Search

BACKGROUND: Diaphragmatic respiratory effort during mechanical ventilation is an important determinant of patient outcome, but direct measurement of diaphragmatic contractility requires specialized instrumentation and technical expertise. We sought to determine whether routinely collected clinical variables can predict diaphragmatic contractility and stratify the risk of diaphragm atrophy. METHODS: We conducted a secondary analysis of a prospective cohort study on diaphragm ultrasound in mechanically ventilated subjects. Clinical variables, such as breathing frequency, ventilator settings, and blood gases, were recorded longitudinally. Machine learning techniques were used to identify variables predicting diaphragm contractility and stratifying the risk of diaphragm atrophy (> 10% decrease in thickness from baseline). Performance of the variables was evaluated in mixed-effects logistic regression and random-effects tree models using the area under the receiver operating characteristic curve. RESULTS: Measurements were available for 761 study days in 191 subjects, of whom 73 (38%) developed diaphragm atrophy. No routinely collected clinical variable, alone or in combination, could accurately predict either diaphragm contractility or the development of diaphragm atrophy (model area under the receiver operating characteristic curve 0.63--0.75). The risk of diaphragm atrophy was not significantly different according to the pres- ence or absence of patient-triggered breaths (38.3% vs 38.6%; odds ratio 1.01, 95% CI 0.05--2.03). Diaphragm thickening fraction < 15% during either of the first 2 d of the study was associated with a higher risk of atrophy (44.6% vs 26.1%; odds ratio 2.28, 95% CI 1.05--4.95). CONCLUSIONS: Diaphragmatic contractility and the risk of diaphragm atrophy could not be reliably determined from routinely collected clinical variables and ventilator settings. A single measurement of dia- phragm thickening fraction measured within 48 h of initiating mechanical ventilation can be used to stratify the risk of diaphragm atrophy during mechanical ventilation. [ABSTRACT FROM AUTHOR]

Background: Being able to predict negative postoperative outcomes is important for helping select patients for treatment as well for informed decision‐making by patients. Frailty measures are often time and resource intensive to use as screening measures, whereas the Braden scale, a commonly used measure to assess patients at risk of developing pressure ulcers after surgery, may be a potential tool to predict postoperative complication rates and longer length of stay (LOS) in patients undergoing major head and neck cancer surgery. Methods: A retrospective analysis of Braden scale scores was performed on a prospectively collected cohort of patients undergoing major head and neck surgery recruited between December 2011 and April 2014. The association of Braden scale score with the primary outcomes of complications and LOS was analyzed using logistic regression and linear regression models on univariate analysis (UVA), respectively. Multivariate analysis (MVA) was performed based on a backward stepwise selection algorithm. Results: There were 232 patients with a mean (SD) Braden scale score of 14.9 (2.8) with a range from 9 to 23. The Braden scale (β = −.07 per point; 95% CI −0.09, −0.04, P <.001) was an independent predictor of increased LOS on UVA, but not on MVA when adjusted for other variables. For overall complications, as well as type of complication, the Braden scale score was not a significant predictor of complications on either UVA or MVA. Conclusion: In the sample population, the Braden scale did not demonstrate an ability to predict negative outcomes in head and neck surgery patients. Level of Evidence: Level 2b individual cohort study. Being able to predict negative postoperative outcomes is important for helping select patients for treatment as well for informed decision‐making by patients. The Braden Scale, a commonly used measure to assess patients at risk of developing pressure ulcers after surgery, may be a potential tool to predict postoperative complication rates and longer length of stay in patients undergoing major head and neck cancer surgery. In the sample population the Braden scale did not demonstrate an ability to predict negative outcomes in head and neck surgery patients [ABSTRACT FROM AUTHOR]

Optimal initial non-invasive management of acute hypoxemic respiratory failure (AHRF), of both coronavirus disease 2019 (COVID-19) and non-COVID-19 etiologies, has been the subject of significant discussion. Avoidance of endotracheal intubation reduces related complications, but maintenance of spontaneous breathing with intense respiratory effort may increase risks of patients' self-inflicted lung injury, leading to delayed intubation and worse clinical outcomes. High-flow nasal oxygen is currently recommended as the optimal strategy for AHRF management for its simplicity and beneficial physiological effects. Non-invasive ventilation (NIV), delivered as either pressure support or continuous positive airway pressure via interfaces like face masks and helmets, can improve oxygenation and may be associated with reduced endotracheal intubation rates. However, treatment failure is common and associated with poor outcomes. Expertise and knowledge of the specific features of each interface are necessary to fully exploit their potential benefits and minimize risks. Strict clinical and physiological monitoring is necessary during any treatment to avoid delays in endotracheal intubation and protective ventilation. In this narrative review, we analyze the physiological benefits and risks of spontaneous breathing in AHRF, and the characteristics of tools for delivering NIV. The goal herein is to provide a contemporary, evidence-based overview of this highly relevant topic., Competing Interests: Domenico Luca Grieco has received payments for travel expenses by Getinge and Air Liquide; speaking fees by Intersurgical, Gilead, Pfizer, General Electric Healthcare, and Fisher & Paykel; and a research grant by General Electric Healthcare. All other authors declare that they have no conflicts of interests., (© 2022 The Author(s). Published by Elsevier B.V. on behalf of Chinese Medical Association.)

Competing Interests: Competing interests: None declared.

Background: The traditional, panel style interview and the multiple mini interview (MMI) are two options to use in the selection of medical trainees with each interview format having inherent advantages and disadvantages. Our aim was to compare the traditional and MMI on the same cohort of postgraduate applicants to the Department of Otolaryngology - Head & Neck Surgery at the University of Toronto., Method: Twenty-seven applicants from the 2010 Canadian Residency Matching Service selected for interview at the University of Toronto, Department of Otolaryngology - Head & Neck Surgery were included in the study. Each applicant participated in both a traditional interview and MMI., Results: Traditional interviews marked out of a total maximum score of 570. On the traditional interview, scores ranged from 397-543.5 (69.6 - 95.3%), the mean was 460.2. The MMI maximum score was out of 180. MMI scores ranged from 93 - 146 (51.7 - 81.1%) with a mean of 114.8. Traditional interview total scores were plotted against MMI total scores. Scores correlated reasonably well, Pearson Correlation = 0.315 and is statistically significant at p = 0.001. Inter-interview reliability for the two interview methods was 0.038, with poor overall agreement 0.07%., Conclusions: MMI and traditional interview scores are correlated but do not reliably lead to the same rank order. We have demonstrated that these two interview formats measure different characteristics. One format may also be less reliable leading to greater variation in final rank. Further validation research is certainly required.