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Persisting diaphragmatic dysfunction (DD) for more than 24 hours after thoracic surgery is associated with higher rates of pulmonary complications and prolonged intensive care unit stays. Despite advances in less invasive techniques, the incidence of DD remains significant, affecting ~55%–68% of patients after video-assisted thoracoscopic surgery (VATS). Non-intubated VATS (NIVATS) has gained popularity for its safety, but its impact on outcomes, particularly DD, remains unclear. We aim to determine the incidence of DD following NIVATS in adult patients.
The DYNASTY (Diaphragmatic dYsfunction after Non-intubated video ASsisted Thoracic surgerY) study is a prospective, single-centre, single-arm observational study including 100 adult patients undergoing NIVATS for minor elective thoracoscopic procedures. Diaphragmatic function is assessed using bedside ultrasound preoperatively (baseline) and at 2 and 24 hours postoperatively. The primary outcome is the incidence of DD at 24 hours (defined as diaphragmatic excursion ≤10 mm on quiet breathing). Secondary outcomes include the incidence of postoperative respiratory complications (eg, pneumonia, acute chronic obstructive pulmonary disease exacerbation) and their association with DD. Statistical analyses will estimate DD incidence with 95% CIs and employ multivariable logistic regression to identify predictors of DD, adjusting for potential confounders.
The study protocol was approved by an institutional ethics committee (ID 2024-A009121-45), and all participants will provide written informed consent. Results will be disseminated through peer-reviewed publications and conference presentations. De-identified data will be made available on reasonable request, and the trial registry will be updated with data availability in line with International Committee of Medical Journal Editors (ICMJE) recommendations.
by Denise Skiadopoulos, Alaina Bandstra, Valerie Kattouf, Corina van de Pol, Vivek Labhishetty, Sumeer Singh
ObjectiveHeterophoria is routinely measured during a comprehensive ocular examination. The aim of the current study is to compare the inter-examiner repeatability of the Neurolens measurement device (nMD), a commercially available instrument that objectively assesses phoria, to the inter-examiner repeatability of prism alternating cover test and the von Graefe method.
Methods91young adults aged between 18–60 years were enrolled. Two experienced optometrists assessed phoria on each subject using three methods: the von Graefe method (VG), prism alternating cover test (PCT) and nMD. VG and PCT were performed at distance (6m) and near (40 cm). The nMD measurements were obtained using virtual distance (6m) and near (50 cm) targets. All the tests were performed in a single session by both the examiners in a randomized order.
ResultsAll study participants were students, staff, and faculty of the Illinois College of Optometry. Of the 91 participants recruited, 65 were female. All participants completed the study with no missing data. The repeatability analysis showed nMD (distance: 0.69 ± 0.77PD; near: 1.00 ± 0.98PD) to have the smallest mean absolute difference at both distance and near compared to VG (distance: 3.28 ± 3.18PD; near: 4.48 ± 3.99PD) and PCT (distance: 1.50 ± 2.36PD; near: 4.05 ± 3.69PD). Bland Altmann analysis showed that the phoria measurements from nMD exhibited significantly less variability when compared with VG and PCT.
ConclusionsThe Neurolens measurement device (nMD) has the highest inter-examiner repeatability when compared to traditional VG and PCT methods. Given that the measurements are objective and repeatable compared to the two traditional methods, this device has the potential to be a useful addition to current methods of clinical practice.
FreshRSS 