43 research outputs found
Chest Compression-Related Flail Chest Is Associated with Prolonged Ventilator Weaning in Cardiac Arrest Survivors
Chest compressions during cardiopulmonary resuscitation (CPR) may be associated with iatrogenic chest wall injuries. The extent to which these CPR-associated chest wall injuries contribute to a delay in the respiratory recovery of cardiac arrest survivors has not been sufficiently explored. In a single-center retrospective cohort study, surviving intensive care unit (ICU) patients, who had undergone CPR due to medical reasons between 1 January 2018 and 30 June 2019, were analyzed regarding CPR-associated chest wall injuries, detected by chest radiography and computed tomography. Among 109 included patients, 38 (34.8%) presented with chest wall injuries, including 10 (9.2%) with flail chest. The multivariable logistic regression analysis identified flail chest to be independently associated with the need for tracheostomy (OR 15.5; 95% CI 2.77–86.27; p = 0.002). The linear regression analysis identified pneumonia (β 11.34; 95% CI 6.70–15.99; p < 0.001) and the presence of rib fractures (β 5.97; 95% CI 1.01–10.93; p = 0.019) to be associated with an increase in the length of ICU stay, whereas flail chest (β 10.45; 95% CI 3.57–17.33; p = 0.003) and pneumonia (β 6.12; 95% CI 0.94–11.31; p = 0.021) were associated with a prolonged duration of mechanical ventilation. Four patients with flail chest underwent surgical rib stabilization and were successfully weaned from the ventilator. The results of this study suggest that CPR-associated chest wall injuries, flail chest in particular, may impair the respiratory recovery of cardiac arrest survivors in the ICU. A multidisciplinary assessment may help to identify patients who could benefit from a surgical treatment approach
Treatment Effect of CT-Guided Periradicular Injections in Context of Different Contrast Agent Distribution Patterns
Acutely manifesting radicular pain syndromes associated with degenerations of the lower
spine are frequent ailments with a high rate of recurrence. Part of the conservative management are
periradicular infiltrations of analgesics and steroids. The purpose of this study is to evaluate the
dependence of the clinical efficacy of CT-guided periradicular injections on the pattern of contrast
distribution and to identify the best distribution pattern that is associated with the most effective pain
relief. Using a prospective study design, 161 patients were included in this study, ensuring ethical
standards. Statistical analysis was performed, with the level of statistical significance set at p = 0.05.
A total of 37.9% of patients experienced significant but not long-lasting (four weeks on average)
complete pain relief. A total of 44.1% of patients experienced prolonged, subjectively satisfying pain
relief of more than four weeks to three months. A total of 18% of patients had complete and sustained
relief for more than six months. A significant correlation exists between circumferential, large area
contrast distribution including the zone of action between the disc and affected nerve root contrast
distribution pattern with excellent pain relief. Our results support the value of CT-guided contrast
injection for achieving a good efficacy, and, if necessary, indicative repositioning of the needle to
ensure a circumferential distribution pattern of corticosteroids for the sufficient treatment of radicular
pain in degenerative spine disease
Percutaneous hepatic melphalan perfusion: single center experience of procedural characteristics, hemodynamic response, complications, and postoperative recovery
BACKGROUND: Percutaneous hepatic melphalan perfusion (PHMP) for the selective treatment of hepatic metastases is known to be associated with procedural hypotension and coagulation disorders. Studies on anesthetic management, perioperative course, complications, and postoperative recovery in the intensive care unit (ICU) have not been published. METHODS: In a retrospective observational study, we analyzed consecutive patients who were admitted for PHMP over a 6-year period (2016–2021). Analyses included demographic, treatment, and outcome data with regard to short-term complications until ICU discharge. RESULTS: Fifty-three PHMP procedures of 16 patients were analyzed. In all of the cases, procedure-related hypotension required the median (range) highest noradrenaline infusion rate of 0.5 (0.17–2.1) μg kg min(-1) and fluid resuscitation volume of 5 (3–14) liters. Eighty-four PHMP-related complications were observed in 33 cases (62%), of which 9 cases (27%) involved grade III and IV complications. Complications included airway constriction (requiring difficult airway management), vascular catheterization issues (which resulted in the premature termination of PHMP, as well as to the postponement of PHMP and to the performance of endovascular bleeding control after PHMP), and renal failure that required hemodialysis. Discharge from the ICU was possible after one day in most cases (n = 45; 85%); however, in 12 cases (23%), prolonged mechanical ventilation was required. There were no procedure-related fatalities. CONCLUSIONS: PHMP is frequently associated with challenging cardiovascular conditions and complications that require profound anesthetic skills. For safety reasons, PHMP should only be performed in specialized centers that provide high-level hospital infrastructures and interdisciplinary expertise
Risk factors and outcomes of unrecognised endobronchial intubation in major trauma patients
Background Emergency tracheal intubation during
major trauma resuscitation may be associated with
unrecognised endobronchial intubation. The risk factors
and outcomes associated with this issue have not
previously been fully defined.
Methods We retrospectively analysed adult patients
admitted directly from the scene to the ED of a single
level 1 trauma centre, who received either prehospital
or ED tracheal intubation prior to initial whole-body
CT
from January 2008 to December 2019. Our objectives
were to describe tube-to-
carina
distances (TCDs) via CT
and to assess the risk factors and outcomes (mortality,
length of intensive care unit stay and mechanical
ventilation) of patients with endobronchial intubation
(TCD <0 cm) using a multivariable model.
Results We included 616 patients and discovered 26
(4.2%) cases of endobronchial intubation identified
on CT. Factors associated with an increased risk of
endobronchial intubations were short body height
(OR per 1 cm increase 0.89; 95% CI 0.84 to 0.94;
p≤0.001), a high body mass index (OR 1.14; 95% CI
1.04 to 1.25; p=0.005) and ED intubation (OR 3.62;
95% CI 1.39 to 8.90; p=0.006). Eight of 26 cases
underwent tube thoracostomy, four of whom had no
evidence of underlying chest injury on CT. There was no
statistically significant difference in mortality or length
of stay although the absolute number of endobronchial
intubations was small.
Conclusions Short body height and high body mass
index were associated with endobronchial intubation.
Before considering tube thoracostomy in intubated
major trauma patients suspected of pneumothorax, the
possibility of unrecognised endobronchial intubation
should be considered
Prognostic Factors for Iatrogenic Tracheal Rupture: A Single-Center Retrospective Cohort Study
Iatrogenic tracheal ruptures are rare but severe complications of medical interventions. The main goal of this study was to explore prognostic factors for all-cause mortality and rupture-related (adjusted) mortality. We retrospectively analyzed patients admitted to an academic referral center over a 15-year period (2004–2018). Fifty-four patients met the inclusion criteria, of whom 36 patients underwent surgical repair and 18 patients were treated conservatively. In a 90-day follow-up, the all-cause mortality was 50%, while the adjusted mortality was 13%. Rupture length was identified as a predictor for all-cause mortality (area under the curve, 0.84; 95% confidence interval (CI) 0.74–0.94) with a cutoff rupture length of 4.5 cm (sensitivity, 0.70; specificity, 0.81). Multivariate analysis confirmed rupture length as a prognostic factor for all-cause mortality (adjusted hazard ratio (HR) 1.5; 95% CI 1.2–1.9; p = 0.001), but not for adjusted mortality (HR 1.5; 95% CI 0.97–2.3; p = 0.068), while mediastinitis predicted adjusted mortality (HR 5.8; 95% CI 1.1–31.7; p = 0.042), but not all-cause mortality (HR 1.6; 95% CI 0.7–3.5; p = 0.243). The extent of iatrogenic tracheal rupture and mediastinitis might be relevant prognostic factors for all-cause mortality and adjusted mortality, respectively
Endovascular Treatment of Intracranial Aneurysms in Small Peripheral Vessel Segments—Efficacy and Intermediate Follow-Up Results of Flow Diversion With the Silk Vista Baby Low-Profile Flow Diverter
Background and Purpose: Low-profile flow diverter stents (FDS) quite recently
amended peripheral segments as targets for hemodynamic aneurysm treatment;
however, reports on outcomes, especially later than 3 months, are scarce. This study
therefore reports our experience with the novel silk vista baby (SVB) FDS and respective
outcomes after 8 and 11 months with special respect to specific adverse events.
Materials and Methods: Forty-four patients (mean age, 53 years) harboring 47
aneurysms treated with the SVB between June 2018 and December 2019 were included
in our study. Clinical, procedural, and angiographic data were collected. Follow-ups were
performed on average after 3, 8, and 11 months, respectively. Treatment effect was
assessed using the O’Kelly Marotta (OKM) grading system.
Results: Overall, angiographic follow-ups were available for 41 patients/45 aneurysms.
Occlusion or significant reduction in aneurysmal perfusion (OKM: D1, B1–B3 and
A2–A3) was observed in 98% of all aneurysms after 8 months. Only 2% of the treated
aneurysms remained morphologically unaltered and without an apparent change in
perfusion (OKM A1). Adverse events in the early post-interventional course occurred
in seven patients; out of them, mRS-relevant morbidity at 90 days related to FDS
treatment was observable in two patients. One death occurred in the context of
severe SAH related to an acutely ruptured dissecting aneurysm of the vertebral artery.
Conclusion: The SVB achieves sufficient occlusion rates of intracranial aneurysms
originating from peripheral segments, which are comparable to prior established
conventional FDS with acceptably low complication rates. However, alteration of a
hemodynamic equilibrium in distal localizations requires special attention to prevent
ischemic events
Delayed Stroke after Aneurysm Treatment with Flow Diverters in Small Cerebral Vessels: A Potentially Critical Complication Caused by Subacute Vasospasm
Flow diversion (FD) is a novel endovascular technique based on the profound alteration
of cerebrovascular hemodynamics, which emerged as a promising minimally invasive therapy for
intracranial aneurysms. However, delayed post-procedural stroke remains an unexplained concern.
A consistent follow-up-regimen has not yet been defined, but is required urgently to clarify the
underlying cause of delayed ischemia. In the last two years, 223 patients were treated with six
different FD devices in our center. We identified subacute, FD-induced segmental vasospasm (SV) in
36 patients as a yet unknown, delayed-type reaction potentially compromising brain perfusion to a
critical level. Furthermore, 86% of all patients revealed significant SV approximately four weeks after
treatment. In addition, 56% had SV with 25% stenosis, and 80% had additional neointimal hyperplasia.
Only 13% exhibited SV-related high-grade stenosis. One of those suffered stroke due to prolonged
SV, requiring neurocritical care and repeated intra-arterial (i.a.) biochemical angioplasty for seven
days to prevent territorial infarction. Five patients suffered newly manifested, transient hemicrania
accompanying a compensatorily increased ipsilateral leptomeningeal perfusion. One treated vessel
obliterated permanently. Hence, FD-induced SV is a frequent vascular reaction after FD treatment,
potentially causing symptomatic ischemia or even stroke, approximately one month post procedure.
A specifically early follow-up-strategy must be applied to identify patients at risk for ischemia,
requiring intensified monitoring and potentially anti-vasospastic treatment
The European Reference Genome Atlas: piloting a decentralised approach to equitable biodiversity genomics.
ABSTRACT: A global genome database of all of Earth’s species diversity could be a treasure trove of scientific discoveries. However, regardless of the major advances in genome sequencing technologies, only a tiny fraction of species have genomic information available. To contribute to a more complete planetary genomic database, scientists and institutions across the world have united under the Earth BioGenome Project (EBP), which plans to sequence and assemble high-quality reference genomes for all ∼1.5 million recognized eukaryotic species through a stepwise phased approach. As the initiative transitions into Phase II, where 150,000 species are to be sequenced in just four years, worldwide participation in the project will be fundamental to success. As the European node of the EBP, the European Reference Genome Atlas (ERGA) seeks to implement a new decentralised, accessible, equitable and inclusive model for producing high-quality reference genomes, which will inform EBP as it scales. To embark on this mission, ERGA launched a Pilot Project to establish a network across Europe to develop and test the first infrastructure of its kind for the coordinated and distributed reference genome production on 98 European eukaryotic species from sample providers across 33 European countries. Here we outline the process and challenges faced during the development of a pilot infrastructure for the production of reference genome resources, and explore the effectiveness of this approach in terms of high-quality reference genome production, considering also equity and inclusion. The outcomes and lessons learned during this pilot provide a solid foundation for ERGA while offering key learnings to other transnational and national genomic resource projects.info:eu-repo/semantics/publishedVersio
Retrospective evaluation of whole exome and genome mutation calls in 746 cancer samples
Funder: NCI U24CA211006Abstract: The Cancer Genome Atlas (TCGA) and International Cancer Genome Consortium (ICGC) curated consensus somatic mutation calls using whole exome sequencing (WES) and whole genome sequencing (WGS), respectively. Here, as part of the ICGC/TCGA Pan-Cancer Analysis of Whole Genomes (PCAWG) Consortium, which aggregated whole genome sequencing data from 2,658 cancers across 38 tumour types, we compare WES and WGS side-by-side from 746 TCGA samples, finding that ~80% of mutations overlap in covered exonic regions. We estimate that low variant allele fraction (VAF < 15%) and clonal heterogeneity contribute up to 68% of private WGS mutations and 71% of private WES mutations. We observe that ~30% of private WGS mutations trace to mutations identified by a single variant caller in WES consensus efforts. WGS captures both ~50% more variation in exonic regions and un-observed mutations in loci with variable GC-content. Together, our analysis highlights technological divergences between two reproducible somatic variant detection efforts
Prognostic Factors for Iatrogenic Tracheal Rupture: A Single-Center Retrospective Cohort Study
Iatrogenic tracheal ruptures are rare but severe complications of medical interventions. The main goal of this study was to explore prognostic factors for all-cause mortality and rupture-related (adjusted) mortality. We retrospectively analyzed patients admitted to an academic referral center over a 15-year period (2004–2018). Fifty-four patients met the inclusion criteria, of whom 36 patients underwent surgical repair and 18 patients were treated conservatively. In a 90-day follow-up, the all-cause mortality was 50%, while the adjusted mortality was 13%. Rupture length was identified as a predictor for all-cause mortality (area under the curve, 0.84; 95% confidence interval (CI) 0.74–0.94) with a cutoff rupture length of 4.5 cm (sensitivity, 0.70; specificity, 0.81). Multivariate analysis confirmed rupture length as a prognostic factor for all-cause mortality (adjusted hazard ratio (HR) 1.5; 95% CI 1.2–1.9; p = 0.001), but not for adjusted mortality (HR 1.5; 95% CI 0.97–2.3; p = 0.068), while mediastinitis predicted adjusted mortality (HR 5.8; 95% CI 1.1–31.7; p = 0.042), but not all-cause mortality (HR 1.6; 95% CI 0.7–3.5; p = 0.243). The extent of iatrogenic tracheal rupture and mediastinitis might be relevant prognostic factors for all-cause mortality and adjusted mortality, respectively