Edwardsbush3025
To investigate whether individualized optimization of mechanical ventilation through the implementation of a lung rescue team could reduce the need for venovenous extracorporeal membrane oxygenation in patients with obesity and acute respiratory distress syndrome and decrease ICU and hospital length of stay and mortality.
Single-center, retrospective study at the Massachusetts General Hospital from June 2015 to June 2019.
All patients with obesity and acute respiratory distress syndrome who were referred for venovenous extracorporeal membrane oxygenation evaluation due to hypoxemic respiratory failure.
Evaluation and individualized optimization of mechanical ventilation by the lung rescue team before the decision to proceed with venovenous extracorporeal membrane oxygenation. The control group was those patients managed according to hospital standard of care without lung rescue team evaluation.
All 20 patients (100%) allocated in the control group received venovenous extracorporeal membrane oxygenat extracorporeal membrane oxygenation, duration of mechanical ventilation, and ICU length of stay. Mortality was not modified by the lung rescue team intervention.
Early palliative medicine consult in the ICU can significantly improve outcomes in high-risk patients. We describe a pilot study of including a recommendation for palliative medicine consult in the ICU morning huddle.
A prospective, observational, quality improvement study.
Adult patients (age above 18 yr) admitted with cardiac arrest, stage IV cancer, admission from a long-term acute care facility, and circulatory shock on mechanical ventilation to the medical ICU.
We aim to assess the effect of an early palliative medicine consultation in selected high-risk patients on change in code status, referral to hospice, tracheostomy, and or percutaneous gastrostomy tube placement.
There were 83 patients who triggered an early palliative medicine consult. Palliative medicine consultation occurred in 44 patients (53%); 23 patients (28%) had a palliative medicine consult within the first 48 hours, 21 (25%) had a palliative medicine consult afterwards. There was a significantly higher number of patients who de-escalated their code status in the palliative medicine consult group compared with the no palliative medicine consult group (63.6% vs 7.7%); however, the number was higher in the late palliative medicine consult group (71.4% vs 56.5%). There were more patients referred to hospice in the palliative medicine consult group. No difference in length of stay was observed.
Early palliative medicine consultation in the daily ICU morning huddle is achievable, can produce a palliative medicine consultation in most cases, and results in a significant change in code status toward less aggressive measures.
Early palliative medicine consultation in the daily ICU morning huddle is achievable, can produce a palliative medicine consultation in most cases, and results in a significant change in code status toward less aggressive measures.
Specific factors affecting generalizability of clinical prediction models are poorly understood. Our main objective was to investigate how measurement indicator variables affect external validity in clinical prediction models for predicting onset of vasopressor therapy.
We fit logistic regressions on retrospective cohorts to predict vasopressor onset using two classes of variables seemingly objective clinical variables (vital signs and laboratory measurements) and more subjective variables denoting recency of measurements.
Three cohorts from two tertiary-care academic hospitals in geographically distinct regions, spanning general inpatient and critical care settings.
Each cohort consisted of adult patients (age greater than or equal to 18 yr at time of hospitalization), with lengths of stay between 6 and 600 hours, and who did not receive vasopressors in the first 6 hours of hospitalization or ICU admission. Models were developed on each of the three derivation cohorts and validated internally on the eatures such as measurement indicators in clinical prediction modeling should be carefully considered if the goal is to develop generalizable models.
We developed and externally validated models for predicting the onset of vasopressors. We found that practice-specific features denoting measurement recency improved local performance and also led to more generalizable models if they are adjusted for during model development but discarded at validation. The role of practice-specific features such as measurement indicators in clinical prediction modeling should be carefully considered if the goal is to develop generalizable models.[This corrects the article DOI 10.1148/ryct.2020200219.].A 50-year-old man presented to the hospital for workup of a symptomatic inguinal hernia. At presurgical workup, findings from a contrast material-enhanced CT of the chest, abdomen, and pelvis revealed a large, well-defined and enhancing middle mediastinal mass arising from the right ventricular outflow tract. The mass was ultimately deemed resectable due to preserved fat planes between the mass and other mediastinal structures and the preservation of the right and left coronary arteries. The tumor was diagnosed as a mediastinal paraganglioma at histologic assessment. Keywords Adults, Angiography, CT-Angiography, MR-Angiography, Cardiac, Neoplasms-Primary ©RSNA, 2021.Internal mammary lymph node (IMLN) is the second most common site for nodal metastases in breast cancer. The authors present a case of a 58-year-old woman with a history of coronary artery bypass graft surgery 1 year prior who presented with a neck mass. Imaging showed an enlarged IMLN along the course of the translocated left internal mammary artery (LIMA) bypass graft on the surface of the heart, and the patient was later proven to have recurrent breast cancer. To the authors' knowledge, this is the first case report in the literature of a breast cancer recurrence in an IMLN along the postoperative translocated LIMA bypass graft. check details Keywords Adults, CT, PET/CT, Breast, Thorax, Lymphatic, Metastases © RSNA, 2021.
