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JOURNAL WATCH Continued from page 20 Several small studies have previously identifi ed ICH hematoma derivation from a large multi-center sample with prospectively growth predictors, including larger ICH volume, earlier collected data, and complete baseline and 24-hour CT presentation after symptom onset, and use of oral anticoagulants. acquisition per a pre-defi ned protocol. The small sample size in these studies, however, limited the ability Limitations are that only hypertensive patients were included, as to adjust for known confounders. In addition, the “spot sign” has well as those within 6 hours after symptom onset. In addition, been identifi ed as a reliable risk factor for hematoma expansion, over 90% of subjects were Chinese in the validation cohort. but this requires additional contrast administration for a CT These factors limit generalizability of the score. Validation in angiogram, which may not be routinely performed for all ICHs. an ethnically diverse and non-hypertensive cohort is warranted. This is an important risk score, which can be used both Finally, the clinical use of this score is limited. For example, clinically and for research to identify patients at high risk to even if the score may predict low hematoma growth risk in a have signifi cant hematoma volume growth. Strengths of this coagulopathic patient, standard clinical care would still call for score include the external validation in an independent cohort, rapid reversal. TECH CORNER BronchoGuide App – Bronchoscopy Simulation for iPhone, iPad, and Android By Susanne Muehlschlegel, MD, MPH In the fi rst Currents Tech Corner article about bronchial segments are described by their numeric names (Netter three years ago, I reviewed the free web-based nomenclature), unfortunately not by their anatomic names (for bronchoscopy simulator on www.thoracic- example, superior segment of the right lower lobe). To back the anesthesia.com. While I still use and recommend bronchoscope out, one taps on the anatomic landmarks listed in this site for bronchoscopic anatomy review, I the right top corner. From a button menu on the bottom, a full now would like to share the also-free mobile screen bronchial tree overview graphic can be displayed. Here, app BronchoGuide. This app, which is arrows inside the bronchial tree can be clicked, which simulates available for iPhone, iPad, and Android, is the advancing the bronchoscope. ideal app to review the airway anatomy before In the left top corner, the endoscopic view correlating to the any bedside bronchoscopy in the ICU. position within the bronchial tree overview graphic is displayed. I After opening the app, it automatically enters into a demo mode, like this option in particular as a visual, rather than verbal learner. which can be skipped by clicking on it and then choosing “Main From the main menu, one can choose the “insertion” option, Menu.” The main menu offers several options, including “Start which displays a video without voice-over beginning right above Navigation” and “Insertion.” The navigation option allows the epiglottis and continuing through the larynx into the trachea. the steering and advancing of the bronchoscope towards the This may be an interesting option to prepare for a bronchoscopy desired direction. When tapping on the right main bronchus, the in non-intubated patients in order to identify important bronchoscope is directed into it. landmarks along the upper airway upon insertion. A video with the endoscopic view, and – if turned on – a voice The app’s main advantages are the beautiful 3D graphics and real explaining the bronchial visualization and anatomy follow. The videos. The downsides are the really small size icons, which are video is halted at the next lower bronchial tree split in order to very diffi cult to click on an iPhone screen, as well as the very small allow the operator a close look around, as well as to decide where font. I have not tried the app on an iPad, but the larger display to navigate to next. In the right bottom corner of the screen, a may be of advantage for this app. small bronchial tree graphic appears and shows where in the In conclusion, this free app with beautiful graphics and videos bronchial tree the camera is located. In the right top corner, one is a great tool to have immediately at the bedside to help with sees a listing of the bronchi and landmarks passed. Both are very bronchial tree anatomy during bronchoscopy. helpful in the 3D orientation inside the bronchial tree. Further distally, the 21


219126_NCS_Currents_March_2_eMag
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