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Tiruvoipati R, Kaul S, Gupta S, Haji K. VENT-AVOID Trial - Avoiding Acute Hypercapnic Respiratory Failure! Am J Respir Crit Care Med 2024. [PMID: 38608272 DOI: 10.1164/rccm.202403-0514le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 04/11/2024] [Indexed: 04/14/2024] Open
Affiliation(s)
| | - Sameer Kaul
- Peninsula Health, 5644, Frankston, Victoria, Australia
| | - Sachin Gupta
- Frankston Hospital, 60087, Frankston, Victoria, Australia
- Monash University Faculty of Medicine Nursing and Health Sciences, 22457, Clayton, Victoria, Australia
| | - Kavi Haji
- Frankston Hospital, 60087, Frankston, Victoria, Australia
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2
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Vukovic D, Wang A, Antico M, Steffens M, Ruvinov I, van Sloun RJ, Canty D, Royse A, Royse C, Haji K, Dowling J, Chetty G, Fontanarosa D. Automatic deep learning-based pleural effusion segmentation in lung ultrasound images. BMC Med Inform Decis Mak 2023; 23:274. [PMID: 38031040 PMCID: PMC10685575 DOI: 10.1186/s12911-023-02362-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 11/03/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Point-of-care lung ultrasound (LUS) allows real-time patient scanning to help diagnose pleural effusion (PE) and plan further investigation and treatment. LUS typically requires training and experience from the clinician to accurately interpret the images. To address this limitation, we previously demonstrated a deep-learning model capable of detecting the presence of PE on LUS at an accuracy greater than 90%, when compared to an experienced LUS operator. METHODS This follow-up study aimed to develop a deep-learning model to provide segmentations for PE in LUS. Three thousand and forty-one LUS images from twenty-four patients diagnosed with PE were selected for this study. Two LUS experts provided the ground truth for training by reviewing and segmenting the images. The algorithm was then trained using ten-fold cross-validation. Once training was completed, the algorithm segmented a separate subset of patients. RESULTS Comparing the segmentations, we demonstrated an average Dice Similarity Coefficient (DSC) of 0.70 between the algorithm and experts. In contrast, an average DSC of 0.61 was observed between the experts. CONCLUSION In summary, we showed that the trained algorithm achieved a comparable average DSC at PE segmentation. This represents a promising step toward developing a computational tool for accurately augmenting PE diagnosis and treatment.
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Affiliation(s)
- Damjan Vukovic
- School of Clinical Sciences, Queensland University of Technology, Gardens Point Campus, 2 George St, Brisbane, QLD 4000, Australia.
- Centre for Biomedical Technologies (CBT), Queensland University of Technology, Brisbane, QLD 4000, Australia.
| | - Andrew Wang
- Department of Surgery (Royal Melbourne Hospital), University of Melbourne, Royal Parade, Parkville, VIC 3050, Australia
| | - Maria Antico
- School of Clinical Sciences, Queensland University of Technology, Gardens Point Campus, 2 George St, Brisbane, QLD 4000, Australia
- CSIRO Health and Biosecurity, The Australian eHealth Research Centre, Herston, QLD 4029, Australia
| | - Marian Steffens
- School of Clinical Sciences, Queensland University of Technology, Gardens Point Campus, 2 George St, Brisbane, QLD 4000, Australia
| | - Igor Ruvinov
- School of Clinical Sciences, Queensland University of Technology, Gardens Point Campus, 2 George St, Brisbane, QLD 4000, Australia
| | - Ruud Jg van Sloun
- Department of Electrical Engineering, Eindhoven University of Technology, 5600 MB, Eindhoven, The Netherlands
| | - David Canty
- Department of Surgery (Royal Melbourne Hospital), University of Melbourne, Royal Parade, Parkville, VIC 3050, Australia
- Department of Medicine and Nursing, Monash University, Wellington Road, Clayton, 3800, Victoria, Australia
| | - Alistair Royse
- Department of Surgery (Royal Melbourne Hospital), University of Melbourne, Royal Parade, Parkville, VIC 3050, Australia
| | - Colin Royse
- Department of Surgery (Royal Melbourne Hospital), University of Melbourne, Royal Parade, Parkville, VIC 3050, Australia
- Outcomes Research Consortium, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kavi Haji
- Department of Surgery (Royal Melbourne Hospital), University of Melbourne, Royal Parade, Parkville, VIC 3050, Australia
| | - Jason Dowling
- CSIRO Health and Biosecurity, The Australian eHealth Research Centre, Herston, QLD 4029, Australia
| | - Girija Chetty
- School of IT & Systems, Faculty of Science and Technology, University of Canberra, 11 Kirinari Street, Bruce, ACT 2617, Australia
| | - Davide Fontanarosa
- School of Clinical Sciences, Queensland University of Technology, Gardens Point Campus, 2 George St, Brisbane, QLD 4000, Australia.
- Centre for Biomedical Technologies (CBT), Queensland University of Technology, Brisbane, QLD 4000, Australia.
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3
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Tiruvoipati R, Ludski J, Gupta S, Subramaniam A, Ponnapa Reddy M, Paul E, Haji K. Evaluation of the safety and efficacy of extracorporeal carbon dioxide removal in the critically ill using the PrismaLung+ device. Eur J Med Res 2023; 28:291. [PMID: 37596670 PMCID: PMC10436516 DOI: 10.1186/s40001-023-01269-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/05/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND Several extracorporeal carbon dioxide removal (ECCO2R) devices are currently in use with variable efficacy and safety profiles. PrismaLung+ is an ECCO2R device that was recently introduced into clinical practice. It is a minimally invasive, low flow device that provides partial respiratory support with or without renal replacement therapy. Our aim was to describe the clinical characteristics, efficacy, and safety of PrismaLung+ in patients with acute hypercapnic respiratory failure. METHODS All adult patients who required ECCO2R with PrismaLung+ for hypercapnic respiratory failure in our intensive care unit (ICU) during a 6-month period between March and September 2022 were included. RESULTS Ten patients were included. The median age was 55.5 (IQR 41-68) years, with 8 (80%) male patients. Six patients had acute respiratory distress syndrome (ARDS), and two patients each had exacerbations of asthma and chronic obstructive pulmonary disease (COPD). All patients were receiving invasive mechanical ventilation at the time of initiation of ECCO2R. The median duration of ECCO2R was 71 h (IQR 57-219). A significant improvement in pH and PaCO2 was noted within 30 min of initiation of ECCO2R. Nine patients (90%) survived to weaning of ECCO2R, eight (80%) survived to ICU discharge and seven (70%) survived to hospital discharge. The median duration of ICU and hospital stays were 14.5 (IQR 8-30) and 17 (IQR 11-38) days, respectively. There were no patient-related complications with the use of ECCO2R. A total of 18 circuits were used in ten patients (median 2 per patient; IQR 1-2). Circuit thrombosis was noted in five circuits (28%) prior to reaching the expected circuit life with no adverse clinical consequences. CONCLUSION(S) PrismaLung+ rapidly improved PaCO2 and pH with a good clinical safety profile. Circuit thrombosis was the only complication. This data provides insight into the safety and efficacy of PrismaLung+ that could be useful for centres aspiring to introduce ECCO2R into their clinical practice.
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Affiliation(s)
- Ravindranath Tiruvoipati
- Department of Intensive Care Medicine, Frankston Hospital, Peninsula Health, Frankston, VIC, 3199, Australia.
- Division of Medicine, Peninsula Clinical School, Monash University, Frankston, VIC, Australia.
- ANZIC-RC, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
| | - Jarryd Ludski
- Department of Intensive Care Medicine, Frankston Hospital, Peninsula Health, Frankston, VIC, 3199, Australia
| | - Sachin Gupta
- Department of Intensive Care Medicine, Frankston Hospital, Peninsula Health, Frankston, VIC, 3199, Australia
- Division of Medicine, Peninsula Clinical School, Monash University, Frankston, VIC, Australia
| | - Ashwin Subramaniam
- Department of Intensive Care Medicine, Frankston Hospital, Peninsula Health, Frankston, VIC, 3199, Australia
- Division of Medicine, Peninsula Clinical School, Monash University, Frankston, VIC, Australia
- ANZIC-RC, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
- Department of Intensive Care Medicine, Dandenong Hospital, Dandenong, Australia
| | - Mallikarjuna Ponnapa Reddy
- Department of Intensive Care Medicine, Frankston Hospital, Peninsula Health, Frankston, VIC, 3199, Australia
- Division of Medicine, Peninsula Clinical School, Monash University, Frankston, VIC, Australia
- Department of Intensive Care, Calvary Hospital, Canberra, ACT, Australia
| | - Eldho Paul
- ANZIC-RC, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
- Alfred Hospital, Melbourne, VIC, Australia
| | - Kavi Haji
- Department of Intensive Care Medicine, Frankston Hospital, Peninsula Health, Frankston, VIC, 3199, Australia
- Division of Medicine, Peninsula Clinical School, Monash University, Frankston, VIC, Australia
- Department of Surgery, University of Melbourne, Melbourne, VIC, Australia
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4
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Tiruvoipati R, Gupta S, Haji K. COVID-19 Is Not Comparable to H1N1 Influenza. Ann Am Thorac Soc 2022; 19:509-510. [PMID: 34818143 PMCID: PMC8937222 DOI: 10.1513/annalsats.202110-1097le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Affiliation(s)
- Ravindranath Tiruvoipati
- Penninsula HealthMelbourne, Victoria, Australia
- Peninsula Clinical School, Monash UniversityMelbourne, Victoria, Australia
- Corresponding author (e-mail: )
| | - Sachin Gupta
- Penninsula HealthMelbourne, Victoria, Australia
- Peninsula Clinical School, Monash UniversityMelbourne, Victoria, Australia
| | - Kavi Haji
- Penninsula HealthMelbourne, Victoria, Australia
- Monash UniversityMelbourne, Victoria, Australia
- University of MelbourneMelbourne, Victoria, Australia
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5
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Hanson L, Goh C, Vogrin S, Al-Mukhtar O, Schneider D, Kadhmawi A, Cheng Y, Wexler N, Haji K, Neil C, Stub D, Cox N, Chan W. Left Ventricular End-Diastolic Pressure Is Associated With Incident Contrast-Induced Nephropathy and Clinical Outcomes in Patients With ST-Elevation Myocardial Infarction Undergoing Primary Percutaneous Intervention. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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6
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Tsai CH, van der Burgt J, Vukovic D, Kaur N, Demi L, Canty D, Wang A, Royse A, Royse C, Haji K, Dowling J, Chetty G, Fontanarosa D. Automatic deep learning-based pleural effusion classification in lung ultrasound images for respiratory pathology diagnosis. Phys Med 2021; 83:38-45. [DOI: 10.1016/j.ejmp.2021.02.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/09/2021] [Accepted: 02/22/2021] [Indexed: 12/13/2022] Open
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7
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Haji K, Muthu S, Banakh I, Tiruvoipati R. Prolonged encephalopathy and associated nonconvulsive seizures from suspected pregabalin and tapentadol: Two case reports and review of literature. Clin Case Rep 2021; 9:1362-1366. [PMID: 33768845 PMCID: PMC7981720 DOI: 10.1002/ccr3.3772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 05/17/2020] [Accepted: 10/20/2020] [Indexed: 02/05/2023] Open
Abstract
A combination of pregabalin and tapentadol may be associated with prolonged encephalopathy.
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Affiliation(s)
- Kavi Haji
- Department of Intensive Care MedicineFrankston HospitalFrankstonVic.Australia
- School of Public HealthFaculty of Medicine, Nursing and Health SciencesMonash UniversityMelbourneVic.Australia
- Faculty of SurgeryUniversity of MelbourneMelbourneVic.Australia
| | - Sachin Muthu
- Department of Intensive Care MedicineFrankston HospitalFrankstonVic.Australia
| | - Iouri Banakh
- Department of PharmacyFrankston HospitalFrankstonVic.Australia
| | - Ravindranath Tiruvoipati
- Department of Intensive Care MedicineFrankston HospitalFrankstonVic.Australia
- School of Public HealthFaculty of Medicine, Nursing and Health SciencesMonash UniversityMelbourneVic.Australia
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8
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Cid X, Wang A, Heiberg J, Canty D, Royse C, Li X, El‐Ansary D, Yang Y, Haji K, Haji D, Denault A, Tivendale L, Brooks K, Hu X, Royse A. Point-of-care lung ultrasound in the assessment of patients with COVID-19: A tutorial. Australas J Ultrasound Med 2020; 23:271-281. [PMID: 34760606 PMCID: PMC8411694 DOI: 10.1002/ajum.12228] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/25/2020] [Accepted: 08/30/2020] [Indexed: 02/05/2023] Open
Abstract
The adoption of point-of-care lung ultrasound for both suspected and confirmed COVID-19 patients highlights the issues of accessibility to ultrasound training and equipment. Lung ultrasound is more sensitive than chest radiography in detecting viral pneumonitis and preferred over computed tomography for reasons including its portability, reduced healthcare worker exposure and repeatability. The main lung ultrasound findings in COVID-19 patients are interstitial syndrome, irregular pleural line and subpleural consolidations. Consolidations are most likely found in critical patients in need of ventilatory support. Hence, lung ultrasound may be used to timely triage patients who may have evolving pneumonitis. Other respiratory pathology that may be detected by lung ultrasound includes pulmonary oedema, pneumothorax, consolidation and large effusion. A key barrier to incorporate lung ultrasound in the assessment of COVID-19 patients is adequate decontamination of ultrasound equipment to avoid viral spread. This tutorial provides a practical method to learn lung ultrasound and a cost-effective method of preventing contamination of ultrasound equipment and a practical method for performing and interpreting lung ultrasound.
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Affiliation(s)
- Ximena Cid
- Department of SurgeryUniversity of MelbourneMelbourneVictoriaAustralia
- Department of Medicine and Community CareRoyal Melbourne HospitalParkvilleVictoriaAustralia
| | - Andrew Wang
- Department of SurgeryUniversity of MelbourneMelbourneVictoriaAustralia
| | - Johan Heiberg
- Department of SurgeryUniversity of MelbourneMelbourneVictoriaAustralia
- Department of Cardiothoracic and Vascular SurgeryAarhus University HospitalAarhusDenmark
| | - David Canty
- Department of SurgeryUniversity of MelbourneMelbourneVictoriaAustralia
- Department of Anaesthesia and Perioperative MedicineMonash HealthMelbourneVictoriaAustralia
- Department of Anaesthesia and Pain ManagementRoyal Melbourne HospitalParkvilleVictoriaAustralia
- Department of MedicineMonash UniversityClaytonVictoriaAustralia
| | - Colin Royse
- Department of SurgeryUniversity of MelbourneMelbourneVictoriaAustralia
- Department of Anaesthesia and Pain ManagementRoyal Melbourne HospitalParkvilleVictoriaAustralia
- Outcomes Research ConsortiumCleveland ClinicClevelandOhioUSA
| | - Xiaoqiang Li
- Department of AnesthesiologyWest China HospitalSichuanChina
| | - Doa El‐Ansary
- Department of SurgeryUniversity of MelbourneMelbourneVictoriaAustralia
- Department of Health ProfessionsSwinburne University of TechnologyMelbourneVictoriaAustralia
| | - Yang Yang
- Department of SurgeryUniversity of MelbourneMelbourneVictoriaAustralia
| | - Kavi Haji
- Department of SurgeryUniversity of MelbourneMelbourneVictoriaAustralia
- Department of MedicineMonash UniversityClaytonVictoriaAustralia
- Intensive Care UnitFrankston HospitalPeninsula HealthFrankstonVictoriaAustralia
| | - Darsim Haji
- Department of SurgeryUniversity of MelbourneMelbourneVictoriaAustralia
- Emergency DepartmentFrankston and Rosebud HospitalsPeninsula HealthFrankstonVictoriaAustralia
| | - Andre Denault
- Department of Anesthesiology and Critical Care MedicineInstitut de Cardiologie de MontréalMontrealQuebecCanada
- Centre Hospitalier de l'Université de MontréalMontrealQuebecCanada
| | - Lynda Tivendale
- Department of SurgeryUniversity of MelbourneMelbourneVictoriaAustralia
| | - Kyle Brooks
- Department of SurgeryUniversity of MelbourneMelbourneVictoriaAustralia
- Intensive Care UnitEpworth RichmondEpworth HealthcareRichmondVictoriaAustralia
| | - Xiaobo Hu
- Department of Critical Care MedicineShandong Provincial Hospital Affiliated to Shandong First Medical UniversityShandongChina
| | - Alistair Royse
- Department of SurgeryUniversity of MelbourneMelbourneVictoriaAustralia
- Department of Cardiothoracic SurgeryRoyal Melbourne HospitalParkvilleVictoriaAustralia
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9
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Abstract
Good quality sleep is considered to be essential for healthy living and recovering from illness. It would be logical to think that good quality sleep is most required when a patient is critically ill in an intensive care unit (ICU). Several studies have demonstrated poor quality of sleep while the patients are in ICU. Subjective tools such as questionnaires while simple are unreliable to accurately assess sleep quality. Relatively few studies have used standardized polysomnography. The use of novel biological markers of sleep such as serum brain-derived neurotrophic factor concentrations may help in conjunction with polysomnography to assess sleep quality in critically ill patients. Attempts to improve sleep included nonpharmacological interventions including the use of earplugs, eye sleep masks, and pharmacological agents including ketamine, propofol, dexmedetomidine, and benzodiazepines. The evidence for these interventions remains unclear. Further research is needed to assess quality of sleep and improve the sleep quality in intensive care settings.
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Affiliation(s)
- Ravindranath Tiruvoipati
- Department of Intensive Care Medicine, Frankston Hospital, Frankston, Victoria, Australia
- School of Public Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
- Ravindranath Tiruvoipati, Department of Intensive Care Medicine, Frankston Hospital, Frankston, Victoria 3199, Australia.
| | - Juan Mulder
- Department of Respiratory and Sleep Medicine, Frankston Hospital, Frankston, Victoria, Australia
| | - Kavi Haji
- Department of Intensive Care Medicine, Frankston Hospital, Frankston, Victoria, Australia
- School of Public Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
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Abstract
Vanishing bile duct syndrome (VBDS) refers to a group of acquired disorders associated with progressive destruction and disappearance of the intrahepatic bile ducts. We report a case of meropenem-induced VBDS in a patient who had undergone surgical repair of a ruptured abdominal aortic aneurysm. Meropenem was used to treat Serratia marcescens isolated from blood, urine, sputum, and wound swab cultures. The patient developed severe mixed liver injury with no obstruction noted in radiological imaging. Because of the patient's increasing serum bilirubin level, VBDS was suspected and the meropenem was therefore changed to ciprofloxacin on postoperative day 18. Although the bilirubin level decreased, meropenem was restarted 3 days later because of clinical concerns regarding worsening fever and sepsis. Restarting meropenem was associated with an immediate increase in the serum bilirubin level. This further increase in bilirubin after reintroduction of meropenem strongly suggested meropenem-induced VBDS. The antibiotic therapy was changed from meropenem to ciprofloxacin and metronidazole, leading to a dramatic decrease in the bilirubin level to normal within a few weeks. In patients receiving meropenem, VBDS as a cause of deranged liver function and cholestasis should be considered after ruling out mechanical and other probable causes of liver injury.
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Affiliation(s)
- Alexandr Zubarev
- Department of Intensive Care Medicine, Frankston Hospital, Frankston, VIC 3199, Australia
| | - Kavi Haji
- Department of Intensive Care Medicine, Frankston Hospital, Frankston, VIC 3199, Australia
- School of Public Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, VIC 3800, Australia
| | - Matthew Li
- Department of Pharmacy, Frankston Hospital, Frankston, VIC 3199, Australia
| | - Ravindranath Tiruvoipati
- Department of Intensive Care Medicine, Frankston Hospital, Frankston, VIC 3199, Australia
- School of Public Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, VIC 3800, Australia
- Ravindranath Tiruvoipati, Department of Intensive Care Medicine, Frankston Hospital, 2 Hastings Road (PO Box 52), Frankston, Victoria 3199, Australia. E-mail:
| | - John Botha
- Department of Intensive Care Medicine, Frankston Hospital, Frankston, VIC 3199, Australia
- School of Public Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, VIC 3800, Australia
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11
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Lim A, Be K, Haji K, Wong C. 297 Cardiac MRI Reclassifies Device Therapy Candidates; A Comparative Study With Transthoracic Echocardiogram. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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12
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Clarke N, Kangaharan N, Costello B, Tu S, Hanna-Rivero N, Agahari I, Choo W, Pitman B, Gallagher C, Haji K, Robertson-Thomson K, Sanders P, Wong C. 701 Left Atrial, Pulmonary Vein, and Left Atrial Appendage Anatomy in Indigenous Individuals: Implications for Atrial Fibrillation. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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13
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Haji K, Marwick T, Neil C, Stewart S, Carrington M, Wright L, Chan Y, Simons K, Wong C. P4377Use of LV Deformation Imaging to predict long term Heart Failure Risk in high risk patients. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The increasing prevalence of heart failure (HF), due to hypertension, ischaemic heart disease, diabetes, obesity, and ageing population demands identification of at-risk subgroup whom we could target on prevention strategies. In a same cohort of patients at risk of HF (70% with CAD), 13% developed new HF hospitalization or death over 4.3 years of follow-up, however, disease management program did not confer any benefit to outcome and LV ejection fraction (EF) was not predictive of progression to HF. Better risk stratification strategies are needed. In this study, we sought whether advanced echo measure on deformation, global longitudinal strain (GLS) would predict HF admission over a long term follow up and thereby define an at-risk group. Aim: To determine which of the LV morphology, function and deformation parameters, best predict new HF admission or HF death in pts at risk but without prior dx of HF.
Method
Echocardiograms (including measurement of LV, size, function, morphology and deformation) were obtained in 431 inpatients (mean age 65±11, 72% male) at risk of HF. LV global longitudinal strain (GLS) and strain rate (GLSR) were measured offline (EchoPac, GE). Long term (9 years) follow up data were obtained via data linkage.
Results
63 pts (15%) reached the end-point of HF admission or HF death. LV deformation showed a univariable association with outcome (Table). In multivariable analysis, including known significant predictors of outcome (age, sex, BMI, diabetes, hypertension), GLS less than 18 remained an independent predictor (Table), in addition to age and DM at baseline. EF and LV mass were not predictors of heart failure.
HR (95% CI) P value HR (95% CI) P value HR (95% CI) P value Age 1.1 (1–1.1) <0.01 1.1 (1–1.1) 0.04 1 (1–1.1) 0.04 Sex 1.0 (0.6–1.7) 0.9 0.8 (0.4–1.8) 0.6 0.8 (0.4–1.8) 0.6 BMI 1.0 (1–1.1) 0.05 1 (0.9–1.1) 0.7 1 (0.9–1.1) 0.7 DM 2.6 (1.6–4.3) <0.01 2.7 (1.4–5.3) <0.01 2.7 (1.4–5.2) 0.04 LVMI 1.0 (1.0–1.0) <0.01 1 (0.9–1.0) 0.7 1 (0.99–1.0) 0.7 Impaired EF, % 1.0 (0.9–1.0) <0.01 1 (0.9–1.0) 0.16 0.97 (0.94–1.0) 0.04 Diastolic dysfunction 2.3 (1.4–3.7) <0.01 0.8 (0.3–1.7) 0.5 0.7 (0.3–1.7) 0.5 GLS 1.3 (1.4–1.2) <0.01 1.1 (1–1.2) 0.07 GLS <18 5.3 (2.8–10.2) <0.01 2.3 (1.1–5.1) 0.04
Conclusion
GLS <18 is independently associated with increasing new onset heart failure admission and HF mortality in patients at risk of HF.
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Affiliation(s)
- K Haji
- Western Hospital, Cardiology, Melbourne, Australia
| | - T Marwick
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - C Neil
- Western Hospital, Cardiology, Melbourne, Australia
| | - S Stewart
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - M Carrington
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - L Wright
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - Y Chan
- Australian Catholic University, Melbourne, Australia
| | - K Simons
- Western Hospital, Cardiology, Melbourne, Australia
| | - C Wong
- Western Hospital, Cardiology, Melbourne, Australia
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14
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Haji K, Wong C, Neil C, Gupta M, Marwick T. Multi Reader Assessment of Accuracy and Interobserver Variability in Aortic Stenosis by Echocardiography. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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15
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Haji K, Wong C, Neil C, Marwick T. Association between Left Ventricular Strain and Health Related Quality of Life and Functional Capacity in Stage A and B Heart Failure. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Haji K, Marwick T, Neil C, Carrington M, Stewart S, Chan Y, Wong C. Use of Left Ventricular Strain imaging to Predict Long Term Heart Failure Risk in High Risk Patients. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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Ge V, Banakh I, Tiruvoipati R, Haji K. Bleomycin-induced pulmonary toxicity and treatment with infliximab: A case report. Clin Case Rep 2018; 6:2011-2014. [PMID: 30349718 PMCID: PMC6186889 DOI: 10.1002/ccr3.1790] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 08/08/2018] [Indexed: 02/05/2023] Open
Abstract
Given the current understanding of bleomycin-induced pneumonitis (BIP), the use of tumor necrosis factor alpha (TNF-α) inhibitors such as infliximab for late-stage disease appears to be of limited benefit. Further research regarding prevention and management of advanced BIP is required.
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Affiliation(s)
- Victor Ge
- Department of Intensive Care MedicineFrankston HospitalFrankstonVictoriaAustralia
| | - Iouri Banakh
- Pharmacy DepartmentFrankston HospitalFrankstonVictoriaAustralia
| | - Ravindranath Tiruvoipati
- Department of Intensive Care MedicineFrankston HospitalFrankstonVictoriaAustralia
- School of Public HealthFaculty of Medicine, Nursing and Health SciencesMonash UniversityClaytonVictoriaAustralia
| | - Kavi Haji
- Department of Intensive Care MedicineFrankston HospitalFrankstonVictoriaAustralia
- School of Public HealthFaculty of Medicine, Nursing and Health SciencesMonash UniversityClaytonVictoriaAustralia
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Haji K, Marwick T, Neil C, Carrington M, Stewart S, Chan Y, Simons K, Wright L, Wong C. P2745Use of left ventricular deformation imaging to predict heart failure risk in cardiac inpatients. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- K Haji
- Western Hospital, Cardiology, Melbourne, Australia
| | - T Marwick
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - C Neil
- Western Hospital, Cardiology, Melbourne, Australia
| | - M Carrington
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - S Stewart
- Australian Catholic University, Melbourne, Australia
| | - Y Chan
- Australian Catholic University, Melbourne, Australia
| | - K Simons
- Western Hospital, Cardiology, Melbourne, Australia
| | - L Wright
- Western Hospital, Cardiology, Melbourne, Australia
| | - C Wong
- Western Hospital, Cardiology, Melbourne, Australia
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19
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Haji K, Pathan F, Wong C, Neil C, Cox N, Mulligan A, Oreto M, Wright L, Marwick T. P5633Handheld ultrasound: a way to reduce requests for inappropriate echocardiograms. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- K Haji
- Western Hospital, Cardiology, Melbourne, Australia
| | - F Pathan
- Menzies Research Institute, Hobart, Australia
| | - C Wong
- Western Hospital, Cardiology, Melbourne, Australia
| | - C Neil
- Western Hospital, Cardiology, Melbourne, Australia
| | - N Cox
- Western Hospital, Cardiology, Melbourne, Australia
| | - A Mulligan
- Western Hospital, Cardiology, Melbourne, Australia
| | - M Oreto
- Western Hospital, Cardiology, Melbourne, Australia
| | - L Wright
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - T Marwick
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
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Haji K, Haji D, Canty DJ, Royse AG, Green C, Royse CF. The impact of heart, lung and diaphragmatic ultrasound on prediction of failed extubation from mechanical ventilation in critically ill patients: a prospective observational pilot study. Crit Ultrasound J 2018; 10:13. [PMID: 29971618 PMCID: PMC6029991 DOI: 10.1186/s13089-018-0096-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 05/03/2018] [Indexed: 12/19/2022] Open
Abstract
Background Failed extubation from mechanical ventilation in critically ill patients is multifactorial, complex and not well understood. We aimed to identify whether combined transthoracic echocardiography, lung and diaphragmatic ultrasound can predict extubation failure in critically ill patients. Results Fifty-three participants who were intubated > 48 h and deemed by the treating intensivist ready for extubation underwent a 60-min pre-extubation weaning trial (pressure support ≤ 10 cmH2O and positive end expiratory pressure 5 cmH2O). Prior to extubation, data collected included ultrasound assessment of left ventricular ejection fraction, left atrial area, early diastolic trans-mitral flow velocity wave (E), early diastolic trans-mitral flow velocity wave/late diastolic trans-mitral flow velocity wave (E/A), early diastolic trans-mitral flow velocity wave/early diastolic mitral annulus velocity (E/E′), interatrial septal motion, lung loss of aeration score and diaphragm movement. At the end of the weaning trial, the rapid shallow breathing index and serum B-type natriuretic peptide concentration were measured. Success and failure of weaning was assessed by defined criteria. Decision to extubate was at the discretion of the treating intensivist. Failure of extubation was defined as re-intubation, non-invasive ventilation or death within 48 h after extubation. Of 53 extubated participants, 11 failed extubation. Failed extubation was associated with diabetes, ischaemic heart disease, higher E/E′ (OR 1.27, 95% CI 1.05–1.54), left atrial area (OR 1.14, CI 1.02–1.28), fixed rightward curvature of the interatrial septum (OR 12.95, CI 2.73–61.41), and higher loss of aeration score of anterior and lateral regions of the lungs (OR 1.41, CI 1.01–1.82). Conclusions Failed extubation in mechanically ventilated patients is more prevalent if markers of left ventricular diastolic dysfunction and loss of lung aeration are present.
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Affiliation(s)
- Kavi Haji
- Department of the Intensive Care Unit, Frankton Hospital, PO Box 52, Frankston, VIC, 3199, Australia. .,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
| | - Darsim Haji
- Frankston Hospital, Frankston, VIC, Australia.,Department of Surgery, University of Melbourne, Melbourne, Australia
| | - David J Canty
- Department of Surgery, University of Melbourne, Melbourne, Australia.,Department of Medicine, Health Sciences and Nursing, Monash University, Melbourne, Australia.,Royal Melbourne Hospital, Melbourne, Australia
| | - Alistair G Royse
- Ultrasound Education Group, Department of Surgery, The University of Melbourne, Melbourne, Australia.,Department of Cardiothoracic Surgery, The Royal Melbourne Hospital, Melbourne, Australia
| | - Cameron Green
- Department of the Intensive Care Unit, Frankton Hospital, PO Box 52, Frankston, VIC, 3199, Australia
| | - Colin F Royse
- Ultrasound Education Group, Department of Surgery, The University of Melbourne, Melbourne, Australia.,Department of Anaesthesia and Pain Management, The Royal Melbourne Hospital, Melbourne, VIC, Australia
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21
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Botha J, Green C, Carney I, Haji K, Gupta S, Tiruvoipati R. Proportional assist ventilation versus pressure support ventilation in weaning ventilation: a pilot randomised controlled trial. CRIT CARE RESUSC 2018; 20:33-40. [PMID: 29458319 DOI: pmid/29458319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Proportional assist ventilation with load-adjustable gain factors (PAV+) is a mode of ventilation that provides assistance in proportion to patient effort. This may have physiological and clinical advantages when compared with pressure support ventilation (PSV). Our objective was to compare these two modes in patients being weaned from mechanical ventilation. DESIGN Prospective randomised controlled trial comparing PSV with PAV+. SETTING University-affiliated, tertiary referral intensive care unit (ICU). PARTICIPANTS Mechanically ventilated patients on a controlled mode of ventilation for at least 24 hours, who were anticipated to be spontaneously ventilated for at least 48 hours after randomisation. INTERVENTIONS Nil. MAIN OUTCOME MEASURES The primary outcome was time to successful liberation from the ventilator after the commencement of a spontaneous mode of ventilation. Secondary outcomes were requirement of rescue (mandatory) ventilation, requirement of sedative drugs, requirement for tracheostomy, re-intubation within 48 hours of extubation, ICU length of stay (LOS), hospital LOS, and ICU and hospital mortality. RESULTS 50 patients were randomised to either PSV (n = 25) or PAV+ (n = 25). There was no significant difference between the PAV+ and PSV groups in time to successful weaning (84.3 v 135.9 hours, respectively; P = 0.536). Four patients randomised to PAV+ were crossed over to PSV during weaning. There was no significant difference between groups for rescue ventilation, reintubation within 48 hours, tracheostomy, sedatives and analgesics prescribed, and ICU and hospital LOS. ICU mortality was higher in the PSV group (25% v 4 %; P = 0.002). CONCLUSIONS Both modes of ventilation were comparable in time to liberation from the ventilator.
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Affiliation(s)
- John Botha
- Department of Intensive Care Medicine, Peninsula Health, Frankston, Victoria, Australia.
| | - Cameron Green
- Department of Intensive Care Medicine, Peninsula Health, Frankston, Victoria, Australia
| | - Ian Carney
- Department of Intensive Care Medicine, Peninsula Health, Frankston, Victoria, Australia
| | - Kavi Haji
- Department of Intensive Care Medicine, Peninsula Health, Frankston, Victoria, Australia
| | - Sachin Gupta
- Department of Intensive Care Medicine, Peninsula Health, Frankston, Victoria, Australia
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Haji K, Wong C, Pathan F, Neil C, Cox N, Mulligan A, Oreto M, Wright L, Marwick T. Using Handheld Ultrasound to Reduce Rarely Appropriate Echocardiograms. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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23
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Haji K, Haji D, Canty DJ, Royse AG, Tharmaraj D, Azraee M, Hopkins L, Royse CF. The Feasibility and Impact of Routine Combined Limited Transthoracic Echocardiography and Lung Ultrasound on Diagnosis and Management of Patients Admitted to ICU: A Prospective Observational Study. J Cardiothorac Vasc Anesth 2017; 32:354-360. [PMID: 29126689 DOI: 10.1053/j.jvca.2017.08.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Limited transthoracic echocardiography (TTE) and lung ultrasound increasingly is performed in the intensive care unit (ICU), though used in a goal-directed rather than routine manner. DESIGN Prospective observational study. SETTINGS Tertiary ICU. PARTICIPANTS Ninety-three critically ill participants within 24 hours of admission to ICU. METHODS A treating intensivist documented a clinical diagnosis and management plan before and after combined limited TTE and lung ultrasound. Ultrasound was performed by an independent intensivist and checked for accuracy offline by a second reviewer. RESULTS Ultrasound images were interpretable in 99%, with good interobserver agreement. The hemodynamic diagnosis was altered in 66% of participants, including new (14%) or altered (25%) abnormal states or exclusion of clinically diagnosed abnormal state (27%). Valve pathology of at least moderate severity was diagnosed for mitral regurgitation (7%), aortic stenosis (1%), aortic stenosis and mitral regurgitation (1%), tricuspid regurgitation (3%), and 1 case of mitral regurgitation was excluded. Lung pathology diagnosis was changed in 58% of participants including consolidation (13%), interstitial syndrome (4%), and pleural effusion (23%), and exclusion of clinically diagnosed consolidation (6%), interstitial syndrome (3%), and pleural effusion (9%). Management changed in 65% of participants including increased (12%) or decreased (23%) fluid therapy, initiation (10%), changing (6%) or cessation (9%) of inotropic, vasoactive or diuretic drugs, non-invasive ventilation (3%), and pleural drainage (2%). CONCLUSION Routine screening of patients with combined limited TTE and lung ultrasound on admission to ICU is feasible and frequently alters diagnosis and management.
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Affiliation(s)
- Kavi Haji
- Intensive Care Unit, Frankston Hospital, Frankston, Victoria, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
| | - Darsim Haji
- Frankston Hospital, Frankston, Victoria, Australia; Ultrasound Simulation, Department of Surgery, University of Melbourne, Melbourne, Australia
| | - David J Canty
- Department of Surgery, University of Melbourne, Melbourne, Australia
| | - Alistair G Royse
- Ultrasound Education Group, Department of Surgery, The University of Melbourne, Melbourne, Australia
| | - Dhaksha Tharmaraj
- Intensive Care Unit, Frankston Hospital, Frankston, Victoria, Australia
| | - Meor Azraee
- Intensive Care Unit, Frankston Hospital, Frankston, Victoria, Australia
| | - Lynda Hopkins
- Frankston Hospital, Frankston, Victoria, Australia; Ultrasound Education Group, Department of Surgery, The University of Melbourne, Melbourne, Australia
| | - Collin F Royse
- Ultrasound Education Group, Department of Surgery, The University of Melbourne, Melbourne, Australia
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Haji K, Royse A. Sonographic evaluation of the diaphragm morphology and function in the critically ill. Ann Transl Med 2017; 5:15. [PMID: 28164100 DOI: 10.21037/atm.2016.12.61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Kavi Haji
- Intensive Care Unit, Frankston Hospital, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
| | - Alistair Royse
- Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia;; The Royal Melbourne Hospital, Melbourne, Victoria, Australia
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25
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Haji K, Wong C, Seman M, Neil C. The Yield of Complications on Inpatient 2D Transthoracic Echocardiography Post STEMI. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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26
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Haji K, Brady S, Chandra N, Truong H, Corkill W, Kangaharan N. A Retrospective Audit of Pulmonary Hypertension Sub-Classes in Central Australia. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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27
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Haji K, Nogic J, Baker L, Abeyaratne A, Waugh S, Dick R. Long-Term Clinical Outcomes of the Absorb Bioresorbable Vascular Scaffold – An Australian Experience. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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28
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Tiruvoipati R, Haji K, Gupta S, Braun G, Carney I, Botha J. Low-flow veno-venous extracorporeal carbon dioxide removal in the management of severe status asthmatics: a case report. Clin Respir J 2016; 10:653-6. [PMID: 25515844 DOI: 10.1111/crj.12252] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 11/18/2014] [Accepted: 12/07/2014] [Indexed: 02/05/2023]
Abstract
Status asthmaticus is a life-threatening condition that requires intensive care management. Most of these patients have severe hypercapnic acidosis that requires lung protective mechanical ventilation. A small proportion of these patients do not respond to conventional lung protective mechanical ventilation or pharmacotherapy. Such patients have an increased mortality and morbidity. Successful use of extracorporeal membrane oxygenation (ECMO) is reported in such patients. However, the use of ECMO is invasive with its associated morbidity and is limited to specialised centres. In this report, we report the use of a novel, minimally invasive, low-flow extracorporeal carbon dioxide removal device in management of severe hypercapnic acidosis in a patient with life threatening status asthmaticus.
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Affiliation(s)
- Ravindranath Tiruvoipati
- Department of Intensive Care Medicine, Frankston Hospital, Melbourne, Vic., Australia.
- School of Public Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic., Australia.
| | - Kavi Haji
- Department of Intensive Care Medicine, Frankston Hospital, Melbourne, Vic., Australia
| | - Sachin Gupta
- Department of Intensive Care Medicine, Frankston Hospital, Melbourne, Vic., Australia
| | - Gary Braun
- Department of Respiratory Medicine, Frankston Hospital, Melbourne, Vic., Australia
| | - Ian Carney
- Department of Intensive Care Medicine, Frankston Hospital, Melbourne, Vic., Australia
- School of Public Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic., Australia
| | - John Botha
- Department of Intensive Care Medicine, Frankston Hospital, Melbourne, Vic., Australia
- School of Public Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic., Australia
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30
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Rashid H, Ramkumar S, Haji K, Nerlekar N, Mottram P, Moir S. Determining the Aortic Root Geometry of Congenital Bicuspid Aortic Valves Through 320-Slice Multidetector CT and its Implications for Transcatheter Aortic Valve Replacement. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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31
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Haji K, Moir S, Leong P, D’Mello A. A Case of Platypnea-orthodeoxia Syndrome Post Lobectomy. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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32
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Haji K, Heron V, Davis R, Nandurkar D, Kelman A, Miller A. A Case of Aortic Mural Thrombus in the Absence of Atherosclerotic or Aneurysmal Disease. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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33
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Haji K, Nasis A. Clinical and Radiological Characteristics of Cardiac Myxoma with CT Coronary Angiography. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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34
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Haji K, Royse A, Green C, Botha J, Canty D, Royse C. Interpreting diaphragmatic movement with bedside imaging, review article. J Crit Care 2016; 34:56-65. [PMID: 27288611 DOI: 10.1016/j.jcrc.2016.03.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 02/09/2016] [Accepted: 03/04/2016] [Indexed: 12/11/2022]
Abstract
The diaphragm is the most important muscle of respiration. At equilibrium, the load imposed on the diaphragmatic muscles from transdiaphragmatic pressure balances the force generated by diaphragmatic muscles. However, procedural and nonprocedural thoracic and abdominal conditions may disrupt this equilibrium and impair diaphragmatic function. Diaphragmatic dysfunction is associated with respiratory insufficiency and poor outcome. Therefore, rapid diagnosis and early intervention may be useful. Ultrasound imaging provides quick and accurate bedside assessment of the diaphragm. Various imaging techniques have been suggested, using 2-dimensional and M-mode technology. Diaphragm viewing depends on the degree of robe movement, determined by the angle of incidence of the ultrasound beam and by the direction of probe movement. In this review, we will discuss the function of the diaphragm focusing on clinically important anatomical and physiological properties of the diaphragm. We will review the literature regarding various sonographic techniques for diaphragm assessment. We will also explore the evidence for the role of the tidal displacement of subdiaphragmatic organs as a surrogate for diaphragm movement.
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Affiliation(s)
- K Haji
- Department of Intensive Care Medicine, Frankston Hospital, Frankston, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia.
| | - A Royse
- Department of Surgery, The University of Melbourne, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - C Green
- Department of Intensive Care Medicine, Frankston Hospital, Frankston, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
| | - J Botha
- Department of Intensive Care Medicine, Frankston Hospital, Frankston, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
| | - D Canty
- Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - C Royse
- Department of Anaesthesia and Pain Management, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
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35
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Haji K, Butler E, Royse C. A case of chronic inflammatory demyelinating polyneuropathy with reversible alternating diaphragmatic paralysis: case study. Crit Ultrasound J 2015; 7:16. [PMID: 26490681 PMCID: PMC4614851 DOI: 10.1186/s13089-015-0033-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 10/12/2015] [Indexed: 11/10/2022] Open
Abstract
Respiratory failure requiring mechanical ventilation has been reported in patients with bilateral diaphragmatic paralysis due to CIDP. We report a case of CIDP that progressed to respiratory failure with normal chest radiography despite unilateral diaphragmatic paralysis. This manifestation would have been missed if ultrasound was not employed.
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Affiliation(s)
- Kavi Haji
- Intensive Care Unit, Frankston Hospital, Peninsula Health, Hastings Road, Frankston, VIC, 3199, Australia.
| | - Ernest Butler
- Department of Neurology, Frankston Hospital, Peninsula Health, Frankston, VIC, Australia.
| | - Colin Royse
- Department of Surgery, The University of Melbourne, Melbourne, VIC, Australia. .,Department of Anaesthesia and Pain Management, The Royal Melbourne Hospital, Melbourne, VIC, Australia.
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36
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Haji K, Royse A, Tharmaraj D, Haji D, Botha J, Royse C. Diaphragmatic regional displacement assessed by ultrasound and correlated to subphrenic organ movement in the critically ill patients—an observational study. J Crit Care 2015; 30:439.e7-13. [DOI: 10.1016/j.jcrc.2014.10.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Revised: 09/19/2014] [Accepted: 10/27/2014] [Indexed: 10/24/2022]
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37
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Janardan J, Haji K, Al Alawi A, Wong D, Gibbs H, Soward A. An audit of inter-hospital patient transfers for coronary angiography from a rural centre in Australia. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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38
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Haji K, Dick R, Baker L, Waugh S. Bioresorbable scaffold stents, single centre experience. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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39
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Tiruvoipati R, Gupta S, Haji K, Braun G, Carney I, Botha JA. Management of severe hypercapnia post cardiac arrest with extracorporeal carbon dioxide removal. Anaesth Intensive Care 2014; 42:248-52. [PMID: 24580392 DOI: 10.1177/0310057x1404200213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Normocapnia is recommended in intensive care management of patients after out-of-hospital cardiac arrest. While normocapnia is usually achievable, it may be therapeutically challenging, particularly in patients with airflow obstruction. Conventional mechanical ventilation may not be adequate to provide optimal ventilation in such patients. One of the recent advances in critical care management of hypercapnia is the advent of newer, low-flow extracorporeal carbon dioxide clearance devices. These are simpler and less invasive than conventional extracorporeal devices. We report the first case of using a novel, extracorporeal carbon dioxide removal device in Australia on a patient with out-of-hospital cardiac arrest where mechanical ventilation failed to achieve normocapnia.
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Affiliation(s)
- R Tiruvoipati
- Department of Intensive Care Medicine, Frankston Hospital, Frankston, Victoria
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40
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Tiruvoipati R, Chiezey B, Lewis D, Ong K, Villanueva E, Haji K, Botha J. Stress hyperglycemia may not be harmful in critically ill patients with sepsis. J Crit Care 2012; 27:153-8. [PMID: 21855283 DOI: 10.1016/j.jcrc.2011.06.011] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Revised: 06/13/2011] [Accepted: 06/18/2011] [Indexed: 02/05/2023]
Abstract
BACKGROUND Stress hyperglycemia (SH) is commonly seen in critically ill patients. It has been shown to be associated with adverse outcomes in some groups of patients. The effects of SH on critically ill patients with sepsis have not been well studied. We aimed to evaluate the effects of SH in critically ill patients with sepsis. METHODS In this retrospective study, patients with sepsis admitted to intensive care unit (ICU) over a 5-year period were included. RESULTS Of 297 patients, 204 (68.7%) had SH during the study period. The mean blood glucose level in patients with SH was 8.7 mmol/L compared with 5.9 mmol/L in those without SH (P < .05). There were no statistically significant differences in age; sex; sepsis severity; cardiovascular, respiratory, and renal comorbidities; requirement of mechanical ventilation; inotropes; and Acute Physiology, Age, and Chronic Health Evaluation III and Simplified Acute Physiology 2 scores on ICU admission. Intensive care unit mortality was significantly lower in patients who had SH. The median duration of ICU and hospital length of stay was longer in patients with SH. On logistic regression analysis, the presence of SH was associated with reduced ICU mortality. Subgroup analysis revealed SH to be protective in patients with septic shock. CONCLUSION Stress hyperglycemia may not be harmful in critically ill patients with sepsis. Patients with SH had lower ICU mortality.
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Tiruvoipati R, Lewis D, Haji K, Botha J. High-flow nasal oxygen vs high-flow face mask: a randomized crossover trial in extubated patients. J Crit Care 2010; 25:463-8. [PMID: 19781896 DOI: 10.1016/j.jcrc.2009.06.050] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2009] [Revised: 04/14/2009] [Accepted: 06/21/2009] [Indexed: 02/05/2023]
Abstract
PURPOSE Oxygen delivery after extubation is critical to maintain adequate oxygenation and to avoid reintubation. The delivery of oxygen in such situations is usually by high-flow face mask (HFFM). Yet, this may be uncomfortable for some patients. A recent advance in oxygen delivery technology is high-flow nasal prongs (HFNP). There are no randomized trials comparing these 2 modes. METHODS Patients were randomized to either protocol A (n = 25; HFFM followed by HFNP) or protocol B (n = 25; HFNP followed by HFFM) after a stabilization period of 30 minutes after extubation. The primary objective was to compare the efficacy of HFNP to HFFM in maintaining gas exchange as measured by arterial blood gas. Secondary objective was to compare the relative effects on heart rate, blood pressure, respiratory rate, comfort, and tolerance. RESULTS Patients in both protocols were comparable in terms of age, demographic, and physiologic variables including arterial blood gas, blood pressure, heart rate, respiratory rate, Glasgow Coma Score, sedation, and Acute Physiology and Chronic Health Evaluation (APACHE) III scores. There was no significant difference in gas exchange, respiratory rate, or hemodynamics. There was a significant difference (P = .01) in tolerance, with nasal prongs being well tolerated. There was a trend (P = .09) toward better patient comfort with HFNP. CONCLUSIONS High-flow nasal prongs are as effective as HFFM in delivering oxygen to extubated patients who require high-flow oxygen. The tolerance of HFNP was significantly better than in HFFM.
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Tiruvoipati R, Lewis D, Ong K, Gupta M, Haji K, Botha J. Impact of glycemic control on survival in critical care patients with sepsis. Crit Care 2010. [PMCID: PMC2934499 DOI: 10.1186/cc8804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Haji K, Haji D, Le Blanc V, Botha J. Effect of prolonged emergency department length of stay on inpatient length of stay and inhospital mortality in severe sepsis and septic shock. Crit Care 2008. [PMCID: PMC4088789 DOI: 10.1186/cc6639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Kinuya S, Yokoyama K, Haji K, Konishi S, Hwang EH, Michigishi T, Tonami N. In-111 labeled leukocyte scintigraphy of infected prosthesis with Candida parapsilosis in a patient without predisposing risk factors. Clin Nucl Med 1996; 21:885-6. [PMID: 8922857 DOI: 10.1097/00003072-199611000-00017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- S Kinuya
- Department of Nuclear Medicine, Kanazawa University School of Medicine, Japan
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Abstract
We performed lymphoscintigraphy with 99mTc-human serum albumin in a case of suspected lymphedema of the right leg after inguinal lymph node dissection. Dermal backflow of the leg and lymphocele at the inguinal chain were observed, and lymphatic reflux into the scrotum was also delineated. The scintigraphy could demonstrate a persistent lymphatic problem under conservative treatment, and could lead the physician to conduct surgical treatment. Scintigraphic demonstration of the inguinoscrotal lymphatic reflux has not been previously reported.
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Affiliation(s)
- S Kinuya
- Department of Nuclear Medicine, Kanazawa University School of Medicine, Japan
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