Senses and Sciences

lung ultrasound versus transpulmonary thermodilution in assessing extravascular lung water in septic shock after initial resuscitation

reham abdelhamid elqotesh — Thu, 28 Dec 2023 18:00:01 +0000

Background: The prognostic value of extravascular lung water index (EVLWI) which is determined by transpulmonary thermodilution has been widely investigated. The aim of this study is to assess the prognostic value of lung ultrasound compared to transpulmonary thermodilution in assessing EVLW in septic shock. Materials & Methods: This is a prospective observational study where fifty adult patients of both genders with septic shock received initial fluid resuscitation and underwent continuous hemodynamic monitoring using pulse index continuous cardiac output (PiCCO) and simplified lung ultrasound protocol, analyzing the prognostic value of lung ultrasound score (LUS) compared to EVLWI in 48 hours after initial resuscitation. Results: With ICU mortality as the end point, 50 patients were divided into a survivor group (30 patients) and a non-survivor group (20 patients). LUS showed significant linear correlation with EVLWI (Spearman’s r=0.848, P=<0.001^* at T48). LUS and EVLWI were significantly higher in non-survivors than in survivors (P =<0.001^*at T48). The areas under the receiver operating characteristic curves of LUS and EVLWI measured by PiCCO were 0.843 and 0.921 at T48, respectively. The cut-off of LUS and EVLWI for prognosis prediction were 12 and 12.7, respectively. Pairwise comparison of both ROC curves showed no significant difference between LUS and EVLWI as predictors of mortality at T48, p =0.125. Conclusion: Lung ultrasound is a useful, simple, non-invasive tool for predicting the prognosis of septic shock patients compared to EVLWI measured by PiCCO.

The role of video-assisted thoracoscopic surgery in patients with advanced ovarian malignancies

Ahmed Ali Eleba — Thu, 28 Dec 2023 18:20:54 +0000

Background: Through video-assisted thoracoscopic surgery (VATS), physicians can perform pleural effusion drainage in addition to evaluating macroscopic pleural disease and, in certain cases, removing large tumors. When compared to the chest CT , VATS can change the therapeutic plan of ovarian cancer patients and enhance FIGO staging accuracy. The key aim of this study is to inspect the accuracy of preoperative chest CT scans and the relevance of VATS in the decision-making process for patients with advanced ovarian cancer.

Methods: This prospective study was conducted during the period between June 2021 and January 2023. Patients with advanced ovarian cancer (Stage III OR IV) were enrolled in the study and believed qualified to obtain the VATS. Preoperative evaluation of supra-diaphragmatic disease by Chest-CT was equated with the intra-operative VATS estimation to consider the function of VATS in further treatment choices in those patients.

Results: There was a statistically meaningful variation between chest CT and VATS in detection rate of pleural nodules in advanced stage ovarian cancer patients. 8.8 % (6) of cases displayed suspicious nodules by chest CT, whereas pleural nodules were found in 29.4% (20) of cases during VATS. It changed disease stage in 32.4% (22) of patients. Overall, VATS changed preliminary management decision based on clinical and radiological preoperative assessment in 18 patients constituting 26.5% of cases enrolled in our study.

Conclusion: When ovarian cancer is assumed to be advanced, VATS can be used to define the amount of the disease, obtain tissue for histopathologic diagnosis if macroscopic disease is found, treat the effusion, and choose patients for intrathoracic cytoreduction or neoadjuvant chemotherapy quickly and safely. Furthermore, VATS is more effective than chest CT in detecting intrathoracic disease.

INFRACLAVICULAR FIRST RIB RESECTION FOR DECOMPRESSION OF VENOUS THORACIC OUTLET SYNDROME

Mohammed Abdelhamid Elsabbagh — Thu, 28 Dec 2023 18:42:07 +0000

Background: McCleery syndrome is a form of venous thoracic outlet syndrome. This study aims to monitor the effectiveness of infraclavicular approach for decompression of venous thoracic outlet syndrome.

Methods: A prospective study at Alexandria University hospital where patients presented with intermittent upper limb venous symptoms due to venous thoracic outlet syndrome were included to study the outcome of interventions. Only patients who had decompression via the infraclavicular approach were included in this article, data regarding the intervention and its outcome was collected and analysed to calculate the frequencies.

Results: 15 patients (10 males) with mean age of 35 years (23 – 53 years) were recruited. All patients were diagnosed as McCleery syndrome. Eighty percent had right side presentation in the form of intermittent pain and swelling. Patients had first rib resection using the infra-clavicular approach with technical success of 100%. Complete resolution of symptoms was achieved in 100% of the study group after a secondary intervention. The symptoms resolution after the initial intervention was achieved in 93.3%. No perioperative complications were recorded. The mean follow-up duration was 8.6 months.

Conclusion: Infraclavicular approach for first rib resection in venous thoracic outlet syndrome is safe and effective in the short term.

Prediction of High Flow Nasal Cannula Failure In Patients With COVID-19 Pneumonia Suffering from Acute Hypoxemic Respiratory Failure

Hagar Hamdy Ashry — Thu, 28 Dec 2023 00:00:00 +0000

Background: High flow nasal cannula (HFNC) is one of the most often employed methods of oxygen therapy for COVID-19 pneumonia and respiratory failure patients. Since the causes of HFNC failure and success are still undetermined, the goal of this study was to identify potential predictors of HFNC failure in COVID-19 pneumonia given that early detection of HFNC failure during episodes of acute hypoxemic respiratory failure (AHRF) can improve clinical treatment and accurately categorize patients for the best ventilation maneuver. Patients and Methods: This observational trial was conducted on 100 COVID-19 pneumonia cases with acute hypoxemic respiratory failure who were referred to our COVID-19 intensive care units from 1 August 2020 to 31 December 2022 and required HFNC therapy as rescue therapy. In patients who were finally weaned from this modality and have not been intubated, HFNC was considered successful; while patients who were intubated or put on continuous positive airway pressure (CPAP) were considered as failures. Results: there was a significant association between HFNC failure and obesity, high levels of inflammatory markers, and/or Sequential Organ Failure Assessment (SOFA) score. ROX score of less than 3.91 after 24 h of HFNC application and Procalcitonin were significant predictors of HFNC failure. Conclusions: In COVID-19 pneumonia, HFNC therapy can be a convenient tool to avoid invasive mechanical ventilation, however, patient selection is very crucial.

Keywords: Acute hypoxemic respiratory failure; COVID-19; High flow nasal cannula