(1) The Cole formula for uncuffed tubes: ID (intenal diameter) in mm= (age in years)/4 + 4 (2) The Motoyama formula for cuffed ETTs in children aged 2 yr or older: ID in mm = (age in years)/4 + 3.5 (3) The Khine formula for cuffed ETTs in children younger than 2 yr: ID in mm = (age in years)/4 + 3.0

xlomafota13 shared this article with you from Inoreader Message: https://resus.me/kids-tracheal-tubes-formulas-galore/ An ultrasound study of paediatric airways showed sonographic measurement to be a better predictor of tracheal tube size (using a formula – derived and then validated – to estimate external tube diameter) than traditional formulae for selecting the internal tube diameter based on age. Since the measurements, taken at the lower edge of the cricoid cartilage, were made after patients were paralyzed, and were performed without ventilation or positive end-expiratory pressure to minimize fluctuation in tracheal diameter, taking about 30 seconds, this is not something I anticipate applying in critical care practice. However, the paper does provide a good opportunity to revise some of the existing formulae. They used: (1) The Cole formula for uncuffed tubes: ID (intenal diameter) in mm= (age in years)/4 + 4 (2) The Motoyama formula for cuffed ETTs in children aged 2 yr or older: ID in mm = (age in years)/4 + 3.5 (3) The Khine formula for cuffed ETTs in children younger than 2 yr: ID in mm = (age in years)/4 + 3.0 The formula established in the study was: cuffed ETT outer diameter (OD) = 0.46 x (subglottic diameter) + 1.56 uncuffed ETT OD = 0.55 x (subglottic diameter) + 1.16 Age in months also correlated with optimal ETT size in mm, although the correlation was weaker than for subglottic diameter: cuffed ETT OD = 0.027 x (age) + 5.2 uncuffed ETT OD = 0.030 x (age) + 5.4 BACKGROUND: Formulas based on age and height often fail to reliably predict the proper endotracheal tube (ETT) size in pediatric patients. We, thus, tested the hypothesis that subglottic diameter, as determined by ultrasonography, better predicts optimal ETT size than existing methods. METHODS: A total of 192 patients, aged 1 month to 6 yr, who were scheduled for surgery and undergoing general anesthesia were enrolled and divided into development and validation phases. In the development group, the optimal ETT size was selected according to standard age-based formulas for cuffed and uncuffed tubes. Tubes were replaced as necessary until a good clinical fit was obtained. Via ultrasonography, the subglottic upper airway diameter was determined before tracheal intubation. We constructed a regression equation between the subglottic upper airway diameter and the outer diameter of the ETT finally selected. In the validation group, ETT size was selected after ultrasonography using this regression equation. The primary outcome was the fraction of initial cuffed and uncuffed tube sizes, as selected through the regression formula, that proved clinically optimal. RESULTS: Subglottic upper airway diameter was highly correlated with outer ETT diameter deemed optimal on clinical grounds. The rate of agreement between the predicted ETT size based on ultrasonic measurement and the final ETT size selected clinically was 98% for cuffed ETTs and 96% for uncuffed ETTs. CONCLUSIONS: Measuring subglottic airway diameter with ultrasonography facilitates the selection of appropriately sized ETTs in pediatric patients. This selection method better predicted optimal outer ETT diameter than standard age- and height-based formulas. Prediction of Pediatric Endotracheal Tube Size by Ultrasonography Anesthesiology. 2010 Oct;113(4):819-24 AIRWAYANAESTHESIACRITICAL CAREPAEDIATRICULTRASOUND Post navigation PREVIOUS POST Two hands on the jaw for mask ventilation NEXT POST Fever in head injury might not be bad 3 THOUGHTS ON "KIDS TRACHEAL TUBES – FORMULAS GALORE" Christopher MARCH 30, 2011 AT 9:32 AM I think the question we have in the field is not tube size but rather cuff inflation volume! Easy for adults, 10 mL until the pilot balloon feels solid. For kids do we start with 5 mL? Less? Tube size based? All we have is a Broselow tape and cuffed tubes, no manometers to get the 20 cmH2O or less required to seal the airway. Are there any formulas for this? REPLY Cliff MARCH 30, 2011 AT 11:33 AM Good question! I think less – in fact less even for adults check out this table http://www.ncbi.nlm.nih.gov/pmc/articles/PMC535565/table/T3/ which comes from the article 'Endotracheal tube cuff pressure in three hospitals, and the volume required to produce an appropriate cuff pressure' at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC535565/. I think for kids especially a manometer is a good idea Cliff REPLY Christopher MARCH 31, 2011 AT 10:35 AM Uh oh, field experience shows we fill the cuff with a full syringe! Likely we need to adjust our thinking and probably grab some more studies to get our protocols in order. Thank you for the link. REPLY LEAVE A REPLY Your email address will not be published. Required fields are marked * Comment Name * Email * Website Save my name, email, and website in this browser for the next time I comment. Just another WordPress site Search for: Search … RECENT POSTS How far can exponential spread of coronavirus go? Blow Them Away in Resus Humeral Intraosseous – Stay In & Stay Straight Analysing Difficult Resuscitation Cases – 2 Analysing Difficult Resuscitation Cases RECENT COMMENTS Cliff on Humeral Intraosseous – Stay In & Stay Straight Amy on Humeral Intraosseous – Stay In & Stay Straight Cliff on Humeral Intraosseous – Stay In & Stay Straight David williams on Humeral Intraosseous – Stay In & Stay Straight Cliff on Analysing Difficult Resuscitation Cases – 2 ARCHIVES April 2020 August 2019 October 2018 April 2018 March 2018 December 2017 September 2017 August 2017 June 2017 March 2017 February 2017 November 2016 October 2016 September 2016 August 2016 June 2016 May 2016 December 2015 November 2015 August 2015 July 2015 June 2015 May 2015 March 2015 January 2015 December 2014 November 2014 October 2014 September 2014 August 2014 July 2014 May 2014 April 2014 March 2014 February 2014 January 2014 December 2013 November 2013 October 2013 September 2013 August 2013 July 2013 June 2013 May 2013 April 2013 March 2013 February 2013 January 2013 December 2012 November 2012 October 2012 September 2012 August 2012 July 2012 June 2012 May 2012 April 2012 March 2012 February 2012 January 2012 December 2011 November 2011 October 2011 September 2011 August 2011 July 2011 June 2011 May 2011 April 2011 March 2011 February 2011 January 2011 December 2010 November 2010 October 2010 September 2010 August 2010 July 2010 June 2010 May 2010 April 2010 March 2010 February 2010 January 2010 December 2009 November 2009 October 2009 September 2009 June 2009 May 2009 April 2009 March 2009 February 2009 January 2009 December 2008 November 2008 October 2008 September 2008 CATEGORIES Acute Med All Updates Fascinomata Guidelines ICU Kids PHARM Podcasts Resus Trauma Ultrasound Uncategorized Video META Log in Entries RSS Comments RSS WordPress.org Proudly powered by WordPress Accuracy of Age-Based Formula to Predict the Size and Depth of Cuffed Oral Preformed Endotracheal Tubes in Children Undergoing Tonsillectomy. Via ear nose throat Related Articles Accuracy of Age-Based Formula to Predict the Size and Depth of Cuffed Oral Preformed Endotracheal Tubes in Children Undergoing Tonsillectomy. Ear Nose Throat J. 2021 Feb 09;:145561320980511 Authors: Tareerath M, Mangmeesri P Abstract OBJECTIVES: To retrospectively investigate the reliability of the age-based formula, year/4 + 3.5 mm in predicting size and year/2 + 12 cm in predicting insertion depth of preformed endotracheal tubes in children and correlate these data with the body mass index. PATIENTS AND METHODS: Patients were classified into 4 groups according to their nutritional status: thinness, normal weight, overweight, and obesity; we then retrospectively compared the actual size of endotracheal tube and insertion depth to the predicting age-based formula and to the respective bend-to-tip distance of the used preformed tubes. RESULTS: Altogether, 300 patients were included. The actual endotracheal tube size corresponded with the Motoyama formula (64.7%, 90% CI: 60.0-69.1), except for thin patients, where the calculated size was too large (0.5 mm). The insertion depth could be predicted within the range of the bend-to-tip distance and age-based formula in 85.0% (90% CI: 81.3-88.0) of patients. CONCLUSION: Prediction of the size of cuffed preformed endotracheal tubes using the formula of Motoyama was accurate in most patients, except in thin patients (body mass index < -2 SD). The insertion depth of the tubes was mostly in the range of the age-based-formula to the bend-to-tip distance. PMID: 33559493 [PubMed - as supplied by publisher] View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Cranial aseptic osteomyelitis associated with pyoderma gangrenosum.

xlomafota13 shared this article with you from Inoreader Cranial aseptic osteomyelitis associated with pyoderma gangrenosum. Via Sociedad Luso-Española de Neurocirugía Related Articles Cranial aseptic osteomyelitis associated with pyoderma gangrenosum. Neurocirugia (Astur). 2021 Feb 02;: Authors: Piqué-Durán E, Morera Molina J, Limeres-González MÁ, Espejo-Gil AM Abstract Neutrophilic dermatoses include a heterogeneous group of entities. Uncommonly, they can accumulate aseptic neutrophilic abscesses in other tissues in addition to the skin. A 34-year-old female complained of a headache which was unresponsive to usual drugs. A TAC revealed an osteolytic lesion in the right parietal bone. The biopsy showed osteomyelitis. One year later, pyoderma gangrenosum appeared in the anterior aspect of both legs. The headache and the cutaneous lesions disappeared after treatment with oral prednisone. The bone involvement in the background of neutrophilic dermatoses is exceptional. Usually, it involves children in the context of chronic recurrent multiple osteomyelitis (CRMO). Only two cases have been described in adults. One of them was a 26-year-old woman who had had CRMO since childhood, and the other one in contiguity with the cutaneous lesions of pyoderma gangrenosum. PMID: 33546980 [PubMed - as supplied by publisher] View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Clinical Impact of Adherence to NCCN Guidelines for Biomarker Testing and First-Line Treatment in Advanced Non-Small Cell Lung Cancer (aNSCLC) Using Real-World Electronic Health Record Data

xlomafota.13 shared this article with you from Inoreader Clinical Impact of Adherence to NCCN Guidelines for Biomarker Testing and First-Line Treatment in Advanced Non-Small Cell Lung Cancer (aNSCLC) Using Real-World Electronic Health Record Data Via Latest Results Abstract Introduction Although clinical guidelines are broadly available, the relationship between adherence and outcomes is not well studied. This study aimed to assess the association between adherence to National Comprehensive Cancer Network (NCCN) guidelines and clinical outcomes for adult patients with advanced non-small-cell lung cancer (aNSCLC). Methods This was a retrospective cohort study of adult patients with aNSCLC (stages IIIB, IIIC, and IV) from a de-identified real-world database. The objective was accomplished in a two-step analysis process. We first assessed adherence to NCCN recommendations for biomarker testing and overall survival (OS). Next, we assessed adherence to NCCN-recommended first-line therapy and time to treatment discontinuation (TTD). Multivariable Cox regression analyses were conducted to evaluate the association between guideline adherence and patient outcomes. Kaplan–Meier analyses were used to assess median OS and TTD. Results A total of 28,784 patients with a diagnosis for aNSCLC between January 1, 2011 and July 31, 2019 met the inclusion criteria for the analysis of NCCN-recommended biomarker testing adherence. Two-thirds of these patients (n = 19,787) had evidence of biomarker testing (adherent). Multivariable Cox models found that testing-adherent patients had a significantly lower risk of mortality [hazard ratio (HR) = 0.89, 95% confidence interval (CI) 0.86, 0.92; p < 0.01]. Median OS was modestly longer in the testing-adherent group compared to the testing-non-adherent group (15.4 vs. 14.2 months; p < 0.01). For the first-line therapy analysis, 15,898 patients met the inclusion criteria, of which 69.9% had evidence of appropriate first-line therapy (first-line-adherent). The multivariable Cox model found that adherent patients had significantly lower risk of treatment discontinuation versus non-adher ent patients (HR = 0.60, 95% CI 0.57, 0.62; p < 0.01). First-line-adherent patients had a modest, yet significantly longer median TTD compared to first-line-non-adherent patients (3.45 vs. 2.40 months; p < 0.01). Conclusions Improved clinical outcomes were observed in patients who were adherent to NCCN-recommended biomarker testing and first-line therapy. This study demonstrated the value of following NCCN guideline recommendations and the need to prioritize timely access to biomarker testing and individualized treatment. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Gastrointestinal dysfunction in movement disorders

xlomafota.13 shared this article with you from Inoreader Gastrointestinal dysfunction in movement disorders Via Latest Results for Neurological Sciences Abstract Purpose of review This article provides an overview of the clinical presentation, investigations, and treatment options for gastrointestinal tract (GIT) dysfunction in patients with Parkinson's disease (PD) and other movement disorders. Recent findings GIT dysfunction commonly appears as constipation and fecal incontinence (mostly overflow, accompanied with sphincter failure in multiple system atrophy [MSA]). Bowel dysfunction (underactive) occurs irrespectively from the site of the neurologic lesion, which is in contrast to site-dependent bladder dysfunction (brain, overactive; periphery, underactive). GI emergencies may arise, including intestinal pseudo-obstruction, intussusception, volvulus, and stercoral ulcer (ulcer of the colon due to pressure and irritation resulting from severe, prolonged constipation). Bowel function tests in neurologic patients often show a combination of slow transit and anorectal dysfunction. Management for slow transit constipation includes bulking agents, softening agents, yogurt/probiotics, and prokinetic agents. Suppositories, botulinum toxin injections, and transanal irrigation are options for managing anorectal constipation. Conclusions Function of the bowel is commonly affected in PD and other movement disorders. Neurologists play an important role in assessing bowel symptoms in their patients and planning treatment strategies, often in collaboration with specialist teams. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Headache Gauge: a real-life calendar-based tool for headache monitoring

xlomafota.13 shared this article with you from Inoreader Headache Gauge: a real-life calendar-based tool for headache monitoring Via Latest Results for Neurological Sciences Abstract Background This study aimed to validate a semi-quantitative composite score tool, "Headache Gauge" (HG), to monitor the treatment effect in primary headaches in everyday clinic practice, adjustable to any chosen timeframe. Method A cohort validation study of HG was performed in primary headache patients, recovering their clinical data and patient-related outcome measures (PROMs) for headache (HIT-6, MIDAS, HURT), work impact (WPAIQ), quality-of-life (SF-12), and mood (STAI, ZUNG). HG score distribution, its relation to clinical variables, its internal consistency, and its convergent validity were determined. Results HG was plotted in 233 patients: 90.1% females, age average 37 years, 86% with migraine, 27% with chronic headaches, and 28% with medication overuse. HG ranged from 0.21 to 58.3 in this sample, higher in chronic headaches (HG 16) and medication overuse (HG 15). HG presented good concurrent validity, significantly correlating with HIT-6 (p < 0.0001), SF-12 (p = 0.001), WPAIQ (p < 0.0001), MIDAS (p < 0.0001), and HURT (p < 0.0001). Good sensitivity to change (p < 0.001) and moderate test-retest reliability (p = 0.001) were calculated after reassessment of 147 patients (63.1% of the initial sample). Conclusions Headache Gauge is a clinical data-based outcome measure that conceptually translates the percentage of lost time to headache in any given timeframe. It relates to headache impact, therefore bearing the potential to be relevant in real-life clinical monitoring. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The protean manifestations of central nervous system IgG4-related hypertrophic pachymeningitis: a report of two cases

xlomafota.13 shared this article with you from Inoreader The protean manifestations of central nervous system IgG4-related hypertrophic pachymeningitis: a report of two cases Via Latest Results for Chinese Neurosurgical Journal Abstract Background IgG4-related hypertrophic pachymeningitis is a relative newly recognized and rare manifestation of IgG4-related disease, an immune-mediated fibroinflammatory tumefactive disorder. Fewer than 80 patients have been reported in the literature, and it can mimic common neurosurgical conditions. We describe the clinical presentation of two patients that were initially considered to have a subdural collection, tuberculous meningitis, and a cervical spinal meningioma, but were eventually diagnosed with this disease. Case presentation Two ethnic Chinese men, 86 and 62 years old, experienced a 4-week history of headache. Both patients had a history of autoimmune disease, namely glomerulonephritis and Grave's disease, respectively. Magnetic resonance brain imaging revealed diffuse dural thickening with the latter patient exhibiting homogeneous and intense gadolinium-contrast enhancement. Since the 86-year-old patient also had progressive bilateral visual loss, giant cell arteritis was suspected and a 2-week course of glucocorticoid therapy was prescribed, but his symptoms failed to improve. The 62-year-old patient also had accompanying low-grade fever and was treated empirically as having tuberculous meningitis although there were no confirmatory microbiological findings. This patient further developed right hemiparesis, and additional imaging revealed a C4/5 intradural-extramedullary contrast-enhancing lesion resembling a meningioma causing cord compression. Both patients underwent neuros urgical intervention with the former undergoing a dural biopsy and the latter having the cervical lesion resected. The final diagnosis was IgG4-related hypertrophic pachymeningitis with the hallmark histological features of lymphoplasmacytic infiltration of IgG4+ plasma cells, storiform fibrosis, and obliterative phlebitis. In addition, their serum IgG4 levels were elevated (i.e., > 135 mg/dL). Both patients received at least 6 months of glucocorticoid therapy while the latter also had azathioprine. Their symptoms improved significantly and recurrent lesions were not detected on follow-up imaging. Conclusions A high index of suspicion for this condition is suggested when a male patient with a history of autoimmune disease and compatible radiological findings, experiences subacute headache that is disproportionate to the degree of dural involvement. Neurosurgeons should consider early meningeal biopsy to establish a definitive histological diagnosis in order for early effective immunosuppressive treatment to be initiated and to avoid unnecessary morbidity. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Neutral endopeptidase depletion decreases colon cancer cell proliferation and TGF-β1 synthesis in indirect co-cultures with normal colon fibroblasts

xlomafota.13 shared this article with you from Inoreader Neutral endopeptidase depletion decreases colon cancer cell proliferation and TGF-β1 synthesis in indirect co-cultures with normal colon fibroblasts Via Latest Results for Clinical and Translational Oncology Abstract Purpose Although recent studies have suggested that neutral endopeptidase (NEP) is implicated in the regulation of colon cancer (CC) cell growth and metastasis, the influence of the tumor microenvironment on this role of NEP has not been investigated so far. Normal colon fibroblasts (NCFs) constitute a component of the stroma surrounding a tumor in an early stage of its development. NCFs can influence transformed cells via different paracrine factors, including TGF-β1. This in vitro study was undertaken to evaluate the role of NEP in CC promotion in conditions of indirect co-culture of CC cells (LS180 and SW620) with NCFs (CCD-18Co) or their conditioned medium (CM-18Co). Methods We examined cell proliferation (with the BrdU assay) and invasiveness (using BME-coated inserts, 8 µm) of NEP-expressing, NEP-silenced (siRNA), and NEP-inhibited (with thiorphan, i.e. a NEP specific inhibitor) CC cells cultured alone or co-cultured with CCD-18Co or with their conditioned medium. The Western blot and ELISA methods were used to assess the level of TGF-β1. Results The results showed that the co-culture of the NEP-depleted CC cells with NCFs or their conditioned medium resulted in a significant decrease in cell proliferation in comparison with the proliferative potential of NEP-silenced/inhibited CC cells cultivated alone. In contrast, the NEP depletion did not influence the invasiveness of CC cells in the co-cultures. The co-culture of CC cells with CCD-18Co or CM-C18Co resulted in increased synthesis of TGF-β1, while the NEP downregulation decreased the synthesis of TGF-β1 in CC cells and abolished the stimulatory effect of the co-cultures on TGF-β1 production. Conclusions The results suggest that the expression of NEP by colon cancer cells is essential for their proliferation and TGF-β1 synthesis during paracrine interactions with NCFs. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.