Establishment of a nomogram for predicting prolonged mechanical ventilation in cardiovascular surgery patients.

AIMS: This study aimed to develop a nomogram model for predicting prolonged mechanical ventilation (PMV) in patients undergoing cardiovascular surgery. METHODS AND RESULTS: In total, 693 patients undergoing cardiovascular surgery at an Affiliated Hospital of Nantong University between January 2018 and June 2020 were studied. Postoperative PMV was required in 147 patients (21.2%). Logistic regression analysis showed that delirium [odds ratio (OR), 3.063; 95% confidence interval (CI), 1.991-4.713; P < 0.001], intraoperative blood transfusion (OR, 2.489; 95% CI, 1.565-3.960; P < 0.001), obesity (OR, 2.789; 95% CI, 1.543-5.040; P = 0.001), postoperative serum creatinine level (mmol/L; OR, 1.012; 95% CI, 1.007-1.017; P < 0.001), postoperative serum albumin level (g/L; OR, 0.937; 95% CI, 0.902-0.973; P = 0.001), and postoperative total bilirubin level (µmol/L; OR, 1.020; 95% CI, 1.005-1.034; P = 0.008) were independent risk factors for PMV. The area under the receiver operating characteristic curve for our nomogram was found to be 0.770 (95% CI, 0.727-0.813). The goodness-of-fit test indicated that the model fitted the data well (χ2 = 12.480, P = 0.131). After the model was internally validated, the calibration plot demonstrated good performance of the nomogram, as supported by the Harrell concordance index of 0.760. Decision curve analysis demonstrated that the nomogram was clinically useful in identifying patients at risk for PMV. CONCLUSION: We established a new nomogram model that may provide an individual prediction of PMV. This model may provide nurses, social workers, physicians, and administrators with an accurate and objective assessment tool to identify patients at high risk for PMV after cardiovascular surgery.

Prediction model for delirium in patients with cardiovascular surgery: development and validation.

BACKGROUND: The aim of this study was to construct a nomogram model for discriminating the risk of delirium in patients undergoing cardiovascular surgery. METHODS: From January 2017 to June 2020, we collected data from 838 patients who underwent cardiovascular surgery at the Affiliated Hospital of Nantong University. Patients were randomly divided into a training set and a validation set at a 5:5 ratio. A nomogram model was established based on logistic regression. Discrimination and calibration were used to evaluate the predictive performance of the model. RESULTS: The incidence of delirium was 48.3%. A total of 389 patients were in the modelling group, and 449 patients were in the verification group. Logistic regression analysis showed that CPB duration (OR [Formula: see text] 1.004, 95% CI: 1.001-1.008, [Formula: see text] 0.018), postoperative serum sodium (OR [Formula: see text] 1.112, 95% CI: 1.049-1.178, [Formula: see text] 0.001), age (OR [Formula: see text] 1.027, 95% CI: 1.006-1.048, [Formula: see text] 0.011), and postoperative MV (OR [Formula: see text] 1.019, 95% CI: 1.008-1.030, [Formula: see text] 0.001) were independent risk factors. The results showed that AUC[Formula: see text] was 0.712 and that the 95% CI was 0.661-0.762. The Hosmer-Lemeshow goodness of fit test showed that the predicted results of the model were in good agreement with the actual situation ([Formula: see text] 6.200, [Formula: see text] 0.625). The results of verification showed that the AUC[Formula: see text] was 0.705, and the 95% CI was 0.657-0.752. The Hosmer-Lemeshow goodness of fit test results were [Formula: see text] 8.653 and [Formula: see text] 0.372, indicating that the predictive effect of the model is good. CONCLUSIONS: The establishment of the model provides accurate and objective assessment tools for medical staff to start preventing postoperative delirium in a purposeful and focused manner when a patient enters the CSICU after surgery.

The effect of laryngopharyngeal reflux on arousal in patients with obstructive sleep apnea.

BACKGROUND: Laryngopharyngeal reflux (LPR) may be associated with the severity of obstructive sleep apnea (OSA). However, it is unknown whether LPR may be associated with arousal. OBJECTIVE: To clarify the effect of LPR on arousal in OSA. METHODS: This study included 120 OSA patients. The correlations between LPR scores and arousal index (ArI) were analyzed. Finally, to further clarify the effect of LPR on ArI, we analyzed the correlations between respiratory event-related arousal index (BERAI), leg-movement-related arousal index (LMRAI), snore-related arousal index (SRAI), spontaneous arousal index (SAI), and RSI score. RESULTS: Partial correlation analysis showed that the RSI score was positively correlated with ArI (p = .000), mainly correlated with BERAI and SAI (r = 0.422, p = .000; r = 0.212, p = .020). While controlling for apnea-hypopnea index (AHI), the RSI score was still positively correlated with ArI (p = .002), mainly correlated with BERAI and SAI (r = 0.252, p = .006; r = 0.200, p = .029). CONCLUSIONS AND SIGNIFICANCE: The effect of LPR symptoms on arousal in OSA exists. The more severe the LPR was, the more frequent the arousal in OSA patients was. Thereinto, respiratory event-related arousal and spontaneous arousal were the most obvious.

Measurement of Lingual Artery Using Ultrasound Versus Computed Tomography Angiography for Midline Glossectomy in Patients With Obstructive Sleep Apnea.

OBJECTIVE: To clarify the differences in assessing the course of the lingual artery between lingual artery computed tomography angiography (CTA) and ultrasound (US). METHODS: Twenty-six OSA patients were included in this study and accomplished lingual artery CTA and US, respectively. The differences in the depths of the lingual arteries and the distances between the bilateral lingual arteries on 3 measurement levels based on lingual artery CTA and US were compared. RESULTS: The depths of the lingual arteries on 3 measurement levels by CTA were deeper than those by US (P < .01). There was no significant difference in the distances between bilateral lingual arteries on 3 measurement levels between CTA and US (P > .05). CONCLUSIONS: The parameters of lingual artery measured by lingual artery US were similar to or smaller than those measured by lingual artery CTA. Like lingual artery CTA, lingual artery US could be used as an effective method to ensure the safety of the operation.

Endotracheal cuff undersizing diagnosed by computed tomography: Case report.

We herein report a case in which the trachea could be completely sealed only when the cuff pressure reached 100 cmH2O. An excessive cross-sectional area of the trachea is a rare phenomenon, but we believe that our case will be helpful for clinicians who encounter similar situations.

A Method by Disposable Medical Hydrogel to Reduce Water Vapor in Goggles.

In this letter, we describe a method about disposable medical hydrogel recommended inside surgical masks to reduce the water vapor in the goggles. The introduction is as follows.Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 . Letter to the Editor.

[Prevalence of sensitization to allergens in 1 139 patients with allergic rhinitis in Zhengzhou area].

OBJECTIVE: To investigate the main allergens in patients with allergic rhinitis in Zhengzhou district. METHODS: Twenty standardization allergens were used to perform skin prick test in 1 139 patients with allergic rhinitis. The samples were divided into four groups according to the age of the patients. The distributions of different allergens in the four groups were analyzed. RESULTS: The top five inhaled allergens were dermatophagoides farina (920 cases, 80.8%), dermatophagoides pteronyssinus (870 cases, 76.4%), cat hair (517 cases, 45.4%), herbs (397 cases, 34.9%) and poaceae (353 cases, 31.0%); the top five ingestive ones were shrimp (143 cases, 12.6%), peanut (66 cases, 5.8%), egg (56 cases, 4.9%), carp (51 cases, 4.5%) and meat (48 cases, 4.2%). The distribution of allergens was different among the different age groups. CONCLUSION: Dust mites, cat hair, herbs and poaceae were the most common allergens in Zhengzhou district.