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Author(s): D. Chiumello [sup.1] , A. Marino [sup.2] , M. Lazzerini [sup.3] , M. L. Caspani [sup.1] , L. Gattinoni [sup.1] Author Affiliations: (1) grid.414818.0, 0000000417578749, Dipartimento di Anestesia, Rianimazione [...]

Teleradiology is a useful practice to provide remote consultation from specialists or senior staff, when no staff is available "on-site", and a quick consultation or a second opinion is necessary. Recently smartphones with high quality display have been marketed. The aim of our study was to determine if these devices could be used for paediatric radiologic remote consultation without loss of diagnostic information. Ninety-three paediatric exams were evaluated. CT and MRI examinations were randomly chosen among performed exams and sent to two different smartphones (Apple iPhone and Nexus One -Android OS-) using a VPN encrypted connection. Two independent radiologists evaluated the images prospectively. Results were collected in a database and compared with the gold standard result (PACS system, EBIT Aet DICOMed Review v.4.1, and monitors officially certified for radiologic interpretation). Concordance between diagnostic interpretation using smartphones and the golden standard was 97.52%. Values of specificity and sensitivity were respectively 100% and 96.3%, with a PPV of 100% and a NPV of 93.0%. Missing findings were only minor ones, while the overall diagnostic interpretation was essentially the same. These preliminary results show that diagnostic accuracy of radiologic paediatric interpretation using smartphones is overall acceptable. Although such system is not suitable for long consultation sessions, they can be used for quick remote consultation on single cases. [ABSTRACT FROM AUTHOR]

Rationale: Unphysiologic strain (the ratio between tidal volume and functional residual capacity) and stress (the transpulmonary pressure) can cause ventilator-induced lung damage. Objectives: To identify a strain-stress threshold (if any) above which ventilator-induced lung damage can occur. Methods: Twenty-nine healthy pigs were mechanically ventilated for 54 hours with a tidal volume producing a strain between 0.45 and 3.30. Ventilator-induced lung damage was defined as net increase in lung weight. Measurements and Main Results: Initial lung weight and functional residual capacity were measured with computed tomography. Final lung weight was measured using a balance. After setting tidal volume, data collection included respiratory system mechanics, gas exchange and hemodynamics (every 6 h); cytokine levels in serum (every 12 h) and bronchoalveolar lavage fluid (end of the experiment); and blood laboratory examination (start and end of the experiment). Two clusters of animals could be clearly identified: animals that increased their lung weight (n = 14) and those that did not (n = 15). Tidal volume was 38 ± 9 ml/kg in the former and 22 ± 8 ml/kg in the latter group, corresponding to a strain of 2.16 ± 0.58 and 1.29 ± 0.57 and a stress of 13 ± 5 and 8 ± 3 cm H(2)O, respectively. Lung weight gain was associated with deterioration in respiratory system mechanics, gas exchange, and hemodynamics, pulmonary and systemic inflammation and multiple organ dysfunction. Conclusions: In healthy pigs, ventilator-induced lung damage develops only when a strain greater than 1.5-2 is reached or overcome. Because of differences in intrinsic lung properties, caution is warranted in translating these findings to humans. [ABSTRACT FROM AUTHOR]