Individualized positive end-expiratory pressure in obese patients during general anaesthesia: a randomized controlled clinical trial using electrical impedance tomography.
For each modelling method, after building the predicted model, the root mean square error (RMSE) from Leave One Out Cross Validation is calculated and after comparing, the model with the lowest RMSE is selected as the best prediction model. The multiple regression model included gender, PW/BW, and PW/BMI. MELD (measured at the time of CPEX test) score and Na (measured at the time of LT) can be used to predict LOH after LT. PW/BW and PW/BMI are both involved in the prediction model as independent variables and perform better than AT according to RMSE (18.34 vs 18.46, 18.47). PWI may be a better predictor of LOH than the currently used AT. Although promising, this finding needs to be validated in more and different LT centres.
relaxants. A link between MH susceptibility and potential impairment in oxygen metabolism suggests the possibility of chronic mitochondrial dysfunction. Here we evaluated mitochondrial function in skeletal muscle biopsies after in vitro contracture test (IVCT) from MH susceptible (MHS) and nonsusceptible (MHN) individuals, by measuring oxygen consumption rate as flux control ratios (FCR) using the Oroboros Oxograph-2k analyzer. Biopsy samples were permeabilized with saponin and subjected to a protocol adapted for high resolution respirometry 1,2 . Samples taken before and after static halothane IVCT were assessed for differences in FCR for each mitochondrial complex state. Compared with MHN samples, human MHS samples showed significant activity reduction in complex II, likely the result of mitochondrial damage caused by chronically elevated resting calcium previously reported in MHS muscle 3 . Halothane exposure during IVCT significantly increased FCR in complex II and the max electron transport system (ETS) state of MHS muscle only ( Fig. 6). Based on these data we conclude that there is clear evidence of altered oxygen metabolism in MHS skeletal muscle mitochondria, which we hypothesize to be a result of chronic mutant RYR1 induced increases in cytoplasmic Ca 2þ , supporting a connection between MH susceptibility and mitochondrial dysfunction. Fig 6. FCR comparison between MHN (n¼30) and MHS (n¼20) in 6 respiratory states, generated after normalizing oxygen consumption rates to complex IV activity. Significant comparisons are annotated with an asterisk (p<0.05). Error bars are ±1 SE.Lung protective ventilation (LPV) with low peak inspiratory pressures (Ppeak) and high positive end expiratory pressure (PEEP) is associated with improved outcome and widely accepted as best practice with regards to positive pressure ventilation strategy. Recent work in ICU and general surgical patients has shown that LPV is only associated with favourable outcomes when the difference between Ppeak and PEEP (Driving Pressure: DP) is also decreased. Patients undergoing One Lung Ventilation (OLV) are at high risk of developing postoperative lung injury, therefore we investigated the association between intra-operative DP and outcome in this population.With ethics approval we performed a retrospective casecontrol study of patients undergoing lung resection. Data was collated from a previous study examining critical care admission following lung resection. We used propensity matching to match 5 controls (not ventilated) to 1 case (ventilated for respiratory failure). Multivariate regression and best-subset model selection was used to determine the matched group. DP was recorded for duration of ventilation and a novel algorithm was created to detect the start and end of OLV, allowing exposure to DP during OLV to be calculated.These were modelled against the primary outcome of ventilation for respiratory failure. Length of hospital stay and worst recorded PaO 2 :FiO 2 ratio 6e24 hours post-operatively were used as secondary outcomes. Exp...
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