study was performed at the ICU of the Saint Lucas Hospital in Apeldoorn, The Netherlands. Fourteen consecutive patients with a clinical diagnosis of noncardiogenic ARF were included in the study. The diagnosis was based on the presence of respiratory distress associated with dyspnea and tachypnea, hypoxemia, and bilateral and diffuse opacities on the chest roentgenogram in the absence of an elevated pulmonary capillary wedge pressure. Patients received mechanical ventilation with pressure control ventilation (Servo 900C; Siemens-Elema AB; Solna, Sweden). The levels of positive end-expiratory pressure (PEEP) and fraction of inspired oxygen (Fio2) were chosen according to clinical requirements. Read the rest of this entry »

Electrical Impedance Tomography in the Assessment of Extravascular Lung Water in Noncardiogenic Acute Respiratory FailureIn many cases of acute respiratory failure (ARF), pulmonary edema contributes to mechanical and gas exchange abnormalities. However, radiographic and gas exchange abnormalities may not be sensitive and specific and may not accurately reflect the extent of pulmonary edema. Assessing the amount of extravascular lung water (EVLW) at the bedside is useful because the amount of directly measured pulmonary edema may have prognostic significance in ARF, and amelioration of the edema may decrease morbidity and mortality. On the other hand, assessing the amount of EVLW at the bedside is not simple. For this purpose, the thermal dye double indicator dilution technique (TDD) is used, but the invasiveness of the technique, which utilizes two catheters, has hampered widespread clinical application. Despite limitations inherent to the technique, including the potential underestimation of EVLW in poorly perfused lung regions, the technique is considered as the “gold standard” for measuring EVLW. In fact, EVLW measured by TDD may largely reflect gravimetric EVLW measurements at autopsy of ARF patients. further
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Perioperative Anticoagulation in Patients With a Mechanical Heart Valve Who Are Undergoing Elective Noncardiac Surgery: ConclusionOf those respondents who preferred IV heparin for postoperative anticoagulation therapy, the risk of bleeding influenced the timing of heparin initiation.
A significantly higher proportion of respondents preferred later heparin initiation (ie, > 12 h after surgery) in high-risk bleeding scenarios compared with low-risk bleeding scenarios. To our knowledge, there are no studies investigating when it is safe to initiate IV heparin after surgery. Presumably, this will depend on the surgical procedure, inasmuch as patients undergoing urologic, neurosurgical, or cancer-related procedures are more susceptible to postoperative bleeding.- It is possible that withholding IV heparin for as little as 24 to 48 h after surgery might substantially reduce the risk of postoperative bleeding, although having a negligible effect on patients’ risk of TE. add comment
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