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PubMed2004

Genetic evidence reveals density-dependent mediated success of alternative mating behaviours in the European bitterling (Rhodeus sericeus).

The reproductive success of alternative mating behaviours may vary within and among populations in relation to environmental factors and demographic parameters. We used behavioural and genetic data to investigate how male density affects reproductive success of territoriality and sneaking in the European bitterling (Rhodeus sericeus, Cyprinidae), a freshwater fish that spawns on the gills of living freshwater mussels. Keeping the number of spawning sites constant, we manipulated male densities in laboratory and mesocosm experiments. We showed that sneaked fertilizations were common in R. sericeus, and that they increased significantly with male density. Territorial mating was almost 17 times more successful than sneaking at the lowest male density treatment, and still 2-3 times more successful at intermediate densities. However, both behaviours conferred the same fitness pay-off at the highest male density. While the success of territorial males declined with male density, the success of individual sneaking males remained constant across densities. Notably, the capacity of territorial males to outcompete sneakers by preoviposition sperm loading was the best predictor of male reproductive success, rather than aggression, body size or postoviposition ejaculation.

Animals↗

PubMedDate not supplied

Multidimensional success criteria and expectations for treatment of chronic pain: the patient perspective.

OBJECTIVE: The study's primary objective is to define treatment success from the patient perspective across four domains (pain, fatigue, emotional distress, interference with daily activities) using the Patient Centered Outcomes Questionnaire (PCOQ). Secondary objectives include examination of patient expectations for treatment across domains and derivation of patient subgroups based on PCOQ responses. DESIGN: Cross-sectional. Setting. University of Florida or affiliated pain clinics. Patients. Participants were 110 patients seeking treatment for chronic pain who completed the PCOQ before their routine medical appointment. RESULTS: Patients reported moderate usual levels of pain (mean = 6.1), fatigue (mean = 5.9), distress (mean = 5.5), and interference (mean = 6.4). Patients considered a mean reduction in pain of 3.4 points (56%) to represent treatment success. Mean reductions in fatigue, distress, and interference of 3.35 points (57%), 3.64 points (65%), and 4.3 points (68%), respectively, also signified treatment success. Analyses revealed patients expected their level of interference following treatment (mean = 2.6) to be higher than their success criterion for interference (mean = 2.0). Cluster analysis of PCOQ responses revealed a three-cluster solution. Differences were obtained among clusters on demographic and pain-related variables. CONCLUSIONS: Patients might require larger reductions in pain than has previously been reported in the literature as "meaningful" for them to consider treatment successful. Patients did not expect treatment to meet their criterion for success in the interference domain, suggesting patients' success criteria and treatment expectations might differ for some domains. The finding of patient subgroups has implications for treatment matching.

Activities of Daily Living↗

PubMed1992

Reproducibility of successful drug trials in patients with inducible sustained ventricular tachycardia.

Patients whose inducible sustained ventricular tachycardia is suppressed during serial electrophysiological testing have a small but gradually increasing actuarial incidence of recurrent arrhythmias despite therapy with the "successful" drug. In an effort to improve the predictive value of a drug response, in 1990 we began to require that our full stimulation protocol be repeated successfully several times before considering a drug to be effective. In 23 consecutive patients who had inducible sustained ventricular tachycardia which was suppressed by at least one drug during invasive serial drug testing using a standard stimulation protocol, the identical stimulation protocol was performed six times during therapy with the initially successful drug (three trials on Day 1 and three trials on Day 2). Repeat trials were completed (i.e., either all six trials were successfully finished or sustained tachycardia was induced) for 29 initially successful drugs in these 23 patients. With 18 of these 29 initially successful drugs (62%), sustained ventricular tachycardia was eventually induced during repeat trials. The eventual drug failures could not be correlated with specific drugs tested, subtherapeutic or falling serum drug levels, marked fluctuations in autonomic tone, or changes in anatomic substrate. The proportion of patients failing each repeat trial was relatively constant: 4/29 (14%) failed Trial 2, 2/25 (8%) failed Trial 3, 7/23 (30%) failed Trial 4, 2/16 (13%) failed Trial 5, and 3/14 (21%) failed Trial 6. The increase in the cumulative incidence of drug failure during repeat trials was nearly linear. Inducibility of ventricular tachycardia appears to be a probability function; a successful drug study should not be regarded as an absolute phenomenon.

Adolescent↗

PubMed1994

The probability of defibrillation success and the incidence of postshock arrhythmia as a function of shock strength.

The effects of high voltage defibrillation shocks given to six swine were studied to determine if there is a limit to the advantage gained from increasing the shock strength. An endocardial electrode was placed in the right ventricle, and a 114-cm2 cutaneous patch was placed on the left lateral thorax. Monophasic (10 msec) and single capacitor biphasic (5/5 msec) shocks with leading edge voltages of 200, 400, 600, 800, and 990 volts (approximately 2.3-59 J) were tested. For monophasic shocks, the probability of successful defibrillation ranged from 0% at 200 V to 90% at 990 V. The incidence of postshock arrhythmia increased from 0% for successful shocks at 600 V to 67% for successful shocks at 990 V. For biphasic shocks, the probability of success peaked at 97% for the 600-, 800-, and 990-V shocks. The incidence of postshock arrhythmia increased from 8% at 400 V to 55% at 990 V. Although more postshock arrhythmias occurred at lower strengths for biphasic than for monophasic shocks, an efficacy criterion, quantifying the probability of defibrillation success and the probability that a postshock arrhythmia will not occur, was always higher for biphasic shocks. The probability of success never reached 100% for either waveform while the incidence of postshock arrhythmia increased as the shock strength increased. In conclusion, for the catheter-patch electrode configuration, increasing the shock strength does not always improve the probability of success and may increase the incidence of postshock arrhythmia.

Animals↗

PubMed2006

The magnitude of sinus cycle length change during ventricular tachycardia is predictive of successful antitachycardia pacing.

BACKGROUND: Despite the wide use of antitachycardia pacing (ATP) in patients with implantable cardioverter defibrillators (ICDs), predictors of ATP success remain poorly understood. We hypothesize that the degree of sympathoexcitation, as measured by the sinus cycle length (SCL) shortening during ventricular tachycardia (VT), is a predictor of ATP success. METHODS AND RESULTS: The charts of 462 patients with dual-chamber ICDs were reviewed. A total of 88 events in 26 patients met the inclusion criteria and were analyzed. The mean SCL during the 4 seconds preceding the VT onset (SCL-baseline), and during the 4 seconds prior to ATP delivery (SCL-VT) was measured. The percent shortening in SCL was calculated as ((SCL-baseline) - (SCL-VT))/(SCL-baseline) x 100. Patients were classified into the ATP-success and ATP-failure groups depending on the VT(s) response to ATP. Using a t-test analogue for clustered data, patients in the ATP-success group exhibited a greater shortening in SCL when compared with the ATP-Failure group (5.8% compared to 4.7%, P = 0.007). The successful ATP events displayed an average SCL shortening of 6.0% compared to 1.8% in the unsuccessful ATP events (P = 0.029). When the events were analyzed, the sensitivity and specificity of a shortening in SCL of >10% in predicting ATP success were 0.29 and 1. CONCLUSION: We have shown that the SCL change during VT, a marker of the autonomic changes that accompany a tachycardia, is useful in predicting ATP success. Our findings suggest that analysis of the SCL during VT might play a role in future programming of ATP in patients with ICDs.

Cardiac Pacing, Artificial↗

PubMed2004

Immediate termination of fibrillation at 50% probability of overall success correlates with defibrillation dose-response curve width.

INTRODUCTION: Issues in transthoracic defibrillation, including waveform shape, fixed versus escalating dose protocol, and low- versus high-energy shocks, can be addressed by examining the defibrillation dose-response curve. We tested the hypothesis that, for commonly used defibrillation waveforms, the steepness of the overall defibrillation dose-response curve, measured as normalized curve width, correlates with the probability of a successful defibrillation being immediate at the shock intensity producing 50% success. METHODS AND RESULTS: We used 16 isolated rabbit hearts to determine probability of overall success as a function of shock intensity and probability that a successful defibrillation is immediate rather than progressive (followed by several extrasystoles) at the shock intensity producing 50% overall defibrillation success. Two waveform pairs were tested--a monophasic damped sine versus a biphasic truncated exponential waveform commonly used for transthoracic defibrillation, and a monophasic/biphasic truncated exponential waveform pair similar to those used in internal cardioverter defibrillators. There was a close correlation between probability of a successful defibrillation being immediate at 150 and normalized curve width for the defibrillation dose-response curve. CONCLUSION: Our findings suggest that a high probability of successful defibrillation being immediate at low shock intensities is correlated with a narrow normalized curve width for the defibrillation dose-response curve.

Action Potentials↗

PubMed2001

Successful weight loss maintenance.

Obesity is now recognized as a serious chronic disease, but there is pessimism about how successful treatment can be. A general perception is that almost no one succeeds in long-term maintenance of weight loss. To define long-term weight loss success, we need an accepted definition. We propose defining successful long-term weight loss maintenance as intentionally losing at least 10% of initial body weight and keeping it off for at least 1 year. According to this definition, the picture is much more optimistic, with perhaps greater than 20% of overweight/obese persons able to achieve success. We found that in the National Weight Control Registry, successful long-term weight loss maintainers (average weight loss of 30 kg for an average of 5.5 years) share common behavioral strategies, including eating a diet low in fat, frequent self-monitoring of body weight and food intake, and high levels of regular physical activity. Weight loss maintenance may get easier over time. Once these successful maintainers have maintained a weight loss for 2-5 years, the chances of longer-term success greatly increase.

Basal Metabolism↗

PubMed2003

Predictors of successful clinical and laboratory outcomes in patients with primary sclerosing cholangitis undergoing endoscopic retrograde cholangiopancreatography.

UNLABELLED: Endoscopic retrograde cholangiopancreatography (ERCP) in patients with primary sclerosing cholangitis (PSC) can be a challenging and sometimes gratifying opportunity for therapeutic intervention. Although there often appears to be initial radiological improvement after ERCP, the benefit as measured by serial estimations of subsequent liver enzymes is questionable. The fluctuating course of the inflammatory process makes the interpretation of serology even more difficult. OBJECTIVES: To document and compare the liver profile and clinical status of patients before and after diagnostic and therapeutic ERCP; to determine predictors of clinical and laboratory success in patients with PSC; and to assess the complication rate of diagnostic and therapeutic ERCP in these patients. METHODS: All patients with PSC who underwent ERCP at the authors' medical centres between January 6, 1987 and January 12, 1998 were identified using a computerized database. Presenting symptoms, liver enzymes (aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase) and bilirubin were recorded before ERCP. Clinical success was defined as resolution of the presenting symptoms. Laboratory success was defined as improvement in two of three liver enzymes by at least 50%, or resolution of jaundice. RESULTS: One hundred four patients underwent 204 ERCPs of which 56 ERCPs were diagnostic. Clinical improvement was seen in 35% of the patients after diagnostic ERCP and in 70% after therapeutic procedures (chi 2=18.4, P=0.001). Laboratory improvement was seen in 35% of patients undergoing diagnostic ERCP and in 52% of the patients undergoing therapeutic ERCP (P=0.04). The reductions in liver enzymes were significant in both the diagnostic and therapeutic groups. Serum bilirubin level decreased significantly in the therapeutic ERCP group only. In a univariate analysis, patients with common bile duct strictures, any dominant stricture and those who underwent a therapeutic procedure were most likely to have clinical and laboratory improvement. In multivariable logistic regression, the presence of a dominant stricture, endoscopic therapy and high serum bilirubin were all independent predictors of a successful clinical outcome. There was no difference in total complication rates (18% versus 14%) when comparing the diagnostic and therapeutic ERCP groups. However, all seven severe complications occurred in the therapeutic ERCP group. CONCLUSIONS: First, in PSC, clinical and laboratory improvement is more common in patients undergoing therapeutic ERCP than diagnostic ERCP. Second, aspartate aminotransferase, alanine aminotransferase and alkaline phosphatase improve following both diagnostic and therapeutic ERCP, and should therefore not be relied upon to determine the success of the procedure. Third, bilirubin levels decreased in the therapeutic group but remained unchanged in the diagnostic group, suggesting that the serum bilirubin level may be a more sensitive indicator of successful therapeutic intervention than transaminases. Fourth, common bile duct strictures, dominant strictures and bilirubin levels are important variables in determining the success of an ERCP in PSC. Finally, complication rates after therapeutic ERCP are similar to those after diagnostic ERCP in PSC patients. However, severe complications occur more commonly in the therapeutic group.

Adult↗

PubMed2005

[Predictive factors related to success of non invasive ventilation and mortality in the treatment of acute cardiogenic pulmonary edema].

BACKGROUND AND OBJECTIVE: Recent studies support the use of non invasive ventilation (NIV) in patients with acute cardiogenic pulmonary edema (ACPE). We aimed to evaluate the factors related to the success of the technique in patients admitted to an intensive care unit (ICU) with ACPE. PATIENTS AND METHOD: An observational prospective study was performed in ICU.199 consecutive patients were enrolled with ACPE at admission who received treatment with NIV and standardized pharmacological treatment. The success of the NIV was achieved when endotracheal intubation was avoided and patients were alive without dyspnea within and 24 hours after discharge from the ICU. Clinical, physiological and gasometric parameters were analyzed at admission and one hour after starting NIV. RESULTS: Patient's age was 74 years. 43% were male. The SAPS II was 45. 74.4% of the patients were successfully treated with NIV. 12.6% required endotracheal intubation. In a multivariate analysis, the success of the technique (values expressed as odds ratio [95% confidence interval]) was related to: SAPS II (0.95 [0.91-0.99]); the place of admission (6.78 [1.85-24.79]); value of PCO2 at admission (1.05 [1.01-1.09]); PO2/FiO2 index (1.03 [1.01-1.06]) and respiratory frequency (0.91 [0.84-0.99]) within the first hour; SOFA (acute failure organics score) (0.62 [0.49-0.78]); concomittant acute myocardial infarction (AMI) (0.05 [0.01-0.22]) and number of complications (0.17 [0.47-0.65]). The hospital mortality rate was 32.7%. The non intubation order (0.12 [0.04-0.32]) and the success of the technique (100.03 [28.71-348.47]) were related to the hospital mortality. CONCLUSIONS: The success of NIV in the treatment of ACPE is related to a lower SAPS II, admission at the emergency department, elevated PCO2 at admission, improvement of the PO2/FiO2 index and the respiratory rate within the first hour. The non intubation order and the success of the technique were related to the hospital mortality.

Acute Disease↗

PubMed2004

Relationship of serum cardiac markers following successful percutaneous coronary intervention and subsequent exercise capacity in patients with chronic stable angina: a pilot study.

We performed a pilot study to assess the significance of modest, asymptomatic, elevated serum cardiac markers--troponin T (TnT) and creatinine kinase-MB (CK-MB)--18-24 h following successful elective percutaneous coronary intervention (PCI) and to explore their relationship with changes in aerobic exercise capacity, as measured by peak oxygen consumption (VO2), 6 weeks following the procedure. Twenty-three patients with single-vessel disease and chronic angina performed an incremental cardiopulmonary exercise test before and 6 weeks after successful uncomplicated PCI. A venous blood sample was taken at rest before PCI and 18-24 h after the procedure. Successful PCI resulted in a trend towards an increased peak VO2 [21.62 +/- 0.64 (pre) vs. 23.03 +/- 0.75 ml/ kg/min (post), p = 0.07; mean +/- SEM]. There was a significant increase [median (IQR)] in TnT, from 0.00 (0.00) microg/l at baseline increasing to 0.02 (0.03) microg/l at 18-24 h, p = 0.002. CK-MB levels showed no significant difference. In the group of 15/23 (65%) patients with an elevation in serum TnT (>/=0.01 microg/l), 18-24 h after successful PCI, there was no significant increase in peak VO2 [23.31 +/- 0.96 (pre) vs. 23.89 +/- 1.09 ml/kg/min (post), p = 0.57]. In 8 (35%) patients with no rise in TnT at 18-24 h, a significant increase in peak VO2 was observed following successful PCI [23.10 +/- 0.91 (pre) vs. 25.09 +/- 0.75 ml/kg/min (post), p = 0.02]. Although 7 of these 8 patients increased their peak VO2, the absence of a TnT rise at 18-24 h was not significantly associated with an increase in peak VO2 following successful PCI (p = 0.18). To confirm these interesting initial results and investigate the relationship of serum cardiac markers following successful PCI and subsequent exercise capacity, further studies are required.

Adult↗

PubMed1979

Factors influencing the success of ventricular defibrillation in man.

To define the factors influencing the success of emergency ventricular defibrillation, we identified 52 patients defibrillated at the University of Iowa Hospital during 1974--1976. Thirty-eight patients were successfully defibrillated at least once; 14 could not be defibrillated, despite multiple attempts. Comparisons between these groups revealed no significant differences in body weight, heart weight, energy per kilogram of body weight and energy per gram of heart weight. Factors that militated against successful defibrillation included a prolonged delay before the first defibrillatory shock (successful 7 +/- 7 minutes (SD); unsuccessful 17 +/- 13 minutes, p less than 0.001), acidosis (successful pH 7.36 +/- 0.22; unsuccessful pH 7.23 +/- 0.12, p = 0.05) and hypoxia (successful PO2 100 + 98 torr; unsuccessful PO2 40 +/- 67 torr; p = 0.06). These three conditions tended to occur together in individual patients. Metabolic factors are important in determining defibrillation success; however, the role of high-energy doses is uncertain.

Acidosis↗

PubMed1998

Absence of junctional rhythm during successful slow-pathway ablation in patients with atrioventricular nodal reentrant tachycardia.

BACKGROUND: The presence of junctional rhythm has been considered to be a sensitive marker of successful slow-pathway ablation. However, in rare cases, junctional rhythm was absent despite multiple radiofrequency applications delivered over a large area in the Koch's triangle, and successful ablation was achieved in the absence of a junctional rhythm. METHODS AND RESULTS: This study included 353 patients with AV nodal reentrant tachycardia (143 men and 210 women; mean age, 50+/-17 years) who underwent catheter ablation of the slow pathway. Combined anatomic and electrogram approaches were used to guide ablation. Inducibility of AV nodal reentrant tachycardia was assessed after each application of radiofrequency energy. Successful sites were located in the posterior area in 18 (90%) of 20 patients without junctional rhythm during slow-pathway ablation compared with 200 (60%) of 333 patients with junctional rhythm (P<0.001). The fast-slow form of tachycardia was more common in patients without than in those with junctional rhythm (30% versus 3%; P=0.001). At the successful ablation sites, patients with junctional rhythm had a higher incidence of a multicomponent or slow-pathway potential (51% versus 10%; P<0.001), a longer duration of the atrial electrogram (64+/-8 versus 50+/-9 ms; P=0.04), and a smaller atrial/ventricular electrogram amplitude ratio (0.29+/-0.18 versus 0.65+/-0.27; P<0. 001) than those without junctional rhythm. Mean temperatures at successful sites (56+/-6 degreesC versus 58+/-9 degreesC; P=0.57) and incidence of transient AV block (2% versus 0%; P=0.86) were similar between patients with and without junctional rhythms. By multivariate analysis, location of ablation sites, atrial/ventricular electrogram amplitude ratio, absence of a multicomponent or slow-pathway potential, and occurrence of the fast-slow form of tachycardia were independent predictors of the absence of a junctional rhythm during successful slow-pathway ablation. CONCLUSIONS: In some rare cases, successful slow-pathway ablation is possible in the absence of a junctional rhythm.

Adolescent↗

PubMed1993

Clinical and angiographic determinants of initial percutaneous transluminal coronary angioplasty success.

Clinical and anatomic determinants of primary success of percutaneous transluminal coronary angioplasty were retrospectively evaluated in 299 patients. Successful angioplasty (residual stenosis < 50%) was achieved in 350 (94%) of 373 lesions. The success rate in patients chronically treated with aspirin was higher than that of patients not treated with aspirin (95% versus 86%, P < 0.03). An additional finding was that the success rate in patients referred for coronary angioplasty because of acute myocardial infarction or postinfarction angina was lower than that of those without these characteristics (89% versus 96%, P < 0.01). No other clinical features studied influenced the outcome of coronary angioplasty. The angiographic characteristics of the lesions did not differ between patients with successful or failed angioplasty except for the degree of stenosis prior to the procedure, being lower in patients with successful procedure (92.4 +/- 7.6% versus 97.3 +/- 3.1%), P < 0.002). Thus coronary angioplasty can be performed with a high rate of success. Long-term pretreatment with aspirin may have a beneficial effect.

Aged↗

PubMedDate not supplied

Predictive factors of success or failure in the endoscopic management of laryngeal and tracheal stenosis.

Stenosis of the larynx and/or trachea presents perplexing problems. No one technique has proved totally satisfactory in the management of all varieties of stenosis. Recent reports have described the successful use of the CO2 laser in the endoscopic management of stenosis of the larynx and trachea. Failures of this technique need emphasis to assure appropriate selection of therapeutic method. Retrospectively, 49 cases of laryngeal stenosis, 6 cases of tracheal stenosis and 5 cases of combined laryngeal and tracheal stenosis were studied (total 60 patients) following treatment at the Boston University Affiliated Hospitals. Follow-up ranged from 1 to 8 years. Multiple procedures were required in 35 laryngeal patients. Of the laryngeal patients 39 were successfully managed (average number of procedures in successful cases 2.18). Of 11 tracheal patients with combined laryngeal and tracheal procedures, 3 were successfully managed (average number of procedures in successful cases 6). Failures in laryngeal stenosis included four patients in whom an adequate airway was not established though voice was present while maintaining tracheostomies. Thirteen patients failing endoscopic management required open surgery with good result. Factors associated with poor result or failure include circumferential scarring with cicatricial contracture, scarring wider than 1 cm in vertical dimension, tracheomalacia and loss of cartilage, previous history of severe bacterial infection associated with tracheostomy, and posterior laryngeal inlet scarring with arytenoid fixation. In these circumstances, multiple procedures, more extensive alternative open surgical techniques, or maintenance of tracheostomy were necessary. In successful cases only three or fewer procedures on average were required. The factors associated with failure or success of endoscopic methods in the management of laryngotracheal stenosis, including use of the CO2 laser and soft Silastic stents, are analyzed.

Adolescent↗

PubMed1995

Previous tonsillectomy as prognostic indicator for success of uvulopalatopharyngoplasty.

Factors that determine a successful outcome following uvulopalatopharyngoplasty (UPPP) for obstructive sleep apnea (OSA) are not well defined. This study was undertaken to determine if prior tonsillectomy is predictive of a lower response rate to UPPP. A retrospective review of a cohort undergoing UPPP alone or in combination with nasal septoplasty for OSA was undertaken. Preoperative and postoperative polysomnograms were obtained to evaluate the severity of the OSA. The sample was a consecutive series of 79 patients with OSA. Clinical evaluation was performed by both an otolaryngologist and a pulmonologist. Surgical treatment in this group of 79 patients included 52 UPPP and 27 UPPP in patients with prior tonsillectomy. Concurrent septoplasty was undertaken in 17 patients. Criteria for outcome were based on comparison of preoperative and postoperative polysomnograms (i.e., apnea index, respiratory disturbance index change, and lowest saturation). A response to therapy was defined as a reduction in apnea index greater than 50%. A success was defined as apnea index less than 5, reduction of respiratory disturbance index greater than 50%, and nadir saturation greater than 82%. In 79 patients with OSA, 78% responded and 37% reflected therapeutic successes. Patients with history of prior tonsillectomy were less likely to have therapeutic improvement following UPPP. In 52 patients without previous tonsillectomy, 88% responded and 52% had a successful outcome. Of those with previous tonsillectomy, 59% responded and 7% had a successful outcome. The status of previous tonsillectomy is an important prognostic indicator in the success of UPPP for the treatment of OSA. We speculate that the presence of palatine tonsils allows the removal of an extra measure of oropharyngeal tissue, thereby improving the likelihood of success for UPPP.

Adult↗

PubMed2001

A clinical audit into the success rate of inferior alveolar nerve block analgesia in general dental practice.

AIMS AND OBJECTIVES: The aim of this study was to produce some observational evidence of the success rate of inferior alveolar nerve block (IDB) analgesia that is achieved in general dental practice. The objective was to help provide some measure of expected failure rates and help dental practitioners in their self-appraisal of this crucial basic skill. METHOD: Up to 100 consecutive IDB analgesia procedures for four dentists were recorded. In a subdivision of this study 200 consecutive IDBs for a fifth dentist were recorded. This dentist had the greatest experience of giving IDB analgesia of the dentists in this study. In this part of the study the dentist made a note if he anticipated that the procedure would fail. The reason for this was that it was felt that experienced dental practitioners could predict when failure was about to occur. The level of facial nerve palsy was also recorded. RESULTS: Overall, 533 of 580 (91.9%) local anaesthetic administrations were deemed to be successful. The only factor that significantly affected the likelihood of success was the practitioner administering the local anaesthetic, and this was only borderline statistically significant. In order to be certain that the other factors did not affect the outcome, the data were re-analysed using the technique of Poisson regression. This technique investigated the effects of each of the factors in turn while controlling for the differences in success that can be attributed to the different practitioners. The regression analyses also did not detect any differences in success that could be attributed to any of the other recorded factors. The incidence of facial palsy was 0.3%. CONCLUSION: This paper gives an insight into the possible success rates to be encountered by general dental practitioners when they administer IDB analgesia. The only recorded factor that could be shown to affect the chance of a successful local analgesic was the operator. The incidence of facial nerve palsy at 0.3% may be more common than has previously been considered.

Adolescent↗

PubMed1995

Enteral feeding tube placement success with intravenous metoclopramide administration in ICU patients.

OBJECTIVE: The purpose of this study was to determine if intravenous push metoclopramide would facilitate immediate transpyloric passage of a small-bore feeding tube without fluoroscopy or endoscopy. DESIGN: Prospective, randomized trial. PATIENTS: One hundred five medical and surgical ICU patients at a community teaching hospital. INTERVENTIONS: Patients were randomized to receive 10 mg of metoclopramide 10 min before tube insertion or no medication. MEASUREMENT: Successful placement was stated as radiologically verified transduodenal tube location. RESULTS: A 54% success rate was shown with administration of the drug with 46% success for the control. Chi square analysis of the success rate showed no significant relationship between administration of metoclopramide and successful tube placement (p = 0.38). Increasing years of physician training was the only variable associated with successful placement (p = 0.003). No association was found between successful tube placement and presence of endotracheal tube, tracheostomy, or cervical immobility, nor any interaction of metoclopramide with these variables. CONCLUSION: Intravenous metoclopramide, 10 mg, administered 10 min prior to intubation with a small-bore feeding tube (10F), was ineffective in facilitating transpyloric intubation.

Critical Illness↗

PubMed2001

Predictors of extubation outcome in patients who have successfully completed a spontaneous breathing trial.

BACKGROUND: After patients recovering from respiratory failure have successfully completed a spontaneous breathing trial (SBT), clinicians must determine whether an artificial airway is still required. We hypothesized that cough strength and the magnitude of endotracheal secretions affect extubation outcomes. METHODS: We conducted a prospective study of 91 adult patients treated in medical-cardiac ICUs who were recovering from respiratory failure, had successfully completed an SBT, and were about to be extubated. A number of demographic and physiologic parameters were recorded with the patient receiving full ventilatory support and during the SBT, just prior to extubation. Cough strength on command was measured with a semiobjective scale of 0 to 5, and the magnitude of endotracheal secretions was measured as none, mild, moderate, or abundant by a single observer. In addition, patients were asked to cough onto a white card held 1 to 2 cm from the endotracheal tube; if secretions were propelled onto the card, it was termed a positive white card test (WCT) result. All patients were then extubated from T-piece or continuous positive airway pressure breathing trials. If 72 h elapsed and patients did not require reintubation, they were defined as successfully extubated. RESULTS: Ninety-one patients with a mean (+/- SE) age of 65.2 +/- 1.6 years, ICU admission APACHE (acute physiology and chronic health evaluation) II score of 17.7 +/- 0.7, and duration of mechanical ventilation of 5.0 +/- 0.5 days were studied over 100 extubations. Sixteen patients could not be extubated, and 2 patients underwent two unsuccessful extubation attempts, for a total of 18 unsuccessful extubations. Age, severity of illness, duration of mechanical ventilation, oxygenation, rapid shallow breathing index, and vital signs during SBTs did not differ between patients with successful extubations vs patients with unsuccessful extubations. The WCT result was highly correlated with cough strength. Patients with weak (grade 0 to 2) coughs were four times as likely to have unsuccessful extubations, compared to those with moderate-to-strong (grade 3 to 5) coughs (risk ratio [RR], 4.0; 95% confidence interval [CI],1.8 to 8.9). Patients with moderate-to-abundant secretions were more than eight times as times as likely to have unsuccessful extubations as those with no or mild secretions (RR, 8.7; 95% CI, 2.1 to 35.7). Patients with negative WCT results were three times as likely to have unsuccessful extubations as those with positive WCT results (RR, 3.0; 95% CI, 1.3 to 6.7). Poor cough strength and endotracheal secretions were synergistic in predicting extubation failure (Rothman synergy index, 3.7; RR, 31.9; 95% CI, 4.5 to 225.3). Patients with PaO(2)/fraction of inspired oxygen (P:F) ratios of 120 to 200 (receiving mechanical ventilation) were not less likely to be successfully extubated than those with P:F ratios of > 200, but those with hemoglobin levels < or = 10 g/dL were more than five times as likely to have unsuccessful extubations as those with hemoglobin levels > 10 g/dL. CONCLUSIONS: After patients recovering from respiratory failure have successfully completed an SBT, factors affecting airway competence, such as cough strength and amount of endotracheal secretions, may be important predictors of extubation outcomes. Also, a majority (89%) of medically ill patients with P:F ratios of 120 to 200 (four of five patients with P:F ratios from 120 to 150), values sometimes used to preclude weaning, were extubated successfully.

Adult↗