Evaluation of regional ventilation by electric impedance tomography during percutaneous dilatational tracheostomy in neurocritical care: a pilot study.

BACKGROUND: Percutaneous dilatational tracheostomy (PDT) has become a widely performed technique in neurocritical care, which is however known to be accompanied by some risks to the patient. The aim of this pilot study was to assess the derecruitment effects of PDT with the electric impedance tomography (EIT) during the PDT procedure in neurocritical care. METHODS: The prospective observational pilot study investigated 11 adult, intubated, mechanically ventilated patients with acute brain disease. We recorded EIT data to determine regional ventilation delay standard deviation (RVD SD), compliance win (CW) and loss (CL), end-expiratory lung impedance (EELI), with the EIT belt placed at the level of Th 4 before, during and after the PDT, performed in the standard PDT position ensuring hyperextension of the neck. RESULTS: From 11 patients, we finally analyzed EIT data in 6 patients - EIT data of 5 patients have been excluded due to the insufficient EIT recordings. The mean RVD SD post-PDT decreased to 7.00 ± 1.29% from 7.33 ± 1.89%. The mean post-PDT CW was 27.33 ± 15.81 and PDT CL 6.33 ± 6.55. Only in one patient, where the trachea was open for 170 s, was a massive dorsal collapse (∆EELI - 25%) detected. In other patients, the trachea was open from 15 to 50 s. CONCLUSIONS: This pilot study demonstrated the feasibility of EIT to detect early lung derecruitment occurring due to the PDT procedure. The ability to detect regional changes in ventilation could be helpful in predicting further progression of ventilation impairment and subsequent hypoxemia, to consider optimal ventilation regimes or time-schedule and type of recruitment maneuvres required after the PDT.

Fatal intracranial aneurysm rupture after thrombolytic treatment for ischemic stroke: a case report and literature review.

Intravenous thrombolysis is a proven treatment of acute ischemic stroke. Its complications include intracranial hemorrhage; the risk may be increased in the presence of an unruptured aneurysm. We present a case report of a patient who suffered fatal subarachnoid hemorrhage after thrombolysis from a known aneurysm. A history of recent previously inexperienced headaches was revealed retrospectively, suggestive of sentinel bleedings. A similar patient was identified in the literature; we thus propose that this history should be excluded in patients harboring an aneurysm considered for thrombolytic treatment.

Pre-stroke undiagnosed dysphagia lusoria as a rare cause of aspiration pneumonia with respiratory failure in a stroke patient.

INTRODUCTION: Dysphagia is a risk factor for aspiration pneumonia and acute respiratory failure in acute stroke patients. Dysphagia lusoria is caused by compression on the esophagus from artery lusoria, when the aberrant right subclavian artery arises from the descending aortic arch. We present a rare case report of pre-stroke undiagnosed dysphagia lusoria as a cause of aspiration pneumonia with acute respiratory failure in a 67-year-old female patient admitted with a minor left intracerebral hemorrhage in the left basal ganglia. On admission to the stroke unit, she had Glasgow Coma Scale of 15, National Institutes of Health Stroke Scale of 8, and a negative screening test for dysphagia, dysphasia, and right-sided hemiparesis. After 16 h of admission, dyspnea suddenly occurred with a decrease in SpO2 (72%). X-ray of the lungs showed less ventilated areas of the lung due to aspiration pneumonia and a broad disfigured shadow of the anterior mediastinum on the base of the lusoria artery. Dysphagia lusoria was confirmed by spiral computed tomography angiography. CONCLUSION: One aim of neurocritical care is the prevention of pneumonia from dysphagia due to risk of acute respiratory failure and secondary brain damage. Pre-stroke undiagnosed dysphagia lusoria could be one very rare cause. A broad disfigured shadow of the anterior mediastinum in X-ray of the lungs gives rise to the first suspicion of the possibility of dysphagia lusoria.

Influence of a 50 hz extra low frequency electromagnetic field on spermatozoa motility and fertilization rates in rabbits.

Effects of a 50 Hz extra-low frequency electromagnetic field (ELF EMF) on in vitro rabbit spermatozoa motility were analyzed, as well as the effect on fertilization rates after insemination. Pooled semen samples and a control were exposed to 50 Hz ELF EMF. The difference of the samples of the test groups G1 and G2 with the control group CG (75.56%) for spermatozoa motility were found to be significant (P < 0.01). Differences were significant (P < 0.01) for curvilinear velocity (VCL) between the test group G3 (122.38 microm/s) and the control group CG (112.02 microm/s). Hormonally stimulated adult (9-12 months) females (n = 140) were inseminated with semen samples from G1, G2, G3 and CG (0.88 x 109 spermatozoa/0.5 mL average insemination portion) immediately after ELF EMF exposure and fertilization (kindling) rates were calculated. For the G2 it was 54.28% data indicate 50 Hz ELF EMF induced alterations of spermatozoa motility and kindling rate in rabbits, therefore influencing fertility.

The influence of non-ionic radiation on the chicken hatching.

The study considers the influence of non-ionic radiation (white and monochromatic light) on the hatching of the Hampshire breed chickens. The chicken embryos were most sensitive to the white light (El), reaching the hatching time of 503.63 +/- 3.17 h, the hatchability of 95.12 +/- 3.72% and an average weight of incubated chickens 46.83 +/- 2.82 g. Of the monochromatic lights, the chicken embryos were most sensitive to yellow and green lights (E5, E4) with the hatching time of 505.22 +/- 4.03 and 507.14 +/- 3.95 h, respectively, the hatchability of 94.89 +/- 3.02 and 94.47 +/- 2.93%, respectively and the average weight of incubated chickens 45.72 +/- 1.93 and 45.05 +/- 2.66 g, respectively. The least reaction of chicken was observed with violet light (E2) with the hatching time of 510.04+/- 1.97 h, hatchability of 90.81 +/- 4.05% and the average weight of incubated chickens 42.02 +/- 3.72 g. The effect of violet light brings the same results as we observed in the case of hatching in darkness (control group C), when the hatching time was 510.41 +/- 2.82 h, hatchability 90.42 +/- 3.35% and average weight of incubated chickens 41.98 +/- 3.05 g.

The influence of a temporary magnetic field on chicken hatching.

The influence of magnetic field with the intensity of 0.07T on the hatching of the Hampshire breed chicken was investigated. The hatchability of the eggs that were influenced by magnetic field during the storage of the egg set (20-40 min) was increased in comparison with eggs that were not influenced by magnetic field (p < 0.05). In the eggs influenced by magnetic field during their incubation, the hatchability in experimental groups E1 and E2 decreased to 70.08 +/- 1.93% and 70.75 +/- 2.13%, respectively. The difference were significant (p < 0.001) in comparison with the control groups C1 and C2. The negative influence of magnetic field was manifested by lower weight of the hatched chickens in the experimental groups E1 (35.07 +/- 0.95 g) and E2 (35.94 +/- 0.97 g). The results were relevant (p < 0.05) in comparison with the control groups with the average weight of hatched chickens 41.83 +/- 1.15 g (C1) and 44.27 +/- 0.73 g (C2).