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Objective: To evaluate the knees of individuals with renal failure who are on hemodialysis, using magnetic resonance imaging (MRI), comparing them with those of a group of individuals with normal renal function. Materials and Methods: This was a cross-sectional, observational, controlled study conducted between August 2018 and February 2020. The cases consisted of 15 patients who had been on hemodialysis for ≥ 5 years and did not have a quadriceps tendon rupture. The controls consisted of 15 individuals with normal renal function who were matched (1:1) to the cases for sex, age, and physical activity level. The subjects in both groups underwent MRI of the right knee only. Results: The mean ages of the cases and controls were 50 ± 15 years and 49 ± 14 years, respectively. The median time on hemodialysis was 11 years (range, 10-14 years). Serum levels of parathyroid hormone, ferritin, alkaline phosphatase, phosphorus, and creatinine were higher among the cases than among the controls, whereas serum albumin and hemoglobin were lower (p < 0.05 for all). The MRI study showed a hyperintense signal in the quadriceps tendon in 11 of the cases and in three of the controls (p = 0.009). Knee joint effusion was observed in nine of the cases and in three of the controls (p < 0.05). The thickness, length, and width of the tendon did not differ between the groups. A hyperintense signal in the tendon was not associated with the time on hemodialysis; nor with the levels of intact parathyroid hormone, hemoglobin, or alkaline phosphatase. Conclusion: Patients on chronic hemodialysis, even those without a tendon rupture, show a hyperintense signal in the quadriceps tendon on MRI. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To investigate the predictive value of the maximal inspiratory pressure obtained by a digital vacuometer using a unidirectional valve (PImaxUV) as to weaning outcome, and to compare its performance with the respiratory drive using airway occlusion pressure at 0.1 second (P0.1), and P0.1/PImaxUV. METHODS: Patients on mechanical ventilation for > 24 hours who fulfilled the weaning criteria were prospectively enrolled. Measurements of PImaxUV and P0.1 were accomplished with a digital vacuometer with a unidirectional valve that allows only exhalation. Measured values were electronically recorded and stored on the digital vacuometer measurement device. Cutoff points for the used parameters were: absolute values of PImaxUV > 30 cm H2O, P0.1 < 2.3 cm H2O, and P0.1/PImaxUV < 0.10. Receiver operating characteristic curves were calculated to compare the predictive values of the indexes. RESULTS: One hundred three subjects completed the test. The areas under the receiver operating characteristic curve were 0.79 ± 0.04, 0.65 ± 0.05, and 0.74 ± 0.04 for PImaxUV, P0.1, and P0.1/PImaxUV, respectively. The area under the receiver operating characteristic curve for PImaxUV was higher than for P0.1 and P0.1/PImaxUV, but statistical significance was only found against P0.1 (P = .007). CONCLUSIONS: Every studied index had only a modest performance regarding prediction of weaning outcome. Of note, PImaxUV values obtained by digital technology using a unidirectional valve performed better than historically reported using a conventional techniques, surpassing P0.1 and P0.1 in this regard. [ABSTRACT FROM AUTHOR]

BACKGROUND: The measurement of the maximal inspiratory pressure (PImax) is of great importance in choosing the time for the start of weaning. OBJECTIVE: To measure the inspiratory pressure in mechanically ventilated patients suitable for weaning to determine the point at which the PImax is achieved within 60 seconds of observation, and analyze factors associated with PImax values. METHODS: Measurement of PImax was accomplished with a digital vacuometer with a unidirectional valve, which allows only exhalation (PImaxUV). With this technique, values are registered and stored, remaining accessible whenever necessary. All patients were on mechanical ventilation, and met the criteria recommended by the American Thoracic Society/European Respiratory Society in 2007 to undergo weaning trial. RESULTS: Eighty-four from the 87 enrolled patients completed the test. No patients reached the PImaxUV in the first 20 seconds of observation. PImaxUV was achieved between 20.1 and 40 seconds in 12 patients (14.0%), and between 40.1 and 60 seconds in 72 cases (86.0%). In a multivariate analysis model in which age, sex, days of mechanical ventilation, APACHE score, and respiratory drive (measured as airway-occlusion pressure 0.1 s after the start of inspiratory flow [P0.1]) were included, only age (P = .006) and P0.1 (P = .003) were significantly associated with the values of PImaxUV. CONCLUSIONS: Within an observation period of 60 seconds, the majority of patients reached the maximal inspiratory peak between 40.1 and 60 seconds. Older patients were found to have lower PImaxUV values, whereas higher values for P0.1 strongly correlated with higher PImaxUV values. These findings are potentially useful to improve successful weaning prediction in the future, but further studies are needed to better clarify this issue. [ABSTRACT FROM AUTHOR]