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Femoral indicator injection for transpulmonary thermodilution using the EV1000/VolumeView~®: do the same criteria apply as for the PiCCO~®?

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Journal of Zhejiang University-Science B(Biomedicine & Biotechnology) 2016年第7期17卷 561-567页

作者： Wolfgang HUBERt veit phillip Josef HOLLTHALER Caroline SCHULTHEISS Bemd SAUGEL Roland M. SCHMID Second Medical Department Klinikum rechts der lsar Technical University of Munich 81675 Munich Germany

Objective： Comparison of global end-diastolic volume index （GEDVI） obtained by femoral and jugular transpulmonary thermodilution （TPTD） indicator injections using the EV1000NolumnView device （Edwards Lifesci- ences, Irvine, USA）. Methods： In an 87-year-old woman with hypovolemic shock and equipped with both jugular and femoral vein access and monitored with the EV1000NolumeView device, we recorded 10 datasets, each comprising duplicate TPTD via femoral access and duplicate TPTD （20 ml cold saline） via jugular access. Results： Mean femoral GEDVI （（674.6±52.3） ml/m2） was significantly higher than jugular GEDVI （（552.3±69.7） ml/m2）, with P=-0.003. Bland-Airman analysis demonstrated a bias of （＋122±61） ml/m2, limits of agreement of -16 and ＋260 ml/m2, and a percentage error of 22%. Use of the correction-formula recently suggested for the PiCCO device significantly reduced bias and percentage error. Similarly, mean values of parameters derived from GEDVI such as pulmonary vascular permeability index （PVPI; 1.244±0.101 vs. 1.522±0.139; P〈0.001） and global ejection fraction （GEF; （24.7±1.6）% vs. （28.1±1.8）%; P〈0.001） were significantly different in the case of femoral compared to jugular indicator injection. Fur- thermore, the mean cardiac index derived from femoral indicator injection （（4.50±0.36） L/（min.m2）） was significantly higher （P=0.02） than that derived from jugular indicator injection （（4.12±0.44） L/（min.m2））, resulting in a bias of （＋0.38±0.37） L/（min.m2） and a percentage error of 19.4%. Conclusions： Femoral access for indicator injection results in markedly altered values provided by the EV1000NolumeView , particularly for GEDVI, PVPI, and GEF.

关键词： Hemodynamic monitoring Transpulmonary thermodilution Central venous catheter Femoral vein Jugular vein Global end-diastolic volume EVlOOONolumeView PiCCO

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Machine learning-based decision tool for selecting patients with idiopathic acute pancreatitis for endosonography to exclude a biliary aetiology

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世界胃肠病学杂志:英文版 2023年第35期29卷 5138-5153页

作者： Simon Sirtl Michal Żorniak Eric Hohmann Georg Beyer Miriam Dibos Annika Wandel veit phillip Christoph Ammer-Herrmenau Albrecht Neesse Christian Schulz Jörg Schirra Julia Mayerle Ujjwal Mukund Mahajan Department of Medicine II LMU University HospitalMunich 81377Germany Department of Endoscopy Maria Sklodowska-Curie National Research Institute of OncologyGliwice 44-113Poland Department of Internal Medicine II School of MedicineUniversity Hospital Rechts der IsarTechnical University of MunichMunich 81675Germany Department of Gastroenterology Gastrointestinal Oncology and EndocrinologyUniversity Medical CenterGöttingen 37075Germany

BACKGROUND Biliary microlithiasis/sludge is detected in approximately 30%of patients with idiopathic acute pancreatitis(IAP).As recurrent biliary pancreatitis can be prevented,the underlying aetiology of IAP should be *** To develop a machine learning(ML)based decision tool for the use of endosonography(EUS)in pancreatitis patients to detect sludge and *** We retrospectively used routinely recorded clinical and laboratory parameters of 218 consecutive patients with confirmed AP admitted to our tertiary care hospital between 2015 and *** who did not receive EUS as part of the diagnostic work-up and whose pancreatitis episode could be adequately explained by other causes than biliary sludge and microlithiasis were *** trained supervised ML classifiers using H_(2)*** automatically selecting the best suitable predictor model to predict microlithiasis/*** predictor model was further validated in two independent retrospective cohorts from two tertiary care centers(117 patients).RESULTS Twenty-eight categorized patients’variables recorded at admission were identified to compute the predictor model with an accuracy of 0.84[95%confidence interval(CI):0.791-0.9185],positive predictive value of 0.84,and negative predictive value of 0.80 in the identification cohort(218 patients).In the validation cohort,the robustness of the prediction model was confirmed with an accuracy of 0.76(95%CI:0.673-0.8347),positive predictive value of 0.76,and negative predictive value of 0.78(117 patients).CONCLUSION We present a robust and validated ML-based predictor model consisting of routinely recorded parameters at admission that can predict biliary sludge and microlithiasis as the cause of AP.

关键词： Acute pancreatitis Idiopathic acute pancreatitis Biliary pancreatitis Microlithiasis Sludge Endosonography

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Early phase of acute pancreatitis: Assessment and management

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World Journal of Gastrointestinal Pathophysiology 2014年第3期5卷 158-168页

作者： veit phillip Jrg M Steiner Hana Algül II. Medizinische Klinik und Poliklinik Klinikum rechts der Isar der Technischen Universitt München Gastrointestinal Laboratory Department of Small Animal Clinical Sciences College of Veterinary Medicine and Biomedical Sciences Texas A and M University College Station TX 77843-4474 United States

Acute pancreatitis(AP) is a potentially life-threatening disease with a wide spectrum of severity. The overall mortality of AP is approximately 5%. According to the revised Atlanta classification system, AP can be classified as mild, moderate, or severe. Severe AP often takes a clinical course with two phases, an early and a late phase, which should both be considered separately. In this review article, we first discuss general aspects of AP, including incidence, pathophysiology, etiology, and grading of severity, then focus on the assessment of patients with suspected AP, including diagnosis and risk stratification, followed by the management of AP during the early phase, with special emphasis on fluid therapy, pain management, nutrition, and antibiotic prophylaxis.

关键词： Acute pancreatitis Incidence Pathophysiology Etiology Severity Risk stratification Fluid therapy Pain management Nutrition Antibiotic prophylaxis

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