Comparing Pleural Fluid Removal Volume and Oxygenation Change in Therapeutic Thoracentesis: Is There a Relationship?

Background: During therapeutic thoracentesis (TT), pleural fluid is typically drained to completion. Fluid removal improves oxygenation, and the amount of fluid removed is directly associated with the risk of serious complications. A relationship between the amount of fluid removed during TT and the change in oxygenation has not been found in the literature. A direct relationship was hypothesized in this study. Differences in the change in oxygenation between sexes, age, and pre-procedure oxygen support were secondarily hypothesized. This information would assist in the guidance of future TT protocols. Methods: Subjects of this retrospective cohort study were males and females aged 26-74 years. Of the 166 patients who underwent inpatient TT between February 4, 2020, and December 10, 2022, at Berkshire Medical Center (BMC), 16 met the inclusion criteria. They were identified using CPT codes in the electronic medical record (EMR). Demographics, amount of fluid removed, and type of oxygen support were recorded. Pre and post-TT arterial oxygen partial pressure (PaO2) and fraction of inspired oxygen (FiO2) values were collected to calculate the P/F, a metric for oxygenation status. T-test and correlation coefficient were calculated to analyze the change in the P/F ratio versus the amount of pleural fluid removed. Correlation coefficients or ANOVA were calculated to compare oxygenation changes to sex, age, and supplemental oxygen types. Results: There was no statistical significance (p=0.87) in the linear relationship between the amount of pleural fluid drained (mean=660 mL, range=150-1500 mL) and the change in oxygenation (mean=162, range=34-300). There were no statistically significant differences in oxygenation changes between sex (p=0.60), age (p=0.81), or types of oxygen support pre-procedure (p=0.07). There was a statistically significant difference in pre and post-procedure P/F ratio (p\u3c0.001). Discussion: We found a statistically significant change in oxygenation before and after TT, with no evidence of a direct relationship between amount of fluid removed and improvement in oxygenation. There were no complications when removing up to 1500 mL of fluid. A protocol that halts pleural fluid drainage once it is complete or when the amount removed reaches 1500 mL, whichever occurs first, may be optimal

Promoting Optimism: An Interprofessional Approach to Treating Long Covid-19 via Telehealth

A poster entitled: Promoting Optimism: An Interprofessional Approach to Treating Long Covid-19 via Telehealth The objective is to approach a case of chronic illness using an interprofessional team in order to collaboratively and positively address the holistic needs of a patient as a result of long-haul COVID-19https://dune.une.edu/cecespring2022/1008/thumbnail.jp

Renal and Segmental Artery Hemodynamic Response to Mild Hypercapnia

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Successful provision of inter-hospital extracorporeal cardiopulmonary resuscitation for acute post-partum pulmonary embolism

Mortality during pregnancy in a well-resourced setting is rare, but acute pulmonary embolism is one of the leading causes. We present the successful use of extracorporeal cardiopulmonary resuscitation (eCPR) in a 22-year old woman who experienced cardiopulmonary collapse following urgent caesarean section in the setting of a sub-massive pulmonary embolus. Resources and personnel to perform eCPR were not available at the maternity hospital and were recruited from an adjacent pediatric hospital. Initial care used low blood flow extracorporeal membrane oxygenation (ECMO) with pediatric ECMO circuitry, which was optimized when the team from a nearby adult cardiac hospital arrived. Following ECMO support, the patient experienced massive hemorrhage which was managed with uterotonic agents, targeted transfusion, bilateral uterine artery embolisation and abdominal re-exploration. The patient was transferred to an adult unit where she remained on ECMO for five days. She was discharged home with normal cognitive function. This case highlights the role ECMO plays in providing extracorporeal respiratory or mechanical circulatory support in a high risk obstetric patient

An exploratory study into the effects of a 20 minute crushed ice application on knee joint position sense during a small knee bend.

Objectives The effect of cryotherapy on joint positioning presents conflicting debates as to whether individuals are at an increased risk of injury when returning to play or activity immediately following cryotherapy application at the knee. The aim of this study was to investigate whether a 20 minute application of crushed ice at the knee immediately affects knee joint position sense during a small knee bend. Design Pre and post-intervention. Setting University movement analysis laboratory. Participants Eleven healthy male participants. Main Outcome Measures Kinematics of the knee were measured during a weight bearing functional task pre and post cryotherapy intervention using three-dimensional motion analysis (Qualisys Medical AB Gothenburg, Sweden). Tissue cooling was measured via a digital thermometer at the knee. Results Results demonstrated significant reductions in the ability to accurately replicate knee joint positioning in both sagittal (P=.035) and coronal (P=.011) planes during the descent phase of a small knee bend following cryotherapy. Conclusion In conclusion a twenty minute application of crushed ice to the knee has an adverse effect on knee joint repositioning. Team doctors, clinicians, therapists and athletes should consider these findings when deciding to return an athlete to functional weight bearing tasks immediately following ice application at the knee, due to the potential increase risk of injury

Comparison of isokinetic hip abduction and adduction peak torques and ratio between sexes

Objective: To evaluate hip abductor and adductor peak torque outputs and compare their ratios between sexes. Design: A cross-sectional laboratory-controlled study. Setting: Participants visited a laboratory and performed an isokinetic hip abductor and adductor test. All participants performed 2 sets of 5 repetitions of concentric hip abduction and adduction in a standing position at 60 degrees per second. Gravity was determined as a function of joint angle relative to the horizontal plane and was corrected by normalizing the weight of the limb on an individual basis. Participants: A total of 36 collegiate athletes. Independent Variables: Sex (20 females and 16 males). Main Outcome Measures: Bilateral peak hip abductor and adductor torques were measured. The 3 highest peak torque values were averaged for each subject. Results: Independent t tests were used to compare sex differences in hip abductor and adductor peak torques and the abductor:adductor peak torque ratios. Males demonstrated significantly greater hip abductor peak torque compared with females (males 1.29 ± 0.24 Nm/kg, females 1.13 ± 0.20 Nm/kg; P = 0.03). Neither hip adductor peak torque nor their ratios differed between sexes. Conclusions: Sex differences in hip abductor strength were observed. The role of weaker hip abductors in females deserves further attention and may be a factor for higher risk of knee pathologies

Risk factors of anterior cruciate ligament tears: Neuromuscular status

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Ankle proprioception is not targeted by exercises on an unstable surface

Item does not contain fulltextLaboratory study using a repeated measures design. The aim of this study was to determine if ankle proprioception is targeted in exercises on unstable surfaces. Lateral ankle sprain (LAS) has recurrence rates over 70%, which are believed to be due to a reduced accuracy of proprioceptive signals from the ankle. Proprioceptive exercises in rehabilitation of LAS mostly consist of balancing activities on an unstable surface. The methods include 100 healthy adults stood barefoot on a solid surface and a foam pad over a force plate, with occluded vision. Mechanical vibration was used to stimulate proprioceptive output of muscle spindles of triceps surae and lumbar paraspinal musculature. Each trial lasted for 60 s; vibration was applied from the 15th till the 30th second. Changes in mean velocity and mean position of the center of pressure (CoP) as a result of muscle vibration were calculated. Results show that on foam, the effect of triceps surae vibration on mean CoP velocity was significantly smaller than on a solid surface, while for paraspinal musculature vibration the effect was bigger on foam than on solid surface. Similar effects were seen for mean CoP displacement as outcome. Exercises on unstable surfaces appear not to target peripheral ankle proprioception. Exercises on an unstable surface may challenge the capacity of the central nervous system to shift the weighting of sources of proprioceptive signals on balance