Ventilation area measured with eit in order to optimize peep settings in mechanically ventilated patients

INTRODUCTION. Electrical Impedance Tomography (EIT) is a non-invasive imaging technique, which can be used to visualize ventilation. Ventilation will be measured by impedance changes due to ventilation. OBJECTIVES. The aim of this study was to optimize PEEP settings based on the ventilation area of EIT images during a decremental PEEP trial. METHODS. After a recruitment maneuver, a decremental PEEP trial was performed in 10 mechanically ventilated post cardiac surgery patients. Ventilation area, blood gases, FRC and compliance were measured at each PEEP level. The ventilation area was defined as the surface of ventilation at one lung slice measured with EIT and was expressed as percentage of its maximum obtained during a recruitment maneuver (RM). RESULTS. The amount of ventilated pixels during the RM is set as 100 %. Figure 1 shows the amount of ventilated pixels as percentage compared to its maximum during the RM. The ventilation area was significantly smaller at 5 and 0 PEEP compared to its maximum at both the dependent and non-dependent lung. Also PaO2/FiO2 and FRC were significantly lower at these PEEP levels. (Figure presented) Bars represent the mean + SD. Black = dependent lung region, White = non-dependent lung region. *

A systematic review of anatomic predictors of abdominal aortic aneurysm remodeling after endovascular repair

Objective: The long-term outcomes after endovascular abdominal aneurysm repair (EVAR) of abdominal aortic aneurysms (AAAs) have been inferior to those after open surgical repair with regard to reinterventions and late mortality. AAA sac remodeling after EVAR has been associated with endoleaks, reinterventions, and mortality. Therefore, knowledge of the predictors of AAA sac remodeling could indirectly give insight into the long-term EVAR outcomes. In the present review, we aimed to provide an overview of the evidence for anatomic predictors of positive and negative AAA sac remodeling after EVAR. Methods: A systematic literature review and analysis were conducted in accordance with the PRISMA (preferred reporting items for systematic reviews and meta-analyses) and Cochrane guidelines. The PubMed and Scopus databases were searched using terms of AAA sac growth, shrinkage, and remodeling. Eligible studies were identified, and only those studies that had included currently used endografts were included. Results: A total of 19 studies that had reported on a total of 27 anatomic parameters of the aortoiliac anatomy were included. Only 4 parameters had been investigated by more than five studies, 7 parameters were investigated by three to five studies, 7 parameters were investigated by two studies, and 9 parameters were investigated by one study. For the presence of neck thrombus, three of four studies had reported similar results, indicating that the presence of neck thrombus might predict for less AAA sac shrinkage. AAA thrombus, the total AAA volume, the flow-lumen volume, aortic calcification, and the number of hostile neck parameters were only investigated by two to three studies. However, these parameters seemed promising for the prediction of sac remodeling. For hostile neck anatomy, neck length, infrarenal neck angulation, and patency of the inferior mesenteric artery, no significant association with any category of AAA sac remodeling was found. Conclusions: The present review demonstrates neck thrombus, AAA thrombus, number of hostile neck parameters, total AAA volume, AAA flow-lumen volume, and aortic calcification as important anatomic features that are likely to play a role in AAA remodeling after endovascular repair and should be further explored using advanced imaging techniques. We also found that strong, consistent evidence regarding the anatomic predictors of AAA sac remodeling after EVAR is lacking. Therefore, further research with large patient groups for a broad range of predictors of AAA sac change after EVAR is needed to complement the current gap in the evidence

The Supera Interwoven Nitinol Stent as a Flow Diverting Device in Popliteal Aneurysms

PURPOSE: The feasibility of using a compressed interwoven Supera stent as a flow diverting device for popliteal aneurysms was recently demonstrated in patients. It is unclear, however, what the optimal flow diverting strategy is, because of the fusiform shape of popliteal aneurysms and their exposure to triphasic flow. To assess this flow diverting strategy for popliteal aneurysms, flow profiles and thrombus formation likelihood were investigated in popliteal aneurysm models. MATERIALS AND METHODS: Six popliteal aneurysm models were created and integrated into a pulsatile flow set-up. These models covered a bent and a straight anatomy in three configurations: control, single-lined and dual-lined Supera stents. Two-dimensional flow velocities were visualized by laser particle image velocimetry. In addition, the efficacy of the stent configurations for promoting aneurysm thrombosis was assessed by simulations of residence time and platelet activation. RESULTS: On average for the two anatomies, the Supera stent led to a twofold reduction of velocities in the aneurysm for single-lined stents, and a fourfold reduction for dual-lined stents. Forward flow was optimally diverted, whereas backward flow was generally deflected into the aneurysm. The dual-lined configuration led to residence times of 15–20 s, compared to 5–15 s for the single stent configurations. Platelet activation potential was not increased by the flow diverting stents. CONCLUSION: A compressed Supera stent was successfully able to divert flow in a popliteal aneurysm phantom. A dual-lined configuration demonstrated superior hemodynamic characteristics compared to its single-lined counterpart. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00270-022-03118-x

The bilirubin albumin ratio in the management of hyperbilirubinemia in preterm infants to improve neurodevelopmental outcome: A randomized controlled trial - BARTrial

Background and Objective: High bilirubin/albumin (B/A) ratios increase the risk of bilirubin neurotoxicity. The B/A ratio may be a valuable measure, in addition to the total serum bilirubin (TSB), in the management of hyperbilirubinemia. We aimed to assess whether the additional use of B/A ratios in the management of hyperbilirubinemia in preterm infants improved neurodevelopmental outcome. Methods: In a prospective, randomized controlled trial, 615 preterm infants of 32 weeks' gestation or less were randomly assigned to treatment based on either B/A ratio and TSB thresholds (consensus-based), whichever threshold was crossed first, or on the TSB thresholds only. The primary outcome was neurodevelopment at 18 to 24 months' corrected age as assessed with the Bayley Scales of Infant Development III by investigators unaware of treatment allocation. Secondary outcomes included complications of preterm birth and death. Results: Composite motor (100±13 vs. 101±12) and cognitive (101±12 vs. 101±11) scores did not differ between the B/A ratio and TSB groups. Demographic characteristics, maximal TSB levels, B/A ratios, and other secondary outcomes were similar. The rates of death and/or severe neurodevelopmental impairment for th

Selected Abstracts from the 27th Annual Meeting of the Society in Europe for Simulation Applied to Medicine: Development and evaluation of a graduate surgical skills curriculum: How to make medical simulation data Findable, Accessible, Interoperable and Reusable

Introduction Increasingly more simulation studies are published under the Open Access publishing model making them freely accessible online to everyone. Often, the only aspect that is not yet open are the underlying datasets from these publications. Publishing datasets improves reproducibility and reliability of research, it increases visibility of research, and accelerates innovation. Furthermore, unique and highly valuable data from i.e. simulation-based training or surgical techniques is not available to everyone. Our aim is to present a best practice for publishing medical simulation data. A study on development and evaluation of a proficiencybased and simulation-based surgical skills training for technical medicine students is used as an example. Methods A four-station procedural assessment was developed of basic surgical tasks that included scrubbing and donning, local anaesthesia, incision/excision, and suturing. Performance indicators were determined by an expert panel consisting of four professors in surgery and two technical physicians in surgery. A rubric was developed for scrubbing and donning and procedure-specific rating scales were developed for local anaesthesia, incision/excision, and suturing. The surgical skills training was evaluated after at least one clinical rotation with an online survey. Data is published according to the FAIR principles: Findable, Accessible, Interoperable and Reusable. To be ‘Findable’, a unique digital object identifier (DOI) was assigned to the dataset, and metadata described the content, contact information,  location, items and definitions. The data repository is indexed by search engines, i.e. Google Scholar. The data is ‘Accessible’ for everyone under Open Access. To be ‘Interoperable’, MeSH standards were used. Finally, to be ’Reusable’, the data were made readable by translating and describing the assessment scoring rubrics, addition of documentation, and a license permitting data reuse was assigned. Results & Discussion Data for 116 master students from two academic years were refined, and student and assessor data anonymised. Age information was grouped by age intervals, so it can be openly published in an external repository. The dataset was made publicly available in the 4TU.ResearchData repository for reuse in i.e. SESAM community. Researchers should be attributed when data is reused under a CC-BY-SA licence. For medical simulation studies, it is feasible to publish data alongside Open Access peer-reviewed journal articles. The FAIR principles for data management should be incorporated in the design and implementation of future simulation studies

Systematic review of results of kissing stents in the treatment of aortoiliac occlusive disease

Introduction: Severe stenosis or occlusion of the aortoiliac bifurcation is typically treated with open surgery. Patency results of aorto-bifemoral bypass are up to 90 % at 5 years. However, the number and severity of complications seem to have reached a plateau level. A less invasive technique, the kissing stent (KS) is available nowadays. The goal of this review was to give an overview of the current results and status of the kissing stent technique. Method: The Scopus search engine was used to retrieve articles concerning KS, this retrieved 78 abstracts, 60 were rejected and 4 more were rejected after full text screening. One article was included after cross referencing. After a quality check, data was extracted for further analysis. Results: 810 patients ( 72.8 % Rutherford classification of 1/2/3) were included. The most prevalent risk factor was hypertension (37.5-96%) and 50% of patients were treated for TASC C & D lesions. Overall the technical success rate was 98.2 %. Procedural protocols greatly differed on applying protrusion and pre or post dilatation. Clinical improvement at 30 days was achieved in 89.9%. Primary patency at 12, 24, and 36 months was 88.8%, 78.9 and 68.5, respectively. A complication rate of 11 % was reported, of which most are minor . No detailed analysis could be performed because individual patient data are lacking. Conclusion: KS treatment of aortoiliac disease is related with only minor complications and acceptable midterm patency results, this can however not surpass the results seen with open surgery